Mobile Middleware Architecture for Reliable Clinical Communication

Abstract

Mobile clinical applications are useful in emergency care to capture patient-care data from a remote location and send them to a hospital server in real-time. The digital form of the medical data obtained is called electronic medical record (EMR). The clinical messages generated based on the Health Level Seven (HL7) standard to transmit the EMR, must be delivered accurately and in sequence to avoid duplication of records. Due to intermittent wireless connection problems and the limitations of mobile devices, the reliability of the clinical message transmission process is at risk. The inconsistency in messaging instance causes delivery of multiple copies and sometimes, loss of vital information. To prevent these communication errors and improve the reliability, additional messaging mechanisms are required. In this thesis, these mechanisms are identified and built into a mobile middleware framework. A mobile middleware is defined here as a software component that acts as an interface between clinical applications and network operating systems to provide reliable and loss-free communication of confidential data. The mobile middleware developed from this research is called Agent-based Mobile Middleware Architecture (AMMA). It uses mobile agents for safe message delivery using an agent migration protocol (AMP). The AMP utilizes a compact message template derived from HL7–Clinical Document Architecture (CDA) specification for protected mobile clinical communication. The protocol is designed to guarantee sequence delivery of an EMR, with mechanisms for conformance checking and exactly-once delivery. In addition, an adaptive intelligent user-interface with event controls is included to monitor the battery power of the mobile device, the active wireless network interface, and the location information. AMMA was tested using the electronic patient call reporting tool developed for the 9-1-1 emergency medical services of the Saint John regional hospital. The three key mobility parameters: user mobility, signal strength, and bandwidth availability were used for performance evaluation. Evaluation tests for consistency, conformance, and migration of clinical messages demonstrated a high level of reliability with a failure rate less than 0.2. The test results showed that AMMA delivered the clinical data in exactly-once sequence with a reliability score of 4 in a scale of 1 to 5. Equivalent Cs