Software Architecture Discoveries in a Telemedicine System
R. Ann Cecil MS; UPMC; Christine Henderson BA; UPMC; Andrew Eller MD; UPMC;
Content:
As part of an Integrated Medical Information Technologies System (IMITS) study into retinal screening for diabetics using the InterNet, software was developed using basic architectural decisions about middleware, security, timing, portability, and the organization of data. After one year and over 700 participants, evaluation of the software, from both users and developers, produced a mix of change recommendations and affirmations of the architecture.
Technology:
A database in MS SQL Server, a Web Application and a Web Service coded in C# were developed, along with a windows application in C# employing an API to TopCon Medical System, Inc (37 West Century Road, Paramus, NJ, US) camera (TRC-NW6S) software (Imagenet).
Design:
The initial design of the application focused on the Windows application and Web Service, with minimal attention to the Web application (which was actually done as three independent screens, rather than an application). The sql server dbms was designed simply to hold the results of the screens, with little referential integrity. The image data was saved using DICOM compliant formats, with key data in DICOM xml files.
Results:
After use with approximately 500 participants, the three screens were combined into a true Web application, with login verification; the database was redesigned and integrity added, and some searching and reporting functions were added. A further evaluation was done at the end of the project, when 770+ participants had been imaged at two clinics and a variety of health fairs.
Conclusion:
1. Middleware may seem more complex, but provides many advantages down the road. 2. Speed is life may be true on-line, but it is not an effective motto for medical system design. 3. Flexibility in establishing codes and grades is a critical factor in success of the system. 4. The importance of recording all data, no matter how apparently trivial, cannot be exaggerated.
