1. Doctors-OnLine
C. K. Yeo, C. T. Lau, B. S. Lee
School of Computer Engineering
Nanyang Technological University
Nanyang Avenue
S 639798
Republic of Singapore
Email: {asckyeo, asctlau, ebslee}@ntu.edu.sg
Abstract 1. Introduction
This paper describes the design and The increased mobility of rising
development of a Java web application that population of cosmopolitans and tourists
implements the facilities of an online clinic. have heralded the need for vital and personal
Emulation of face-to-face consultation and information, especially financial and
co-diagnosis with other doctors are medical, to be available conveniently and
accomplished via multipoint video and quickly. With the advent and prevalence of
audio conferencing. Patient record and the Internet worldwide, it seems logical that
appointment data management is achieved Internet offers a highly suitable conduit and
through JDBC 2.0 API with a relational this led to the fruition and development of
database. A hardware measurement kit this project, online medical diagnosis
enables vital patient health data to be system.
measured and transmitted to the patient's
PC via Bluetooth Interface. The data is The online medical diagnosis system is
then forwarded to the doctor during a literally an online clinic. It allows patients to
consultation. Presciptions are sent via email request for appointments and doctors to meet
to the patient as well as to the selected up with them via video conferencing. Thus,
pharmacy so that they can be ready for it is possible for doctors and patients to
collection by the patient or be delivered to interact visually and audibly. Moreover, the
the patient. Web-based user interfaces are system also provides a kit to the patient that
generated with Java Servlet 2.2 API and will measure and transmit the patient's health
security is accomplished with Java Secure signs such as body temperature via the
Socket Extension 1.0.2 over the Secure Internet to the doctor. This will aid in the
Socket Layer. doctor's assessment or diagnosis.
Keywords: remote diagnosis, BlueTooth As with any clinic, patient medical
interface, wireless communication, audio, records are stored in the system and is
video conferencing available online to both doctors and patients.
International Journal of The Computer, The Internet and Management, Vol. 10, No3, 2002, p 15 -22
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2. However, only doctors have the permission • Provide video, audio and text
and the professional knowledge to update communications to fully emulate
such records. The patient, on the other hand, physical consultation
benefits from the ability to peruse his or her • Accept patients’ vital health signs such
medical records whenever necessary. as body temperature which are sent over
the Internet to the doctor for diagnosis
Enhydra Java Application Server 3.01 is without patient intervention
used to deploy and manage this system. The • Manage patient medical records
back-end relational database employed is including diagnosis, prescription, image
Inprise Interbase 6.01. Both Enhydra and and document attachments
Interbase are Open Source projects. Video • Allow prescriptions to be emailed to
conferencing capability is achieved with patients upon request
Microsoft Netmeeting 3.01. • Keep track of both doctors and patients
appointments
• Include encryption technology to protect
sensitive and confidential medical
2. System Architecture information
The online clinic system is designed to: This is designed as a Java web
application and is based on a three-tier
• Allow doctors and patients to interact architecture [1]. The architecture comprises
from any place and at any time three separate logical layers, namely, the
presentation layer, business layer and the
data layer. This is illustrated in Figure 1.
HTTP
response
HTTP Presentation
Presentation Presentation
request Manager
Objects Layer
Application
Objects
Session
Manager Business Business
Objects Layer
Data Data
Objects Layer
Database
Manager Database
JDBC
Figure 1 Doctors-Online Application Framework
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3. 2.1 Presentation Layer The Enhydra Database Manager [2] is
responsible for the state of a database
The presentation layer contains connection, the current SQL statement being
presentation objects. These objects are executed by the data object and the result to
loaded and executed by the Enhydra be passed to the data layer. Java Database
Presentation Manager. Connectivity (JDBC) 2.0 API is employed to
communicate with the database servers.
When a patient browser sends an HTTP
request to the server, the Presentation The separation of business logic and
Manager passes the request to the user interface add flexibility to the design of
corresponding presentation object that will this web application. Multiple user interfaces
be instantiated and called. The presentation can be built and deployed without changing
object may further pass the data to and the business layer. Similarly, a change in the
receive data from the business layer. It then data source used may only affect the data
formats the data for display and generates the layer and leaves both the business and
HTTP response back to the patient browser. presentation layers untouched, thereby
Java Servlet API 2.2 is used for the improving maintainability and increasing
generation of HTML pages. performance.
2.2 Business Layer
3. Patient Health Measurement Kit
The business layer contains business
objects. Business objects define the The Patient Health Measurement Kit is a
application’s business logic, including wireless hardware device designed to capture
algorithms and specialised functions, but not the vital health data of the patient. Figure 2
data access or display functions. It serves to shows its block diagram. It comprises a
evaluate information sent by the presentation temperature sensor, an analogue to digital
layer and also transform the data from the converter (ADC) to convert the sensor
data layer into the appropriate form required voltage into digital values for input into the
for display by the presentation layer. PC. The entire kit is controller by an 8-bit
microcontroller, the AT89C51, a flash
The Enhydra Session Manager creates a memory version of the MCS-51 family [3].
unique session object whenever a patient The microcontroller uses serial interface to
logs on. Patient-specific information will be connect to the bluetooth development kit [4]
placed in the session object by the for data transfer. Vital signs of a human
application object. Both the presentation include body temperature, pulse rate and
objects and business objects will make use of blood pressure. However, for this system,
the session information. only the temperature measurement is
implemented. The recordings of pulse rate
and blood pressure have been planned for
2.3 Data Layer future implementation. The setup and
Data layer contains data objects that will operation of the system is shown in Figure 3.
interface with the persistent data source. In
this case, the data source is a relational
database.
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4. Thermistor Analog-to- Micro- Bluetooth
Probe Digital Controller Interface
Converter
Figure 2 Overview of Health Measurement Kit
At the time of appointment, the patient chronological order. Besides this, the doctor
launches the Visual Basic program. The will be able to see whether a patient has
program automatically directs the browser to logged in as well as the generated
access the patient login page for the patient NetMeeting link and a hypertext link to the
to login. The patient will then be prompted examination page of the patient containing
to measure his vital signs. The controller the vital health data that was transmitted
transmits the measured value to the patient’s from the Patient Health Measurement Kit.
computer through the Bluetooth interface The doctor will also be able to access the
[5][6]. This reading is captured by the Visual corresponding patient’s medical records.
Basic program through the RS232 serial port Such medical records can be retrieved by the
which is interfaced to the Stonestreet doctor as shown in Figure 3 for discussion
Bluetooth receiver. Once the readings have with the patient.
stabilised, the program will be sent via the
Internet to the Doctors-Online server. The When the doctor is ready to interact with
server will then capture these data and the patient, he will click on the NetMeeting
presents them to the doctor for diagnosis. link bringing up the NetMeeting software.
The NetMeeting software on the doctor’s
The login procedure is required in order computer shall ‘call’ the NetMeeting
to confirm the identity of the patient in software on the patient’s computer as
concern and ensure that the data is sent over determined by the IP address. If the call is
a secured Internet communication channel. successful, video conferencing will be
established between the doctor and the
patient via ILS servers. The flow of
information is shown in Figure 3. The doctor
4. Video Conferencing and Diagnosis can, in addition, establish a new video link to
another doctor to co-diagnose the patient's
At the same time the Visual Basic condition.
program is been executed, the NetMeeting
software is also activated. Once the patient Based on the health information and the
has successfully logged in, the application interaction, the doctor can proceed to
object determines and stores the IP address diagnose the patient. The diagnosis shall be
of the patient’s computer. This address is stored as part of the patient medical record
used in the generation of a NetMeeting link into the database. In order to fully implement
that will be presented to the doctor in his the features of a patient’s medical records,
appointment page. the doctor can choose to upload files to the
database. In other words, the Doctor-Online
On the appointment page of the doctor, a system will also act as a virtual hard disk.
list of appointments will be displayed in This allows X-ray scans (shown in Figure 4),
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5. detail medical history and other vital 5. Security
information to be uploaded. The patient will
be able to download these files for perusal. Due to the sensitive nature of medical
However, a patient is not allowed to upload. information, security is a vital aspect of this
The doctor has read, write and delete access system. Communication channels between
to the attachments. The upload is done via a the patient and server and that between the
POST request to the Doctors-Online server doctor and the server will be secured. Strong
over Secure Sockets Layer. encryption is employed with the use of
Secure Sockets Layer. This is accomplished
Prescriptions are made and sent via through the provision of the export version
email to the patient as well as to the of Java Secure Socket Extension 1.0.2.
pharmacy selected by the patient. The patient Through the relaxing of US export laws,
can either collect the prescription personally cryptically strong algorithms are made
or have the prescription be delivered. available [7].
Patient Health
Measurement Kit
Bluetooth
Visual
Basic
Doctors
Online
Servers
NetMeetin Doctor
ILS NetMeetin
Patient Compute
Computer
Figure 3 Flow of Information between Patient and Doctor
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6. 6. System Evaluation • The online medical records allow vital
medical information of any patient to be
6.1 Commercial Potential available to doctors, wherever they may
be, to aid in their diagnosis
The commercial potential of this system • Invaluable to business travellers,
are summarised as follows: tourists, elderly, patients who are
physically immobile
• Allows patients, wherever and whenever • Overcomes the problem of travelling in
they may be, to seek medical attention adverse weather conditions and over
from their very own doctors vast distances to seek consultation
• Allows doctors and specialists who are • Allows prompt round-the-clock
geographically distributed to co- healthcare services
diagnose a patient's conditions • Reduces queues in clinics for trivial
• Allows physical bio-medical ailments
measurements to be taken and
transmitted direct to doctors
Figure 4 Web-based User Interface of Doctors Online
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7. 6.2 Comparison with Related Systems • Ease of Use. The use of wireless
technology renders the health
LifeShirt [8] is a comfortable, washable mesaurement kit less cumbersome to be
garment that can be worn at home, work or used. Moreover, it also allows data to be
play. Sensors embedded in the LifeShirt transmitted automatically to the patient's
continuously monitor 40 psychological signs PC as well as to the doctor, without the
and record the data in a small recorder that need for patient's intervention unlike
clips on the patient's belt. Patients can upload LifeShirt where manual uploading is
data stored in the LifeShirt to an Internet- required. This seamless integration
connected PC via a handheld computer. through the Internet together with the use
These readings go to the LifeShirt Data of video conferencing can thus fully
centre, a high-security website where staff emulate a face-to-face consultation.
physicians can analyse the data and make it
available for online viewing by the doctor
and his patient.
7. Conclusion
Micropaq [9] is an ambulatory patient
monitor from Welch Allyn Protocl Inc. It is a The feasibility of implementing an
patient worn telemetry monitor with the online clinic is demonstrated with the
display, alarms and parameters of a Doctors Online system. The system is
standalone portable vital signs monitor. The designed as a Java web application with a
Micropaq monitor is principally designed for modular three-tier architecture to increase
use in cardiac care with ambulatory patients flexibility, facilitate maintenance and
connected wirelessly to Protocol's network improve overall performance. Doctors-
and a central nursing workstation. It can be Online has been designed to facilitate patient
used as a portable or spot-check monitor on to remotely consult his family doctor at any
hospital medical-surgical floors or as a basic time from any place. Consultation is effected
transport monitor when critical patients are via audio and video conferencing to fully
moved from one hospital department to emulate physical consultation. Discussion
another. with doctors other than the family doctor is
accomplished via multipoint audio/video
Although the patient health communications. Physical examination is
measurement toolkit proposed pales in facilitated by providing patients with a kit to
features and complexity when compared to measure health signs such as body
LifeShirt and Micropaq, the Doctors-Online temperature as well as through video.
system as a whole has the following Measured data is transmitted directly to the
advantages in addition to the commercial doctor via Internet. Security is maintained
potential mentioned above: with the use of Secure Socket Layer (SSL).
• Low Cost. Only basic vital signs such as There is room for improvement in the
body temperature, pulse rate and blood system. For instance, code reusability can be
pressure are required for minor medical improved by the use of Enterprise Java
diagnosis. These limited requirements, Beans (EJB) and reduce video conferencing
coupled with low-cost components make dependence on platform and browser by
the hardware affordable for the patients. offering more diverse conferencing choices
other than NetMeeting.
International Journal of The Computer, The Internet and Management, Vol. 10, No3, 2002, p 15 -22
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8. REFERENCES
[1] Programmer to Programmer.
Professional Java Server Programming.
Wrox Press Ltd. 1999. USA.
[2] Ian Evans, Laurel Klein, Michael Maceri,
C. Rand McKinney. Getting Started with
Lutris Enhydra. Lutris Technologies, Inc.
2000. USA. Online document available
at http://www.lutris.com/documentation.
[3] I. Scott MacKenzie, The 8051
Microcontroller, Prentice Hall, 1999.
[4] Stone Street Bluetooth Development Kit,
http://www.stonestreetone.com/bluetooth
/products/bdk/
[5] Bluetooth Special Interest Group,
Specifications of the Bluetooth System
version, 1.0B, vol. 1 and 2,
http://www.bluetooth.com, Dec 1999.
[6] Brent Miller, Chatschik Bisdikian,
Bluetooth Revealed - The Insider's Guide
to an Open Specification for Global
Wireless Communications, Prentice Hall,
2001.
[7] Java Secure Socket Extension,
http://www.java.sun.com/products/jsse.
[8] LifeShirt,
http://ww.vivometrics.com/Products/prod
ucts_flash.html.
[9] Micropaq,
http://www.protocol.com/company/press/
000309micropaq.asp.
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