Study on the Applicable Integration Technology of Onboard Mobile Medical Aid System

Transcription

1 2011 Fourth International Conference on Intelligent Computation Technology and Automation Study on the Applicable Integration Technology of Onboard Mobile Medical Aid System Zhu Shengzhao University of Shanghai for Science and Technology Shanghai Medical Instrumentation College Shanghai, , China Abstract Onboard mobile medical aid (OMMA) provides prehospital first aid that serves as the extension of in-hospital emergency treatment. OMMA effectively shortens the time spent on in-hospital treatment, and poses a direct impact on the success of the treatment, thus, the efficiency of OMMA has a far-reaching effect. Currently, a seamless linkage between pre-hospital aid and in-hospital treatment is yet to be achieved, as information is, relatively speaking, enclosed and isolated in the transportation process. To remove all the obstacles in the transmission of information during emergency process poses as the root problem waiting to be solved. This paper focuses on the study of existing applicable integration technology of OMMA, its models and procedures, and proposes the design and framework for OMMA based on SOA (Service-Oriented Architecture). Keywords- onboard medical treatment; emergency treatment; pre-hospital first aid; applicable integration technology; HL7; Web Services I. INTRODUCTION Once the integration of OMMA is achieved, it is able to keep contact with 120 emergency command center and have instant access to emergency hospital information system through the use of multi-parameter monitoring equipment and data terminal on-board the emergency vehicles, and by means of internet and 3G networks. OMMA is another brand-new practice of the application of integration technology under moving conditions by hospital. In short, OMMA uses computer technology, multimedia technology, and 3G technology to pass on medical information under HL7 international standard. It integrates the heterogeneous systems on the Web Service platform, independent of language. In applying FLEX, FMS and the Internet, it is able to carry out remote video consultations. It realizes realtime monitoring of emergency vehicles through GIS, and achieves the interaction of information among pre-hospital, hospital, and the command center. OMMA integrates technologies concerning multimedia, network, tracking, communication, and medical science. It aims at strengthening the cooperation among relevant departments in emergency treatment, improving the efficiency of emergency treatment. It is a systematic project that covers a wide range of areas, and there has been no complete model available for reference up till now. This paper is to discuss and study certain theoretical and practical problems concerning the application of integration technology in OMMA. II. EXISTING MODELS AND PROBLEMS OF PRE-HOSPITAL FIRST AID Current models of pre-hospital first aid include the SAMU model from France and the EMS model from the United States. The SAMU model features heavily-equipped ambulance and high-quality emergency medical attendants. The EMS model adopts strategy that deals with emergency on the spot before transferring patients rapidly to the back, and resort to hospital treatment later. For developing countries, full application of SAMU or EMS model is impossible because of the special circumstances facing these countries. The existing medical emergency treatment system adopted by China follows: 120 calls for help dispatching emergency vehicles to the needed spot sending patients to the nearest hospital through GPS navigation while keeping the patient under monitoring oral discourse of patient s physical condition doctor diagnosis treatment hospital transfer re-treatment and so on. Due to various uncertainties, such model might cause problems in actual practice, mainly duplication and uncertainty. Duplication: In pre-hospital first aid, medical attendants monitor and diagnose during the transportation process while the initial diagnosis retains in the ambulance without effective sharing with hospitals that are about to give emergency treatment. When patients reached hospital, doctors have to make diagnosis all over again before giving appropriate emergency treatment due to failure in the transmission of information, which causes heavy waste in medical resources, and delay in rescue, missing the best treatment time. Uncertainty: Oral discourse or triplicate are major ways in the transmission of information between pre-hospital and in-hospital treatment. Misunderstanding and ambiguity are thus to rise owing to the limitation of information, personal judgment and outside interference, which affects the accuracy of diagnosis. III. THE OVERALL FRAMEWORK DESIGN In the course of emergency treatment, time is fatal to life. The traditional model inevitably causes delay in rescue, due to oral discourse and in-hospital re-diagnosis. For all that, the new emergency treatment model should have the /11 $ IEEE DOI /ICICTA

2 following functions: (1) Real-time transmission of patient physical conditions onboard the ambulance. Share patients physical conditions with the hospital on the way to the hospital, with the help of vital-sign collection equipment, computer and communication networks, so that in-hospital doctors can make early judgments, develop effective emergency treatment plan, and make appropriate preparations for rescue work. In extending in-hospital diagnosis to the transport process, it effectively reduces the time spent on in-hospital diagnosis, and avoids misunderstanding and ambiguity caused by oral discourse. (2) Remote video consultation. The application of remote video consultation in pre-hospital first aid can not only help medical attendants onboard the ambulance deal with emergencies, but also enable in-hospital doctors to get to know patients physical conditions that are not reflected by parameters more intuitively and effectively, hence, providing strong support to the rescue work. (3) Keeping track of emergency vehicles. In keeping track of the emergency vehicles, hospitals can calculate the time it takes for patients to arrive so that medical resources can be better allocated to patients and rescue work can be prepared accordingly. OMMA applicable integration technology helps solve the problems in the traditional model and achieves the modernization and informationization of the medical emergency service system. OMMA applicable integration technology is to integrate OMMA multi-parameter monitoring equipment with inhospital information systems such as HIS, CIS through 3G wireless networks. The integration of interface makes possible the extension of functions such as video consultation and vehicle location tracking. Compared with the traditional integration practices by digital hospitals, OMMA integration technology involves hardware devices mainly concerning numerical devices (eg. temperature, oxygen and respiratory equipment) and wave devices (eg. ECG) and so on. Data integration features the integration of physiological data collected by multi-parameter monitoring devices and in-hospital systems such as HIS and CIS. Since emergency vehicles are under moving conditions, it is impossible to provide a fixed IP through 3G linkage to the Internet. At the same time, it demands real-time data within short notice. In view of this, the framework design of OMMA integration technology should possess the following six characteristics: a reusable, scalable application interface; the extension of the third party application; stable and reliable operating platform for plug-in equipment; standardized data sharing format; reliable, real-time data transmission between ambulance and hospital; and loose coupling with existing in-hospital systems. Considering the above mentioned characteristics and the advantages and disadvantages of the existing applicable integration technology, the paper make out an OMMA applied integration framework based on SOA (Service- Oriented Architecture). It takes each ambulance as a prehospital rescue unit for direct deployment without considering the differences in emergency vehicle equipment. USB(Universal Serial Bus) interface makes possible the plug-in practice of equipment, onboard monitoring devices are thus connected. As ambulance can not be given a fixed IP address through 3G linkage to the Internet, onboard information terminal can delivery web Service information through hospital's own Web Servers. The integration of ambulance and in-hospital information system is achieved through the loosely-coupled Web Service technology, and language-independent platform. The applied integration of extended functions can be simplified through the application of third party server and the integration of interface. On data level, data produced by various devices are transcoded to suit the HL7 standard so that medical information systems can realize data sharing. Overall framework design is shown in Figure 1. IV. Figure 1. Overall Framework KEY TECHNOLOGY ANALYSIS A. SOA Analysis SOA is a component model. By adding a service layer in between the traditional business layer and the technology layer, it connects independent functional entities that can provide specific services on the Internet to form the software system framework. SOA makes possible the independent practice of the business layer and the technology layer by conducting effective communication between the two layers, thus rendering more flexibility to the system in response to specific business variations. SOA boasts a strong framework that is able to meet the demands for the integration of different applications. It realizes the simplified integration of application programs and is able to work under different platforms, programming languages, operating systems and hardware framework. As a coarse-grained, loosely-coupled service framework, SOA carries out communication among simple, preciselydefined interfaces, without involving low-level programming interface and communication protocols. The paper holds that SOA-based integration model is the best choice for OMMA integration technology

3 In service-oriented framework, each entity plays the role of a service provider, a service recipient or the service registration center. The collaboration in between different roles in the service-oriented framework is shown in Figure 2. In OMMA integration practice, emergency vehicles and hospitals serve as both service providers and service recipients, while emergency command center plays the role of service registration center. Hospitals put the connection interfaces that can provide services under the emergency command center for unified management. Emergency vehicles find the address of the target hospital from the emergency command center before sending its own service address to the hospital and the target hospital pins down the service address and calls the ambulance for service. Figure 2. The Collaboration In Between Different Roles In The Service- Oriented B. Technical Analysis on Web Service As the main implementation method for SOA framework, Web Service provides a technical framework for the interaction and integration of different platforms under loosely coupled Internet. Web Service is a set of standard that defines how application software interacts in the Web. It exposes API that can be invoked through the Web, and can receive requests passed over from the Internet or other systems on the Intranet. It is a simple and independent communications technology, a new platform for the construction of interactive distributed application software. It provides a set of RPC protocol and description language through the Web Service, and bridges the gap in the use of different component models, operating systems and programming languages, making the heterogeneous systems run concurrently as one computer network. Web Service is mainly applied to the following four areas: long-distance communications; integration of application software; B2B integration; software and data reuse. Web Service enjoys the following characteristics: (1) Well-packed Web Service is a web-deployed application that is well-packed. Users can only see the service description, while the implementation of the service and the operation platform is transparent. (2) Loosely-coupled When variation occurs in Web Service, the caller feels nothing as long as the service implementation interface has no change. (3) Standardized protocol All the public protocols of Web Service are described, transmitted and exchanged in standardized protocols, which are identical on various platforms. (4) Highly-integrated In adopting simple, easily-understood standardized Web protocol as the communication protocol, Web Service is able to bridge the gap between different platforms, be it CORBA, DCOM or EJB, which are interactive under the standardized protocol, thus achieving maximum system integrity. (5) Highly-open The Web Service can interact with other Web Services, regardless of the difference in language and platform. It supports various component standards such as CORBA, EJB, and DCOM and various communication protocols such as HTTP, SMTP, FTP, RMI and so on. In view of this, it is appropriate to take Web Service as the core technology in the systematic integration of various key components in OMMA applicable integration technology. C. The Standard For Information Exchange HL7(Health Level Seven) is a medical information exchange standard for electronic data interchange of different system in medical field. It is an industry standard formulated by Hl7 and approved by ANSI in Its main purpose is to develop standards of electronic data of different types of medical information systems, such as clinical, insurance, management, administrative and inspection. HL7 is on the seventh layer (the application layer) of OSI (Open System Interconnection) of ISO (International Standard Organization). Its communications correspond to concept of the seventh layer of OSI from the application to the application interfaces. Hl7 defines the interface standard format from the structure of the interface layer and support the use of existing different coding standards such as ICD- 9/10, SNOMED. In the data formats of HL7, news is one of the smallest units of data between systems. He used to send messages between the different ways in which interconnection is similar to the network packets delivery mode. From the structure we can see the existing information coding standards of HL7 is composed of message, segment, data field, component and sub component. Message is the Logic Corporation of message segment according to sequential sequence. Every message segment includes a number of data fields which may be further divided into components and sub components. These elements are organized to express meanings of message on different levels. The structure of HL7 is shown in Figure 3. Figure 3. Structure of HL7 D. WebGIS GIS (Geographic Information System) is a computer information system which collect, process, store, manage and analyze, outputs geographical space data and its attributes information. WebGIS is a technology which

4 combines Internet and GIS technology and provides GIS for various geographical information with the internet as application environment and the web pages as GIS user interface. Now technology that are mainly used for the development of WebGIS are web map publication based on server (GGI general gateway face and Server API server application interfaces), web map publication based on the client' (GlS Plug-in, GIS ActiveX and GIS Java Applets) and technology based on the client and server. The development of AJAX technology in recent years brought to the new design patterns to WebGIS. It can make use of scripts language on the client JavaScript to simplify the client design without downloading and installing redundant programs. Google Maps API is API function developed by Google Company to promulgate map. It is embedded into JavaScript through code corresponded to syntactic standard and can allow a third party invocates information from Google map database, making the development of WebGIS subsystem of vehicle tracking more convenient and fast. V. SYSTEM COMPOSITION The composition of the applicable integration technology of OMMA, as in Figure 4, includes six parts, call subsystem, vehicle information terminal, HL7 gateway, WebGIS vehicle tracking system, video consultation subsystem, databases subsystem and monitoring system of medical institution. These subsystems is an organic combination to provide realtime data monitoring and remote assistance. Figure 4. The Composition of The Applicable Integration Technology of OMMA Working principle of the applicable integration technology of OMMA system: build voice response system based on Web Service at 120 emergency operations center, ambulances and hospital. Voice response system is mainly used to receive the web interface of voice response system of hospitals which will be stored and managed by Web Service and at the same time it also provide query services of Web Service interface address to ambulance. Voice response system of hospitals is used to release Web Service interface address of the hospital and receive Web Service interface address of ambulances through which it can get data from the ambulance. Voice response system of ambulances is used to acquire Web Service interface address of relevant hospital through which release Web Service interface address of the ambulance, and correspondingly Voice response system of hospitals respond to parameters captured. In the process of data transfer of vital parameters, Hl7 news will be analyzed through Hl7 gateway. Video consultation systems based on FMS will be built at 120 emergency operations center. Real-time sound and video communications between ambulances and hospitals can be achieved through application of rich Internet based on FLEX. Combined with the existing 120 emergency scheduling command system vehicle tracking system of 120 emergency operations center facilitate hospital to get the current position of ambulances. Logic architecture is shown in Figure 5. Figure 5. Logic Architecture System features: (1) In the course of emergency and transit information from the ambulance is transmitted to the hospital in a real-time. Theoretically it can be regarded as the emergency in the hospital, reducing the time needed for the diagnosis, avoiding misunderstanding from verbal communication, thus improving the efficiency of the emergency; (2) Video consultation system which combines instant messaging with Audio-Visual systems reduces the communication barriers depending on sound description alone and provides with rapid and effective remote assistance; (3) Through WebGIS vehicle tracking system, the hospital can locate the current position of ambulance and prepare better for first-aid nursing; (4) According to the physical parameters of patients the medical professionals in hospital, through the video consultation system can assist the staff to carry out appropriate first-aid measures to make up the problem of irregularity in professional quality of emergency medical care personnel; (5) 120 emergency operations center's unified management to hospital Web Service interface address can better implement rational using of existing medical resources, thus indirectly improving the efficiency of dispatching system of 120 emergency operations center; (6) The application of Web Service technology and HL7standard favors the delivery of medical information, providing convenience to further expansion; (7) The application of rich internet in video consultation system reduces the complexity of development and deployment of the system; (8) Patient's vital parameters is transmitted from

5 point to point between ambulance and hospital, which makes full use of resources, reduces the loading of whole system and provides facilities to expansion of the system. The information synchronization of ambulances and hospitals can help medical professionals to analyze the patient's condition better and to formulate corresponding measures. Video consultation further enhances the efficiency of the first aid. WebGIS vehicle tracking and locating enable hospitals to handle the emergency situation orderly. VI. OPERATION MODE AND EFFECT Emergency pattern based on the mobile medical care system integration application technology is quite different with original 120 emergency patterns. The major difference lies in the emergency transport which is the weakest link of traditional 120 mode. Integration of the workflow is shown in Figure 6. furthermore, it improves medical aid efficiency and provides a solid reference for the construction of "green passage" connecting pre- and inner- hospital emergency aid. REFERENCES [1] Zhao yongchun, Jin yali, Zhanglei, Zhang jinjun. Composition and Application of Digital Pre-hospital Emergency Medical System [J]. CHINESE GENERAL PRACTICE, 2009, 12(14): (in Chinese) [2] An tiefeng, Jiang xiaoyan, Zhang jinjun, Zhao yongchun, Zhanglin. Application of Wireless Digital Transmission Mobile Electrocardiogram Monitoring System in Pre-hospital First Aid [J]. CHINESE GENERAL PRACTICE, 2009, 12(6): (in Chinese) [3] Zhang weixian. Research on the Construction of 120 Emergency System Based on"3g"technology [J]. GEOMATICS & SPATIAL INFORMATION TECHNOLOGY, 2008, 31(1): (in Chinese) [4] Gaopeng, Liu yingfang. Rely on 120 hospital emergency centre to achieve integration of the pre-hospital emergency hospital treatment model [J]. Chinese Journal of Critical Care Medicine, 2007, 27(8): (in Chinese) [5] ANSI/HL7 V3 TR ebxml, R [S].USA, HL7 organization, [6] Dupan, Xujin. Discussion about the integration of component services with finer granularity in SOA applications [J]. JOURNAL OF COMPUTER APPLICATIONS, 2006, 10(5): (in Chinese) [7] Yefeng, Cai guangdong, Panlin, Yulun. Remote medical information sharing platform based on SOA [J]. JOURNAL OF FUJIAN COLLEGE OF TRADITIONAL CHINESE MEDICINE, 2007, 17(5): (in Chinese) Figure 6. After the Workflow Application of Integration From a flowchart, we can see with emergency pattern based on the mobile medical care system integration application technology, the emergency transport process become a work which hospitals, experts involved from the work carried out by ambulances alone. With the emergency resources of hospitals early intervention, we can make full use of medical resources, shortening the time needed for diagnosis and improve work efficiency. VII. CONCLUSION This article focuses on currently available applicable integration technology of mobile vehicle-mounted medical aid system, analyzes currently used emergency aid model and process and designs the overall framework of the structuresbasedonhl7 Health Level Seven standard for information exchange and Web Services. Through comparative analysis with traditional modes of emergency we can see mobile vehicle-mounted medical aid system is a breakthrough to the traditional mode of emergency,