The Application of Mobile Telehealth System to Facilitate Patient Information Presentation and Case Discussion

April 27, 2020 Editor

Introduction

In December 2019, a human coronavirus infection, which was named 2019 novel coronavirus (COVID-19), emerged in China, Japan, South Korea, and the United States.¹ Both in hospital and in family settings, infected patients were reported.^2,3 The World Health Organization (WHO) has recently declared the coronavirus disease 2019 (COVID-19) a public health emergency—a pandemic. A total of 81,109 laboratory-confirmed cases have been documented globally up to February 25, 2020.⁴ Most secondary transmission of COVID-19 occurred in a hospital setting, where 3,019 cases have been diagnosed among medical workers up to February 11, 2020. Moreover, it appears that considerable transmission is occurring among close contacts. All hospitals in China are directed to take appropriate measures to respond to the COVID-19 epidemic.⁵

Our hospital, the First Affiliated Hospital of Zhengzhou University, has built eight designated wards to isolate and care for suspected infectious cases and confirmed cases. Three groups of medical workers entered the isolated wards in shifts. One problem encountered was that patient information was stored in the hospital intranet, which was only available to the staff in hospital. In order to issue a case discussion to cut-off contacts between professionals from the isolated area and the un-isolated area, the development of a mobile telehealth system (MTS) was a must.

Telehealth systems have been booming for several decades, and recent developments in mobile technology allow health care professionals in multiple locations to share information.⁶ With the dramatical increase of home telehealth programs, especially over the past decades, the number of home telehealth peer-reviewed publications demonstrates positive outcomes.^7–9 To avoid increase in demand for primary care office visits and spread of desease, telehealth offered a solution to rapidly respond to changes in treatment options during the outbreak response.¹⁰ Mobile health increases access to health care and health-related information (particularly for hard-to-reach populations), and expands access to ongoing medical education and training for health workers.^11,12

The aim of this article is to propose an MTS. When building the system, it provides the presenting of patient information, and includes case discussion among clinicians using mobile phone, without harming medical information security.

Materials and Methods

Data Collection

A hospital information integration platform was set up in 2019 to centralize data. The platform was divided into four parts:

1.	Clinical integrated data repository (IDR): Not only does the IDR integrate hospital business data (like outpatient and inpatient data), but it also includes operational data of hospital.¹³
2.	Enterprise service bus (ESB): We built an ESB to facilitate communication between mutually interacting software applications, which are independently deployed, running, and heterogeneous.¹⁴
3.	Hospital outreach system: To separate the internal and external systems in hospital, the hospital outreach system is responsible for information interaction, and acts as an interface adapter.
4.	All these components adhere to medical information security standards and data standardization.

The needed patient information can be obtained from the platform effectively by mobile phones. We precisely define the interfaces to the platform, and group the data into two categories: (1) inpatient data and outpatient data and (2) 22 interfaces in total. Inpatient data include medical advice, inpatient medical record, laboratory test result, radiology reports and images, and so on. Outpatient data incorporate patient demographics, outpatient medical record, prescription, outpatient radiology reports, outpatient laboratory test result, outpatient radiology reports and image, etc. Figure 1 highlights the architecture of the platform.

Fig. 1. Architecture of hospital information integration platform. IDR integrates hospital data. The platfom makes the integrated data available through hospital outreach system, MTS gets patient information from the hospital outreach system. IDR, integrated data repository; MTS, mobile telehealth system.

Data Presentation

The MTS provides the first-line antiepidemic medical staff members with a concise interface and keeps track of patient information.

We integrated the patient data on the mobile terminal (Fig. 2), so that medical staff members are free to consult patient information, conduct case discussion, and mobile ward round at any time by their mobile phones. At present, there are modules such as medical record module, condition abstract module, medical advice module, laboratory test module, radiology images module, and real-time interaction modul. (Fig. 2).

Fig. 2. The app interface of MTS. It includes medical record, medical advice, laboratory test, radiology images, etc. MTS, mobile telehealth system.

1.
Medical record module: We can look up medical record, progress note of patients from the module (Fig. 3).

2.
Condition abstract module: We have access to complaint, initial diagnosis, present history, diagnosis evidence, differential diagnosis, radiology report, laboratory test outlier, and so on (Fig. 4).

3.
Medical advice module: This module involves diagnosis and treatment for medical condition (Fig. 5).

4.
Laboratory test module: Laboratory test outlier is presented in warning color when consulting the laboratory test result (Fig. 6).

5.
Radiology images module: According to DICOM standard, the module has functions of DICOM original/compressed image retrieval and DICOM image processing. It also has ultrasound, endoscopy, and pathologic JPEG image display function; and quick navigation to check/sequence through thumbnail, double click the thumbnail to load the check/sequence function (Fig. 7).

Fig. 3. The medical record interface. This medical record, as shown in this figure, includes first progress note, admission note, etc.

Fig. 4. The condition abstract module. This module includes a basic description of patient.

Fig. 5. The medical advice module. As shown in this figure, this module involves lists of different categories of medical advice.

Fig. 6. The laboratory test module. This figure shows the laboratory test results ordered by time, and MTS also supports displaying results by test items. MTS, mobile telehealth system.

Fig. 7. The radiology images module. On the left is a sample of CT image, whereas on the right it involves lists of different tests. CT, computed tomography; US, ultrasound.

Case Discussion

In the MTS, we adopt cross-platform interaction with screen technology, which contains two modules: (1) request/response module and (2) real-time interaction module, so that medical personnel can conduct interactive mobile case discussion with screen at different terminals.

The requester is created and the request form is submitted (Fig. 8). The responder receives the request, responds immediately, and begins case discussion. At the end of the discussion, participants can write down their opinions on the discussion, and they can also consult historical opinions. The requester may choose to authorize the sharing of patient data.

Fig. 8. Filling a request form. Before issuing a request, the requester fills a request form. It adds a responder, and authorizes the sharing of medical record.

Real-time interaction module

Under the premise of sharing patient data, the medical professionals participating in the discussion have access to video synchronous display, medical records, inspection, etc. Medical image synchronization and image processing labeling can be processed in the same screen (Fig. 9).

Fig. 9. A screenshot of real-time interaction. During case discussion, medical record, radiology images, laboratory test, and medical advice were shared between requester and responder. Although the responder was marking an area with red circle, the action was synchronized to the requester.

Security Measures

We took a variety of security measures to ensure the safe transmission of data.

From the perspective of network security, an independent gateway server is set up, which adopts dual ethernet cards to connect hospital intranet and internet, respectively. The mobile phone sends a data access request and the gateway server obtains data from the hospital information integration platform through the hospital intranet, and then sends the data to the mobile terminal. Figure 10 shows the network architecture of MTS.

Fig. 10. Network architecture. The gateway server connects the hospital intranet and internet. Network traffic is filtered by firewalls. MTS, mobile telehealth system.

In terms of data security, when obtaining data from the hospital information integration platform, the password of the data request account must be secured, and the user can only access the patient information within the scope of authorization. Patient information is only cached in mobile phone, and the cached information is cleared automatically after exiting the application. Key identification data, such as the patient’s name, are desensitized. There is a watermark for operating medical staff. When you take a screenshot on the phone, a warning message will be sent (Fig. 11).

Fig. 11. At left, there is a watermark of our hospital while browsing medical record; at right, on taking a screenshot, MTS generates pop-up warning statement. MTS, mobile telehealth system.

In consideration of user security, we chose MTS adopts single sign-on as our login mode. When medical personnel login at the other terminal, the system will automatically logout the original online terminal. In user security, MTS allows one device online at a time for each user. Only users who have been authenticated by short message service (SMS) have the right to login. Users need to be authenticated by SMS again when they change login terminal so as to prevent theft login.

Results

In this project, eight wards were involved and there were 65 registered professionals. The MTS had permanent support from two engineers. The system, presenting patient information and supporting case discussion, costs 2 months.

MTS was officially launched for 37 days, and it has been used 3,061 times. As the current COVID-19 event is under control, the use frequency of MTS, together with frequency per user, shows a downward trend, shown in Figure 12. However, compared with frequency, frequency per user per day is still relatively high.

Fig. 12. The frequency of MTS used per day, after MTS was launched. MTS, mobile telehealth system.

Discussion

Telehealth has reported as a useful tool to improve health care outcomes.^15,16 During infectious disease outbreaks, telehealth can provide rapidly accessible information through technology. Telehealth can also assist with disease diagnosis through video consultations with health professionals.¹⁷ This article presents an MTS to present patient information and support case discussion.

MTS makes patient information, which has been integrated in hospital information integration platform, available on mobile phone. To provide sufficient and effective medical information about patients, MTS uses five modules to display patient information.

The system includes two modules to support case discussion. Through the request/response module, a requester could form a request to a designated responder, and choose whether to share patient information with the responder. Although a case discussion was initiated, real-time interaction module assists with disease diagnosis through video consultations, and the marked area will be synchronized to the other side.

Besides, we take measures in three areas to ensure patient information security: (1) network security, (2) data security, and (3) user security.

On the contrary, one of the MTS challenges is concurrent access. In this project, the number of registered health care professionals is low, MTS only allows one-to-one case discussion. When nonisolated wards are involved, we will develop multiple case discussion. For this reason, the next step is to increase the capacity for high concurrency.

There already are several telehealth systems for daily use,^6,17 but they lack mobility. Our study has shown the potential of using mobile collaboration technology to develop an MTS to facilitate health care professionals and decrease person-to-person contact.

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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