Telemedicine Software Specifications

SOFTWARE PROTOCOLS FOR TELEMEDICINE

Working Mechanism

Server End Operation

The central server stores all information like patient records, images and waveforms, electronically in the EHR system. Some of the tools in the system software includes, scheduling, adding new nodes, security etc. which are useful in network administration and management. The server also supports multiple accesses of remote ends to the specialty nodes, depending on the bandwidth and availability of licenses. The software plug-ins like Cardiology, Radiology, Dermatology, ENT, Ophthalmology, Pulmonology, Endocrinology, etc ... are all integrated into server software, depending on the customer requirements.

Remote end Operation

Remote locations here mean small hospital & diagnostic centers. The telemedicine systems in these places are designed to be simple and require very low maintenance. A standard IBM compatible PC is installed with the necessary operating system (windows or equivalent) along with a browser. The medical devices like plus the video conferencing system are connected integrated into one simple system via the PC to the server software.

The Dial up, ISDN or DSL connectivity is used to connect the remote systems with the centralized server. Once the access to the server is established, the relevant components that are needed at the remote end PC are automatically downloaded. This happens only for the first time the remote PC connects to the server. Subsequently, the required controls are stored within the PC and are pulled up automatically on demand. Such architecture keeps the maintenance and service support for the remote simple and less complex.

The doctor / technician at the remote center registers the patient into the system and appends all medical data pertaining to the patient to the server. This gets stored in the central server and through the Space Hospitals streamer, the same data is available for browsing / viewing by a specialist instantaneously. An instant messaging system is also available to SMS or alert the specialist of new incoming data and there by online assistance could be obtained in cases of emergency.

PACS : This type primarily focuses on DICOM and Radiology in addition to the modalities like Cardiology. The server located at this place will have direct connectivity to the modalities like CT/MRI/CR etc.. The Image instance is forwarded to a centralized data server and streamed to the specialist for viewing & reporting.

Specialist End Operation

The specialist terminal, is also a IBM compatible PC with normal (Windows or equivalent OS software), is located either on a LAN - collocated along with the central server.

The medical data from the remote locations online or stored on the server is available to only specialists who have a secured login and password access. When a new patient is referred from remote to a specialist, alerts in the form of SMS, e-mail or paging could be sent. Once the specialist logs in, a user-friendly scheduler tells of the pending cases at a glance. The specialist could then call upon the relevant records or medical information in the form of waveforms or images and type in his / her observations. The referring doctor can access the specialist observations via the server

Video Conferencing system

Video conferencing between medical personnel is possible for tele-Consultation and CME. The system can be used on unicast or broadcast mode depending on the type of solution that one is planning for and the Video conferencing system that is used.

• Stand alone box: High quality and requires good bandwidth and includes: camera, microphone and the display is on a normal television.
• PC add On card: This uses the PC technology and software and the card is generally on the PCI slot or thru a USB interface and the display can be on a monitor or television.
• Web Camera using Windows based software for unicast or broadcast mode thru standard PC's.

Generally the super specialty hospital uses a stand-alone box and the remote nodes with PC add on card. The standards that are used in video conferencing systems are ITU, H.320/. 323. The frame rate has to be anything between 15/30 frames per second.

Reporting

The report format is standardized and can be customized based on the inputs from the customer and will contain all the details pertaining to the Electronic Health Record (EMR) , like patient demographics, Review of system, Symptoms, treatment plan, medication, next visit along with other relevant medical data.

Some of the reports that can be generated are as follows:

• Patient Health record.
• 12 lead Resting ECG
• X-Ray, CT, Angio, MRI, Pathology slides, Dermatology, ENT, Ophthalmology report.
• Monthly records for the hospital.
• Statistical reports.

Administration

The system is provided with a complete administration module with the help of this module the system administrator of the telemedicine network will have the following task:

• Adding new specialist: A complete profile of the specialist is entered. The Specialist is given an individual secured login and password.
• Adding new remote node: Details of the node along with login ID and password are entered with the referring doctor(s) details.
• Scheduling Consultation: e- consultation from the remote locations to the specialists is scheduled depending on the specialist's availability.
• Edit / Modify / Delete - Nodes, specialists, appointments etc.,

Alerts

The Specialist will be alerted either through SMS or through e-mail moment a patient is referred. A message is also sent to him when the ECG is being streamed so that the specialist can go online to see the ECG of the patient on Real time.

Security

This is the fundamental requirement for telemedicine applications. Security strategies, designed to protect the privacy, authenticate, authorize, and maintain integrity. These are necessary to protect against the threats of manipulation, impersonation and unauthorized access to health care information of individuals. The username and ID is given only to the doctors in the remote node and the specialists in the network. The doctors at the remote location and the specialists in the super specialty hospital are informed to change the password on registration so that there is no misuse in the network.

Security elements include storage security, network security, data encryption, audit trails etc. Networks should be reliable and secured to ensure user confidence, system and data integrity, and robust system operation.

a) Hardware and Software Specification

b) Vital Track Monitor

c) Connectivity

Areas of operation and Device Integration

Video conferencing between medical personnel is possible for tele-Consultation and CME. The system can be used on unicast or broadcast mode depending on the type of solution that one is planning for and the Video conferencing system that is used.

• Cardiology

a. Resting ECG
b. Electronic Stethoscope

• Radiology

i) Analog

a. X-ray
b. Ultrasound

ii) Digital

a. CR
c. CT
d. MRI
e. Color Doppler

• Ophthalmology

a. Video indirect Ophthalmoscope
b. Slit lamps
c. Fundus camera

• ENT

a. Video Otoscope

• Dermatology

a. CCD camera

• Pathology

a. Pathology slides
b. Lab report

• Home health care

a. Glucometer
b. Blood Pressure

Devices Planned for integration

1. Critical Care Medicine and Emergency care

a. ECG Monitors
b. Vital sign Monitors

2. Ob and Gyn:

a. Fetal Monitoring
b. Ultrasound

3. Pulmonology

a. Spirometry
a. Asthma monitor

4. Neurology

a. EEG
b. EMG
c. Sleep Studies

Technical Specification

Server end

General Features

• Server browser based architecture with provision for customization.
• The centralized server works on Windows 2000 Professional or above.
• Multiple network configurations - Internet, Intranet, WAN, LAN, RAS and stand-alone Real-time / Store and forward / offline of patient data between medical personnel.
• Integrated with EHR, Waveform and Imaging server
• Complete Patient record is electronically stored and retrieved from a centrally secure data base server.
• Web enable any medical device which has PC connectivity and integrating with our software.
• Confidential and secure data transmission and centralized storage.
• Customizable Graphic user interface (GUI) allows us to design the screen to be simple and user friendly.
• Possibility for Video Conferencing between any medical personnel. In case of a broadcast mode to more than one location.
• Patient file/data/image management subsets of international standards (HL7) and ICD 10, LOINC.
• Secured Login for specialists, doctors and administrators. Easy software workflow with drop downs and menu bar and allow customization.
• Storage of complete patient record and viewing on any PC.
• Uploading of EMR and medical records by patients through secured login.
• E-mail and SMS to the specialists on patients referred.
• The Enterprise Server System will run on the JBOSS Application Server that implements the Java Enterprise (J2EE) Specification.
• Java Management Extension (JMX) to manage the various components and provides services for the Enterprise Java Bean.
• EHR System built over individual components to ease the maintainability and support for distributed transactions.
• EHR System uses the Hibernate Architecture & Interface to implement the support for database.
• Modality added apart from the Out of the box functionality will be integrated by deploying the service as plug-in which can be custom developed.
• HL7 compatible for exporting and importing from existing Hospital management system.
• Server will be able to process and transfer images using DICOM 3.0 standard.
• Simultaneous Connectivity from multiple remote and specialist users.
• Capability of exporting data for data mining and long term storage.
• Customized report format - statistical and medical reports.

EMR/ EHR

• Accurate, efficient and convenient. Optimizes workflow and patient information management.
• Reduced paper work and gets rid of bulky storage.
• Secured storage and retrieval of patient data through 128 bit SSL.
• 3 tiered server based application architecture.
• The Electronic Health Record System is a multi tiered enterprise application system based on J2EE architecture and is highly modular and plug-in design.
• Can be clustered / scaled across multiple systems depending upon load and availability.
• Support for access / retrieval of ICD9 / CPT / LOINC codes.
• Interface to support custom HIS through HL 7 engine ( Optional).
• Easy flow of information of Patient registration, compliant, symptoms, History, Immunization, allergy, Review of system, medication.
• Referral of patient through multilevel structure
• Expert opinion, treatment plan and medication
• Comprehensive report generation
• Seamless integration with modalities like Cardiology, Radiology, Pathology, Critical Care medicine, Ophthalmology, Dermatology, ENT
• Allows Multiple visits & storage of patient records
• Alerts of online patients
• Printing of EHR report

ECG

• Windows operating system with Internet Explorer 5.0 or above browser.
• Server / Browser based architecture.
• Real- time forwarding and access of all 12 lead ECG data simultaneously even on low bandwidth.
• Offline storage and forwarding to the centralized secured server.
• Access of ECG data by the specialist even on a dial-up.
• Simultaneous viewing of all 12 leads.
• User Selectable 3x4, 6x2 or 12x1 channel display of ECG information.
• Sweep speed 12.5, 25, 50 mm/ sec.
• Sensitivity 5 / 10 / 20 mm/mV.
• Sampling frequency 500 samples/ sec/channel.
• Heart Rate Display.
• Freeze / Unfreeze.
• Automatic baseline correction.
• Printing of ECG on 3x4 format with or without grid lines.
• Customizable background display, grid lines, lead colours.

Dicomization:

• Program will work on any Windows environment and does not require any installation: download, unzip and run.
• Allows you to convert any jpeg,bmp,tif into DICOM 3.0 format.
• Allow you to open DICOM files, analyze them with the most common tools , save DICOM images into BMP, PGM, JPEG files, and anonymize your DICOM data.
• Can receive Images from modalities like CT / MRI
• Designed to view, read, analyze, archive and exchange digital images in DICOM format.
• Fully compatible with any other DICOM-compliant software
• Advanced image viewing supports up to 16-bit grayscale image depth.
• Image analysis tools include window/level, zoom, magnifying glass, flip, annotation, measurements, DICOM information, image smoothing, invert.

Data Center - PACS - Space Data

• High performance, secured server that provides centralized image management & distribution
• DICOM 3.0 conformance
• Supports scalable multi-user concurrent access
• Server performs as a DICOM device on any imaging network
• Image data are remotely archived
• Works on Windows server environment
• Storage of DICOM 3.0 Images in a secured database
• Access of Images thru secured Login anywhere & anytime
• Image and data archival thru LAN/ WAN
• Immediate Download of images from Data Centre
• Integrated with Electronic Health record
• Storage component - Database independence
• DICOM Protocol ( SCP/SCU) supported
• C-Echo, C-Verify, C-Store, C-Find, C-Move
• Customized report formats
• Provide on-demand access to work lists, patient folders, exams and physician and departmental

Reporting

• Integrated EHR report with customizable formats
• ECG printing with comments in 4*3 format
• Modality report format includes :

- Radiology - CT / MRI / CR / X-ray
- Pathology - Slides
- Dermatology - Skin lesions
- Ophthalmology - Anterior / Posterior

• Administrative reporting for statistical analysis
• Monthly registration report
• Monthly / Weekly Remote node report
• Monthly / Weekly Specialist doctor report.

Remote end

General Specification

• Supports on any Windows environment.
• Desktop or Laptop
• Plug n play of medical devices.
• Operates on internet explorer (IE 5 or above) browser.
• Supports thru RS232, USB, SCSI, Parallel, PCMCIA, Firewire, Infrared, Mic, SVHS, Video etc.,
• Minimal downloads, installation and distribution of software upgrades.
• Proper Login security
• Integrated Video Conferencing system on international systems.
• Easy to use Graphic User Interface ( GUI).

Imaging

Scanner / Digital Camera - Radiology

• Easy integration of high performance Scanner or digital cameras for any kind of Imaging.
• The Image management Software downloadable from centralized server.
• Storage of data in static or dynamic formats
• Storage in any formats - Jpg, Bmp, tiff.
• Conversion into DICOM format for easy viewing on standard DICOM Viewers at server.
• Integrated with our Electronic patient data management system.
• Customizable report format.

Image Gateway - ProImage - Direct Connectivity with CT / MRI

• Allows seamless integration of DICOM compliant modalities
• Direct Connectivity to any DICOM modality
• Acquire Images from Multiple modalities
• Automatically Pushes the Images to the data center while acquiring image from modality
• Works on Windows environment
• Temporary storage component of DICOM images
• Implements services - C-ECHO, C-VERIFY, C-STORE
• Accepts "pushed" images from DICOM

Specialist End

General Features

• Supports on any Windows environment.
• Desktop or Laptop
• Operates on internet explorer (IE 5 or above) browser.
• Supports thru RS232, USB, SCSI, Parallel, PCMCIA, Firewire, Infrared, Mic, SVHS, Video etc.,
• Minimal downloads, installation and distribution of software upgrades.
• Proper Login security
• Integrated Video Conferencing system on international systems.

Easy to use Graphic User Interface ( GUI).

Dicom Viewer:

Technical Specification

Server end

General Features

• Server browser based architecture with provision for customization.
• The centralized server works on Windows 2000 Professional or above.
• Multiple network configurations - Internet, Intranet, WAN, LAN, RAS and stand-alone Real-time / Store and forward / offline of patient data between medical personnel.
• Integrated with EHR, Waveform and Imaging server
• Complete Patient record is electronically stored and retrieved from a centrally secure data base server.
• Web enable any medical device which has PC connectivity and integrating with our software.
• Confidential and secure data transmission and centralized storage.
• Customizable Graphic user interface (GUI) allows us to design the screen to be simple and user friendly.
• Possibility for Video Conferencing between any medical personnel. In case of a broadcast mode to more than one location.
• Patient file/data/image management subsets of international standards (HL7) and ICD 10, LOINC.
• Secured Login for specialists, doctors and administrators. Easy software workflow with drop downs and menu bar and allow customization.
• Storage of complete patient record and viewing on any PC.
• Uploading of EMR and medical records by patients through secured login.
• E-mail and SMS to the specialists on patients referred.
• The Enterprise Server System will run on the JBOSS Application Server that implements the Java Enterprise (J2EE) Specification.
• Java Management Extension (JMX) to manage the various components and provides services for the Enterprise Java Bean.
• EHR System built over individual components to ease the maintainability and support for distributed transactions.
• EHR System uses the Hibernate Architecture & Interface to implement the support for database.
• Modality added apart from the Out of the box functionality will be integrated by deploying the service as plug-in which can be custom developed.
• HL7 compatible for exporting and importing from existing Hospital management system.
• Server will be able to process and transfer images using DICOM 3.0 standard.
• Simultaneous Connectivity from multiple remote and specialist users.
• Capability of exporting data for data mining and long term storage.
• Customized report format - statistical and medical reports.

EMR/ EHR

• Accurate, efficient and convenient. Optimizes workflow and patient information management.
• Reduced paper work and gets rid of bulky storage.
• Secured storage and retrieval of patient data through 128 bit SSL.
• 3 tiered server based application architecture.
• The Electronic Health Record System is a multi tiered enterprise application system based on J2EE architecture and is highly modular and plug-in design.
• Can be clustered / scaled across multiple systems depending upon load and availability.
• Support for access / retrieval of ICD9 / CPT / LOINC codes.
• Interface to support custom HIS through HL 7 engine ( Optional).
• Easy flow of information of Patient registration, compliant, symptoms, History, Immunization, allergy, Review of system, medication.
• Referral of patient through multilevel structure
• Expert opinion, treatment plan and medication
• Comprehensive report generation
• Seamless integration with modalities like Cardiology, Radiology, Pathology, Critical Care medicine, Ophthalmology, Dermatology, ENT
• Allows Multiple visits & storage of patient records
• Alerts of online patients
• Printing of EHR report

ECG

• Windows operating system with Internet Explorer 5.0 or above browser.
• Server / Browser based architecture.
• Real- time forwarding and access of all 12 lead ECG data simultaneously even on low bandwidth.
• Offline storage and forwarding to the centralized secured server.
• Access of ECG data by the specialist even on a dial-up.
• Simultaneous viewing of all 12 leads.
• User Selectable 3x4, 6x2 or 12x1 channel display of ECG information.
• Sweep speed 12.5, 25, 50 mm/ sec.
• Sensitivity 5 / 10 / 20 mm/mV.
• Sampling frequency 500 samples/ sec/channel.
• Heart Rate Display.
• Freeze / Unfreeze.
• Automatic baseline correction.
• Printing of ECG on 3x4 format with or without grid lines.
• Customizable background display, grid lines, lead colours.

DICOMIZATION

• Program will work on any Windows environment and does not require any installation: download, unzip and run.
• Allows you to convert any jpeg,bmp,tif into DICOM 3.0 format.
• Allow you to open DICOM files, analyze them with the most common tools , save DICOM images into BMP, PGM, JPEG files, and anonymize your DICOM data.
• Can receive Images from modalities like CT / MRI
• Designed to view, read, analyze, archive and exchange digital images in DICOM format
• Fully compatible with any other DICOM-compliant software
• Advanced image viewing supports up to 16-bit grayscale image depth.
• Image analysis tools include window/level, zoom, magnifying glass, flip, annotation, measurements, DICOM information, image smoothing, invert.

Data Center - PACS - Space Data

• High performance, secured server that provides centralized image management & distribution.
• DICOM 3.0 conformance.
• Supports scalable multi-user concurrent access.
• Server performs as a DICOM device on any imaging network.
• Image data are remotely archived. Works on Windows server environment.
• Storage of DICOM 3.0 Images in a secured database.
• Access of Images thru secured Login anywhere & anytime.
• Image and data archival thru LAN/ WAN.
• Immediate Download of images from Data Centre.
• Integrated with Electronic Health record.
• Storage component - Database independence. DICOM Protocol ( SCP/SCU) supported.
• C-Echo, C-Verify, C-Store, C-Find, C-Move.
• Customized report formats.
• Provide on-demand access to work lists, patient folders, exams and physician and departmental.

Reporting

• Integrated EHR report with customizable formats
• ECG printing with comments in 4*3 format
• Modality report format includes :
• Radiology - CT / MRI / CR / X-ray
• Pathology - Slides
• Dermatology - Skin lesions
• Ophthalmology - Anterior / Posterior
• Administrative reporting for statistical analysis
• Monthly registration report
• Monthly / Weekly Remote node report
• Monthly / Weekly Specialist doctor report.

Remote end

General Specification

• Supports on any Windows environment.
• Desktop or Laptop
• Plug n play of medical devices.
• Operates on internet explorer (IE 5 or above) browser.
• Supports thru RS232, USB, SCSI, Parallel, PCMCIA, Firewire, Infrared, Mic, SVHS, Video etc.,
• Minimal downloads, installation and distribution of software upgrades.
• Proper Login security
• Integrated Video Conferencing system on international systems.
• Easy to use Graphic User Interface ( GUI )

Imaging

Scanner / Digital Camera - Radiology

• Easy integration of high performance Scanner or digital cameras for any kind of Imaging.
• The Image management Software downloadable from centralized server.
• Storage of data in static or dynamic formats.
• Storage in any formats - Jpg, Bmp, tiff.
• Conversion into DICOM format for easy viewing on standard DICOM Viewers at server.
• Integrated with our Electronic patient data management system.
• Customizable report format.

Image Gateway - ProImage - Direct Connectivity with CT / MRI

• Allows seamless integration of DICOM compliant modalities.
• Direct Connectivity to any DICOM modality.
• Acquire Images from Multiple modalities.
• Automatically Pushes the Images to the data center while acquiring image from modality.
• Works on Windows environment. Temporary storage component of DICOM images.
• Implements services - C-ECHO, C-VERIFY, C-STORE.
• Accepts "pushed" images from DICOM .

Specialist End

General Features

• Supports on any Windows environment.
• Desktop or Laptop
• Operates on internet explorer (IE 5 or above) browser.
• Supports thru RS232, USB, SCSI, Parallel, PCMCIA, Firewire, Infrared, Mic, SVHS, Video etc.,
• Minimal downloads, installation and distribution of software upgrades.
• Proper Login security.
• Integrated Video Conferencing system on international systems.
• Easy to use Graphic User Interface ( GUI).

DICOM Viewer

• Simple and efficient integration of DICOM Viewer with existing Web application
• Thumbnail pane displays selected images and Region Of Interest (ROI)
• Interactive window level and width adjustment or drop down presets for CT
• Window center and width adjust controls- Mouse-controlled Window adjustment
• Custom Window presets.
• Pixel spacing and Slice thickness Adjustment
• Zoom and Pan- zoom
• Canvas manipulation - Flip, rotate, resample
• Support for Single-frame and Multi-frame images