Doc. dr. sc. Sven Loncaric
Dr. med. Anamarija Margan
Faculty of Electrical Engineering and Computing, University of Zagreb, Croatia
Private practice for Internal Medicine, Cres, Croatia
Providing health care services in rural areas has shown to be a challenging task. Low concentration of population makes health care institutions not self-sustainable so typically only small ambulances with general practitioners are available in rural areas. In such situation, one of the biggest problems is lack of medical specialists.
Significant improvement in providing health care services in mentioned areas can be achieved by use of electronic means of communication. Rapid Internet development in recent years has made possible new medical applications including telemedicine. Telemedicine helps connect rural areas to large medical centers through exchange of medical information between distant locations.
The Virtual Polyclinic, a web-based system provides tools to exchange medical information between general practitioners in rural areas and specialists in large medical centers.
Virtual Polyclinic (VP) is a web-based system that integrates a multimedia teleconsultation and a Internet-based health care record system. VP allows physicians to request and obtain medical consultation from specialist over the WWW, so transport costs can be significantly reduced, furthermore transport could be risky for patient or impossible due to weather conditions. So, we can say that VP provides higher quality health care.
VP system consists of a web server and a database server. Web server provides interface to users who access the system over the web. A database is used to store all information in the system. The system is implemented on Linux platform. Block diagram of the Virtual Polyclinic system architecture can be seen here.
System database can be divided in two main parts. The first part stores teleconsultation data while the second part contains electronic health record data. Teleconsultation data consists of user (physician) record, audit information, teleconsultation requests. Electronic health record data consists of personal information, immunizations, medications, laboratory results (text, images), etc.
User interface for VP modules is based on WWW technology. In this way, user only requires Internet browser to use the system. This approach provides platform independence of the developed system. The system is accessed by opening the initial web page where user authentication is performed.
Teleconsultation module provides users with functionality required to conduct remote teleconsultations. A teleconsultation request contains information about the patient which is located in electronic patient health record and a note from referring physician describing the request.
Electronic health record module provides functionality for maintaining patient records. It enables users to add, edit, and view patient record. For security reasons it is not allowed to edit certain fields in the patient record containing medical information.
Security is a very important aspect in many applications of Internet today such as e-commerce and e-medicine. VP employs many techniques for protecting patient privacy. These techniques include data encryption, user authentication, audit procedures, and database integrity protection. The developed system provides a high level of security.
Authentication is handled via simple login prompt. The security of this phase is ensured using SSL (Secure Socket Layer) encryption. Passwords are not saved on the client (via cookies) to prevent password stealing.
Accountability aspect is handeled in the way that database uses stored procedures to log all the transactions (and all the database access goes via stored procedures).
Database has integrity checks implemented, up to the limitations of SQL. This includes referential integrity checks. SSL protects data integrity in transit (including man-in-the-middle attacks).
As a conclusion we can say that VP system provides means for communication between physicians, thus reduces risk to patient who cannot be transported due to medical problems, or transport is impossible due to weather conditions, or just eliminates need to travel. So,considering all mentioned we can state that VP can significantly improve quality of health care service, and at the same time reduce health care costs.
S. Loncaric and E. Pek and M. Silovic and A. Margan. Virtual Polyclinic: A Web-based system for medical teleconsultation. Proceedings of Emerging Technologies and Life Sciences: Medicine and Communication (MEDICOM), Remagen, Germany, 2000.
S. Loncaric and M. Silovic and E. Pek and A. Margan. A Web-based system for medical teleconsultation: First results. Proceedings of @ITIM: Telemedicine and Health Informatics, Milano, Italy, 2000.