Software Property Solutions
HTN staff is made up of a Group of Information Technology experts who define, develop and implement new and innovative internet software material.
Their strength lies in the way they work and the constant interaction with the ServiceCenter making it possible for them to focus on the critical management issues that come up from time to time.
The software solutions are developed according to working requirements that come from working needs we come across everyday, indicated by the operators of the calls centers, by specialists and by the different types of clients.
From this continuous gathering of feedback from different areas, three property solutions were founded in innovative SmartTelemedicine Platform :
• TelMed (Electronic Health Record)
• TelMed Wireless Solutions.
HTN SmartTelemedicine Platform is a healthcare property platform with the following features:
1. Technological innovation (linked to the use of automated learning techniques integrated with ontological reasoning;, when these techniques are applied in real time together with raw data provided by sensor infrastructures it becomes possible to recognize a vast range of potentially risky clinical situations.
2. Clinical innovation (linked to real-time early diagnosis, long-distance check-ups, follow-up and decision support)
3. Market innovation (can obtain multiple information about patient in his home environment and/or when he/she is in mobility, matching it to the patient’s clinical history)
SmartTelemedicine Platform has:
- Access to medical information by subjects from remote areas (general medicine providers, specialists, hospitals)
- Easy integration with hospital information system to exchange data
- Vast integration with biosignal monitoring systems and devices
- Complete workability among regional facilities for bureaucratic and report purposes.
TelMed – an innovative web-based telemedicine Electronic Health Record
HTN TelMed is a complete backend health service provider system made up of several elements:
- Telemedicine service center
- Telemedicine business rules and policies management
1. Dyamic medical data schema definition
2. Operational workflow
3. Specific Electronic Personal Health Record
- Specific pathologies policies customization (Cardiology, Pneumology, Dermatology, Neurology, etc)
- Real time Bio-signals and images acquisition (Bio-signal Gateway)
- Wireless Sensor Network, ambient and wearable, integration (Specific WSN Gateway)
- Semantic, terminology and syntactic health care standardization
- External platform integration (Business Application Gateway)
- Video monitoring and rehabilitation (TeleRiab Video Module)
This kind of architecture is now used in the daily activity of monitoring patients at home. In a real production telemedicine environment.
HTN TelMed Platform enables the following services:
- Multi specialistic Teleconsultation and Reporting
- Home care Telenursing for chronic patients
- Remote monitoring
- Dedicated Telemedicine Call Center for Hospital
- Activities of telemedicine by specialists
- Remote Rehabilitation.
TelMed platform handles all the medical information about HTN’s patients, and integrates an electronic health record system, which handles all healthcare data in dynamically way.
TelMed platform integrates a component called “TelMed gateway” which enables external systems (such as WSNs, BT Devices, Hospital Information System) to talk with the platform.
Key factors are:
- Web based architecture
- Direct access to information via browser
- Access to information through cross-links
- Dynamic dealing of medical / health data (easily customizable)
Communication support , as the main standard communications systems, to external server to server and / or platforms of technology providers:
- Health information systems (Es. Hospital Information System, public administration network)
- Biological signals acquisition Platforms
Adherence to standards
- Semantic standardization
- Terminology and coding standardization
- Syntactic standardization
HL7,(CDA, Clinical Document Architecture),DICOM
Modularity and extensibility
The software architecture has been designed and developed as a multi level one.
Telmed a technical introduction
Telmed platform is made up by different layers and application components:
- Telmed gateway
- Dynamic Personal Health Record
- Syntactic standardization component
- Call Center module
- Video communication component
An innovative acquisition process has been designed to manage different data sources, automatic bio-signal acquisition, hospital information system integration, clinical specialist activities.
This innovative process is supported through a specific gateway component that can acquire different kind of information such as ECG signal, blood pressure, blood oxygen saturation, glycaemia, ultrasonography imaging ann video, specific clinical information. (For example: a continuous monitoring of blood oxygen saturation is guaranteed H24 allowing the patient to keep his habits).
TelMed’s gateway has been designed to handle medical information, including data that was not present at compile time: an internal catalogue system manages dynamically all medical information, handling his own internal representation of data.
TelMed platform supports data interoperability, providing services using common protocols and standardized data format (e.g. HL7 ).
- Event driven approach: TelMed platform has its own concept of “event of interest” and we consider setting an “event of interest” a core functionality of the platform with a fine granularity. For example, on TelMed platform you can define that the temperature of a human being higher than 38 degree Celsius is an event of interest for patient A, but not for patient B. In case such an event occurs, TelMed will consider it like an “alert”. Please notice that anyway TelMed approach is to store all clinical data, and notify some alerts depending on the definition you gave of “event of interest” (global or per patient). Specific “event of interest” like arrhythmia, detected through monitoring devices, are handled by the platform in a real time process from the signal acquisition up to the clinical specialist alert.
- Data driven approach: Data driven approach is supported, but not usually applied in clinical enviroment. As a rule clinical data is sent and stored as soon as possible from the sensors or from every external system connected to the platform that supports this real-time mode of work.
Historic sensor data could eventually be polled directly by the TelMed Platform following a data driven approach, after an event of interest: offline analysis of historical data can help in discovering trends and giving strong hints to perform a diagnose in case of health failure
- Application driven approach: TelMed platform normally works with an application driven approach to collect data from the sensors. In any case the platform has been designed and implemented to store every single signal from sensors.
Gateway integration protocol
The TelMed platform was born to support Web Service communication natively. Furthermore, it considers Web services’ communication a standard, and it uses other approaches only when needed by external circumstances (e.g. external systems not able to implement Web Services and so on).
In order to meet Business Application interface requirements, TelMed Gateway implements:
- WS-Notification paradigm to support publish&subscribe eventing services to manage WSNs discovery and data collection
- Web services client to access data collection in push mode
- Web services client to access specific services as exposed by WSN nodes (e.g. set data threshold on node, monitor node status, etc)
- Secret handshake over web services to meet mutual authentication ensuring confidentiality of information and trustworthiness of partners
- ACL based on context information to get authorization from external platform
Integration with TelMed platform puts the following requirements, that are common requirements for such integration scenario
Any communication to the platform can be established only if the client has been authenticated from the platform. Clients have to provide a couple of username/password that are verified by TelMed’s Gateway Authentication Filter. If Access is denied at this level an error message is sent to the client and no interaction is permitted with the system
Not every client authenticated on the system is allowed to the same things on the platform. The TelMed platform has a sophisticated system based on access policies and access control list (ACL), with the finest granularity (attribute) on the clinical data. Anyway, this fine granularity is not commonly used in integration scenario, so external system normally authenticates with users that have rights on the entities (and not attributes) they will need to manage. Anytime a client tries to access a resource (read or write) the low level database abstraction layer (internally called CAF) calls the authorization component and check the rights, so that we guarantee nothing can access data if not granted. Insert of new data (typical in the scenario described in this document) is considered a “function” and it has to pass the same checks before being executed.
Integrity and confidentiality of information
All data coming in TelMed platform must be signed through an hashing algorithm and verified in order to fulfill integrity of information.
Communication between telemedicine operators (call center operators, general practitioner, clinical specialist) and patient can be handled through a specific video communication platform.
Video Solution enables:
- Scheduling of rehabilitation video sessions
- Management of daily sessions with activation of recall alert planned systems
- Dealing with groups of patients following the same therapy
- Video training sessions with classes up to 8 people
- Direct Video contact with the patient
- Recording and archiving of sessions
- Creating and managing of case studies library with educational and training purpose.
- Web based software: he doesn’t need to be installed in the patient’s client
- The software platform can manage an unlimited number of rehabilitation sessions at the same time without any problem
- Each session can handle since eight patients per single session.
- you can enable an exclusive and direct communication with the individual patient during the rehabilitation session.
- H264 video compression format for getting best performance and quality
- The platform enables video streaming sessions in full screen mode .
The HTN wireless solutions realize, through the power of the Internet of You (the evolution in the field of health and wellness of the Internet of Things), a user's customized remote monitoring through the use of sensors of small size (in some cases it is of wearables detectors ECG traces, blood pressure, blood sugar, pulse oximetry and in other cases they are integrated sensors in everyday objects such as smartphones).
They are composed of three software modules:
HTN Bee-P Mobile, installed programs and resident directly on a mobile device, able to act as a gateway between the detection device and middleware aimed at receiving active biosignals on the Telemedicine Service Center Platform
Bee-P Services, integrated middleware module on the acquisition of the Telemedicine Service Center data aimed at 'capturing data from the mobile gateway.
Bee-P Web, integrated web system within the service center platform aimed at presenting and viewing data / tracks acquired from monitoring devices.
HTN ensures this through the use of proprietary distributed architecture that integrates communications capabilities BT present on the detection devices with data-acquisition systems located on SmartTelemedicine Platform of the Telemedicine Service Center.