GB2427519A

GB2427519A - Interactive patient terminal

Info

Publication number: GB2427519A
Application number: GB0505953A
Authority: GB
Inventors: Ben Packman
Original assignee: PREMIER TELESOLUTIONS Ltd
Current assignee: PREMIER TELESOLUTIONS Ltd
Priority date: 2005-03-23
Filing date: 2005-03-23
Publication date: 2006-12-27
Also published as: GB0505953D0

Abstract

A networked digital interactive system for use in a hospital comprises one or more servers connected to a plurality of patient terminals. The system comprises means to receive via a terminal a verification of payment from a patient, and means to deliver after receipt of the verification a service from one or more of the servers when a demand for that service is received via a terminal from the patient. The services provided may include patient information, video, telephony television, radio and internet access.

Description

NETWORKED DIGITAL INTERACTIVE SYSTEM The invention relates to a networked digital interactive system for delivering a variety of services to patients in hospitals. PatientPower is a government directive to install bedside TV and telephone systems into all major hospitals. The systems are to be installed at no cost to the trusts by licensed providers. According to the invention, there is provided a networked digital interactive system as defined in Claim 1. Services include (but are not limited to):- Digital Television Digital Radio On-Demand Video On-Demand Audio > Internet & Email Access Games > Information Telephony / Voice Services Some of these services may be charged to the patient and some may be free of charge. Payment is via a pre-pay system using smartcards purchased from vending machines located around the hospital, or via on-site advisory and support staff. The same system delivers services to the hospitals themselves, namely (but not limited to):- Delivery of Bedside Computing Delivery of Information for Patients Delivery of Healthcare Advice Monitoring of Healthcare Conditions Assistance with Clinical Care The networked digital interactive system has multiple parts, which can be defined as:- 1. The Patient Terminal 2. The Terminal Graphical User Interface (GUI) 3 The Terminal Software 4. The Mounting Arm 5. The Network Architecture 6. The Network Security 7. The Back Office Servers 8. The Back Office Software 9. The Customer Relationship Management Toolkit (CRMT) 10. The Vending Machine 11. The Vending Machine GUI 12. The Vending Machine Software 13. The Operational Setup These components are described on the following pages in detail. The Patient Terminal Insert Description Insert Pictures (Back. Front and Side) Insert Note of Key Components o Touchscreen o Processors and Motherboard o Smartcard Reader o Connectivity (USB 2.0, Bluetooth) o Heat management o Call indicator Lights o Handset Cradle o Handset o Remote Control o Power Insert Drawing & Description of Heatsink Insert Drawing & Description of Vents Insert Drawing and Description of Call Indicator Lights Insert Technical Specification The Terminal Graphical User Interface (GUI) . Insert Description .Insert Images of Key Components o Main menu o Sample sub menu o Control Bar o Prompt System o Internet Browser & Keyboard o Account Display Insert Sample and Description of Colour-blind Checks The Terminal Software Insert Description Insert Statement about Premier's Specification Insert Statement of link to GUI Insert Statement of link to Back Office Note use of third party provider The Mounting Arm Insert Description Insert Images of Interface to Terminal Heat Sink Insert Drawings of Interface and Arm Construction Insert Structural Calculations Insert Mounting Details Note Power Distribution Method The Network Architecture Insert Description Insert Network Diagram Note use of third party provider (s) The Network Security Insert Description Insert Network Diagram Note use of third party provider (s)The Back Office Servers Insert Description Insert Diagram List Components o Uninterruptible Power Supply (UPS) o Console Manager o Data Distribution o Database Server o Core Network Switch o Video / Audio on Demand Server o Telephony Gateway o IPTV Head End o Aerial and Distribution Note use of third party provider (s) The Back Office Software Insert Description Insert Statement about Premier's Specification Insert Statement of link to Terminal and Back Office Note use of third part), provider The Customer Relationship Management Toolkit (CRMT) Insert Description Insert Statement about separate Patent application to be made The Vending Machine Insert Description Insert Drawing and list of Components o Touchscreen o Note Reader o Coin Mechanism o Printer o Smartcard Reader & Dispenser o Security o Processor and Motherboard o Network Connectivity The Vending Machine GUI Insert Description Insert Images of Key Components o Main menu o New Card o Top-Up o Refund Insert Sample and Description of Colour-blind Checks The Vending Machine Software Insert Description Insert Statement about Premier's Specification Insert Statement of link to GUI Insert Statement of link to Back Office Note use of third party provider The Operational Setup Insert Description Insert Statement of link to successful operation of the system patient services 15 channels of TV Premium TV Top-Up Free Radio Movies, on demand Telephony Audio books, on demand Internet & Email Games SMS Messaging Gifts Hospital Information How can patients pay? Vending machines around ward areas-refunds also available Credit card via our on-site operators Friends and relatives can use our gift website Hospital services Information on the bedside terminal Bedside Computing ICRS integration (EPR) Food Menu Display Bedside Ordering Hospital Radio Hospital Videos/Channels Links to trust websites Questionnaires Use of our NHSIA approved network Nurse call systems Premier On-Site Staffing Dedicated Site Manager Staff to Patient Ration - 1:100, all patient facing Coverage - 365 days a year All staff CRB vetted Ongoing Training Equal Rights Employer Local Job Creation More than 95% patients are pleased with the support of our staff On-site staff backed up by mobile engineering team and remote diagnostics from head office Terminal Specification -v4 C3 1 Ghz Processor (VIA CLE 266) and onboard MPEG decode Fan-less system 256mb RAM or 512mb RAM option 40Gb Local Storage 15" touch screen monitor (1024 x 768 pixels) up to 32 bit colour support 160 degree viewing angle and 400:1 contrast GEM plus compatible smartcard reader (as requested by NpflT) 2 x USB 2.0 Ports 10/ 100 Base T Network Interface Bluetooth Adapter Terminal The terminal has several unique features: o Fan-less o Specially designed heat sink and vents o Easy to clean o Custom handset cradle for standard telephone o Custom motherboard o Flashing lights on corners o Anti-ingress connections for Smartcard, USB etc o Custom remote control connection Arm Sturdy 4 point swivel action for use at bed or bedside chair Unique interface to heat sink on terminal for heat dispersion Interface (GUI) Easy to use Flexible for all media types Suitable for the colour blind Overview of key points Interface (GUI) Main navigation o Prompt bar o Account actions o Paid services o Free services o Info/contextual bar Touchscreen telephone pad o Large dial numbers o Information o Speed dial TV Controls o Info/contextual bar stays o Control bar appears as required Prompt system o Overlay's to prompt for account actions or incoming calls Media detail o Detailed synopsis for films audio books etc.... Media controls o Follows on from TV controls principle Internet browser keyboard o Pop-up touchscreen keyboard Admin Interface o Follows simple to use principles Architecture & Back Office Designed to deliver a wide range of media and computing services within a closed network environment Uses industry standard techniques and equipment to allow maximum upgrade and future flexibility Core switch feeds fibre to edge switch devices, that then deliver 10/100 Ethernet to every bed Fully digital, fully IP Network schematic Systems Software Ongoing roadmap of development Vending Machine Follows principle of main system GUI Summary All of this combines to deliver the following key points about the premier bedside service: o Fanless PC and Touchscreen on 4 point swivel arm delivering TV, Telephone. On-Demand Media, Internet, Games and Information to patients - at the same time facilitating bedside computing and media for hospitals o Flexible architecture, connectivity and software configuration to deliver maximum services over many years o Friendly, easy to use interface and payment method o On-site staff to assist patients. In order that the invention may more readily be understood, a description is now given, by way of example only, reference being made to the accompanying drawings, in which:- Figure 1 is a schematic diagram of a networked digital interactive system according to the invention; Figure 2 is a front elevation of a patient terminal according to the invention; Figures 3A is a rear elevation of the patient terminal of Figure 2; Figure 3B is a perspective view of the patient terminal of Figure 2; Figure 4A is a front elevation of a mounting arm for the patient terminal of Figure 2; Figure 4B is a perspective view of an attachment bracket of the mounting arm of Figure 4A; Figures 5A and 5B are screenprints of part of a GUI according to the invention; Figures 6A and 6B show an overlaid prompt as part of a GUI according to the invention;Figures 7A and 7B are screenprints of part of a GUI according to the invention: Figures 8A and 8B are screenprints of part of a GUI according to the invention: Figure 9A is a perspective view of a vending machine according to the invention; Figure 9B is a screenprint of part of a GUI of the vending machine of Figure 9A.

Background of the Invention The invention relates to a system developed to deliver a wide variety of services to patients in hospitals, namely (but not limited to):- Digital Television Digital Radio On-Demand Video On-Demand Audio Internet & Email Access Games Information Telephony / Voice Services Some of these services are charged to the patient and some are free of charge. Payment is via a pre-pay system using smartcards purchased from vending machines around the hospital, or via on-site advisory and support staff. The same system is also designed to be flexible enough to deliver services to hospitals themselves, namely (but not limited to):- Delivery of Bedside Computing Delivery of Information for Patients Delivery of Healthcare Advice Monitoring of Healthcare Conditions Assistance with Clinical Care The National Health Service Information Authority (NHSIA) have already approved Premier's network security connections and the NHS National Program for IT (NPfIT) has a programme in place to deliver these services over time and Premier is working within it's guidelines to ensure our system can comply. The solution overall has multiple parts, which can be defined as:- 14.The Patient Terminal 15. The Terminal Graphical User Interface (GUI) 16. The Terminal Software 17. The Mounting Arm 18. The Network Architecture 19. The Network Security 20. The Back Office Servers 21.The Back Office Software 22. The Customer Relationship Management Toolkit (CRMT) 23. The Vending Machine 24.The Vending Machine GUI 25. The Vending Machine Software 26. The Operational Setup These components are described on the following pages in detail.

Bluetooth Bluetooth connectivity - via internal USB header

LAN VT 6103, VT6105, Realtec 8139D or similar The Patient Terminal Insert Description Insert Pictures (Back, Front and Side)

Display Screen Type 15.1" XGA TFT (1024x768 resolution) Brightness [deg] 350Cd minimum brightness (Min) Brightness Control [deg] 20% to 100% User controllable Touch Screen Resistive Touch Controller Internal USB Peripherals and Device Interfaces Headphone Socket [deg] One 3.5mm jack sockets on the LH side of board Phone Handset [deg] Two RJ11 sockets either side of board Smart Card Reader [deg] Integrated with Gemcore chipset (model subject to availability)User Controls [deg] Membrane keyboard integrated on front of display module USB Ports [deg] Two free USB 2.0 ports for external peripherals Visual Call Indication -Call indication visible front and rear Reset Switch -Internal push button in connector recess Power Switch -Internal push button in connector recess Display Inverter [deg] Power enable and separate brightness control Remote Control 15 pin connector - USB, Audio and Spare 4 core for Nursecall Computing Platform CPU [deg] VIA Eden ESP 1GHz Northbndge [deg] CLE266 Southbndge [deg] VT8235 I/O Companion [deg] W83697HF or similar System Memory [deg] 512 Mb DDR 184pin Mpeg2 Decoder [deg] Built into Northbridge 3D Graphics [deg] Built into Northbridge Video Memory [deg] 32 Mb Audio [deg] VT1617, VT1616, VT1615 or similar (4 channel minimum) IDE Ports [deg] Primary master 40pin 3.5" HD with power connector,secondary master 44pin 2.5" HD, secondary slave compact flash socket Serial Ports 1x TTL to connect to Gemcore, lx TTL on header USB 2x External, 1x T/S controller, 2x internal on headers Keyboard Port 1x Internal header Mouse Port 1x Internal header GPIO 48x I/O lines, keypad, buzzer, on-hook, 8x on internal header Thermal Protection Internal sensors generates interrupt Watchdog Programmable up to 255 seconds Power Input 19V DC Audio Sub System Amplifier [deg] 0.3W RMS headphone output per channel (minimum) . Software headphone mute .Software handset mute Independent control of all audio channels via internal mixer Buzzer [deg] Incoming telephone call indication Operating System Capabilities Primary [deg] Linux, Win XP, Win Xpe, Win CE Other Devices Hard dnve [deg] 40 Gb 2.5", master on secondary IDE port Compact Flash [deg] Slave on secondary IDE port Floppy [deg] No Pnnter Port [deg] No Mechanical Specifications Mounting Rear fixture to articulated arm VESA mount 75mm IP Rating [deg] IP65 Front Face, IP54 Rear (TBC) Weight 5 kg (maximum) Cooling Fanless design, rear heatsink, minimal venting Operating Temp 0 0 to +45 degrees C (Continuous Operation) Humidity range 10 to 85% Maximum storage [deg] -10 to +55 degrees C Storage Humidity 10 to 90% Phone handset Specifications Handset Keypad None,keypad to be mapped on display Cable Type Retractable handset coiled cable Interface [deg] RJ11 connection Audio Sub system Amplifier Integrated on motherboard Disability Features Inductive loop pickup for hearing aids Adjustable volume Mechanical Specifications Mounting Via cradle or hook located on side of terminal IP Rating [deg] IP58 Insert Drawing & Description of Heatsink Insert Drawing & Description of Vents Insert Drawing and Description of Call Indicator Lights The Terminal Graphical User Interface (GUI) The GUI is the key part of the patient experience and is used to interface between all software and hardware components. It is a menu driven system, delivered using Dynamic HTML. Pages are stored on the terminal and interface with the back office servers to pick up other services such as video and audio.

Main Menu The screenshot below shows the main menu. The screen is split into three functional areas. 1. Function buttons 2. Control buttons 3. Information panel

Control Buttons This area contains the control buttons that allow you to "Personalise your Account", or in other words, add your own personal information to your account database such as name, age, address etc so that specific services may be delivered to you. "View your account History" shows a list of all recent purchases and subscriptions. "View Messages" takes the user to the messages page where messages can be viewed. Information Panel The information panel is consistent throughout all the GUI pages. This panel contains the following information. The hospital telephone number The patients' extension number Credit remaining on their account The current time and date Operator call button or contextual button (such as "back to menu/') Pressing the Operator call button will prompt the user to pick up the Telephone handset. When the telephone handset is picked up, the call to a pre-programmed Operator extension will be initiated. The prompt on screen will be changed to "connecting to the operator". When the call is terminated and the handset hung up on its cradle, the user is returned to the main menu (or the menu page that they initiated the call from). Functional Buttons Pressing the functional buttons allows access to the various services that the terminal delivers. For example: Pressing the "Watch Television" button switches the user to the television screens. Television Screens

This page allows the user to subscribe to one of two different TV packages for a 24 hour period. Pressing the "Buy this Option" will allow the user to view all the TV channels in the corresponding package providing they have enough credit on their Payment Smart Card. Pressing either of the "No Thanks" buttons returns the user to the main menu screen without any subscription or payment taken. If the user presses either of the "Buy this Option" buttons and if they are a first time user they are taken to the TV View page shown below. If they are not a 1st time user then the prompt does not appear. This page contains four main areas 1. TV viewing area 2. Help Prompt 3. Control Panel 4. Information Panel

TV Viewing Area The TV viewing area is where the TV streams are displayed. The Information panel is always displayed and contains the same information as that on the other pages, except that new buttons have been added. These are "Hide Controls" and "Back to Menu". Pressing the "Back to Menu" button quits the TV function, mutes the audio and returns the user to the Main Menu screen.If the Control Panel is displayed the "Hide Controls" button will be displayed, otherwise it will be labelled "Show Controls" - Pressing these buttons will hide or show the Control Panel respectively. TV Control Panel The control panel is superimposed on top of the TV viewing screen. It is normally only shown for a period of time determined by a preset value programmed into the software. The control panel contains the following control buttons:- Channel Up Show the next channel in the package. If maximum channel of standard TV package is reached, then display a message indicating that the user must upgrade the TV package to view this channel. If the user has already subscribed to the Premium TV package and the maximum channel is reached, it rolls over to display the first channel in the list Channel Down Show the previous channel in the package. If minimum channel is reached, and the user has only subscribed to the Standard TV Package, then display a message indicating that the user must upgrade the TV package to view this channel.If the user has already subscribed to the Premium TV package and the minimum channel number is reached, it rolls over to display the last channel in the list. Volume Up Turn the volume up one step. If the maximum volume is reached, then do nothing Volume Down Turn the volume down one step. If the minimum volume is reached, do nothing TV Guide Show the TV guide page (if available) Upgrade Package Overlay a TV package upgrade prompt to allow the user to upgrade their subscription from the Standard TV package to the Premium Package If a channel information data stream is available for an Electronic Program Guide, the Control Panel will also contain the TV channel name, the name of the program currently being shown and the time that it started at, the name of the TV program that will be shown next and the time that it starts. The availability of this data stream is dependant on Premier Telesolutions entering into a commercial arrangement with a services provider to supply this information stream.If this information is not available, the name of the TV channel will be taken from the Program Setup pages and nothing will be visible in the area reserved for the program names/start times. When a button is pressed, the graphical "LED" light above the button will change colour to simulate an illuminated LED light. When the button is released then the "LED" is returned to its original colour. This provides visual feedback that a button has been activated. After the preset period of time where there has been no activity on the control panel (i.e. screen touches) the Control Panel will automatically disappear. The Information panel at the bottom of the screen will change its "Hide Controls" to "Show Controls".

Again, after a preset time, the colour of the buttons in the information pages changes to simulate the effect of backlighting on the buttons being dimmed (below). This is to prevent these buttons from distracting the viewer. Pressing the touch screen will immediately "switch on" or change the button colour back to that shown above.

Watch a Movie Pressing the "Watch a Movie" on the Main page displays the following page

This page contains three main sections 1. Film Selection 2. Preview Panel 3. Information Panel Film Selection The Film selection section consists of a number of buttons each representing a different movie. Film Preview Panel The Preview Panel shows a small 1/8 size window running a continuous viewing of movie trailers. This movie trailer channel is either multicasted from the Video On Demand server or played from the hard drive of the individual patient terminal. Which one is used is determined by the Program Setup Pages. There is also a button to allow the user to view the preview channel in full screen mode. When this is pressed, the screen changes to one similar to the Television screens The operation of the buttons is the same as before except that when the "Return to Menu" button is pressed, the VOD screen is shown and not the Main Menu. Pressing any movie button in the Film Selection panel will display a page (below) giving information about that particular film. These pages are not held locally on the terminal, rather they are held centrally on the main data server so that they can be changed easily. Film Information The Movie Information page contains a textual description of the movie, running time etc. It contains information regarding the watershed and a trailer specific to that film. It also contains information regarding the cost of the movie. Pressing the "Buy this Option" will deduct the appropriate amount of money from the Prepayment Smart card. If there is not sufficient funds available, a warning message will be posted on the screen. If sufficient funds are available, the screen will switch to a full screen VOD viewing page. The Information Panel at the bottom of the screen contains the usual information as before. Pressing the "Back to Menu" button will bring the user back to the movie menu page and not the Main Menu.

Film Viewing Area The VOD viewing page is similar in appearance to the TV viewing page, except that the control panel is somewhat different. Because the Movie content is Unicast, we have the ability to add trick play functionality to the movie. This trick play functionality allows the user to pause/play, fast forward, and rewind the movie. The new control panel is shown (below). The buttons' functionality are as follows: Pause Pauses the movie Play Resumes playback from pause condition Fast Fwd Fast forwards the movie by preset amount Rewind Rewinds the movie by a preset amount Volume Up Turn the volume up one step. If the maximum volume is reached, then do nothing Volume Down Turn the volume down one step. If the minimum volume is reached, do nothing

Telephone The telephone operation can be initiated in three ways. 1. Telephone button on the Main Menu page 2. Telephone button on the front panel switch 3. Lifting the handset Performing any of these actions will switch to the Telephone Screen as shown below

Telephone Buttons The telephone screen contains a number of buttons 0..9 Dial number digits Control Keys (for DTMF dialing) Clear Clears the last digit dialled Redial Redials the last telephone number dialled Next Call Clears all digits dialled and switches on dial tone, if a call is underway, it terminates the call, clears the dialled digits and produces the dial tone. Operator Calls a predetermined telephone extension to call the operator Nurse Station Calls a predetermined telephone extension to call the Nurses station House Keeper Calls a predetermined telephone extension to call the cleaning staff Telephone Operation No dialling can be made without the handset being lifted from its cradle. Pressing any of the buttons will have no effect until the hanset is off hook. The user will not hear a dial tone until they lift the handset. The action of lifting the handset will change the state of the On.OffHook GPIO line to indicated that the handset is off hook. The audio will be routed to the hanset (instead of the headphones) by changing the state of the AudioSwitch GPIO. A .wav file of a dial tone is played to the user. Normal volume up/down commands are applicable during a phone call. The dial tone will be heard in the handset until the user presses a dial digit button, a redial button or either of the Operator, Nurse Station or Housekeeper buttons. When any of these buttons are pressed, a tone is heard in the handset. If the redial button is pressed, the previous number is displayed and the call is initiated (if the appropriate credit is available on the Prepaid Smart Card). To terminate a call, the user can hang up the handset or press the Next Call button. If either of the Operator, Nurse Station or Housekeeper buttons are pressed, the call is initiated. If a dial digit is pressed, the dial tone is terminated. The appropriate DTMF tone for the button is heard in the phone handset. The user can continue to enter digits to build up the telephone number. If a mistake is made, the user can press the Clear button to clear the last digit typed or press Next Call to start again. Once the number of digits typed equals the minimum number of digits required for a valid number (pre-programmed in Setup Pages), a timer is started. If the timer reaches the dialled digit timeout value (programmed in the Setup Pages), the number is transferred to the Back Office VoIP gateway to initiate the call. If the clear button is pressed, the timer is restarted. To terminate the call, the handset can be hung up or the Next Call button can be pressed. Inbound Calls Inbound telephone calls are not charged for. On reception of an inbound telephone call, the user will be prompted on screen that a telephone call is pending (below). A ringing tone will be heard in the headphones and the lights on the corners of the unit will flash. If allowed to do so, the internal telephone ringer will sound at the pre-programmed volume level. Whether or not the ringer will sound is determined by a time setting in the Setup Pages. Times to select one of the two ringer volume levels are also set in these Setup Pages. The user will have the facility to accept or reject the telephone call. To accept the call, the user simply picks up the handset. The ringing tone will stop in the headset and in the handset, the flashing lights will stop and the audio will be switched to the handset. The call will be connected and the user can talk to the calling party. The screen will not switch to the telephone screen, thus allowing the user to continue watching (without audio) what they were doing when the call came through. To terminate the call the user simply hangs up the handset in its cradle and the audio will be switched back to the headphones to allow the user to continue using the service that they were interacting with when the call was received. If the user wishes to reject an incoming call, they must press the "Reject Call" button on the alert dialog on the screen. This will terminate all the ringing signals and switch the audio back to the viewed service.

Internet Browser If the user presses either of the "Use Internet & Email" buttons on the main menu they are taken to the Internet Browser via a charge warning prompt. This page contains four main areas 1. Navigation Bar 2. Web Page Display Area 3. On-Screen Keyboard 4. Information Panel

Navigation Bar The Navigation bar contains all the usual internet browsing functions such as Back/Forward etc.. and address entry fields. This bar is present onscreen at all times when browsing the internet. Web Page Display Area This section is where the web pages requested are rendered into using normal web browser standards. On-Screen Keyboard This section can be shown or hidden at the users request and contains the standard keyboard functions required to browse the internet. Information Bar The Information panel is always displayed and contains the same information as that on the other pages, except that new buttons have been added. These are "Hide Keyboard" and "Back to Menu". Pressing the "Back to Menu" button quits the function and returns the user to the Main Menu screen. If the Keyboard is displayed the "Hide Keyboard" button will be displayed, otherwise it will be labelled "Show Keyboard" Pressing these buttons will hide or show the Keyboard Other Sections of the GUI The above detailed overview has covered the key features of the GUI.All other pages follow similar principles - for example the Audio Books menu and display mechanism works much the same as the Movie's do and the Radio functionality is the almost the same as the TV. The Terminal Software The software on the terminal is designed to deliver the functionality laid out in the GUI section above. It also has links into the back office servers for the video, audio, voice and television services as well as populating a lot of it's data from the database server - including upgrades. The functionality of this software is therefore intrinsically linked to the rest of the solution and does not require it's own detailed level of explanation within this document. The software is specified by Premier to third party companies for development under a licence arrangement. The Mounting Arm Insert Description Insert Images of Interface to Terminal Heat Sink Insert Drawings of Interface and Arm Construction Insert Structural Calculations Insert Mounting Details Note Power Distribution Method The Network Architecture The Network architecture is based around industry standard network equipment. Within this solution Extreme equipment is used but any standard network equipment that supports multicast can be used. The core uses 1 Gigabit multimode fibre providing a fan out from a central switch to edge switches. Each bedside terminal is connected to a local edge switch using 100Mbps Ethernet running over a CAT5E cabling infrastructure. The edge switches are grouped in multiples of 24 up to a maximum of 96 ports on any single fibre. This port density provides a guaranteed minimum bandwidth available at the bedside terminals of 1 OMbps even during full load conditions. All server, firewalls and content filtering equipment in the central location is connected to the core using either IGBps / lOOMbps Ethernet. The Telephony solution is provided using a Voice over IP gateway connected to single or multiple ISDN 30 circuits. The transport mechanism for data over the network infrastructure uses TCP/IP in either Unicast or multicast modes. Unicast provides the point to point communications system for services like Video on Demand but multicast is used for broadcast of general or paid TV channels.

lP Packets

In a LAN-to-LAN VPN, the source and destination addresses used in the new header are the IP addresses of the outgoing interface (in NAT or Route mode) or the VLAN1 IP address (in Transparent mode); the source and destination addresses of the encapsulated packets are the addresses of the ultimate endpoints of the connection.

Proposed IPSec Protocols IPSec uses two protocols to secure communications at the IP layer: Authentication Header (AH)-A security protocol for authenticating the source of an IP packet and verifying the integrity of its content. Encapsulating Security Payload (ESP)-A security protocol for encrypting the entire IP packet (and authenticating its content) Authentication Header The Authentication Header (AH) protocol provides a means to verify the authenticity/integrity of the content and origin of a packet. You can authenticate the packet by the checksum calculated via a hash-based message authentication code (HMAC) using a secret key and either MD5 or SHA-1 hash functions. Message Digest version 5 (MD5)-An algorithm that produces a 128-bit hash (also called a digital signature or message digest) from a message of arbitrary length and a 16-byte key. The resulting hash is used, like a fingerprint of the input, to verify content and source authenticity and integrity. Secure Hash Algorithm-1 (SHA-1) An algorithm that produces a 160-bit hash from a message of arbitrary length and a 20-byte key. It is generally regarded as more secure than MD5 because of the larger hashes it produces. Note: For more information on MD5 and SHA-1 hashing algorithms, see the following RFCs: (MD5) 1321, 2403; (SHA-1) 2404. For information on HMAC, see RFC 2104. Encapsulating Security Payload The Encapsulating Security Payload (ESP) protocol provides a means to ensure privacy (encryption), and source authentication and content integrity (authentication). ESP in tunnel mode encapsulates the entire IP packet (header and payload), and then appends a new IP header to the now encrypted packet. This new IP header contains the destination address needed to route the protected data through the network. With ESP, you can encrypt and authenticate, encrypt only, or authenticate only. For encryption, you can choose either of the following encryption algorithms: Data Encryption Standard (DES)-A cryptographic block algorithm with a 56-bit key. Triple DES (3DES)-A more powerful version of DES in which the original DES algorithm is applied in three rounds, using a 168-bit key. DES provides a significant performance savings but is considered unacceptable for many classified or sensitive material transfers. Advanced Encryption Standard (AES)-An emerging encryption standard which, when adopted by Internet infrastructures worldwide, will offer greater interoperability with other network security devices. This version of AES uses a 128-bit key. Key Management The distribution and management of keys are critical to successfully using VPNs. IPSec supports both manual and automatic key distribution methods. The proposed Premier solution uses automatic key distribution methods, as follows:- With Manual Keys, administrators at both ends of a tunnel configure all the security parameters. This is a viable technique for small, static networks where the distribution, maintenance, and tracking of keys is not difficult. However, safely distributing Manual Key configurations across great distances poses security issues. Aside from passing the keys face-to-face, you cannot be completely sure that the keys have not been compromised while in transit. Also, whenever you want to change the key, you are faced with the same security issues as when you initially distributed it. When you need to create and manage numerous tunnels, you need a method that does not require you to configure every element manually. IPSec supports the automated generation and negotiation of keys and security associations using the Internet Key Exchange (IKE) protocol. Premier refers to such automated tunnel negotiation as AutoKey IKE and supports AutoKey IKE with preshared keys and AutoKey IKE with certificates. With AutoKey IKE using preshared keys to authenticate the participants in an IKE session, each side must configure and securely exchange the preshared key2 in advance. In this regard, the issue of secure key distribution is the same as that with Manual Keys. However, once distributed, an AutoKey, unlike a Manual Key, can automatically change its keys at predetermined intervals using the IKE protocol. Frequently changing keys greatly improves security, and automatically doing so greatly reduces key-management responsibilities. However, changing keys increases traffic overhead; therefore, doing so too often can reduce data transmission efficiency. The Tunnel exchange and creation To establish an AutoKey IKE IPSec tunnel, two phases of negotiation are required: In Phase 1, the participants establish a secure channel in which to negotiate the IPSec SAs. ' In Phase 2, the participants negotiate the IPSec SAs for encrypting and authenticating the ensuing exchanges of user data. Phase 1 Phase 1 of an AutoKey IKE tunnel negotiation consists of the exchange of proposals for how to authenticate and secure the channel. The exchange can be in one of two modes: Aggressive mode or Main mode (see below). Using either mode, the participants exchange proposals for acceptable security services such as: ' Encryption algorithms (DES and 3DES) and authentication algorithms (MD5 and SHA-1). A Diffie-Hellman Group Preshared Key or RSA/DSA certificates A successful Phase 1 negotiation concludes when both ends of the tunnel agree to accept at least one set of the Phase 1 security parameters proposed, and then process them. Our proposed devices support up to four proposals for Phase 1 negotiations, allowing you to define how restrictive a range of security parameters for key negotiation you will accept. The predefined Phase 1 proposals that our solution provides are as follows: Standard: pre-g2-aesl28-sha and pre-g2-3des-sha Compatible: pre-g2-3des-sha, pre-g2-3des-md5, pre-g2-des-sha, and pre-g2-des-md5 ' Basic: pre-gl-des-sha and pre-gl-des-md5 You can also define custom Phase 1 proposals. Phase 2 After the participants have established a secure and authenticated channel, they proceed through Phase 2, in which they negotiate the SAs to secure the data to be transmitted through the IPSec tunnel. Similarly to the process for Phase 1, the participants exchange proposals to determine which security parameters to employ in the SA. A Phase 2 proposal also includes a security protocol-either Encapsulating Security Payload (ESP) or Authentication Header (AH), and selected encryption and authentication algorithms. The proposal can also specify a Diffie-Hellman group, if Perfect Forward Secrecy (PFS) is desired. Regardless of the mode used in Phase 1, Phase 2 always operates in Quick mode and involves the exchange of three messages4. The Premier devices support up to four proposals for Phase 2 negotiations, allowing you to define how restrictive a range of tunnel parameters you will accept. The predefined Phase 2 proposals that the Premier solution provides are as follows: Standard: g2-esp-3des-sha and g2-esp-aesl28-sha Compatible: nopfs-esp-3des-sha, nopfs-esp-3des-md5, nopfs-esp-dessha, and nopfs-esp-des-md5 ' Basic: nopfs-esp-des-sha and nopfs-esp-des-md5 You can also define custom Phase 2 proposals. Perfect Forward Secrecy (PFS) is a method for deriving Phase 2 keys independent from and unrelated to the preceding keys. Alternatively, the Phase 1 proposal creates the key (the SKEYID_d key) from which all Phase 2 keys are derived. The SKEYID_d key can generate Phase 2 keys with a minimum of CPU processing. Unfortunately, if an unauthorized party gains access to the SKEYID_d key, all your encryption keys are compromised. PFS addresses this security risk by forcing a new Diffie-Hellman key exchange to occur for each Phase 2 tunnel. Using PFS is thus more secure, although the rekeying procedure in Phase 2 takes slightly longer with PFS enabled. The VPN connection does not allow for any opportunity of split tunnels The Smartcard The Smart Card stores a digital certificate private key, and is used by an authorised user to initiate the VPN connection to the NHS Net and patient data from a patient bedside. (Step 1 on the schematic below). An authorised user is defined as a user who is registered for the Smart Card. Once the token is inserted into a Gemplus compatible card reader , the user will be asked to enter the pin code to verify the access to the token (two-factor authentication, something you have and something you know) The attempt to initiate a VPN tunnel is intercepted by the firewall, which then authenticates the digital certificate from the Smart Card with the RSA Certificate Authority Server. (Step 2 on the schematic) Once the certificate is authenticated, the VPN connection to NHS Net is established according to the policies set on the firewall. (Step 3 on the schematic) The User's public key is stored on the smart card and it is used to encrypt the data sent over VPN channel to NHS Net. The secure, encrypted channel is now established between the terminal at the patient's bedside, running via the EAL4 compliant VPN client, to the EAL4 compliant firewall and the patient data System.

Dial-in All sites that connect to the individual NHS Trusts will be fixed access sites. No dialup connections are planned. Internet Access As the NHSnet Code of Connection does not permit concurrent connection, the connection to the Internet is protected by separate ITSEC E3 /EAL 4 standard firewall. Access to the Internet is secured by using double firewalls. All connections from a local site are routed through the IPSec VPN to central hosting site, where the central firewall filters the content before allowing the access to the Internet. Security Policy Security on the Premier LAN is governed by the Premier Security Policy. Any access to the network or devices on the network are litmited to authorised people with requirements to access the network. Physical Security All clients are located on the individual Trust premises and swivel arms are secured into the wall. In addition to physical security, the Premier solution also implements the following network level security:- Port Lock Down - If a device is unplugged from the network, and another device plugged into the network (or even the same device). An automatic alarm is generated and sent to the central 24hr Premier monitoring station. In the case of an unknown device being inserted into the network, the network port will automatically be disabled and will require a manual enablement to restore service. MAC Address Lockdown - In addition to monitoring physical port access, every network port also has a logical match with the physical equipment it expects to see attached to its port. This is by the industry standard 16 digit hexadecimal MAC address associated with a network device. Therefore the port will only allow access from a known MAC address, due to the fact that this MAC address may be duplicated, we associate this with the "Port Lock Down" feature discussed above. This alerts the network management centre to any possible unauthorised access and disables the network access at the point of possible intrusion. Authorised clinical technicians and users will be instructed to log off and close all windows and applications, and remove the Smart Card before leaving the patient's bedside terminal. Other measures, like application timeouts and lockdowns, will be implemented to prevent accidental unattended connections left open while no authorised personnel is present. Once the Smart Card is removed all connections and sessions are automatically closed, however we recommend that users logout cleanly if at all possible. Virus Checking All servers deployed by Premier have anti-virus software installed. The virus reference file used by the software is kept up-to-date by a regular daily update. Anti-virus software is set to clean infected files that it encounters by default. Documented Agreements The connection to NHSnet will be subject to a written policy detailing the responsibilities in respect of NHSnet. Use of the connection will also be governed by a written agreement (policy) between Premier and individual NHS Trusts. This will be set within the initial contract of service with the NHS Trust. Staffing Premier staff manage the network using their own procedures and work instructions. This is in addition to the NHS / Trust requirements. Only two senior operations staff (IT Security Office & Central Team Leader) have access rights to make configuration changes to the Premier's Firewall. The Premier firewall is managed to Premier strict change control procedures, therefore all changes and policies have an audit log detailing, why and when they were implemented or changed. It is the responsibility of Premier network staff to configure the Premier LAN to agreed standards. All staff are made aware of their responsibilities regarding ICT security as part of staff induction. This is reinforced when individual application training is undertaken. Individual NHS Trust network staff will be responsible for issuing and allocating the security tokens and certificates. Network Management The Premier network belongs to Premier and is a routed, managed network. Network Management and fault rectification is the responsibility Premier. The Back Office Servers

As mentioned previously, the purpose of the overall system is to provide TV, Radio, Telephone and on demand services to the bedside terminals.

Television/Radio The TV signals are received from any number of sources, including Digital Satellite (DVB-S), digital terrestrial (DVB-T) or digital cable (DVB-C) sources. These signals are fed to a TV headend which receives, demodulates and streams the selected programs to the bedside terminals via the local area network. Therefore all the TV signals are delivered using TV over IP using multicasting technology. The method of reception and decoding of the TV programs is determined by which source they are transmitted and if they require a conditional access system to decode them (i.e. are the signals scrambled). If the TV programs are transmitted in the clear, the signals (from DVB-S and DVB-T) are fed directly to the IPTV gateway. This box is configured with the appropriate number of DVB-S and DVB-T PCI receiver cards depending on the configuration. Each card has the ability to tune into a single multiplex of programs. The IPTV gateway is programmed to remove the appropriate TV programs from the multiprogram transport stream being transmitted by the TV broadcaster and to repackage the selected programs into single program transport streams. These single program transport streams are then multicasted on the LAN for reception by the patient terminals. If the program to be received is scrambled prior to transmission, a conditional access decoder (with a smart card authorisation card) is required to decode the program stream before retransmission on the LAN. As many different types of conditional access exist, it is not practical to equip the IPTV headend with conditional access systems to decode these signals. A more cost effective method is to employ standard IRDs(Integrated Receiver Decoder) or Set top Boxes which are supplied by the broadcaster to consumers to receive and decoded these channels. As the output of these IRD's is generally analog video and audio, it is necessary to re-encode these channels into MPEG-2 format for retransmission over the LAN. The iSocket TV MPEG Encoders perform this function, one encoder being required for each TV program received.These re-encoded single program transport streams are multicasted on the LAN together with those program streams from the IPTV gateway. Reception of Cable TV programs are dealt with in exactly the same way as the conditional access channels. The LAN uses IGMP aware network switches to ensure minimal traffic on each node of the network.

The software running on the IPTV Gateway and the MPEG encoder hardware is all third party.

Telephone System The telephony system is all IP based using VoIP (Voice over IP) technology. The architecture of the IP Telephony system is shown below. The VoIP gateway is a SIP based gateway that facilitates the conversion of SIP based telephone calls to PSTN standards. Session Initiation Protocol (SIP) is a signalling standard that has quickly evolved into a key underlying technology for converged communication to differentiate businesses and increase productivity. It enables seamless data and voice convergence in multi-supplier environments with multiple applications. The IVR (Integrated Voice Receiver) is a module that acts as an automated attendant, automatically giving voice prompts to the caller to determine how to route the telephone call. This is primarily used during inbound telephone calls where the caller wishes to connect to a particular telephone extension number (patient terminal). The IVR will automatically answer the call and prompt the user for the desired extension number. The caller will dial the extension number using DTMF tones on their phone handset. The IVR detects these DTMF tones and passes this information to the SIP gateway which routes the call through to the correct destination. The PSTN connections to the VoIP gateway are PRI-30 telephone lines, the exact number required depends on the size and configuration of the installation.

The specification of the VoIP gateway must be done on a hospital by hospital basis as the number of PRI trunk line interfaces in the VoIP gateway will be determined by the size of the hospital. The voice systems are all third party products. On-Demand System (Video / Audio) To be added Database Systems To be added Miscellaneous Items To be added The Back Office Software The software in the back office is designed to deliver the functionality laid out in the GUI section and Back Office Servers sections detailed above. It also has links into the terminal software for services as well as populating data - including upgrades. The functionality of this software is therefore intrinsically linked to the rest of the solution and does not require it's own detailed level of explanation within this document. The software is specified by Premier to third party companies for development under a licence arrangement. The Customer Relationship Management Toolkit (CRMT) Insert Description Insert Statement about separate Patent application to be made The Vending Machine Insert Description Insert Drawing and list of Components o Touchscreen o Note Reader o Coin Mechanism o Printer o Smartcard Reader & Dispenser o Security o Processor and Motherboard o Network Connectivity The Vending Machine GUI Insert Description Insert Images of Key Components o Main menu o New Card o Top-Up o Refund Insert Sample and Description of Colour-blind Checks The Vending Machine Software Insert Description Insert Statement about Premier's Specification Insert Statement of link to GUI Insert Statement of link to Back Office Note use of third party provider The Operational Setup Insert Description Insert Statement of link to successful operation of the system

Claims

1. A networked digital interactive system for use in a hospital comprising one or more servers connected to a plurality of terminals, the system comprising means to receive via a terminal a verification of payment from a patient, and means to deliver after receipt of the verification a service from one or more of the servers when a demand for that service is received via a terminal from the patient.

2. The system of Claim 1 further including means to deliver patient-related information to the terminal upon receipt of an authorised request from a hospital employee.

3. The system of Claim 1 or 2 wherein the server(s) include a video server, and/or an audio server, and/or a telephony server, and/or a database server, and/or a firewall/content filter/VPN server.

4. The system of any preceding claim wherein a core switch connects the server(s) to the terminals.

5. The Patient Terminal for a system of Claim 1.

6. The patient terminal of Claim 5 including at least one visible call indicator.

7. The patient terminal of Claim 5 wherein each visible call indicator includes an LED configured to flash.

8. The patient terminal of Claim 5 wherein the LEDs are configured to flash sequentially.

9. The patient terminal of Claim 5 wherein the visible call indicator(s) is (are) located at a corner (plurality of corners) of the terminal.

10. The patient terminal of Claim 5 including a heat sink.

11. The patient terminal of Claim 5 wherein the heat sink includes a plurality of thermally-conductive pipes connected to components of the terminal which are susceptible to damage by heat, and to an external, thermally-conductive surface of the terminal.

12. The patient terminal of Claim 5 wherein the external, thermally-conductive surface is connected to a thermally-conductive mounting arm having a relatively large specific heat capacity.

13. A system or patient terminal substantially as herein before described with reference to, and/or as illustrated in, any one or more of the accompanying drawings.