Development of Distributed E-Healthcare System ...

Advances in Computer Science and Information Technology (ACSIT) Print ISSN: 2393-9907; Online ISSN: 2393-9915; Volume 2, Number 3; January-March, 2015 pp. 221-225 © Krishi Sanskriti Publications http://www.krishisanskriti.org/acsit.html

Development of Distributed E-Healthcare System Using Service Oriented Architecture Sudhanshu Maurya1 and Swati Kumari2 1

Department of Computer Science & Engineering Jharkhand Rai University, Ranchi, Jharkhand Department of Computer Science & Engineering Jharkhand Rai University, Ranchi, Jharkhand E-mail: [email protected], [email protected]

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Abstract—Effective and timely communication between patients, physicians, nurses, pharmacists and other healthcare professionals is vital to good healthcare. Current communication mechanisms based largely on paper records and prescriptions are old fashioned, inefficient and unreliable. In an age of electronic record keeping and communication, the healthcare industry is still tied to paper documents that are easily mislaid often illegible and easy to forge. When multiple healthcare professionals and facilities are involved in providing healthcare for a patient, the healthcare services provided are not often coordinated.

1. INTRODUCTION Countries that have centralized healthcare systems such as the UK have made considerable progress toward electronic medical records and prescriptions, including patients’ excess to them. Despite concerns about security and privacy; such systems provide increased accuracy and efficiency, better communication among healthcare professionals, and reduced risk of prescription errors. In the US, such record keeping and communication are difficult to establish because of the highly diverse and decentralized nature of healthcare. Physicians, offices, clinics, hospitals and pharmacies use computer systems that, for the most part, are not interoperable. In addition, the development of multiple healthcare systems has resulted in data not being easily translated from one system to another. Standards are the key to solving these interoperability problems and enabling collaborations among computer systems. Several organizations including WellPoint, BlueCross and Blue Shield, have initiatives under way to develop electronic prescriptions, but today only 2 to 3 percent of the more than 3 billion prescriptions each year are submitted electronically. Typically, a physician writes a prescription and gives it to the patients. The patient carries the prescription to the pharmacy, waits in line to hand the prescription to the pharmacist, and waits for the pharmacists to fill the prescription. The pharmacist might be unable to read the physician’s handwriting; the patient could modify or forge the

prescription; or the physician might be unaware of medications prescribed by other physicians. These and other problems indicate the need to improve the quality of healthcare, ease access to healthcare and healthcare information and reduce the cost of delivering healthcare. A distributed electronic healthcare system based on the service-oriented architecture (SOA) can address some of these issues and problems. We developed a distributed e- healthcare system for use by physicians, nurses, pharmacists, and other professionals, as well as by patients and medical devices used to monitor patients. Multimedia input and output with text, images, and speech-make the system less computer –like and more attractive to users who are not computer- oriented.

2. SERVICE-ORIENTED ARCHITECTURE In our project, Service – Oriented Architecture (SOA) along with Web services and Atom and RSS feeds, provides the opportunity for diverse systems to interoperate without requiring the use of a particular kind of computer system. SOA-an architecture in which the building blocks are servicesnot only encompasses the services from a technology perspective but also includes the policies and practices that govern service provision and very attractive consumption. SOA enables reusability of software components, provides protocol independence, and facilitates application integration. It enforces basic software architecture principles and such as modular design, abstraction, and encapsulation. With open standards, such as XML and SOAP, SOA provides interoperability between services operating on diverse platforms and between applications implemented in different languages. It supports diverse processing efficiently and easily, enables cross-platform communication, and adapts dynamically to meet changing needs. For healthcare in particular, SOA and healthcare standards enable interoperability by encoding healthcare information using one or more common representations. With healthcare

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staandards, diversse but interopeerable system can improve the quality of healthccare delivered to t patients.

3. DISTRIBUT TED E-HEAL LTHCARE SY YSTEM Ouur prototype distributed d e-heealthcare systeem uses SOA A to enfforce basic sooftware architeecture, principples and provvide intteroperability between b differrent computinng platforms and a appplications thatt communicatee with each other. o The clinnic, pharmacy, and paatient moduless provide the actual a services for thee distributed e-healthcare e system. The devices d accessing theese modules caan be desktop or server com mputers as welll as PD DAs or Smartpphone. They can c also be ellectronic mediical devvices, such as blood b pressuree monitors.

a respoonse from the registry. Althhough, we used our own messagee data format in our prototyype, an actual e-healthcare system would follow w electronic prrescription staandards once they aree adopted and widely w used. The phyysician can usee a PDA to enter and retrievee information about thhe patient durinng or after an appointment and a to access the infoormation later. The e-healthccare system cuurrently uses an OQO O PC, as show wn in Fig. which is a full featuured 3- X 5inch PC C with an 800- X 480- pixel screen that is capable of providinng detailed graphical infformation. Thhe handheld computter can commuunicate with a desktop or seerver using a wirelesss connection.

Altthough, our diistributed e-heealthcare system m provides usserfrieendly interfacces for busy healthcare professionals p a and pattients, securityy and privacy are a particularlyy important in this t areea, so we desiggned the proto otype with secuurity and privaacy in mind. The syystem authentticates users and a logs session infformation and attaches resou urces to the ressource creator,, so thaat only privileged users can view or moddify the data. For F appplications Depployed on deviices such as PDAs, P the systtem striictly enforces authentication a and session management.

4. CLINIC MO ODULE Thhe clinic modulle supports rou utine activities of physicians and a nurrses at the clinic c by maiintaining inforrmation such as apppointments forr a specific day y or week, thee patients that the phyysician has exxamined, and notes related to patients. The T clinnic module exposes e a web b server interrface and a web w serrvice interfacee as Fig. show ws. We designned a web serrver intterface for userrs to prefer thee access the heealthcare services froom a web brow wser. A physician or nurse can usee the Web seerver interface to acccess the clinicc module from m a desktop coomputer or PD DA, andd the patients can use the web w server intterface to requuest apppointment withh the physiciaan for a speciffic date and tim me. Thhe web server uses u a web serrvice to accesss healthcare daata. Appplications annd devices caan use this web service to com mmunicate with the clinic module. m In adddition, monitorring devvices- such ass electronic blo ood pressure monitors, m glucoose moonitors, weighhing scales, pillboxes, p and so forth – can c traansmit informaation to a desk ktop or laptopp computer viaa a wirred or wireless network and d then to the cllinic Web servvice over the internet. Thhe clinic moduule sends presccriptions from the physiciann to thee pharmacy ovver the internet using a pharm macy web serviice. To locate the phharmacy closesst to the patiennt’s home, or the phyysician’s officee, the clinic web w service sennds a web servvice query to a web service registtry, where phaarmacies offerring succh services haave registered. Communicattion between the phyysician and thee pharmacy occcur after the physician p receivves

Fig.1: Clinic module with Web server and d Web b service (WS) interfaces.

The usse of a smalll keyboard makes m it difficcult for the physiciaan to input infformation, so inn addition to the t graphical interfacce, the hand heeld is equippeed with speechh recognition and syynthesis softwaare that lets the physiciann enter and retrievee information by speakingg and receivving spoken feedbacck. These speeech technoloogies help thhe physician complette tasks and encourage e the use of the handheld. h To ensure the t accuracy, thhe physician must m confirm thhe prescribed medicattion and its dosage upoon entry beecause such informaation is criticaal to the patieent’s life. Integgration with pharmaaceutical applications or weeb services thhat warn of interacttions between medications can further improve i the provideed service’s acccuracy. The phharmacy moddule, which provide serviices to the pharmaacist and devicees at the pharm macy keeps a record r of the patient’s prescriptionss for referencee and updates prescription status as a the pharmaacist fills them m. The pharm macy module exposess web server annd web servicee interfaces, ass Fig. shows. The weeb server inteerface lets ussers access thhe pharmacy module from a web browser. Thee pharmacist can c use this

Advances A in Coomputer Sciencce and Informattion Technologgy (ACSIT) Print ISSN: 23 393-9907; Onlline ISSN: 2393-9915; Volum me 2, Number 3; 3 January-Maarch, 2015

Deevelopment of Distributed D E-H Healthcare Sysstem Using Serrvice Oriented Architecture

intterface to view w prescriptions as the pharmaacy receives thhem froom physicians. The patient can use the webb server interfa face to determine whhether a presccription has beeen filled andd is reaady for pick upp or delivery.

Fig. 2: Physiccian’s handheld displaying d a list of medications

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about thhe status of thhe patient’s deescription. Thee pharmacist can quuery the pharm macy module to obtain thhe status of prescripptions, the reccords for a paarticular patiennt, and other informaation, with quuery result shown s as a list for the pharmaacist to view.

Fig. 4: The Web serverr interface to (aa) the pharmacyy module for the phaarmacist and (b)) the patient.

5. PHARMAC CY MODULE

6. PA ATIENT INTE ERFACES

Thhe Web service interface prrovides access for applicatioons depployed at thhe pharmacy. The clinic module sennds preescriptions froom the physician to the phharmacy over the intternet using thhe pharmacy web w service. The T Web servvice verrifies the physsician’s identity y, and also cheecks the patiennt’s inssurance beforre processing the prescripption. Removving hum man intervenntion from communicationn between the phyysician and pharmacists and maintainning informattion eleectronically redduces the possiibility of humann error.

The weeb server interface to the cliinic module leet’s a patient request an appointmeent with a phyysician for a specific s date and tim me using the clinnic Web serverr. In the system m, the patient can botth see his or her h appointmennts with the phhysician and access other informaation. The weeb server interrface to the pharmaacy module, shhown in figuree, lets a patiennt check the status of o a prescriptioon, view his or o her prescripption history, and rennew existing prescriptions. p If the patientt requests a prescripption to be filleed at the website, he or she must m make a paymennt or copaymennt before the pharmacist p cann start to fill the presscription. The pharmacy p moddule sends rem minders to the patient about the statuus of the patiennt’s prescriptionns as well as sends messages m from the t pharmacistt to the patient.. To asseess and reportt the patient’s health status,, the system supportts the use of medical m monitooring devices--on wired or wirelesss networks-to report r periodiccally or, in emergencies, to send ann alert immeddiately. The syystem does noot send any patient-- identifying informationn; rather, itt transmits informaation along wiith the devicee’s serial numbber, and the clinic Web W service makes m the association with thhe particular patient. If the patient has not registtered the devicce, the clinic web serrvice discards the t data from thhe device.

Fig. 3: Pharmacy P modu ule with Web seerver and Web service (W WS) interfaces

Thhe web server interface to th he pharmacy module, m shownn in figgure, lets the pharmacist monitor m incomiing prescriptioons, update their statuus, and inform m the physiciann and the patiient

The e--healthcare syystem is currrently enableed with an electronnic blood preessure monitorr, which trannsmits blood pressuree readings to the t patient’s laaptop or desktoop computer. The datta is then communicated oveer the internet to the clinic Web service for exam mination by thee physician. Thhe physician


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andd the patient can see the historical h dataa from the bloood preessure monitorr as a list or in a chart as a cllinic Web serviice. Figg. shows the output from the patient’ss blood pressure moonitor, and Fig.. shows the pattient’s blood prressure history..

7. UNDERLYING INFORM MATION TEC CHNOLOGY Wee implementedd our prototyp pe e-healthcaree system in jaava beccause of its abbility to deploy y on small wiireless devicess as weell as on pow werful serverss. To ease development d a and debbugging of thee system, the implementatioon uses plain old javva objects (POJJO) based on th he spring framework.

8. WEB SERV VICES Weeb services arre applications that typically execute onn a rem mote computer and can be accessed by clients over the intternet. Web services s are based b on opeen standards- in parrticular, XML and SOAP. These T standardds aim to achieeve intteroperability between ap pplications, implemented i in diffferent languagges, running on n diverse compputer systems, and a com mmunicating over o a network k. Ouur distributed e-healthcare system s uses thhe Apache Axxis2 fraamework (the core c engine forr Web servicess built on Apacche Axxiom) and the Apache Tomccat server. Axiis2 provides data d binndings that enaable application n developers to generate SO OAP meessages withouut being con ncerned about constructing or parrsing them. Weeb Services Security (w www.oasis-openn.org/committeees/ wsss/) – provides a means of in ncorporating seecurity featuress in a SOAP S messagee’s header. It supports multipple trust domaiins, enccryption technologies, sign nature formatts, and securrity tokkens formats.

9. SPEECH SO OFTWARE Ouur distributed e-healthcare sy ystem uses SR RI’s Dyna Speeak speeech recognittion softwaree (www.sri.coom) because it suppports multiple languages, adapts a to diffeerent accents and a does not require training prior to use. Dyna Speak S is ideal for em mbedded platforms because of o its small footprint and its low l com mputing requiirements. Fig. given shows the prescriptiion, graammar for thee e-healthcare system and the t Fig. gives an exaample of its usse on a physiciaan’s handheld device. d Thhe distributed e-healthcare system uses AT&T’s Natuural Vooices speechh synthesis software (www.researrch. att.com/~ttsweb/ttts), which can c accuratelyy and naturaally proonounce words and speak in sentences thhat are clear and a eassy to understannd. Natural Vo oices supports many languagges, maale and femaale voices, and a several speech interfa face staandards.

Fig. 5: (a) Output from m the electronicc blood pressuree monitor on the paatient’s desktop p or laptop.

(b) Thee patient’s bloood pressure history h maintaiined using a clinic Web W service.

10. AT TOM AND RS SS Enablinng physicians, nurses, and phharmacists to use u PDAs or smart phone requires those devices to be able to communicate c with thhe clinic and pharmacy p moddules on theirr desktop or server computers c usinng a wireless orr wired networrk. At certain times or o places, neetwork comm munication might not be availablle- for examplee, in an emergeency such as ann earthquake or a huurricane, a phyysician cannot expect to havve a network connecttion to his or her h desktop orr server. Thus,, Physicians, nurses, and pharmaciists must be able a to access and modify health care c informatioon offline. Atom and a RSS are syndication s tecchnologies bassed on XML that enable the shariing and comm munication of information betweenn heterogeneouus platforms by b making the information self-desscribing. Our distributed d e-heealthcare system m uses Atom with additional a inffrastructure, software s to synchronize informaation on a deskktop or server with the inforrmation on a handhelld. This sofftware lets physicians, nurses, n and pharmaacists view andd update healthccare informatioon when it is offline. A major problem p in healthcare h todday is that ween the phyysician and the patient commuunication betw


Deevelopment of Distributed D E-H Healthcare Sysstem Using Serrvice Oriented Architecture

typpically exists only o within th he physician’s office: once the pattient leaves the t office, communication is very limitted. Hoowever, monittoring the reco overy progresss is essential to good healthcaree. This probleem is even more m severe for hospitals.

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J.G Grimson,W.Grim msonandW.Hasseelebring, “The SII Challenge in Heaalth Care,”Comm m. ACM,Volume 43, no. 6,20000, pp. 48-55. Com mmittee on the Quality of Heallth Care in Ameerica, Inst. Of Medicine, Crossingg the Quality Chhasm; A New Health H System for the 21st Centuryy, US Nat’1 Acaddemic Press, 20000. L.E E. Moser and P.M.Melliar- Smith, “Servvice Oriented Arcchitecture and Web Servicess,” Wiley Enccyclopedia of Com mputer Sciience & Engineeringg, Wiley &Sons,2008;http://m mrw.interscience.wiley.com/em mrw/97804700 501118/ecse/article/eecse510/current//abstract. T.B Bray, “RSS 2.0 and Attom 1.0 Com mpared,”July20005;www.tbray.org/atom/RSS-annd-Atom. F.K Kart, L.E.Moserr and P.M.Mellliar-Smith, “ Reliable R Data Disstribution and Consistent C Data Distribution annd Consistent Datta Replication Using the Atoom Syndication Technology, ”Prroc. Int’l C Conf. Interneet Computingg, CSREA Press,2007,pp.124-130. R.W Weiss, “Medicall Errors Blamedd for Many Deatths: As Many as 98,000 9 a year in i the US Linkeed to Mistakes,”” Washington Posst , 30 Novemberr, 1999, p. A01. T.A A. Branigan, “ Medication Errrors and Boardd Practice ,” Collorado State Booard of Pharmaacy News , Naat’l Assoc. of Boaards of P Pharmacy, F Feb. 2002, pp. 1-4; ww ww.napb.net/ftpfiiles/newsletters/CO/CO022002.ppdf. L.T T. Kohn, J.M.Corrigan , and M. M Donaldson,eeds.,To Err Is Hum man: Building A Safer Healthh System,US Nat’l Academy Press; 2000.

Fig. 6.(a) The e-h F healthcare systeem’s prescriptioon grammar, an nd (b) an example of its use on a physician’s haandheld device.

A distributed e--healthcare sy ystem can hellp to solve this t connundrum. Meddical monitorin ng devices worrn by the patieent, andd frequent eleectronic comm munication betw ween the patiient andd a nurse, can ensure that th he prescribed trreatment is being folllowed and thatt the patient is making good progress. p Thhe e-healthcarre system described here can be readdily exttended to otheer healthcare professionals, inncluding mediical tecchnicians to peerform and report tests and annalyses requessted by physicians. In addition, th he system can be interfacedd to othher applications that provide information onn medications and a dosages and warn w of interaactions betweeen medicatioons. Finnally, it can be b interfaced to drug-delivvery devices that t proompt and monnitor the regullar and timelyy consumption of meedications. Advances A in Coomputer Sciencce and Informattion Technologgy (ACSIT) Print ISSN: 23 393-9907; Onlline ISSN: 2393-9915; Volum me 2, Number 3; 3 January-Maarch, 2015