Abstract
This chapter describes a Web -based application to store and exchange Electronic Health Records (EHR) and medical images in Ophthalmology: TeleOftalWeb 3.2. The Web -based system has been built on Java Servlet and Java Server Pages (JSP) technologies. Its architecture is a typical three-layered with two databases. The user and authentication information is stored in a relational database: MySQL 5.0. The patient records and fundus images are achieved in an Extensible Markup Language (XML) native database: dbXML 2.0. The application uses XML-based technologies and Health Level Seven/Clinical Document Architecture (HL7/CDA) specifications. The EHR standardization is carried out. The main application object is the universal access to the diabetic patients EHR by physicians wherever they are.
TopIntroduction
Healthcare computing or medical informatics is one of the fastest growing areas of information and communication technology (ICT) application. Electronic records in health fall under the purview of health informatics. It is a combination of computation, computer science and medical record keeping. Recent technological advances have enabled the introduction of a great number of telemedicine applications in healthcare computing (Hung, K, Zhang, Y, 2003). The information systems are a necessary part of the telemedicine services. They provide storage, retrieval, connection and evaluation of the medical information. One of these systems is the Electronic Patient Record (EPR). They store and administrate all the medical data about a patient (Horsch, A, Balbach, T, 1999). An EPR is a fundamental part of health information technology and its use is growing quickly. It is indicative of the advances in medical informatics and facilitates the doctor-patient relationship. It can be organized either on a document-based backbone, or on a structured database system. An EPR transmitted through the Internet is especially important. It contains a private material of medical information for a patient.
In most European countries, the National Health Service (NHS) is investing large amounts in information technology (IT) (Mocanu, M.L, et al., 2004). In this context, the idea of electronic health records (EHR) has been around for a decade or more (Ferreira, A, et al., 2004). The EHR is a secure, real-time, point-of-care and patient-centric information resource for physicians. The EHR must enable the communication of healthcare information to support shared patient care, improved quality of care and effective resource utilisation. EHR may contain data about medical referrals, medical treatments, medications and their application, demographic information and other non-clinical administrative information. Some benefits of the EHR systems are their universal access, coding efficiency and efficacy, easier and quicker navigation through the patient record another (Smith, D, Newell, L.M, 2002). In spite of the advantages of EHR, there are several barriers to their adoption such as training, costs, complexity and lack of a national standard for interoperability (Gans, D, et al., 2006).
Many EHR-related initiatives have been announced in Canada. In May 2006, the government of British Columbia announced spending of $150 million towards the creation of online computerized medical records for doctors (Canadian Institute for Health Information, 2006). EHR-related initiatives are under way and each addresses a specific part of health care, primary, acute and community care. For example, the Ontario Primary Care Network in Canada is a pilot project involving approximately 40 physicians and 300.000 patients. Individual physicians are implementing office systems for the capture of patient information and support office administration. Community care providers are piloting projects to improve the delivery of services to their customers (Office of Health and the Information, 2001).
Nowadays, telemedicine applications often involve many institutions using different systems and technologies. This complicates the necessary technical standardization (Holle, R, Zahlmann, G, 1999). International and national institutions and organizations are concerned with standardization of EHR systems such as ISO Health Informatics Standards Technical Committee (ISO/TC 215), CEN Technical Committee (CEN/TC) 251, openEHR, Health Level 7 (HL7), Integrating the Healthcare Enterprise (IHE), Digital Imaging and Communication in Medicine (DICOM) to name but a few (Bott, O.J, 2004).
ISO/TC 215 has defined the EHR and also produced a technical specification ISO 18308 describing the requirements for EHR Architectures. It provides standardization in the field of information for health. It ensures compatibility of data for comparative statistical purposes and to reduce duplication of effort and redundancies.
Key Terms in this Chapter
Reference Information Model: (RIM): It specifies the grammar of HL7 messages and, specifically, the basic building blocks of the language and their permitted relationships. The RIM is not a model of healthcare, although it is healthcare specific, nor is it a model of any message, although it is used in messages. At first site the RIM is quite simple.
Java Server Pages (JSP): It is a Java technology that allows software developers to dynamically generate HTML, XML or other types of documents in response to a Web client request. The JSP syntax adds additional XML-like tags, called JSP actions, to be used to invoke the functionality. It lets you separate the dynamic part of your pages from the static HTML.
Secure Sockets Layer: (SSL): A protocol developed by Netscape for transmitting private documents via the Internet. SSL uses a cryptographic system that uses two keys to encrypt data, a public key known to everyone and a private or secret key known only to the recipient of the message.
Java Database Connectivity (JDBC): It is an API for the Java programming language that defines how a client may access a database. It provides methods for querying and updating data in a database.
Extensible Style Language Transformation: (XSLT): The language used in XSL style sheets to transform XML documents into other XML documents. An XSL processor reads the XML document and follows the instructions in the XSL style sheet, then it outputs a new XML document or XML-document fragment.
Document Type Definition (DTD): DTD is primarily used for the expression of a schema via a set of declarations that conform to a particular markup syntax and that describe a class, or type, of SGML or XML documents, in terms of constraints on the structure of those documents. A DTD may also declare constructs that are not always required to establish document structure, but that may affect the interpretation of some documents.
HyperText Transport Protocol Secure (HTTPS): It is the protocol for accessing a secure Web server. Using HTTPS in the URL instead of HTTP directs the message to a secure port number rather than the default Web port number of 80.
Portable Document Format (PDF): It is a file format developed by Adobe Systems. PDF captures formatting information from a variety of desktop publishing applications, making it possible to send formatted documents and have them appear on the recipient’s monitor or printer as they were intended. To view a file in PDF format, you need Adobe Reader, a free application distributed by Adobe Systems.
International Standardization Organization (ISO): It is a worldwide federation of national standards bodies. The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technical committee has been established has the right to be represented on that committee. International organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.
Base64: It is a positional notation using a base of 64. It is the largest power-of-two base that can be represented using only printable ASCII characters. This has led to its use as a transfer encoding for e-mail among other things. It uses the characters A–Z, a–z, and 0–9 in that order for the first 62 digits but the symbols chosen for the last two digits vary considerably between different systems.
Java: It is an object-oriented applications programming language developed by Sun Microsystems in the early 1990s. Java applications are typically compiled to bytecode, although compilation to native machine code is also possible. The language itself derives much of its syntax from C and C++ but has a simpler object model and fewer low-level facilities.
Joint Photographic Experts Group (JPEG): JPEG is a lossy compression technique for color images. Although it can reduce files sizes to about 5% of their normal size, some detail is lost in the compression