WO2003005237A1

WO2003005237A1 - Integrated service system

Info

Publication number: WO2003005237A1
Application number: PCT/FR2002/002131
Authority: WO
Inventors: René Ebel; Marion Bollard; Pierre Thorel; Philippe Chossegros; Albert Fhima
Original assignee: France Telecom
Priority date: 2001-06-22
Filing date: 2002-06-20
Publication date: 2003-01-16
Also published as: FR2826476A1

Abstract

The invention concerns an integrated service system comprising: a platform section including secure access means to various hosted professional applicative services; a directory service including hierarchical means for managing user accounts; a so-called messaging service, including means for contact management, multimedia interpersonal communication, written discussion, oral and video discussion and presence notification; voice services, at least a communication terminal enabling access to dedicated services on Internet from public places; messaging tools. The invention is characterised in that said system further comprises: installed on the first platform, a second service integrated and secure Intranet/Extranet/Internet platform, adapted to health professionals and sick people, said second platform being designed to provide the user direct access to any useful information; means for accessing medical data files via Internet and/or via a file management software; means for displaying and updating said file by a client; an applicative XML file server equipped with means for storage of and secure access to said files from different terminals. The invention is applicable to health service networks.

Description

INTEGRATED SERVICE SYSTEM

The present invention relates to an integrated system of services, more specifically dedicated to health professionals operating in the medical and social fields, and intended to facilitate the practice of network health. In this context, the term network corresponds to a set of natural persons, including patients and populations, and institutions needing to communicate with each other, and to share information.

This integrated service system, also known as a “bouquet”, is based on telephony and IT products and services providing complementary and modular functionality.

The invention is in the field of information sharing, cooperative work and services for professional communities.

Network health practice is emerging in many countries, particularly in France, and important obstacles such as payment models, liability and security problems remain. However, various experiments carried out as well as a certain number of existing networks in the field for more than ten years allow decision-making bodies to identify the benefits of such practices in terms of health, health economy, and equal access to care.

However, no integrated device or system exists to meet the needs of health professionals in network practice, even if some more or less formal networks already use isolated tools such as forums, electronic messaging, or voice servers. The major drawback of these known service systems is the disparate and inconsistent use of heterogeneous tools. In addition, no system currently makes it possible to share medico-social data between health professionals and patients. Information sharing must be consistent, balanced by networked practice, and organized.

The present invention consists in federating and integrating services based on industrial products, prototypes resulting from developments of telecommunications operators, including inter alia software capable of storing and organizing medico-social data that can be shared between different professionals of health and patients, and work resulting from collaboration between telecommunications operators and associations formed to defend and promote the concept of local medico-social health networks in the health system.

An object of the invention consists of the integration of tools and services on a platform combined with appropriate connection and telecommunication means, with the aim of constituting an offer which can be used and marketed to healthcare professionals, as well as with all those involved in a patient's health journey or target population, as part of network health practice. The complete integration of the services and tools necessary for network health practice covers all and the completeness of the needs updated by the practice. Thus, no member of the network is excluded by the technique.

To this end, the invention proposes an integrated system of services, comprising:

- a first platform comprising secure means of access to various hosted application services,

- a directory service comprising means for hierarchical management of user accounts,

- a service, called "messenger", comprising means for managing contacts, multimedia interpersonal communication, written discussion, voice and video discussion and presence notification, - voice services,

- at least one communication terminal allowing access to dedicated services on the Internet from public places,

- messaging tools, remarkable in that said system further comprises: - installed on the first platform, a second integrated, secure Intranet / Extranet / Internet services platform, suitable for healthcare professionals and the sick , said second platform being able to provide the user with direct access to any useful information, - means of access to medical data files by the Internet and / or by file management software,

means of viewing and updating said file by a client,

- an "XFS" application server provided with storage means and means of secure access to said files from different terminals.

The result obtained is therefore a bundle of integrated services. One of the tools used is the XFS service which will be described in detail later. Some established networks already have a database concerning sick people and treatments. The tool, object of the invention, will have to integrate these bases for a service with high added value.

The integration of services, in the form of products and / or prototypes is done on an "Intranet / Extranet / Intemet" architecture. This means that, depending on their profile, their prior registration with the health networks, the rights that may be given to them by other health professionals or the patient, their situation (mobility, office, ...) and their equipment (management software cabinet, Internet browser, minitel, telephone, ...), healthcare professionals and institutions will be able to:

-Access to information and intelligence tools, -Use communication tools,

-Use decision support tools,

-Form,

-Share medical and social data. These five families of services and tools are installed on an integrated, secure Intranet / Extranet / Internet platform, adapted to the user and his profession. Security, personalization, grouped and integrated functionalities are the essential characteristics of this useful and simplified tool for accessing information and functionalities from a dedicated Intranet communicating externally using an Extranet logic.

The description which follows with reference to the appended drawings, given by way of nonlimiting examples, will make it clear what the invention consists of and how it can be implemented.

Figure 1 is a general diagram of the integrated service system according to the invention.

Figure 2 is a diagram illustrating the exchanges between the server of Figure 1 with a client station.

Figure 3 shows various client workstations according to their pathology.

FIG. 4 is a diagram of the evolution of the tree structure over time in a server of the prior art.

FIG. 5 is a filtering diagram as a function of access rights in a server of the prior art.

The main objectives of a health network are to facilitate access to care for users, and to help health professionals in their mission of care and prevention.

The specifications are as follows:

Information relating to pathologies

Access to this type of function is done for the purpose of informing the patient about a pathology.

It allows the patient to find information relating to a pathology, its consequences and the means to be implemented to improve his situation, this for educational purposes. The consultation thus becomes more optimum, effective and efficient by the trivialization of medical language. It also makes it possible to obtain indications of contacts in order to enter into a better understood and therefore better lived care approach. The information that the patient seeks can be of three types:

- what is my pathology? (meets the need for therapeutic education) - what are the associated risks? (meets the need for a posteriori prevention)

- how to avoid it or reduce the risk? (meets the need for prevention a priori)

These three items can be composed: - of content, - links to addresses and telephone numbers of organizations, and / or links to privileged contacts in these organizations with indication of contact details for direct contacts. This last possibility can be reserved for network members. It allows the doctor to have access to medical information which is outside their field of competence and whose research follows the request of a patient.

The constraint for the professional is to obtain the information instantly in consultation. This item can be composed:

- content,

- the possibility of accessing addresses of network members who have a qualification in relation to their request (second level).

There can be two levels of access to information: visitors and network members.

Daily decision support

This function corresponds to the need for decision support for professionals in their main role. The access to this function is made by the professional, in an individual approach or in a collective approach.

These tools would allow different professionals to access information that will help them in the exercise of their profession.

The constraint for the professional is the instantaneity of the response to give therefore information to receive.

- For doctors, this help relates to diagnosis and therapy, with information on pathologies, on drugs, on the types of exams and treatments to be prescribed.

Certain examinations are only prescribed with certain rights, the constraint associated here is knowledge relating to the patient's rights so that the professional can give him an answer if necessary adapted to his rights.

- For pharmacists, this aid relates to the delivery of drugs and dosages. The constraint associated here is knowledge relating to the rights of the patient.

- for the social worker and associations, this aid relates to resocialisation, and therefore to all information relating to social law, civil law and criminal law. The tool also allows different professionals to access experts who will help them in the exercise of their profession, on elements that they cannot find by the previous means.

The constraint for the professional is the instantaneity of the response to be given and therefore of the response to be received. The principle is to identify members of the network qualified as experts on this or that subject, with the constraint of being able to join them immediately.

The constraint is that this means that the members of the network qualify as an expert in a particular area and that they are ready to play the card of the instantaneity of the response (which it is necessary to define).

The tool also allows different professionals to chat with other members of the network. The response response time can be done in the medium term.

The constraint is the minimum collective mobilization, necessary for this to work:

- discussion groups between professionals in the same sector,

- discussion groups between different professionals.

These discussions may relate to particular themes or to the exercise of their daily activity. These thematic meetings can be organized by members of the network or by the network itself.

There can be two levels of access to information: visitors and network members.

Professional training

The purpose of this function is to allow professionals who are members of the network to keep abreast of existing training relating to the network's theme or relating to their professional practice. The types of training material can be physical, paper, or Internet. This item can:

- deliver information in its content

- provide access to links on existing sites. It can be open to everyone.

Finding information about a person's journey

This function allows any professional member of the network to access information relating to a patient member who enters or who is in the network. Access to this information is not systematic and does not necessarily concern all health professionals. The constraints identified are:

- in the existing, multiple media and in particular paper currently containing this information,

- all the information cannot be accessible to all members of the network, - need to define the people who have access to this information.

The type of information required to consult is different depending on the profiles of the different players. For that, it is necessary to work with the actors of the network to make them express the items that they need to consult and those that they would be ready to make available. For the doctor: The information he needs to exercise his profession is a priori the following:

- civil status

- family situation - professional situation

- state of his rights vis-à-vis social security

- social habits and practices

- for the medical: medical history, allergy, examinations and laboratory results, state of prescriptions and appointment made, - medical and historical background

For the patient:

- The information he might need is:

- the state of his prescriptions with indication of the necessary renewal dates - the calendar of his medical course

For social workers:

- civil status

- family situation

- professional situation - state of his rights with regard to social security

- social habits and practices

- course

- capacity for professional and social integration For pharmacists: - state of their rights vis-à-vis social security

- allergies

- prescriptions

For nurses and physiotherapists:

- medical history - marital status

- family situation

- professional situation

- state of his rights vis-à-vis social security Provision of information on the medico-social situation of a patient

The information consulted, previously described, must be entered and made available by one or more members of the network. It is the person entering who will make this information available. For the doctor in charge of the network, he has most of the information to consult, except that relating to the patient's journey that he does not have systematically (during hospitalizations ....; see below, "together network professionals ”). The referring doctor will make available some of the information he has in his possession, seized at his office, to certain members of the network (defined above).

Constraints: - determine the information that can be viewed,

- identify the persons to whom this information will be open,

- identify the information to be made available according to the type of profile,

- avoid the multiplication of seizures of this information on different media.

For all professionals in the network, this function relates to letters and / or events (hospitalization, nursing home) relating to the patient, which could retrace the patient's journey or history. It concerns the provision of these letters with the aim of saving time, systematizing follow-ups and making it easier to find a patient's journey. It can be done in two ways:

* Or by making the couriers available. They are grouped in one place and concern all the mail relating to this patient and intended for all the members of the network according to their Constraints profile:

- seizure of mail on the post of the health professional,

- hosting of mail on the post of the health professional, in a joint mailbox, or both,

- access to different mail according to the profiles, - definition of the type of access according to the profile (for example the recipient will have access to the contents of the mail, while the others will have access only to the label or title of the mail),

- define the type of mail: content and / or only labels (name and profession of the editor, date of writing, recipient, subject). * Either by making mail available to a single recipient, but quickly and securely.

Exchange of patient information

This function follows on from the previous one. It differs from it by the fact that the mail arrives at a recipient and that this recipient has access to the contents of the mail (which is not necessarily the case in what is described in the previous paragraph).

Mail provision for the entire network

Once the mail has been written, send a message to the recipient of the mail notifying him that he has received mail on the common server.

Or send mail: one to the recipient and one to the common mailbox.

Alternative: providing mail to a single recipient, but quickly and securely Knowledge of the different actors involved in the network

This function corresponds to the need of the various professionals in the network to fulfill their relay function.

The purpose of this function is to allow different health professionals to identify and indicate the professional or organization that can respond to the request made by a patient. It can also respond to the continuity of care when the competence of the professional lies outside its field of competence.

Medical request (contacts: health centers, hospitals, private doctors, pharmacies, paramedics):

- for processing questions

- for questions of pathologies

- for diagnostic questions

- for questions of substitutions Socio-educational request (contacts: associations, social workers, institutions):

- for prevention

- for education

- for professional integration - for housing

- for administrative and institutional assistance.

The level of information can be different depending on network members and visitors. The needs identified are grouped into 5 families, making it possible to identify the necessary tools and services, based on the judicious integration of computer and telephone technologies:

- information and intelligence tools: Web servers, communication terminals, search engines, indexing and annotation tools, hierarchical directory, voice server, telephone call center

- communication tools: secure messaging server, three-way conversation, telephone meeting, flash meeting, conference call, Top Message, red list, different ringtones, rerouting to voice mail, caller identification, remote secretary, forum server , "cat", address book

- decision support tools: practical sheets, information pages

- training tools: practical sheets, newsletters - a service for sharing medico-social data: XFS server, Internet browser, profile manager, doctor's office software The integrated service system according to the invention includes:

- a first platform allowing secure access to various hosted business application services, - a second service platform installed on the first platform, an integrated, secure Intranet / Extranet / Internet platform, suitable for healthcare professionals and sick people; such a portal aims to provide the user, at a glance, direct access to all the information they need,

- a shared file (medical file) integrating the medico-social data It structures these data in semi-quantitative form according to, on the one hand, the time and the interventions of the professionals, and, on the other hand, the social situation and pathologies. It can be viewed and updated either by a thin client directly accessible via the Internet or by a thick client integrated with medical file management software,

- an "XFS" application server storing medico-social files and allowing their secure access from different terminals, - an "LDAP" directory service allowing "hierarchical" management of the user accounts of the coordinating body, for example , and different member networks,

- a "Messenger" service, available for all IAP (Internet Access Provider) in PSTN (Switched Telephone Network) and ADSL (Asymmetry Digital Subscriber One), allowing contact management, interpersonal multimedia communication, written discussion (text, whiteboard sharing, file transfer), voice and video chat, and presence notification; - commercial telecommunications products in the voice sector, such as call filtering on mobile phones and the voice server;

- a communication terminal allowing access to dedicated services on the Internet from public places, and very useful for institutions and patient associations;

- commonly used messaging, chat and forum tools. Such a system allows for example to a general practitioner on the move to connect to the intranet of his health network from his laptop or other mobile terminal with the following characteristics: - Security: After he has inserted his card of a health professional in the reader, then typed his secret code, the Web server of his health network sends him his personalized home page.

- Personalization: Information of the day on themes that he himself has selected, product / drug sheets, calendar, directory, easily accessible.

- Cooperative work: In the "to do" section, he finds requests for opinions from his colleagues working in the same network if it concerns common patients, or other networks for cases made anonymous. The integrated IP videoconferencing tool allows you to reach other network participants in a user-friendly way. - Communication / Exchange: Electronic messaging forums and "chat" allow to exchange on cases.

- Telephony: The activation of the "telephone" icon programs the forwarding of all his calls to his secretary, or the filtering of calls. - Shared agenda: Reading the (shared) agenda of some of his hospital colleagues allows him to see their availability, as well as that of technical platforms.

- Security: Removing the card from the reader makes unauthorized access to the Intranet impossible. The reintroduction of the card allows you to find all the information in the previous state.

- Shared resources: The personalized management of several information channels makes it possible to host several intranets at the same time, each of them remaining strictly watertight and adapted to the style and needs of the network. Like virtual private networks, this solution combines the advantages of a private network with the savings made by pooling resources.

The XFS server implemented in the invention will now be described in detail.

The proposed server, shown in FIG. 1, is a document server in XML format intended to allow the sharing of these documents by a set of users. This server, called "XFS" (XML File Server), is at the center of a classic client-server architecture, namely a central server accessible, via any network, by client workstations. The server provides services comparable to those of a relational DBMS, but with XML documents:

- definition of user accounts,

- storage of documents in a transparent manner for the user,

- management of access to documents according to precise rules, - search for documents on the basis of certain criteria (but in a very limited way compared to a relational DBMS, the objective being the sharing of documents and not the search for information) ,

- execution of transactional requests.

Compared to a relational model, the adoption of the XML format to represent the data allows us, moreover:

- effectively arbitrate write access to the different parts of a document,

- to fine-tune access rights, at any level in the XML tree, - to associate binary files with documents,

- to give direct access to the server to a wide range of platforms and client software.

The goal is to be able to provide all these services by reducing to the strict minimum the constraints imposed on hosted XML documents and by making the server independent of the data processed. To allow server access to a wide variety of clients, the server function invocation protocol is simplified to the maximum. The options chosen are:

- requests independent of each other (no notion of session),

- transactional operation (a request is either canceled or executed in full),

- except for the description of the attached files, a purely ASCII format for queries (as in SQL) and, moreover, of XML type, as for the documents handled.

The invocation of functions through XML requests is in line with the principle of the Simple Object Access Protocol (SOAP). However, a much simpler and specific formulation for processing XML documents has been adopted. Unless the client requests a binary file associated with a document, the server also responds with an XML message.

Figure 2 illustrates the principle of client-server dialogue in XML. The envelope represents the communication protocol, the nature of which does not really matter. In practice, the http protocol has been chosen, since it is now available on a large number of client workstations. Any software capable of dialoging in XML with the server, according to the appropriate communication protocol (HTTP, etc.), can a priori play the role of client. To allow direct access to the server (that is to say without intermediary software) from thin clients such as HTML or WML browser, a mechanism for transforming the XML response using style sheets has been integrated to the server.

The simplicity of access to the server and the possibilities of applying stylesheets lead to a wide range of potential customers, as illustrated in Figure 3.

In order to validate the concepts developed and their possible application in tele-medicine, we have modeled client software of each type.

There are a certain number of concepts or products which have common points with the system which we propose:

- The SOAP protocol (Simple Object Access Protocol): this protocol makes it possible to execute functions remotely. Compared to other protocols used in distributed computing (RMI, CORBA, DCOM ...), it is characterized by an exchange of messages in XML format.

- XML compatible relational DBMS: many relational DBMS editors offer openings to XML. The storage remains in relational (or object-oriented relational) form, the XML language is only used as an exchange or query format and not as storage. The advantage of the relational model lies in the possibility of processing complex requests.

- XML DBMS: in this case, the documents are well stored in XML. - Request languages in XML (information search or update).

However, the existing XML servers were essentially designed to facilitate the search for information on the basis of any criteria (as for relational DBMS) and not for the purpose of sharing XML documents and managing access rights in these documents.

However, in the latter case, the query languages of XQL type and related (XUpdate, SXQL, etc.) seem rather unsuitable, insofar as the designation of the tags is based on a description of paths in the XML tree. The problem lies in the fact that this tree is constantly evolving in a multi-user context (addition or deletion of sub-trees by different users) and depends on access rights (two users may not have an identical view of 'same document on the server).

A first type of drawbacks concerning the evolution of the tree structure over time is represented in FIG. 4. A document on the server is simultaneously read by three users and then updated by them using a "XUpdate" type syntax. Although there is no error generated, we note that user number 3 believes to modify the tag "<B> 2 </B>" while in reality he modifies the tag "<B> 3 </ B> ”.

A second drawback relating to the effect of filtering as a function of access rights is shown in FIG. 5. In this simple example, the read access rights are signified by an "Access" attribute. It is easy to understand that the designation of the beacons by a path is difficult in this case, especially since the access rights can themselves change over time.

As already mentioned above, the main purpose is to share XML documents and not to search for information in these documents. On the two examples in the previous paragraph, it is therefore expected that the updates carried out by the different users will be carried out without ambiguity. In other words, the server must efficiently manage the concurrency as well as the access rights at any level of the XML tree. We want to allow, in particular, users to work simultaneously on different tags of the same document.

To allow efficient sharing of documents, there is provision for unique and systematic labeling by the server of all document tags. This way of proceeding makes the documents larger but leads to a concise and unambiguous expression of the modification requests.

This original designation technique has been combined with a simple version management mechanism. Each user indicates the version of the document he has, which allows the server, by comparison with version numbers associated with each tag on the common document, to arbitrate access competition.

As for access rights, the hierarchy of XML tags lends itself well to an expression of rights in the form of attributes. It therefore appears clearly that the solutions proposed at these different levels are very naturally integrated into a new query language in XML format, which is at the same time simple, efficient and capable of encompassing many useful functionalities on an XML document server. (association of files with documents, administration of accounts, notion of domain, application of style sheets ...).

The XFS server developments were motivated by a telemedicine application aimed at sharing patient medical records between a set of healthcare professionals. In this area, the access rights management functions are particularly useful. In addition, sharing medical information seems to meet a very real need.

The implementation of the invention requires the following elements:

* at the material level:

- a server computer - a network

- one or more client workstations * at the software level:

- an XFS server

- an HTTP server with support for the CGI interface - for thin clients: the client software to download (HTML pages,

WML, Javascript, WMLScript ...) * on the client:

- heavy client: client software

- thin client: HTML or WML browser.

Claims

CLAIM

1. Integrated system of services, comprising: - a first platform comprising means of secure access to various hosted application services,

- a service, called "messenger", comprising means for managing contacts, interpersonal multimedia communication, written discussion, voice and video discussion and presence notification,

- voice services,

- messaging tools, characterized in that said system further comprises:

- installed on the first platform, a second integrated, secure Intranet / Extranet / Internet services platform, suitable for healthcare professionals and sick people, said second platform being able to provide the user with access direct to any useful information,

means of accessing medical data files via the Internet and / or via file management software, means of viewing and updating said file by a client,

2. Integrated service system according to claim 1, characterized in that said medical data files are capable of organizing said data in semi-quantitative form as a function, on the one hand, of the time and of the interventions of professionals, and, d on the other hand, the social situation and pathologies.