Scholarly article on topic 'Personal Health Service Framework'

Personal Health Service Framework Academic research paper on "Computer and information sciences"

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Abstract of research paper on Computer and information sciences, author of scientific article — Shirin Ghorbani, Weichang Du

Abstract In this paper, the Personal Health Service Framework (PHSF) is proposed which is an open architecture for developing patient-centric health applications and monitoring systems. PHSF uses new advancements of service-oriented architec- ture to provide a baseline for developing health-related systems. PHSF services are used to make self-monitoring and remote monitoring possible, and to link healthcare providers and patients. PHSF is implemented as a combination of web services provided in 7 components in 4 layers. A heart monitoring application built on PHSF is described in this paper.

Academic research paper on topic "Personal Health Service Framework"

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Computer Science

Procedia Computer Science 21 (2013) 343 - 350

The 3rd International Conference on Current and Future Trends of Information and Communication Technologies in Healthcare (ICTH-2013)

Personal Health Service Framework

Shirin Ghorbani*, Weichang Du

Faculty of Computer Science, University of New Brunswick, Frederiction NB, Canada

Abstract

In this paper, the Personal Health Service Framework (PHSF) is proposed which is an open architecture for developing patient-centric health applications and monitoring systems. PHSF uses new advancements of service-oriented architecture to provide a baseline for developing health-related systems. PHSF services are used to make self-monitoring and remote monitoring possible, and to link healthcare providers and patients. PHSF is implemented as a combination of web services provided in 7 components in 4 layers. A heart monitoring application built on PHSF is described in this paper.

© 2013 TheAuthors. Published by Elsevier B.V.

Selection andpeer-reviewunder responsibility of Elhadi M. Shakshuki

Keywords: E-health, Health monitoring, SOA, Web service

1. Introduction

Health is one of the most important concerns in people's lives. Computer science, networking and electrical engineering have changed the delivery of healthcare services through the concept of e-health. E-health is a promising field for improving healthcare quality by offering early symptom detection, early diagnosis, prevention, emergency case survival and offering health monitoring either by patients themselves or healthcare providers [1][2][3].

One of the achievements of e-health is the use of electronic health measurement devices. Recently there has been increasing interest in wearable health monitoring devices which can measure a variety of physiological parameters. These devices may be designed to show test results to the patient, store data or have the capability to transmit data to health applications that reside on the patient's smartphone, PC or PDA. These devices also may transmit it to a remote health server or portals for future analysis and reports.

In real life situation, when patients are away from hospital, they may not be able to measure their health signs as much as they should. Health measurement devices are expected to play a role in alleviating this problem. Measurement devices can be used in e-health systems to gather health data and store it. The stored data can be analyzed and used to diagnose, advise treatment and find risky situations later or in real time.

* Corresponding author

Email addresses: shirin.ghorbani@unb.ca (Shirin Ghorbani ), wdu@unb.ca (Weichang Du)

1877-0509 © 2013 The Authors. Published by Elsevier B.V. Selection and peer-review under responsibility of Elhadi M. Shakshuki doi: 10.1016/j.procs.2013.09.045

Using health measurement devices to measure health conditions, many health systems including Personal Health Monitoring (PHM) and Remote Health Monitoring Systems, have been developed.

Using PHM, both patients and their relatives can measure and keep track of physiological signs and compare them with historical data so that they can control their health issues themselves [4][5]. Although personal health monitoring is a good start in e-health, the need for a patient to be monitored by specialists has spawned the idea of remote monitoring, in which health data is retrieved from devices and transmitted to the providers' servers. Remote monitoring would enable physicians to monitor their patients in real time and provide a better diagnosis through accessing health data and patients' current condition [6][7] [8].

Examining existing e-health systems, their subsystems guided us to find the potential for using service-oriented architecture to ensure a flexible component-based framework to build e-health systems. Thanks to improvements in technology, some e-health monitoring systems have been designed to monitor health conditions which contain three major subsystems in common as follow[9][10][11]. Patient subsystem may include a variety of sensors to measure physiological data, one or more devices for collecting and transmitting data, etc. Infrastructure subsystem stores patient demographics, clinical data, and information that monitoring system generates. Provider subsystem contains either mobile providers such as an ambulance or immobile providers such as hospitals [12].

Although there have been many improvements in e-health technology to date, there are some limitations associated with the existing e-health systems as follow. Existing health systems are not flexible and offer predefined functionalities, and they do not have the ability to change or expand. and they only offer an end to end infrastructure. Most of the existing health systems are closed-systems that provide independent standalone solutions which do not integrate easily with other healthcare providers [13][2][14]. The communication between physicians and patients is limited [13][15].

Since the healthcare field and its demands are changing so quickly, a distributed e-healthcare system that is offered as a combination of web services provides flexibility to change or expand over time. Using service-oriented architecture, providers can offer different services, and users can choose them based on the functionality they need at that time. In this regard, we propose a framework that can be used to build health related systems that can work with heterogeneous health devices and different health providers by using achievements service-oriented architecture. Capabilities of SOA, coupled with a lack of standards for developing e-health systems, motivate us to provide a framework for mobile healthcare which offers a way to build more pervasive component-based health systems. Such an e-health framework forms a concrete connection between healthcare providers and patients in a more practical way that is not limited to specific providers.

The rest of the paper is organized as follows. In section 2 the overview of the proposed framework is presented. Section 3 presents the detail of the PHSF components and services in more details. Section 4 provides the case study that is implemented on the PHSF and section 5 provides the summary and future work.

2. PHSF Design

PHSF is an open architecture and is used to integrate health-related services for building health systems. Different e-health systems and web applications for delivering worthwhile health care services can be built upon this framework by using the provided services. Services in this framework are grouped together in different components based on the nature of work they fulfill. Services in each component have similar functionalities and closely followed goals. Each of these services in these components has a specific task that contributes to the overall system. The PHSF is presented in 4 layers. Figure 1 depicts the detailed view of the PHSF layers, their services and the relation between services in different layers. There are four layers in this framework as follow.

1. The first layer includes front-end services that are used by end users, which can be either external web services or applications. The PHSF provides support for both providers (include physicians, nurses, and other healthcare professionals) as well as patients' parties and both of them together.

2. The second layer includes intermediate services which are doing some tasks for the front-end services.

3. The third layer is the data access layer, which includes services to access the databases. Services in this layer are used to prevent other services from accessing the database directly. This layer contains 5 parts. Four of them are used to access each database, and services in the cross DB access are used when data should be shared between these databases.

4. The forth layer is the database itself which contains 4 databases as follow. Health record database which contains health data, patients' information, reminder logs and instructions by the providers. Device database which contains the information about the registered health measurement devices. Provider database which contains information about healthcare providers and their statuses. Security database which contains information about both patients' and providers' security and privacy.

PHSF has implemented using Java programming language, J2EE platform and Spring framework. MySql is the selected database for this project.

Fig. 1. PHSF Layers

3. PHSF Components and Services

In previous section PHSF was presented in a layered-based architecture. Viewed from another perspective PHSF consists of 7 components that are integrated as an intermediary component, and together cover functionalities that are needed for building health monitoring systems. Figure 2 depicts PHSF components ans their services. Following sections describe the provided components in the PHSF and their services.

• Device Client Services: This component includes services for managing, manipulating and communicating, with health measurement devices. All services that are related to measurement devices would be placed in this component include:

Device Adjustment Service which is aimed to calibrate a device when the data obtained from the measurement device is not correct.

Device Reporting Services which are services for providing reports on devices.

Monitor Scheduling Service for stop and start monitoring. For start monitoring it schedules the monitoring event to be repeated in the mentioned interval. After parsing the request and finding the state of all the desired devices, it will activate them and gather data from them based on the duration and attributes mentioned in the requests.

Fig. 2. PHSF Components

Patient Application Services: This component contains services that are responsible for communicating with and providing services for patients including:

Risk Analysis Service which determines whether the patient's situation is risky or not from the health records based on the schema rules and risk boundaries, that have been defined previously, for a specific health attribute, either by patients or providers.

Emergency Call Service which is used to call nearest providers to patient's location in emergency situations.

Reminder Service which is used to remind some tasks to a patient. Patient Reporting Service which is used to provide report on patients.

Provider Client Services: This component contains all services responsible for managing providers including saving, retrieving and manipulating basic information about providers include:

Provider Reporting Services which are used for making reports on providers.

Find Closest Provider which is responsible for finding the closest provider to the current position of a patient.

Provider Application Services: This component contains services to serve providers' requests through the access to the information storage and retrieval services include:

Save HL7 Record Service which is used to save a health record that has HL7 format.

Retrieve HL7 Record Service which is used to retrieve a health record in the HL7 format which is understandable for the healthcare providers.

• Information Storage and Retrieval: Information storage and retrieval component, which is also called data access layer, contains services for accessing the databases in order to prevent services of other components to have a direct access to the database. This component is used as a strong backup for all the information in the system and adds a precious amount of robustness to the whole system.

Save/Retrieve Health Records Service is used to save/retrieve health records.

Save/Retrieve Patient Service is used to register/retrieve patients.

Save/Retrieve Schema Rule Service is used to add/retrieve bounding rules for an attribute. Such a rule is being used later to find risky situations.

Save/Retrieve Instruction Service is used to add/retrieve advices for a patient by a provider. Save/Retrieve Provider Service is used to save/retrieve providers.

Save/Retrieve Device Service which is used to register/retrieve devices in/from the database.

Save/Retrieve Activity Service which is aimed to save/retrieve activity logs for a patient.

Assign/Revoke Device Services which is used for assigning/revoking a measurement device to/from a patient.

• Data Transformation Services: Since the format of health data exchange is HL7, there is a need to have services for transforming health data from what is retrieved from the information storage and retrieval component to the HL7 format and vice versa. These transforming services are used to make the health data understandable for providers. This layer integrates the information storage and retrieval services and providers, and makes the communication between them possible include.

Transform HL7 to PHR Service which is used to transform a health record from the HL7 format to the PHR format, so the data can be stored in the information storage and retrieval.

Transform PHR to HL7 Service which is used to transform a health record from the PHR format, to the HL7 format, so the data can be understandable for healthcare providers.

• Privacy and Security Services: This component contains services to make sure that personal health information can only be accessed by the proper and authorized patients and providers.

Authentication Service checks the user credentials to determine if this is a valid user or not.

Authorization Service which checks if the user is authorized to consume a service or not.

Authorize Provider Service which is used by a patient to authorize a provider.

• Patient Device Interfaces: This component contains interfaces that are expected to be implemented on devices that want to work in PHSF include:

Activate/Deactivate device interface which activates/deactivate a health measurement device.

Gather data interface which is an interface for a service on the health measurement device that is responsible to gather health attributes' value from a device.

Calibration interface which is an interface for a service that calibrates a device.

Status interface which returns the status of the measurement device whether it is active or not.

Alarm interface which is used to send a notification to patients.

• Provider Device Interfaces: This component contains interfaces for services that reside on providers' devices. The interface for the provider call service is one of these services which is used to call a provider in case of emergency.

In the PHSF some services do not operate without the existence of other services. Figure 3 shows the dependency diagram for the PHSF. In other words this diagram shows the order in which services should be called in order to have a complete performance of the PHSF.

Fig. 3. PHSF Service Dependency Diagram

4. Application Example

Using the proposed framework various personal health-related applications can be built. In this paper we present, a heart monitoring application that has been implemented as a case study based on what is described in [16]. This monitoring system continuously monitors the heart condition of the patient with cardiac disease through the use of smart phones and a wireless ECG sensor. This application is expanded in this case study. Figure 4 shows the requirements for a heart monitoring application in a use case diagram.

Fig. 4. Use ase Diagram, Mobile Heart Monitoring System

This application is considered to be a self-monitoring application through which patients can monitor themselves at regular intervals. Patients also can authorize providers to access their health data and allow them to set monitoring sessions, reminders and provide instructions that patients can follow later. Both

providers and patients need to pass the authentication for login and providers should be authorized before doing any task. The smart phone application analyzes sensor data in real time and automatically alert the ambulance and preassigned caregivers when a heart patient is in danger. Also the location of the person should be reported automatically so that ambulance services can be directed to the patient. Each monitoring request sets a timer and at each timer tick, a request will be sent to the measurement device to read the health data. Figure 5 shows activity diagrams for monitoring scheduling that is done by a provider. The left side figure contains a black box for gathering data which means that in each timer tick another sequence of action for gathering data (the right side figure) is going to be repeated.

Fig. 5. Activity Diagram, Gathering Data

Figure 6 shows examples of the implemented heart monitoring application. The figure on the right, is where a monitoring session for a patient can be stopped or started, by specifying a device and the health attribute, as well as the duration and intervals that the health data should be measured in. Once the save button is pressed, a monitoring session would be started. In each monitoring session a timer is set and when the timer ticks a request would be sent to the patient's health device to gather the health attribute value.

Heart Mouitoriiig

Start a Monitoring Session for Shirin Ghorbani

Device ECG 0

Sun Dite 2013-01-01

End Date 2013-02-01

Interval 20 Missises

Home Schema Moffllomij

Senior V'V:>:r TaBrinp

Personal Health Monitor

Measurement Notice!

Please measure following heallh metrics and enter them in »he assigned boxes.

Blood PressurefHigh) 12.0 Blood Pressure(Low) 3,0 Pulse per minute 30

Remind Me,,. C(ear Save

Personal Health Monitor

Emergency Situation

The nrioriitc'ing system iden^tifitd a emergency situation because of ■he Following

High Blood Pressure

Call Emergency (Calling in & Sec.) Cancel

Fig. 6. Mobile Heart Monitoring Application

An android device is used as a measurement device to insert health attributes, as shown in the middle in figure 6. If the health value is labeled as high risk, an alarm message will be sent to the physician. Also, a message like what is shown in the right in figure 6 will appear to the patient indicating the situation is

risky and asking the patient to discard the message if he feels healthy. Otherwise the application retrieves the patient's location and finds the closest emergency station and calls that station to help the patient.

5. Concluding Remarks

In this research, a framework for e-health systems is proposed that utilizes the advantages of using service-oriented architecture in the field of e-health. This framework would offer a high flexibility and extensibility which are required for the field of healthcare. Since the framework is designed in SOA, systems that are built upon the framework can be altered easily without downtime. This ease of change would fit the healthcare system perfectly since its demands change quickly.

PHSF covers some of the problem that are associated with existing e-health systems such as the fol-lowings. Some existing health systems concentrate on special diseases and are not open systems for all patients. Using the PHSF new functionalities can be added to the systems, because every functionality of framework is provided as services. Existing health systems are ad-hoc and limited to a specific healthcare provider. Using those systems, the physicians in different institutions can not communicate with each other, but communication between different institutions is possible using the PHSF.

For future work many functionalities can be added to this framework as a service, such as safety services that are responsible to make sure that any instructions from health care providers do not cause safety problems for their patients, which prevents medical error that often leads to adverse healthcare events. Also the PHSF can be offered on the cloud to let the systems that are built upon this framework provide on-demand health services 24/7 to many users all over the world.

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