Internet communication services

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Literature review:-

During past several years the internet using is rapidly increased. The application of computer and communication technologies has resulted in the birth of telemedicine (D.G. Kilman, D.W. Forslund, 1997), (F.L. Kitson, T. Malzbender, V. Bhaskaran, 1997), (L. Kleinhoiz., 1994), (R. Simon, D. Krieger, T. Znati, R. Lofink, R.J. Sclabassi., 1995)., generally defined as the use of computer and communication technologies to communicate health information and to provide health care services over distances. Meanwhile, the recent rapid development of collaborative computing technology urges the necessity of collaborative medicine and collaborative consultation. "The Internet is a global communication system. This is a combination of hardware and software infrastructure, they provide links to computers" (Sutherland, Davies, Taylor, and NCP). In contrast, the web is one of the services communicated via the internet. It is a collection of inter connected documents and other resources, linked by hyperlinks and URLs.

The best communication services in the world are available on the internet. The first one is E-mail and online chat applications. "E-Mail is the concept of sending electronic text messages between parties as analogous to mailing letters or memos from the earlier creation of the Internet" (Sutherland, Davies, Taylor, and NCP).

"Online chat can refer to any way of activity to convey the information over the world wide web, but is initially meant a one to one chat or text based group chat, using tools such as instant messengers, internet relay chat, speakers and possibly MUDs" (Gregzade, Online chat) [6]. The expression online chat comes from the word chat which means "informal conversation" (Chat, Dictionary), NA).

Participants are many different computer vendors, but the Regional Health Care Network to work together in UN / EDIFACT standards for the electronic communications systems possible. The systems used by the various health professionals to exchange structured information in addition to the free e-mail text (H.B. Jensen, 1994). Thus, the data entered in the system of transmitters can be re-used in receivers of the system. More than 40 different vendors approved and implemented the standards of their systems, and in 2001 more than 25 million messages were exchanged with the clinical content of the Danish health care sector (figure-1) (MedCom, December 1999).

The definition of primary health care defined by Australian health minister's Council in 1988.

"Primary health care is to expand primary health care development in the health care of patients. The aim is to protect problems early on. Primary health care services involve continuity of care, health promotion and education, the integration of the prevention of ill treatment, as well as concerns about the population individual health, community involvement and use of technology"

Primary health care aim is to provide real-time communication between the patient and doctor by using the chatting application with appropriate security.


The web-technologies was primarily based on information sharing and broadcast, its network and operating system shows its use as a collaboration platform for worldwide distributed working groups. The World Wide Web is collaborative technology in the weak sense of the word, since it allows people to share information.

The basic idea is coming from the valuable several previous work based on these technologies provides effective health services in the community. There are more than 25 Project on medical health care records and some other projects are using more advanced technologies, it's not affordable for all people. Mean while in theses 5% projects are not succeed but it will help to continuing research on this filed and these are helpful for succeed project like Electronic medical records in US primary health care.

The major developments in the informatics in primary health care to provide better computerised services and reducing the human era are as follows:

Computerized Medical Records:-

Its purpose is to provide primary health care, general medical care in Central and requires that providers have the necessary information if they provide assistance (2003, J Am Med Inform Assoc, NA). The highly functional Electronic Medical Record only 5% health care providers use them effectively in the organization. Recently, there are only few effecting investment funds in Australia, New Zealand and England has achieved major positive result in carrying out EMR in primary care. Significant benefits realizable through routine electronic health records among the better the quality, safety and efficiency, coupled with increased ability to carry out education and research (David W Bates, Mark Ebell and Edward Gotlieb). Both England and Australia have conducted a Major national program to encourage the use of Journal of American Medical Informatics Association Volume 10 Amount 1 January / February 2003, when the patient's primary care provider EMR typically provides a snapshot of important information, including but not limited to, patient demographics, problem list, medicines and health maintenance. The data is used to create reminders, which increases the likelihood that patients actually receive the necessary treatment (Tierney WM, Miller ME, Overhage JM, McDonald CJ, 1993). Without such support the decision, it is very difficult to quickly determine what actions are takes place (David W Bates, Mark Ebell and Edward Gotlieb), (2003, J Am Med Inform Assoc, NA).The Electronic health records in primary care (Mount CD, Kelman CW, Smith LR, Douglas RM,2000). Other countries, including New Zealand and the Netherlands have also made significant progress (Thakurdas P, Coster G, Gurr E, Arroll B, 1996). In terms of speed, Australia is the most dramatic results. In May 2000, 70% of General Practitioners said that most of the doctors in its practice through their office computer to create most of their ethical drug. Please note that the transition can be achieved in Australia, providing financial assistance for GPs to help buy a computer that supports the implementation of the system for those in need and incentive for the providers of takes electronically. Most of the countries benefit from the use of EMR in Primary health care sector. After successfully implementation EMR in several countries, now every physician (almost 98%) is accessed EMR system in their work place computers. Almost all use this recipe for implementation and 30% reported that their activities are performed online by using the EMR. Only three vendors provide data necessary for the sale of accreditation systems that means they avoid use of paper documents in the health care sector. This is the major progress of new system. The application interacts with an application called Prodigy, interacts with the application and supporting management support, the plan is to share it applies to all primary care physicians (August 23 2002, NHS Information Authority, NA).

TeleMed (D.G. Kilman, D.W. Forslund, 1997):

TeleMed provides an international collaboration based on virtual patient records. The virtual patient record is a media-rich, graphical patient record utilizing data gathered from several different remote locations. TeleMed is implemented by using Java and CORBA technologies.

Med Fast (F.L. Kitson, T. Malzbender, V. Bhaskaran, 1997):

The US Department of Defence Advanced Research Projects Agency (DARPA) funded the telesurgery project named Med Fast, or Medical Forward- Area Surgical Telepresence. The concept is to operate the surgical unit in areas of conflict, accidents or natural disasters. The surgeon, from a safe distance, controls the remote operation through force-feedback devices such as surgical instruments. The system could also use specialized aircraft and satellite systems.

MedNet (R. Simon, D. Krieger, T. Znati, R. Lofink, R.J. Sclabassi, 1995):

MedNet and its predecessor, NeuroNet, were established at the University of Pittsburgh. This system is based on the Ethernet and provides real-time monitoring and multiparty consultation in the field of brain surgery. The inter-operative monitoring places a real-time control loop in front of the patients and surgeon, to warn the surgeon when the patient's nervous system is incurring damage.

Bermed (L. Kleinhoiz., 1994):

Bermed was German Heart Institute and Rudolf Virchow University Hospital. Bermed logically linking a shared, multi-media patient data and provide transparent access to authorized doctors to one job. The system provides asynchronous remote data access and synchronization between the pc connected to the conferences between doctor ATM and ISDN wide-area networks.


This project aims to promote cooperation between health care providers to meet and promote the transfer of real-time maintenance (V.Jagannathan., April 1995). Interdisciplinary Group for developers of computer systems, physicians and health scientists use research prototypes and commercial off-the-shelf in order to develop an open environment, cooperation in the field of health care. ARTEMIS, Community Care networks consist of the collection of primary care and specialized health care providers together to meet the health needs of the community. This allows the communications infrastructure for primary care doctors to consult specialists in remote areas of radiology, perinatology, and with your support for the X-ray, ultrasound, voice and other multimedia information on the label.

Telemedicine verses Face - To - Face health care:-

Telemedicine is an effective use of information technology in medicine and patient health care-related work. Thanks to the technological development of primary health care, telemedicine has been used in various field of health, although health care providers are interested in this technology to offer better services to the public and also those funds for projects to develop more sophisticated technologies.

The use of telemedicine has been reported in a variety of forms, from the 1960's onwards, and it has been defined in a variety of ways. Some of the early projects were part of military and space technology research programs, and the Top of the range of telemedicine has been used in health care. Recent applications of telemedicine encompass activities such as remote consultations in specialties' from dermatology to psychiatry, the transmission of electrocardiograms and radiological images, the provision of accident and emergency expertise to off shore oil rigs, remote fetal monitoring, and education for health professionals. The rapid developments in the technology are enabling health care organizations to see new ways of providing health care, and as the boundaries between health care settings become increasingly blurred, so too do the traditional roles of health care professionals. It might be expected that the fundamental relationships between patients and their health care attendants could also be significantly changed through the use of telemedicine. Telemedicine therefore raises questions of transfer of resources from hospitals to primary care settings, accessibility and acceptability of services for patients, and major issues of education, substitution and rescaling for health care staff.

According to the Cochrane collaboration (1999, Coherence collaboration project, NA), Studies provided variable and inconclusive results with other results such as psychological measures, and no analyzable data on the cost-effectiveness of telemedicine systems.

Information Flow in Primary health care systems:-

Primary care is vital to the preparation of good medical care. (Star field B., 1991), (Star field B., 1994), (Star field B., 1993) in 1996 one of the Medicine Institute specifies primary care as the preparation of stretchered, approachable health care services to address the most doctors to understand the personal health needs, develop a continuing collaboration of patients and applying in the circumstance of family and residential area. (1996, Institute of Medicine, NA) The growing number of people receiving treatment in medical care compared to any other direct observation of patient surroundings. (Green LA, Fryer GE Jr, Yawn BP, Lanier D, Davey SM, 2001) These activities reflect the major changes in the U.S., primary health care like the most of office brings down to primary care suppliers (1999, National Centre for Health Statistics, NA), is an acute chronic and preventive care, including the "precedence" situations like asthma, heart disease, diabetes and depression. (Green LA., 1998) Primary care providers manage information (patient or other sources), to integrate this knowledge of biomedicine, and to decide on action plans for patients. Figure -2 shows the how we effectively gather the date, how we can integrate with that gather data in organization and finally take the action means how we can effectively implement system and provide the e-health in different ways of communication to reach the services in correct time in far distances around the world.

Primary health care in U.K.:-

Recently in U.K primary health care sector there is lot of changes takes place. NHS Direct is a national service was established in 1998, UK National Health Service (NHS) to provide 24-hour nurse-led telephone advice and assistance. NHS Direct is a free service (local call cost only) to the public (2003, Department of Health, NA) are currently available to approximately 7.5 million calls a year in England and Wales (Eaton L., 2002). In 2000, the UK government introduced a plan for future investments and reforms within the NHS (2003, Department of Health, NA). Focus on the amendments was to give health care built on the needs of patients, including the need for knowledge and information. Modern means of communication, such as the Internet, has introduced new ways of access to health care and information. As with other, particularly Western, countries in number of Internet users in the UK is growing rapidly. NHS Direct has decided to extend their services on the Internet by introducing NHS Direct Online in 1999 (Tarpey AM., 2003). NHS direct online is provide a web chat application in the replacement of clinical enquire service but it is not successful because it is too expensive to use in the community and patient need to fill the form before start the conservation with trained nurse but is use full for particular patients like old people, some group of people who are disable like deaf, socially isolated people. It was thought that such a service could also provide access to health information and advice to customers, whose needs are currently, met the NHS Direct telephone service, because of availability problems, such as socially isolated or who have hearing or speech limitations. There are many web sites offer chat services to specific patient groups, such as cancer (2002, Cancer Information and Support International, NA) or in patients with schizophrenia (2004, Schizophrenia Chat Room, NA). Many web sites are designed to chat rooms, where patients can ask questions directly to the doctor specialized in the field. However, there is no service to provide one on one chat with a medical service.

NHS Direct Online (NHSDO) extends the NHS Direct, which allows the phone to be replaced by the Internet and new ways of providing better health care services to the community. The NHSDO service builds on the Clinical Inquiry Service (CES), which uses Web chat communication. In this web chat they are used form filling every time session begins. After filling introduction form about patient, then patient allowed to communicate with NHS trained nurse.


According to the study of previous work on informatics in the primary health care sector is very use full for the present proposal. During the study of previous developments and Technologies very useful for the development and expect the outcomes of the proposed system. The computer-based, collaborative medicine allows medical specialists to do the teleconsultation among themselves or with patients and finally, allows medical specialists to supply high-quality health-care services. Using proposed system, the patient can register for making online appointment with doctor. For interaction between patient and doctor chatting has provided. By this facility patient would chat with doctor. The development of this proposed system contains the following activities, this new approach provide real-time services with very low price by using the chatting application and medical records store in the database.

  1. Chatting application is purely text -based to communication between the patient, doctor, manager and administrator.
  2. In the patient prospective, patient must register about his personal and previous health information to use the system.
  3. After registration, if patient well known about the disease means patient could be able to communicate with the doctor. Otherwise, patient can be contact with the hospital manager. Manager allocates the doctor then patient can be proceeding with the doctor.
  4. After the conversation with doctor the entire reports will stored in the centralized database including doctor, patient and prescription details.
  5. Doctor will able to view patient related documents. When the doctor communicate with the patient through the chatting application by using the registration user id.
  6. Managers are to provide an Appointment of a Doctor to a Patient on request (based on Doctor's available timings).
  7. They are able to see the Complaints given by the Patient and must provide the Response for that.
  8. They have a facility to communicate using chat, email facility with other stakeholders and Search facility to find a Patient or Doctor and can check their Profile or History details.
  9. Administrator prospective, he is the main super user in this system. He can have privileges to do anything in this system and also he is the people who received the profile of doctor and accept or reject the registration of the doctor.
  10. He is also able to receive the complaints from the patient and redirects respective doctor for response.
  11. He is only person responsible for backup of patient, doctor details and maintains history.
  12. He is able to generate reports, log files, recovery of the data any time.
  13. Proposed system has search facility to the patients. Patients can search for the doctors and their available timings for take appointments.
  14. Proposed system has generate different kinds of reports such are
    • Patients History and prescriptions
    • Doctors list
    • Lab reports
    • Daily & Monthly Reports, Appointment list of Patients for Managers

Finally, Authentication is nothing but providing security to the system. Here every must enter into the system throw login page. The login page will restrict the UN authorized users. A user must provide his credential like user Id and password for log into the system. For that the system maintains data for all users. Whenever a user enters his user id and password, it checks in the database for user existence. If the user is exists he can be treated as a valid user. Otherwise the request will throw back.

Proposed SDLC for Web-chat application:-

My proposal is based on health care sector for this application I need to consider some professional experts ideas and as well of supervisor ideas to implement and some modifications may be occur in any stage of the development. So, I need to specify the SDLC to development of chatting application between the doctor and patient by using the medical records. At first I studied the different SDLC methodologies, after careful consideration I would propose "spiral model" is very suitable for this kind software development. General structure of the spiral model is shown below figure-3

SDLC play special role in the development of product. By using this model we completely analysis the requirements of the system and is there any changes occur in requirement stage; we can easily modify and continue development of the system.

Barry Boehm was specified Spiral model in 1988; "this is software development and Enhanced model" (Boehm B., 1986). The specialty of this model is iteration process takes place through entire system from initial stage means requirements stage to the testing stage. In this each stage starts with a target goal and ends with end user reviewing. Analysis and organizing are involved in stage of the project. There are several models to discuss iterative development, but this is the first model to discuss why we are using iterative models compared to other models. The following steps are involved in the Spiral modal (Boehm B., (1988).

  1. The new system requirements are defined in much detail as possible. This process involves consultations with number of corresponding users and all users exit in the system like, internal, external and other views of the existing system. A overture design is created for the new system (Boehm B., 1988).
  2. This phase is the most important part of the "spiral model". In this phase, all possible (and available) alternatives, which could help in the development of a cost-effective project is analyzed and strategies are decided to use them. This phase was added specifically to identify and resolve all the possible risks in the project development. If the risks indicate any form of uncertainty in the requirements, prototyping may be used to proceed with the available information and possible solutions to deal with possible changes in requirements inventions (Boehm B., 1988).
  3. The first model of the new system is composed of the preliminary draft. It is usually a scaled-down system, and represents an approximation of the characteristics of the final product (Boehm B., 1988).
  4. A second model is involves by a four-times routine Boehm B., 1988) :
    • Evaluation of the first model in terms of its weaknesses, Strengths, and risks;
    • Defining the requirements of the second prototype;
    • planning and design of the second prototype;
    • Building and testing the second prototype.


In the proposed system which includes web-based chatting application and this application is mainly developed, for the purpose of chatting between the patient and the doctor. All the details of the patient will be stored in the database which is accessible by the administrators, allowed managers and doctors. When the patient starts the chat with the particular doctor assigned to him, all the database of that particular patient was seen by the doctor. According to previous data and information given by the patient in the chat application, the proper medication was given to the patient. The key issue here is the patient data will not be shared with the outside members apart from the doctor.

The good idea behind the chatting application is, whenever a patient comes to the doctor for his/her medical condition to the hospital, the patients used to forget all the things they want say to the doctor because they are bit nervous as doctor is busy and the patient has to tell his/her symptoms within the short span of time. But, by using this chat application patient had enough time to describe his/her symptoms without forgetting anything. By this, he/she can get the exact medication from the doctor.


  • UN / EDIFACT: United Nations/Electronic Data Interchange For Administration, Commerce and Transport.
  • EMR: Electronic Medical Records.
  • TIE: Telemedicine Information Exchange
  • DARPA: Department of Defence Advanced Research Projects Agency.
  • CORBA: Common Object Request Broker Architecture
  • NHSDO: National Health Service Direct Online
  • CES: Clinical Inquiry Service
  • SDLC: Software Development Life Cycle


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