The Health & Social Care Information Centre (HSCIC) assist organisations and individuals to create and test applications to communicate through the NHS UK-wide secure communication network.
They have created a suite of testing tools including validators, responders, and automated emulators to provide a safe testing environment. They also provide suppliers and clinicians with consultancy at no charge.
The software and tools created by HSCIC are built using the Java programming language and are mostly available on the internet from the Github code repository with some still being migrated from previous code management platforms. A key application is the Tool Kit Workbench (TKW) which is used as the test suite for ITK & Spine messaging.
One challenge that their work is addressing is that of tele-health. Many years ago, the vision of monitoring patients in their own home inspired a nation. Technology was not able to deliver reliable connectivity at the right cost so solutions were only realised in specialist cases. Other uses identified include the automated collection and transmission of data collected when children are measured in schools.
Richard Robinson from the Messaging & Integration team has produced an operational prototype 'MediPi' using a blend of Open Source software and Open Source hardware to create a Linux & Raspberry Pi patient monitoring system that connects directly to the NHS Spine. The Spine is a backbone securely connecting applications in over 21,000 organisations across the healthcare service.
Following the guidance from central government and NHS England, the project is focussed around Open Source and Open Standards. Richard was proud to state "Whatever we create, we create as Open Source."
At EHI-Live 2015, Richard presented a demonstration of the tele-health prototype using low-cost hardware with 2-way communications through the secure Spine network. This effectively connects the patient at home to their clinician. It was developed with support from a community of healthcare professionals including Dr Neil Paul, NHS England and the Airedale NHS Foundation.
The hardware on show included a Raspberry PI with an enclosure, button board and power supply, all costing under £35, a commodity weighing scale with USB connection from Argos for around £25 and a finger pulse oximeter available from Ebay, also around £25.
The operating system is the latest Debian Jessy with the MediPi Java application with a small Python wrapper to access some of the peripherals.
The Raspberry Pi connects to the Spine through wired or wireless connections so uses any established broadband or mobile network and the data is authenticated and encrypted during transmission.
The demo shows how weight, blood oxygen, pulse wave form, heart rate, body fat, water and muscle data can be instantly transported to the intended destinations. The user presses simple buttons to instruct the device to start and stop a reading, then once the reading is taken, a 'send' button transmits it.
For the techies, each data element is encrypted and compressed, wrapped up in a ITK distribution envelope, and then enclosed in an ITK Trunk message ready for transmission over the Spine. This allows the messages to be sent to any point on the Spine, or to a specific ITK endpoint for further processes. Data is split down so it can be sent to many different endpoints and each one can only access the data that it is intended for.
Should a clinician want to send a return message in response, or even send a routine notification about an appointment, they can post a reply to the data, or just send a message. A light flashes on the device to alert the user that a message is waiting so the user can view it through a standard TV. The device is likely to be fitted with a small on-board display so simple messages can be presented without the use of a TV at all.
The ITK is a framework of message transmissions used by several parties and available as a fully Open standard.
Essentially, this means that the information can be used across any GP or clinical system that conforms to the SPINE or ITK standards.
Richard's key points are that this was built from off-the-shelf retail-priced components for less than £100. The data transmission is secure using tried and tested encryption using the established Open Standard Spine communications so is fully interoperable with existing applications used every day across the NHS. The on-board software is both free and open, therefore robust and flexible.
With the software being free & open, others can download it improve and integrate with other solutions. New applications can be developed and prototyped using the ITK tests mentioned above and if certified, can then deliver messages and patient updates to their medical team.
The solution is still in prototype but the key features are fully functional for passing clinical data. There are still unresolved issues with authenticating the user, but it proves that the hard part can be done for under a couple of hundred pounds using commodity components.
HSCIC plan to release a white paper in the near future and, although Richard is currently in consultation with clinicians to explore the practical uses for the prototype, he welcomes more clinical engagement from the healthcare community. You can reach Richard by email: firstname.lastname@example.org
Posted by Stuart J Mackintosh on 05/11/2015