BR102012033125A2 - TELEMEDICNA METHOD FOR REMOTE AND REAL-TIME MONITORING OF MEDICAL PROCEDURES - Google Patents

Abstract

TELEMEDICINE METHOD FOR REMOTE AND REAL-TIME MONITORING OF MEDICAL PROCEDURES This patent application refers to a new systemic computational method in telemedicine, the purpose of which is to enable remote monitoring of medical procedures under Telemedicine in real time. and interactively and iteratively; allow the performance of these medical procedures to be performed in places where there is no presence of medical specialists, without impairing the effectiveness of the procedure, and in many cases avoiding the need to travel patients to distant cities with these specialists; enable medical specialists to work remotely on the analysis and preparation of reports and diagnoses after medical procedures

Description

TELEMEDICINE METHOD FOR REMOTE AND REAL-TIME MONITORING OF MEDICAL PROCEDURES

Field of the invention

The present patent application relates to a new

method for remote monitoring of medical procedures in the field of telemedicine, in real time, interactively and iteratively.

It has applicability aimed at performing complementary exams, laparoscopic surgeries and other medical procedures based on hospital equipment.

Fundamentals of the invention

Several technological resources are currently available for hospitals and clinics, especially regarding the registration of information, in databases, about patients and on complementary exams. However, important tasks for process optimization and cost reduction are not yet automated or widely accessible, mainly due to the lack of computational resources. Examples include the capture, follow-up and analysis of examinations and procedures that work with video and 20 images, such as endoscopy, colonoscopy, laparoscopy, among others.

Specifically regarding medical applications, an important feature is the adoption of standards for image storage. In addition, there is a shortage of technological resources that enable doctors and specialists to follow medical procedures and perform their analysis remotely, in real time, and interactively and iteratively.

Thus, the design of computational methods that can assist in these processes is important. Telemedicine is defined by the American Telemedicine Association -ATA as the use of the exchange of medical information between different places through electronic communication in order to improve the patient's health condition. Already according to Current Medical Diaqnosed & Treatment 2000. Telemedicine is "the use of electronic information and other communication technologies to provide and support health when distance separates participants from the process."

From the identification of these possibilities for improvements and the contributions that can be made to the medical area, a model was defined by this invention applying technological resources to assist in the real-time monitoring of medical procedures.

Currently, in the state of the art, there are several works that use the concept of telemedicine to develop technologies that aim to assist medical activity. However, to date no methodology has been developed to enable real-time follow-up and discussion of medical procedures along with communication of medical equipment based on videos and images.

In order to determine the state of the art and to substantiate the

In accordance with item 15.1.2 of INPI Normative Act 127/97, the following is a list of patents and patent applications and articles covering the same area of knowledge as this patent application.

US2011106557-A1 patent application consists of a

ihasClinic for real-time remote interaction and monitoring between patients, healthcare professionals and others. You can store patient data and records on the server and locally. It can also be used to schedule or change appointment schedules. The architecture of this invention is comprised of a central server and web browser. The central server contains the patient data and through a web page it is possible to have real-time interaction (audio and video) between the patient and the doctor, as well as access to the data. The existing invention cannot be used for the follow-up and interaction of healthcare professionals to perform a real-time medical procedure. This request does not treat images and videos from medical equipment such as the videocolonoscope. Video conferencing in the existing invention is used for communication between physicians and patients and not for the transmission of medical procedure videos in real time. There are no mechanisms for capturing and sharing images from any video stream, and it is limited to each participant to capture local images and make them available to others. Regarding the mode of storage of images and patient data, no defined standards are applied for this area, as is the case with the Dicom format. The database was not designed in the existing invention for future performance of intelligent data analysis. In short, it is a distinct technology in relation to the present application, both in its methodology and its purpose.

Patent TW400503 (B) discloses a method for communicating between central monitoring stations and patient monitoring stations by encapsulating data (video, audio and equipment data) in packets and can use multiple types of network architectures. Communication with hospital equipment is used through serial devices, USB, among others. Commonly used equipment is pressure gauges, thermometers and electrocardiograms. Video conferencing equipment is used both on site and at the remote station, and the system is responsible for sorting and sending different types of data to the correct destinations. Although both inventions apply multimedia and videoconferencing features, the proposed invention has the advantage of allowing local and remote real-time monitoring of medical procedures, especially those based on video and images. Through this feature of the proposed invention, practitioners can actively participate in performing such procedures and can not only communicate, but also capture and share images relating to the procedure being performed (LABI-IMAGESHARING method, defined in the proposed invention). The videoconferencing portion of the existing invention utilizes equipment commonly applied for this purpose and does not have resources for the transmission of videos from medical equipment such as the proposed invention. Another feature of the proposed invention is the storage of medical procedure images according to the Dicom standard, and the provision of a method for authentication and secure communication for the execution of all processes and the construction of an examination and imaging base. for the future application of computational intelligence methods.

Regarding the scientific article SILVA, J. C. F .; VIEIRA, E .; STEPS, M .; MELO, E. A .; MOTTA1 G. Η. M. B .; TAVARES, T. A .; SOUZA FILHO, Guido We read from. “A Tool for Health Collaboration Video”. In: Argentine Congress of Informatics and Health 2011, 2011, Cordoba Argentina. Proceedings of CAIS 2011, 2011, this is a computational solution for the follow-up of surgeries. At work, two rooms have been defined, one in the surgery site and another in a Telemedicine room. The objective was to allow the use of these resources so that students and residents could follow and interact, through audio and video, during surgery without being in the room where the procedure takes place. In the work were used multimedia resources of video and audio. For this a camera was installed in the operating room and another in the Telemedicine room. Those in the Telemedicine room could follow both the video of the operating room and videos of internal cameras used in the surgical procedure. The interactivity between the two rooms was defined through audio and video. Cryptographic techniques were also defined for the transmission of media streams. In the proposed invention features are provided for remote monitoring of medical procedures, including the possibility of real-time monitoring of videos and images from hospital equipment. Resources (video, audio and text) are also defined for discussion about medical procedures, also in real time, among participants present at the place of execution and in remote locations. In the context of the proposed invention multiple tracking sites may be provided. Another difference is the mechanisms of interaction. In the proposed invention it is possible not only to interact by audio and video, but also to participate actively in the medical procedure by capturing and sharing images both locally and remotely. In addition to surgical procedures, the proposed invention has mechanisms for patient data management and examination, allowing storage in a format standardized by the medical field. In the proposed invention, resources have also been made available for further analysis of the procedures, as well as issuing reports and making diagnoses.

The present patent application stands out from the state of the art,

It allows real-time follow-up and discussion of medical procedures, and there is a method of communication with medical equipment based on video and images. For this there is a collaborative environment that allows you to follow videos of exams during their performance, as well as the sharing of videos, audio, chat and capture and sharing of images of medical equipment during the procedure, remotely and interactively. To perform these procedures the participants are authenticated and the transmitted data is encrypted using a method based on Artificial Immune Systems. The security policy was defined through an innovation carried out by the research group and called LABI-SIA method, which will be the subject of an independent patent application. Exam data and images can be exported to Dicom format. A structured database of patient and exam history is also fed, enabling future application of methods for intelligent data analysis.

The main advantages of the proposed technology are: a) Resources for both local and remote real-time monitoring of medical procedures. In this way participants can have access, via the Internet, to video, audio and data streams from 30 hospital equipment; b) In addition resources are available that allow participants, local and remote, to discuss about the medical procedure through multimedia resources, including video, audio and text. This interactivity can be used both during medical procedures and after their completion; c) Participants, locally and remotely, can actively participate in performing medical procedures by capturing and sharing related images. This way, professionals anywhere in the world can interact and iterate through these technological resources. This method was termed in this invention as LABI-IMAGE-SHARING; (d) Development of a security-specific method to preserve the privacy of patient data and examinations. This method, called LABI-SIA, applies principles of Artificial Immune Systems and were based on computational security and encryption techniques; e) Development of an algorithm for the secure distribution of video and audio streams, called LABI-PUBLISH.

Brief Description of the Invention

This patent application refers to a new systemic computational method in telemedicine, the purpose of which is to enable remote monitoring of medical procedures in Telemedicine, in real time and in an interactive and iterative manner; allow the performance of these medical procedures to be performed in places where there is no presence of medical specialists, without impairing the effectiveness of the procedure, and in many cases avoiding the need to move patients to distant cities with these specialists; allow specialist physicians to work remotely on analysis and preparation of reports and diagnoses after medical procedures have been performed.

To enable the remote follow-up method, a telemedicine system (Figure 1) consisting of an interaction model between the Medical Procedures Room (2k where k = 1..pep = total number of medical procedure rooms) was structured in the which are the patients and the team responsible for the procedure; and the Remote Interaction and Monitoring Units (3j where j = 1..m and m = total number of remote clients), where doctors, health professionals and / or researchers are present. The interaction method was designed to provide resources for monitoring, assisting and remote interaction 5 in real time while performing such procedures. To make this interactivity possible, resources present in the Medical Procedures Management Center (4), including the Application Server (5), the Database (6), the Image and Video Base (7), the Module Security (8), Internal Network (9), External Security Module 10 (11) and External Network (10).

Broadly speaking, the telemedicine method for remote and real-time follow-up of medical procedures can be defined by seven steps, which are described below.

Step 1: Providing Services The first step is to make configurations

Telemedicine system to provide the necessary services to Local Execution Unit (s) (13) and Remote Interaction Monitoring (s) (3j). For this a series of initializations / configurations are performed:

1. Streaming Server Startup \

2. Database Server Initialization;

3. Web page server startup;

4. Initialization of the Security Policy Module;

5. Application of Settings defined for the Telemedicine System.

Step 2: Authentication Process

The authentication process is a prerequisite for access to any system functionality, and is performed whenever a user connects to the system on both Local Execution Unit (s) (130) and Unit (s) ( Remote Interaction Tracking (s) (3j) The algorithm executed is presented in Figure 2. As shown in Figure 2, authentication consists in validating the identification of a user (Iogin) and his password. (Yogin) and password are compared with the information stored in the database (encrypted) If the authentication process is successful, the user is added to the list of authenticated users connected to the system. from user to system is rejected.

Success in the authentication process is a prerequisite for users to gain access to system functionality.

Step 3: Initialize Local Execution Unit

After performing steps 1 and 2, Local Execution Unit (13j) performs the following actions:

1. Establishes the Protocol of Communication with Medical Equipment;

2. Establish connection with Application Server (5);

3. Starts the acquisition of video and / or audio streams from medical equipment, according to the algorithms presented through Figures 3 and 4.

As shown in Figure 3, for video acquisition is

an object is started for this purpose, and then some settings are made (video codec setting, resolution, frame rate, quality, and compression ratio when applicable). After such settings the video capture is effectively started.

As shown in Figure 4, for audio acquisition is

an object is started for this purpose, and later some settings are made (audio codec setting, quality and echo suppression index setting). After such settings the audio capture is effectively started. 4. Local Execution Unit (13j) makes these video and / or audio streams available to Application Server (5) according to the algorithms presented by Figures 5 and 6.

As shown in Figure 5, for video publishing an object is started to establish a stream channel with Application Server (5) (which is also a Stream server), an identification (name) is defined for that stream, The connection with the Application Server (5) is established, a communication channel is allocated for the stream publication and finally the video is made available through this channel.

As shown in Figure 6, for audio publishing is

an object is started to establish a stream channel with the Application Server (5) (which is also a Stream server), an identification (name) is defined for that stream, the connection to the Application Server (5) is established, A communication channel is allocated for the stream publication and finally the audio is made available through this channel.

Step 4: Remote Follow-Up of Medical Procedures

Through the Remote Interaction and Monitoring Unit (s) (3j) it is possible to follow medical procedures in real time. Performing this step requires authentication to the system as defined in Step 2.

For each new Remote Interaction Tracking Unit (3j) that connects to the system, the following procedures are performed.

1. The Application Server (5) updates the connection list and sends this list to all active connections, both to the

Local Execution (13) for Remote Monitoring and Interaction Unit (s) (3j);

2. The Application Server (5) sends the running exam data to the new Interaction Tracking Unit

Remote (3j); 3. The new Remote Interaction Tracking Unit (3j) connects to the Application Server (5) and receives video and / or audio streams from the exam running on the Local Execution Unit (13,) ;

4. The new Remote Interaction Tracking Unit

(3j) downloads and displays images related to the currently running exam, if any.

Step 5: Interactivity While Performing Medical Procedures

In addition to monitoring medical procedures, the

Proposed technology provides mechanisms for professionals to interact in real time through video, audio, text messaging capabilities; as well as capturing and sharing images related to the medical procedure being performed. To gain access to this set of 15 features, the user must also be authenticated as defined in Step 2. The following are the mechanisms employed for each of these interactivity modes.

Video Interaction

For each new Remote Interaction Tracking Unit (3j) that makes its video stream available, the following actions are performed:

1. The new Remote Interaction Tracking Unit (3j) performs the video acquisition process and its publication as described in Step 3, processes 3 and 4;

2. From each video posting made, the Server

Application (5) updates the list of video streams;

3. The Application Server (5) sends a message to all active connections identifying the new published video stream and the user data and the new Remote Interaction Tracking Unit (3j) sharing the media. of video; 4. All Remote Interaction Tracking Units (3j) and Local Execution Unit (13), except the new Remote Interaction Tracking Unit (3j) that is making the new video stream available, create a new video channel. communication to receive the new video stream and start to get and display that video.

Interaction through Audio

For each new Remote Interaction Tracking Unit (3j) that makes its audio stream available, the following actions are performed:

1. The new Remote Interaction Tracking Unit

(3j) performs the audio acquisition process and its publication as described in Step 3, processes 3 and 4;

2. From each audio publication performed, the Application Server (5) updates the list of audio streams;

3. The Application Server (5) sends a message to

all active connections with the identification of the new published audio stream, and with user data and the new Remote Interaction Tracking Unit (3j) sharing the audio media;

4. All Remote Interaction Tracking Units (3j) and Local Execution Unit (13), except the new Remote Interaction Tracking Unit (3j) that is making the new audio stream available, create a new audio channel. receive the new audio stream and start to get and play that audio.

Interaction via text messaging All Tracking Units and Remote Interaction (3j)

and the Local Execution Unit (13) connected to the system have a mechanism for performing text message exchange. For each text message sent from a Remote Interaction Tracking Unit (3j) or Local Execution Unit (13), the following procedures are performed: 1. The text message and user ID are sent to the Application Server (5);

2. The Application Server (5) forwards the text message and user ID to all Tracking Units and

Remote Interaction (3j) active and for Local Execution Unit (13,);

3. All Remote Interaction Tracking Units (3j) and Local Execution Unit (13) receive and display the text message and user ID.

Interaction through Images Related to the Running Medical Procedure

Any participant, either at the Local Execution Unit (13i) or some Remote Interaction Monitoring and Unit (3j), can capture images of the medical procedure being performed, and these images are made available in real time to all participants. 15 When an image is captured on the Local Execution Unit (13) or any Remote Interaction Tracking Unit (3j), the following procedures are performed:

1. The image is transmitted to the Application Server (5);

2. The Application Server (5) stores this image in the Image and Video Base (7);

3. The Application Server (5) communicates the image location in the Image and Video Base (7) to the connection that originally captured the image, either at the Local Execution Unit (13) or the Monitoring and Monitoring Unit. Remote Interaction (3j);

4. From where the image was taken,

Local Execution Unit (13) or Remote Interaction Tracking Unit (3j), a message is sent to all active connections, ie Local Execution Units (13), and Remote Interaction Tracking Units (3j) that have active connections. The content of this message is the location of the image captured in the Image and Video Base (7); 5. The Local Execution Unit (13;) and all Remote Interaction Tracking Units (3j) receive the message, download the image, and make it available graphically in an area of the screen intended for images relating to the medical procedure being performed.

Step 6: Completion of the Medical Procedure

After the medical procedure is completed, the following procedures are performed:

1. Local Execution Unit (13) terminates publication of video and / or audio stream (s);

2. Application Server (5) communicates all Units

Tracking and Remote Interaction (3j) active to terminate communication channels relating to the receipt of audio and / or video streams relating to the medical procedure;

3. All Tracking and Remote Interaction Units (3j) close the communication channels for receiving

video and / or audio previously established to follow the medical procedure;

4. The Local Enforcement Unit (13) terminates communication with medical equipment;

5. Local Execution Unit (13) ends communication

with the Application Server (5).

Step 7: Examination, Diagnosis, and Report Analysis

In addition to real-time remote monitoring and interaction, the method proposed in this invention includes features that allow 25 professionals to remotely access patient and exam data. These features can be used through Remote Interaction Tracking Units (3j) with the prerequisite for system authentication as defined in Step 2. The Application Server provides the following features:

1. Registration, viewing and editing of professional data and

patients; 2. Visualization of procedure data and images

doctors;

3. Creation, visualization and editing of reports.

Two software were developed following the Client / Server model. Thus both are embedded in the Application Server (5) and are used in the Local Execution Unit (13) and the Remote Interaction and Monitoring Units (3).

In existing inventions and literature, models that use multimedia features typically apply only two locations, one where the procedure is performed and the other for remote monitoring. Usually these resources are applied to the patient to talk to health professionals, for residents to follow medical procedures, for educational issues, among others.

In other technologies, there is no interaction while performing medical procedures. These are performed and stored in a database and then physicians access remotely for diagnostics.

Thus the great differentials of the proposed invention are:

• For a medical procedure, you have the place where it is performed and you can have n

Remote Monitoring and Interaction. This n should be scaled according to the available computational resources, such as computer capacity, number of servers, Internet connection speed, among others;

• Remote professionals not only follow, but can actively participate in the medical procedure by discussing with other local and remote professionals. For this they are applied

video, audio and text messaging features; Professionals, locally and remotely, in addition to discussing, can capture images regarding medical procedures. These images are automatically presented to all participants and are also stored as part of the examination or medical procedure. The method for managing this image capture and management was created by the research group and was called LABI-IMAGE-SHARING, which will be described in detail in an independent patent application;

After the procedure is completed, data and images can be exported to Dicom format, which is not done by existing solutions, mainly applied to video procedures such as endoscopic procedures and videolaparoscopy;

The data related to the medical procedure after the exams can be analyzed and discussed remotely, facilitating the analysis, reports and diagnoses;

The entire solution works through the Internet and Web environment, requiring only a browser to access the system;

The entire process of authentication and data transmission has been defined through security layers, with several procedures to protect the privacy of participants and data related to medical procedures. This security policy was defined by creating a method called LABI-SIA. In this method, on all successful or unsuccessful accesses, the user receives an email report of the attempt, where they tried, whether or not they succeeded, wrongly attempted passwords, and a photo of the person / place where the system is being tried. used;

• The database has been defined and designed for future application of intelligent data analysis techniques.

· The method can also be applied for objectives.

so that residents can follow and interact with medical procedures without having to be in the place of execution, where spaces are typically reduced. This would also allow applications made by

existing;

Brief Description of the Figures

Figure 1 shows a diagram of an (but not limited to) architectural model of the present invention consisting of a Telemedicine system (1); medical procedure rooms (2) each consisting of a remote monitoring and interaction unit (3), hospital equipment (12) and a local execution unit (13) being interconnected by a communication method; a management center (4) consisting of a database (6) and a database of 20 images and videos (7) connected to the Application Server (5) and the internal security module (8); an internal network (9); an external security module (11); and an external network (10).

Figure 2 refers to the authentication algorithm.

Figure 3 refers to the algorithm for video acquisition.

Figure 4 refers to the algorithm for audio acquisition.

Figure 5 refers to the algorithm for video publishing.

Figure 6 refers to the algorithm for audio publishing. Detailed Description of the Invention

In order to achieve the objectives described in the brief description of the invention, a telemedicine system has been defined for monitoring, monitoring and interaction between healthcare professionals and / or researchers while performing medical procedures such as examinations. videocolonoscopy, upper digestive endoscopy, surgery through videolaparoscopy, among others.

The proposed method contemplates the interaction and active participation 5 of medical professionals in real time, locally and remotely, during medical procedures. In addition features are provided to facilitate standardized management and storage with regard to patient data, exams, videos and images. Due to the importance of these procedures and the need for privacy regarding information, the entire process of communication and information exchange was outlined applying security techniques, especially cryptographic methods.

The components that are part of the invention are shown in Figure 1, from which the details of their constituent elements and methods applied will be described. Although a specific configuration is presented, the method can be performed in different ways in the face of customizations that may be applied, including for conducting and monitoring experiments.

For a global understanding of the architecture presented by means of Figure 1, the present invention consists of a Telemedicine system (1) for performing medical procedures. For this, an interaction model was defined between the Medical Procedure Room (2k where k = 1 ..p and p = total number of medical procedure rooms), in which the patients and the team responsible for the procedure are located; and the Remote Interaction and Monitoring Units (3jOnde j = 1..m and m = total number of remote clients), where doctors, health professionals and / or researchers are present. The interaction method was designed in order to provide resources for monitoring, assisting and remote interaction in real time while performing such procedures. To make this interactivity possible, resources present in the Medical Procedures Management Center (4), including the Application Server (5), the Database (6), the Image Base (7) and the Security Module, are used. Internal (8).

As illustrated in Figure 1, the method defines the presence of several Tracking and Remote Interaction Units (3j). A Remote Interaction Tracking Unit (3j) may be located within the Medical Procedures Room itself (2k), elsewhere within the Institution by communicating with an Internal Network (9) or at any other physical location by connection to the External Network (10) in conjunction with the External Security Module (11). Each Health Facility may also have several Medical Procedure Rooms (2k) integrated into the Telemedicine system (1). All the solution proposed in this invention has the characteristic of being used by distributed systems, having as default configuration the application of the model in Web environment. Alternative configurations can be applied depending on the specificities and the available computational and technological resources.

Through these components and the applied methods, the present invention allows high flexibility for real-time monitoring and interaction between medical professionals and / or researchers regarding medical procedures and / or performing 20 experiments, mainly related to health. Among the resources provided by this invention is the sharing of the following items:

• data regarding the medical procedure being performed;

• images and videos captured at the Medical Procedures Room (2k) and / or at the Remote Interaction and Monitoring Units (3j);

• Interaction between participants through audio, video and text messaging capabilities.

In addition to the real-time characteristics, this method allows the recovery and subsequent analysis of complementary exams and / or medical procedures and / or experiments performed, making the activities more flexible. From these definitions the characteristics of the constituent elements of Figure 1 and the description of the methods applied in the present invention will be presented.

This invention is not limited to the construction details set forth herein but may be embodied by other alternative embodiments.

In normal execution condition, in the Medical Procedure Room (s) (2k) are the patients who are undergoing a certain medical procedure, the team responsible for the procedure, the respective Equipment (s). Hospital (s) (12j) and Local Execution Unit (s) (13).

Hospital Equipment (12), in normal performance, may be used for medical procedures, such as for complementary videocolonoscopy, videoendoscopy, videolaparoscopic surgical interventions, 15 among other types of video and imaging examinations and procedures. . Alternatively, it would be possible to use other hospital equipment to monitor patient information, including ECG, EEG, temperature, blood pressure, among others. If applied for experiments could be used other specific hospital equipment or even other machines with other applications, such as precision scales, among others.

The medical procedure team present at the Medical Procedures Room (2k) may use the Local Execution Unit (s) (13j) to assist in the automation of some tasks, including 25 registration and editing. information about patients, complementary exams and / or experiments, and especially for the acquisition and analysis of data, images and videos from the Hospitalare Equipment (s) (12,).

Within this context, Local Execution Unit (s) (13j) is responsible for establishing the communication protocol with Hospital Equipment (s) (12,). Considering the normal flow defined in this invention, Hospital Equipment (12) would be applied for video and image based procedures. As the vast majority of Hospital Equipment (12j) belonging to this category make available videos in analog format (composite video, super video, among others), the 5 Local Execution Unit (s) (13) have the capture these videos, convert them to digital format and then forward them to the Application Server (5), which is located at the Medical Procedures Management Center (4). In the case of Hospital Equipment (s) (12) already providing digital video, the analog to digital video conversion feature 10 is not applied.

In alternative execution situations, the Hospital Equipment (s) (12) could transmit data other than video and / or images. Under these conditions Local Execution Unit (s) (13j) shall apply communication protocols compatible with 15 other specific equipment, including serial, ethernet, wireless, TCP / IP, among others.

Local Execution Unit (s) (13) connect to the Application Server (5) present in the Medical Procedures Management Center (4). For this the Internal Network (9) is used and the security policy defined by the Internal Security Module (8) is applied. To use Local Execution Unit (s) (13), an authentication procedure is required, and for communication between Local Execution Unit (13j) and the Application Server (5) It is necessary to use encryption features. These safety-related designs were developed by the research group and called the LABI-SIA method, which will be described in an independent patent application.

Local Execution Unit (s) (13) are continuously receiving videos and / or other information from Hospital Equipment (s) (12), and encapsulating this data into a protocol. most appropriate and with support for security mechanisms (encryption). After this treatment, this data is transmitted to the Application Server (5) using the protocol architecture provided by the Internal Network (9). The most commonly used protocols for this type of web transmission are the Internet Protocol-IP - and the Transport Control Protocol - TCP.

According to the model set forth in this invention, the 5 Local Execution Unit (s) (13) may also receive video and / or audio streams from text-format messages from the Application Server (5) and images in text format. This is a function of the interaction model developed, as doctors and / or professionals present in the Remote Interaction and Monitoring Unit (s) can make their 10 video and / or audio streamings available, and interact during the performance. medical and / or experimental procedure through audio, video, text messaging and capturing and sharing images. The image sharing model (LABI-IMAGE-SHARING) will be described in detail in specific patents.

Because medical information requires confidentiality, it is critical to

use of strict safety criteria. With this view, communication and data transmission in different formats between Local Execution Unit (s) (13) and Application Server (5) is accomplished by adopting strong security policies with regarding authenticity and privacy.

The main focus of this invention was on the application of methods for performing video and image based examinations as well as for interaction between professionals through multimedia resources. Thus, particular care was taken regarding the publication of audio and video streamings 25. The method made for this purpose (LABI-PUBLISH) will be presented in a specific patent application.

At the Remote Monitoring and Interaction Unit (s) (3j), under normal execution conditions, may be present medical specialists, health professionals, researchers and / or persons related to the procedure being performed. . These Remote Interaction Tracking Unit (s) (3j) may be present in the Medical Procedures Room (2 | <), anywhere within the Hospital or Clinic where the medical procedure is being performed, or even in any geographic location that has a connection to any interconnected network, with the Internet currently being the most widely applied network for these purposes. In normal execution all computational interactions are performed through the Web, applying Internet browsers. Alternatively, any other technology covering network communication may be applied.

Initially, the Monitoring and Interaction Unit (s)

Remote (3j) connect to the Application Server (5) present at the Medical Procedures Management Center (4). For this connection to occur, it is also necessary to have the authentication of a professional with access rights to the tool. When the Monitoring and Remote Interaction Unit (s) (3j) are located within the Hospital or Clinic where the procedure is being performed, the resources provided by the Internal Network (9) will be used and the security policy will be applied. defined by the Internal Security Module (LABI-SIA). If the Remote Interaction and Monitoring Unit (s) (3j) are located outside the Institution where the procedure is being performed, the resources of the External Network (10) and the Internal Network (9) will be used. security policies defined by the External Security Module (11) and subsequently by the rules set out in the Internal Security Module

(8). This entire authentication process and security procedures are defined using the LABI-SIA method, which will be covered in a specific section.

After establishing a connection with the Application Server (5), the Remote Interaction Tracking Unit (3j) will receive the data streams, videos, audios and images for the procedure (s) being performed. ) being performed in the Medical Procedure Room (2r) in real time. Because Application Server (5) manages and makes these resources available to the Remote Interaction Tracking Unit (s) (3j), it can simultaneously receive all of these stream categories from different Medical Procedure Rooms, and for therefore, from different Hospital Equipment (s) (12j).

Application Server (5) also provides features for

discussions, and sharing multiple media among active professionals in all Monitoring and Remote Interaction Units (3j). Thus, the Remote Interaction Tracking Unit (3j) will also receive from the Application Server (5) the resources 10 shared by all Remote Interaction Tracking Units (3j). These features consist of audio and / or video streams, as well as sharing text messages and captured images in any Medical Procedure Room (2k) and / or Remote Interaction Tracking Units (3j).

As previously presented, the

Remote Interaction Tracking (3j) can also make your Unit's video and / or audio available to other participants through the Application Server (5). This publication of audio and video streams is performed using the LABI-PUBLISH method. This method has been designed in this invention to protect such flows, emphatically the flows from medical procedures, against improper access and connection.

The default setting for organizing these flows is the separation of medical procedures and participants into separate locations, allowing participants to interact only with the specific procedure of interest 25, ie having a single Medical Procedure Room (2k) and several Monitoring and Remote Interaction Units (3j) to perform a single medical procedure.

In addition to real-time actions, the Remote Interaction Monitoring and Follow-up Unit (s) (3j) allows analysis after the medical procedure is performed. In this way it is possible to access data related to any medical procedure, as well as images, audio, videos and any other information related to a certain complementary exam and / or procedure, after performing such procedure.

From this feature it is possible to perform local or remote analysis, individually or collectively, at any time and interactively. Another feature provided in this invention with respect to complementary examinations and other conventional telemedicine systems is that it allows the export of procedure data and captured images to DICOM format.

The Medical Procedures Management Center (4), through the Application Server (5), is responsible for access control, reception and distribution of audio and video streams between the Remote Interaction and Monitoring Units (3j). ) and Local Executing Units (13) for storing medical procedure data in the Database (6) and for storing videos and 15 images from medical procedures in the Image and Video Base (7). Additionally, the Medical Procedures Management Center (4) defines the security policies and internal access control through the Internal Security Module (8).

Database (6) is where the medical procedure data held in the Medical Procedure Room (s) (2k) is physically stored. The definition of the Database Manager System to be applied and its administration and management policy should be defined according to the available technological alternatives and the particularities of each Institution. The number of database servers 25 may vary depending on the amount of data being handled and the number of Medical Procedure Rooms (2k) that will be used.

In the Image and Video Base (7), the images and videos acquired and captured in the Medical Procedures Room (s) (2k) are stored and organized during complementary exams, experiments or any other medical procedure. The number of Application Servers (5) may vary depending on where the method is applied, and should be defined as a function of the number of Medical Procedure Rooms (2k) and Remote Interaction Tracking Units (3j).

Application Servers (5) communicate over the network with

with the clients (Local Execution Units (13) and Remote Interaction Monitoring and Units (3j)), through their own protocols for this purpose. which is TCP / IP.

Application Server (s) (5) receive data regarding

patients and their medical procedures and store them in the Database (6). Similarly the Application Server (s) (5) host the images and videos captured in the Medical Procedure Rooms (2k) and Remote Tracking Units (3j), and the 15 forward to the Image and Video Base (7). This historical information can later be consulted and retrieved through Local Execution Units (13) and Remote Monitoring and Integration Units (3j). Another function of Application Servers (5) is to convert image-based medical procedures to DICOM format 20 and to record this information in the database (6).

As mentioned earlier, Application Server (5) is also responsible for managing and distributing all multimedia streams among all participants who use these resources through Local Execution Unit (s) (13). ) and the Remote Monitoring and Interaction Unit (s) (3j). The technologies to be used to provide these services should be selected according to the specificities of each institution. Thus, Application Servers (5) are responsible for authenticating, receiving, distributing, and managing all multimedia sessions. The most widely used technologies today for these functions are Flash Media Server, RedS, and Wowza Media Server. The services provided by the Application Server (s)

(5), through the management of these multimedia resources, constitute a support tool for physicians, specialists and researchers to allow the discussion of complementary exams and other medical procedures, through the use of these different media, including audio, video. , text messaging and image sharing.

In the Internal Network (9) various interconnection resources may be used. The most common today are the Ethernet and Wireless standard. Regarding the External Network (10) any available network can also be applied, such as dedicated channels, cable networks, ADSL networks, among others.

a) LABI-IMAGE-SHARING Image Sharing Method

As shown in Figure 1, iterative and interactive participation between medical professionals and / or specialists and / or researchers takes place through the Local Execution Unit (s) (13) and Unit ( s) Remote Monitoring and Interaction (3j). In this context, in addition to the use of conventionally applied media in videoconferencing systems, this invention has added a mechanism that allows these professionals to actively participate in the performance of 20 medical procedures by capturing and sharing images related to the medical procedure that is being performed.

To clarify the developed algorithmic method, first we present the context in which the LABI-IMAGE-SHARING method is applied. Prior to initiating the medical procedure, participants present at 25 Local Execution Unit (s) (13) and Remote Interaction Monitoring (s) (3j) are authorized to use the system ( authentication) through the policies defined in the LABI-SIA method. While performing the medical procedures, the Local Execution Unit (13) transmits the video to the Application Server (5) and the latter performs the distribution of this video to all 30 Remote Interaction and Monitoring Units (3j). Similarly, the Remote Interaction Tracking Units (3j) may optionally send your video and / or audio media to the Application Server (5) and it is responsible for distributing these media to all Tracking and Interaction Units. Remote (3j) and Local Execution Unit (13 |). Images captured during medical procedure 5 should be stored in the Image and Video Base (7). The entire process of video and image transmission is performed privately, applying encryption techniques, as outlined in the LABI-SIA method.

From this state, any participant, either at the Local Execution Unit (13) or the Remote Interaction Monitoring and Follow-up Unit (s) (3j), can capture medical procedure images and these should be made available on real time, for all participants,

b) Safety Method Based on LABI-SIA Artificial Immune Systems

The security model outlined in this invention, LABI-SIA, consists of a method based on the concepts of Artificial Immune Systems. In this way, different layers and applications are defined in order to protect the solution against attacks.

External Security Module (11)

This part of the method is responsible for the interface between the internal network and the external network. Therefore, the most general security policies that relate to the entire institution should be applied.

The LABI-SIA method is used in the system access process, during user authentication, and at all times when data is transmitted. Includes encryption policies, password setting, locking and account recovery, among others.

Homeland Security Module (8)

The internal security module (8) is applied for access and connection management from both the internal network.

(9) as well as connections requested through the external network (10) and previously authorized by the external security module (11). The following are the main features defined in the Internal Security Module (8):

c) Method for Publishing LABIPUBLISH Video and Audio Streamings

The LABI-PUBLISH method was defined in order to protect the

video and audio streaming against interceptions and unwanted connections. The method is applied to the invention whenever a stream is published, both from hospital equipment (120) and from the media used in Remote Interaction and Monitoring Units (3j).

The present invention is in the field of Telemedicine,

being applied mainly for the monitoring of medical procedures and / or experiments, both locally and remotely, in real time and in an interactive and iterative way, through computational resources.

The main advantages of the proposed technology are: a) Resources for both local and remote real-time monitoring of medical procedures. In this way participants can have access via the Internet to video, audio and data streams from hospital equipment; b) In addition resources are available that allow participants, local and remote, to discuss about the medical procedure through multimedia resources, including video, audio and text. This interactivity can be used both during medical procedures and after their completion; c) Participants, locally and remotely, can actively participate in performing medical procedures by capturing and sharing related images. This way, professionals anywhere in the world can interact and iterate through these technological resources. This method was termed in this invention as LABI-IMAGE-SHARING; d) Development of a security-specific method to preserve the privacy of patient data and examinations; e) Development of an algorithm for the secure distribution of video and audio streams, called LABI-PUBLISH. The invention was initially designed to be used for complementary colonoscopy, endoscopy, videolaparoscopic surgery and other medical procedures based on hospital equipment that work with video and images. Method 5 can be applied to other healthcare procedures and experiments that require communication with hospital equipment and remote real-time monitoring. Other categories of complementary exams can be cited in areas such as radiology, ultrasound, among others. The invention, within the context of healthcare, may also be applied for the conduct and discussion of medical experiments and for the discussion of patient cases and the elaboration of diagnoses by means of remote real-time monitoring and discussion. , and also after performing medical procedures and / or experiments. In addition to medical procedures and experiments, the invention can be used for 15 educational purposes and can be used for the dissemination of knowledge about the execution of different procedures in the medical field. The method can also be applied to other areas of knowledge that require real-time resources for sharing text, audio, video and image messages.

Claims (9)

1. Telemedicine method for remote and real-time follow-up of medical procedures comprising the following steps: a. First, the specific configurations of the Telemedicine system are made in order to provide the necessary services to the Local Execution Unit (s) (13) and to the Remote Interaction and Monitoring Unit (s) (3j); B. Authentication is processed by the algorithm described in FIG. 2; ç. Establishes the Protocol of Communication with the Medical Equipment; d. Connects to Application Server (5); and. Starts the acquisition of video and / or audio streams from medical equipment through the algorithms described in figures 3 and 4; f. Local Execution Unit (13) makes these video and / or audio streams available to Application Server (5) via the algorithms described in Figures 5 and 6; g. Professional interaction is promoted in real time through video, audio, text messaging capabilities; as well as capturing and sharing images related to the medical procedure being performed; H. Local Execution Unit (13) terminates publication of the video and / or audio stream (s), Application Server (5) reports all active Remote Interaction and Tracking Units (3j) to terminate the communication channels for receiving audio and / or video streams related to the medical procedure, all Monitoring and Remote Interaction Units (3j) close communication channels for receiving previously established video and / or audio streams, the Unit Local Execution Unit (13) terminates communication with medical equipment; Local Execution Unit (13) terminates communication with Application Server (5); Telemedicine method for remote and real-time monitoring of medical procedures according to claim 1, characterized in that for each new Monitoring and Remote Interaction Unit (3j) that connects to the system, the following procedures are performed: • The Application Server (5) updates the connection list and sends this list to all active connections to both Local Execution Unit (131) and the Interaction Tracking Unit (s). Remote (31); • The Application Server (5) sends the running exam data to the new Remote Interaction Tracking Unit (31); • The new Remote Interaction Tracking Unit (31) establishes a connection with the Application Server (5) and now receives video and / or audio streams from the exam running at the Local Execution Unit (131); • The new Remote Interaction Tracking Unit (31) downloads and displays images for the currently running exam, if any. Telemedicine method for remote and real-time monitoring of medical procedures according to claim 1, characterized in that in step "a" a series of initializations / configurations are performed: • Streanningm Server Initialization, • Database Server; • Web page server startup; • Initialization of the Security Policy Module; • Application of Settings configured for Telemedicine System Telemedicine method for remote and real-time monitoring of medical procedures according to claim 2, characterized in that, for each new unit, video interaction takes place through the following actions: • The new Monitoring Unit and Remote Interaction (31) performs the process of video acquisition and its publication; • From each video publication made, the Application Server (5) updates the list of video streams; • The Application Server (5) sends a message to all active connections identifying the new published video stream, and user data and the new Remote Interaction Tracking Unit (31) sharing the media. video; • All Remote Interaction Tracking Units (31) and Local Execution Unit (131), except the new Remote Interaction Tracking Unit (31) that is making the new video stream available, create a new communication channel for receive the new video stream and begin to get and display that video. Telemedicine method for remote and real-time monitoring of medical procedures according to claim 2, characterized in that, for each new unit, audio interaction takes place through the following actions: • The new Monitoring Unit and Remote Interaction (31) performs the audio acquisition process and its publication; • From each audio publication performed, the Application Server (5) updates the list of audio streams; • The Application Server (5) sends a message to all active connections identifying the new published audio stream, and the user data and the new Remote Interaction Tracking Unit (31) sharing the media. audio; • All Remote Interaction Tracking Units (31) and Local Execution Unit (131), except the new Remote Interaction Tracking Unit (31) that is making the new audio stream available, create a new communication channel for receive the new audio stream and start to get and play that audio. Telemedicine method for remote and real-time follow-up of medical procedures according to claim 2, characterized in that, for each new unit, interaction by text messaging takes place through the following actions: text message and user ID are sent to the Application Server (5); • The Application Server (5) forwards the text message and user ID to all active Remote Interaction Tracking Units (31) and the Local Execution Unit (131); • All Remote Interaction Tracking Units (31) and Local Execution Unit (13) receive and display the text message and user ID. Telemedicine method for remote and real-time follow-up of medical procedures according to claim 2, characterized in that, for each new unit, interaction by means of images relating to the medical procedure being performed is by means of the following: actions: • The image is transmitted to the Application Server (5); • Application Server (5) stores this image in the Image and Video Base (7); • The Application Server (5) communicates the image location in the Image and Video Base (7) to the connection that originally captured the image, either on the Local Execution Unit (131) or the Remote Interaction Tracking Unit. (31); • From where the image was taken, Local Execution Unit (131) or Remote Interaction Tracking Unit (31), a message is sent to all active connections, ie Local Execution Units ( 131) and for Remote Interaction Tracking Units (31) that have active connections. The content of this message is the location of the image captured in the Image and Video Base (7); • The Local Execution Unit (131) and all Remote Interaction and Tracking Units (31) receive the message, download the image, and make it available graphically in an area of the screen intended for images relating to the medical procedure being performed. Telemedicine method for remote and real-time monitoring of medical procedures according to claim 1, characterized in that it allows the analysis of data collected during the medical procedure by means of two computer programs embedded in the Application Server (5). ) which are used in the Local Execution Unit (13) and the Accompaniment Units. Telemedicine method for remote and real-time monitoring of medical procedures according to claim 8, characterized in that the Application Server (5) provides the following features: Registration, viewing and editing of data of professionals and patients; Visualization of data and images relating to medical procedures; Creation, visualization and edition of reports.