We are presenting the principles of a telematic tool for 'home medical and health care' based on the MINITEL. , and the carrying out of a device, the BIOMASTER ...
A TELEMATIC SYSTEM TOOL FOR HOME HEALTH CARE Norbert Noury, Dr Paul Pilichowski* Laboratoire d'Instrumentation, Micro-informatique et Electronique Universite Joseph Fourier-BP
53X- F38041 Grenoble
Cedex
*CHU: Service de chirurgie cardiaque et thoracique- Physiotel - Grenoble
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ABSTRACT. We are presenting the principles of a telematic tool for 'home medical and health care' based on the , and the carrying out of a device, the BIOMASTER
MINITEL
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I. INTRODUCTION
,.... ....
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Therapy .... ··c·
protocol
Today's 'medical care delivery' organised around the sole hospital bed is no more adapted to our advanced societies in terms of efficiency,
costs
PHYSICIAN
and social behaviour. The
hospital has become a big costly monolithic structure no more
adapted
to
deal
with
light
affections,
also
Medical
its
informations with its authority area. To face this situation, new concepts need to be invented in medical care delivery,
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First, the role of the hospital needs to be redefined as,
Then, a rationnal approach of medical care delivery at home must , -take in charge the patients as early as possible as they leave the hospital structure, -keep the patient in his social and affective environment, -reduce the costs of hospitalisation, -organise the information flow between the hospital, the home, and the professionnal working 'on the ground'. AT
HOME AND TELEMATIC
Fig. 1 and 2 respectively show the therapeutic act inside the hospital and at home, using a telematic tool.
Paper file
piagnostic
i
I
I
Home
>:
Fig. 2-A networked therapeutic manner.
-a place where only heavy therapy is to be carried out.
K
.
>i,C( Telematic link>k
Hospital
-a diagnostic centre,
II.ME DICAL CARE
Parameters
File
'concentrative mode' of operation prohibits the flow of
The
act
of therapy can
a
be seen as
'closed
loop
mechanism' inside the hospital, the physician at home being most of the time off. Home
hospitalisation
cannot
be
imagined
without
a
permanent share of information between the specialists in the
hospitals
and
the
medical
team
'on
the
ground'
(physicians, nurses, ...). The specialist would never accept to let one of his patients return earlier at home if he is not sure to dispose of a medical team on the ground, and loop back informations on the therapy effectiveness. To follow the therapy at home, a telematic tool needs to be
defined
and
set
to
work,
largely
including
the
physician[l], and with the patient participation[2].
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III. TECHNICAL CHOICES
The telematic tool is organized as in Fig.3. In order to
PAmNT
optimise the solution [3], the main words are: -generalisation of the tool,
-standllrdislltion of his components,
!PHYSICIAN I
-control of the costs. In this way, the information system is based on, -the
telephone
network
(accessible
from
everywhere,
fiability proved, and known costs),
Parameters
-the national
TRANSPAC
network (same reasons),
-a 'telematic data base ' which fills a 24 hour duty. The software tools running on the central data base must
Hospital
;
K
Fig.
1-The classical therapeutic manner.
0-7803-0785-2/92$03.00 ©IEEE
Home
be independent of the hardware, such are the following 'accepted standards', -UNIX operating system,
1175
Patient
Home
MINITEL
Parameter file heade
ED
-Question .Mnemonic
�Unit
Tvpe of 'single'
kind
Id
lenlOr
onolog
im ..IC
- - -*-!__ _ __ -
coo HOSPITALI
J; ;;-�
0
Tvpe of 'record'
_
PHYSICIAN OFFICE
onolog
- -kqui,ltion,pec
_
num ..ic
- -*_.* -_!__!_____
soItwol.handl..
_
Fig. 4-Description of the physiological parameters.
-Some parameters are simply put into the system manually
Fig. 3-The telematic network.
(e.g. : temperature, weight, blood pressure...),
-ORACLE relational data base,
-Others are caught automatically through sensors.
-the standard querry language SQLlSQL-net,
Among the 'automatic' parameters are,
-a standard multiprotocol VIDEOTEX core,
-'single information' parameters which are fetched once at
-C language developped drivers.
each observation (e.g. : glycemy, blood pressure, blood
As far as the home environnement is concerned, the key
oxygen saturation ...),
telematic access point is the MINITEL (for FRANCE)
-'recorded informations' which must be monitored for a
which proved its fiability, relative simplicity, and is free of
while (e.g. : heart rythm, blood oxygen saturation, fetal
charge.
activity...).
But this wonderfull telematic terminal doesn't fuHfill all the needs,
We will also consider the way the sensors deliver their informations (analog sensors, intelligent sensors with a
-medical data access protection,
numeric output such as an asynchronous RS232 link, ...)
-data storing capacities,
and
-automatic transfer (simplicity and costs),
the
acquisition-relative
items
(sampling
frequency,
filtering method, etc...).
-physiological sensors inputs,
Also, there should be no limitation to the number of
-portability.
parameters being simultaneously caught.
So we completed it with an inexpensive light acquisition
We worked on the definition of this 'telematic multi
station, called 'BIOMASIER'.
sensor acquisition station'
(Fig.4), and we achieved a
prototype which we early named 'BIOMASIER'.
IV. CLASSIFICATION OF THE INFORMATIONS At home, the physician needs to find, -an abstract of the former therapy carried out on the patient in the hospital,
V. THE BIOMASTER This 'home medical telematic terminal', mainly features, -simple ergonomic interface through a 16 character LCD
-updated recommandations about the present therapy,
backplane ,and a (10 numeric and 2 function) keyboard.
-the possibility to send back observations to the specialist.
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In the hospital, the specialist needs, -the different observations from physicians, nurses ,etc... operating at home. -biological and physiological 'parameters' directly given by the patient. Most of these informations are text-oriented and can easily be fetched through 'fill in' forms, but for the parameters many different methods are to be considered (Fig.4),
controlled
through
a
'credit
either
a
-8 bit microprocessor driven, -2 MegaByte battery powered storage capacity, -Real Time Calendar for datation, -inputs for physiological sensors (8 analog inputs, asynchronous
serial
interface,
1
synchronous
1
serial
interface for networked sensors), -pluggable to the minitel for modem communication, power source, and local video display,
1176
card',
magnetic or a chip-card (Personal Identification Number),
-small size (180 x 140 x 50 mm) and weight (500 gr), -self powered (9V NiCd battery, 6F22 size). We started with the integration of oximeters delivering an asynchronous (RS232) serial numeric information: BIOX 3740 (Ohmeda), OXY (Radiometer), N200 (Nelcor). Also, we are working on the definition of a flexible low level 'field bus' to interconnect different numeric sensors. VI. THEORY OF OPERATION Whenever powered, the BIOMASTER asks for the identification of the user through its card PIN number. The device has 3 modes of operation. In stand alone mode it is self powered, so it is possible to bring and use it anywhere. This mode is reserved for parameters acquisition either manually or plugged to sensors (electrical safety). The descriptive file of the arguments of a parameter is loaded (Fig.4). Each individual acquisition starts with a question displayed on the screen. The user can either validate or invalidate the question whether or not he whishes (or can) answer it. If validated, the mnemonic is displayed along with the unit or type.The acquisition is then performed under the control of the parameters arguments (type of sensor, max and min values...) using the defined software handler. Once all the parameters have been submitted, a whole record is dated and stored. Then, if ever, the acquisition of 'recorded signals' can start (sensors only), and will be stopped whenever the user decides it, being then dated and stored. The device is then turned off automatically. The device operates in the local mode when plugged to a minitel, the host screen is then used. If the identified user is a physician, he can consult the locally stored data (an abstract of the medical file, recommandations from the specialists, display of the parameters). Then he can fill in his 'observations form' which is dated and stored in local. From this mode the user is allowed to select the automatic transfer mode. : the device dials the access code of the distant data base (i.e. its phone number). As soon as the central data base has identified the 'caller', a simple 'operating system like' protocol permits to load all data from the BIOMASTER into the data base. and load onto the BIOMASTER updated informations from the specialist for the physician. We made the choice for flexibility with the BIOMASTER running a simple 'operating system' rather than a 'built in software'. Most of its functionnalities can be specified through description files,
-the parameters descriptive file possibly updated at each transfer with the distant data base, -the software handlers related to peculiar sensors, -the loaded 'fill in' observation forms. For conveniancy, the physician can call the central data base directly from his office with a single minitel and a BIOMASTER. In this case, the physician, identified through his PIN, may only access his patients medical files. The hospital working station is a modem-equipped personnal computer (IBM PC), running a 'Windows graphic environment ' software that permits to access the distant data base, displays the informations through diagrams and gives the possibility to update the therapy protocol. VII. FIELDS OF APPLICATION The pathologies concerned by 'networked home care' can be classified in 5 topics : -Ambulatory surgery (orthopaedy,endoscopic surgery, ...) -Chemotherapy care (organs transplants, AIDS, leukemia... ) -Chronic diseases (diabetes[4], hypertension, asthma, dialysis ....) -Critical diseases (high risk pregnancy[2]) -Therapeutical actions (enteral and parenteral nutrition...) CONCLUS ION
A prototype of the telematic system was carried out including 3 BIOMASTERS and a single personnal computer running (in 'multi-tasking') both the telematic data base and the 'windows environnement' software of the hospital working station. Presented for demonstration during the 'HOPITAL EXPO' exhibition (December 1991, VILLEPINTE - FRANCE) it met a real success. So that we were invited for the annual congress of the 'French federation for home care' (FNE-HAD, March 1992, ORLY FRANCE). A real test is about to take place on a set of patients on 'peritoneal dyalisis', another one with patients on AIDS, with the GRENOBLE CHU. REFERENCES [1 ]
1. P. BOISSEL, "Essais c1iniques en medecine praticienne : la solution
telematique", 7herapie, vo1.45, no 6, pp.471-474, 1990. [2] S. UZAN, "Autosurveillance
11 domicile de certaines grossesses a
risque", Revue du Praticien, vo1.39, no 27, pp. 2441 -2442, 1989.
[3] B. MARTI, "Telematique : Techniques, Normes et Services·, ed. DUNOD Informatique, pp 613-626, Aout 1990.
[4] A. BILLIARD, md, "Telematic transmission of computerized blood glucose profiles for IDDM patients", Diabetes Care, vol.l4, no 2, pp .1301 34, feb 1 991.
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