With the continuous development of next-generation network technology, soft switching has not only transplanted the public switched telephone network PSTN (Public Switched Telephone Network, PSTN) to the IP network, and realized the voice over Internet Protocol (VoIP). Provide an excellent system architecture to integrate voice services, video services, and emerging Internet services into a unified framework, and the SIP protocol is a key link among them. The SIP-related standards issued by the SIP working group, one of the youngest working groups of the IETF, have become research hotspots in the communications and networking community. At present, there are more than 30 protocols and drafts published by the SIP Working Group. In addition to the core protocol, other protocols cover QoS, security, message header and method extension, interoperability with other protocols such as PSTN, penetration of firewalls and NAT, and many applications. Message body, instant message and many other topics, the ultimate goal is to provide ubiquitous access for all successful Internet applications, and become an important medium to connect the Internet with telecommunications and multimedia.
This article is based on the general policy of the country to vigorously develop community medical care and the project needs of the Shandong Province Information Industry Special Development Fund Project "Research and Development of Virtual Hospital Integration Platform". Analyze and comprehensively use electronic technology, computer technology and modern communication technology to design a community remote monitoring network system for chronically ill patients and elderly people based on SIP protocol. The system serves as a bridge between hospitals and patients, reducing unnecessary "patient visits to hospitals" and the number of times doctors prescribe patients, enabling more effective and higher quality patient care, so that patients can stay at home as much as possible to accept colleges and universities Doctor's guidance and care measures. The results of a trial operation in a community in Jinan City showed the feasibility and advanced nature of the system design.
1 SIP architecture
SIP is an application layer control protocol. Like HTTP, SIP is also a communication protocol and is a collection of standards. He defined how terminal devices (computers, landlines, and mobile phones) exchange information with each other through protocols.
SIP can establish, modify, and terminate multimedia sessions or calls. SIP mainly has 2 kinds of structural elements, namely user agent UA and network server. UA is located in the SIP terminal station. It contains two parts: one is the user agent client (UAC), which is responsible for issuing SIP requests; the other is the user agent server (UAS), which is responsible for responding to SIP requests. In general, these two parts can be converted to each other. Among them, there are three different types of user proxy servers, namely: redirect server, proxy server and register server (Register).
The network architecture diagram of SIP is shown in Figure 1.
As one of the three types of user proxy servers, the redirect server processes the INVITE message by sending the SIP URL address obtained by the callee. The proxy server performs SIP request and response routing at the application layer. The proxy server can be memorized or non-memory. After processing a call, the memorized proxy server will completely forget all information about the call until the next message arrives. In addition, the agent can be a branch agent or a branchless agent. For example, a branch agent can make several phones ring at the same time until someone picks up one of them, while a branchless agent can only have one phone at a time. Ringing. The registration server is generally used to record SIP addresses (SIP URL) and related IP addresses, and is usually used for registration after startup. Since the SIP URL address is used in the REGISTER message, when the INVITE request arrives, the proxy server or the redirect server can directly forward the request information. This forwarding feature based on the registration server forms the basis for the network to support true number mobility services. Usually, a SIP network server can realize the combination of different types of servers. The typical flow of SIP calls is shown in Figure 2.
In Figure 2, as a UAC, hoping to talk with each other, UAC first sends an INVITE request, after the local SIP proxy server sipl.com receives the INVITE request, after address resolution, it is sent to the SIP proxy server sip2.corn, while sip1 .com returns a 100 Trying message to User1. After receiving the INVITE request from sip1.com, sip2.com forwards it to sip1.com and returns a Trying message. After User2 receives the INVITE request, before responding, it will return a 180 Ringing message to sip2.com. This Ringing message will be forwarded to sip1.com and User1 in turn. If User2 decides to answer the call, it returns a 200 OK message. This message goes through sip2.com, sip1.com, and finally reaches User1. After receiving the 200 OK message, User1 directly sends an ACK confirmation message to User2. At this point, the call establishment process is complete, and a media channel can be established between User1 and User2 for dialogue. When one party wants to end the call, send a BYE message to the other party, the other party returns a 200 OK message, and the SIP call is terminated.
The community telemedicine system uses the SIP protocol as the key protocol for system design, based on its obvious advantages in combining with the Internet design:
(1) SIP has excellent scalability, which can greatly reduce the pressure on the central node (core network server) and marginalize system services.
(2) Using the SIP protocol can easily embed inexpensive end-user devices, and can ensure its interoperability, enabling different devices to communicate.
(3) SIP emphasizes the support of multi-party conferences, including IP multicast and request branch functions, which provides good support for remote consultations.
2 System overall design ideas and implementation
The SIP protocol has been successfully applied in the fields of network video surveillance, network conferencing, and VoIP. Drawing on the successful experience of SIP in these aspects, the community-based remote network system based on SIP given in this article uses a personal computer as the basis, a computer communication network as the technical platform, and a modular design. The main framework of the first phase project is to monitor ECG, Physiological parameters such as blood pressure are the target, and a monitoring network for remote consultation can be realized, so that patients can get many medical services such as emergency treatment, rehabilitation guidance, medical history management, etc. of doctors or field experts in the community in a timely manner. The system adopts a modular design, which can provide different service functions for different chronic patients and elderly patients' monitoring requirements.
2.1 The hardware configuration and connection of the system
The community telemedicine system is composed of user terminal equipment (home camera, personal computer, medical terminal), community doctor's electronic workstation, community health file database, etc. Use the existing computer network system in the hospital area and community to install the system software and use it. The system adopts C / S structure and is divided into client, business logic middle layer and server. From the content, it is divided into user information management, personal health file management, doctor information management and consultation management. The system consists of a database server, a client of the community clinic server, a home client, and a user interface file system. During installation, the system will distinguish between the community client and the home client, and automatically install the required files and complete the corresponding settings. Each communication is initiated by a randomly started client process, and the server process is in a waiting state from power on, responding to the client process at any time, thereby meeting the monitoring requirements.
The basic hardware composition of the community medical system is shown in Figure 3.
In the hardware design of the system, a database server needs to be established, and a medium-to-high-end microcomputer with a large hard disk can be used. The main reason is that the storage capacity of the hard disk should be large to facilitate the establishment of a patient database and storage of medical data. The server is installed with Windows NT Server operating system. Because he provides client / server mode, the network processing speed can be accelerated. In the user and community clinics, only one microcomputer and some simple monitoring and collection equipment are needed to enable patients to achieve a convenient mode of medical treatment at home. In addition, some patients with severe chronic diseases and the elderly can be equipped with monitoring instruments in their homes, such as: blood glucose meters for diabetic patients; peak respiratory flow meters for asthma patients; electrocardiographs for heart patients; Electronic sphygmomanometer for hypertensive patients. At the same time, the community clinic can also provide some monitoring equipment for the fetus and pregnant women, rent and monitor the pregnant families in the community, which has a good help and guidance for pregnant women, especially high-risk pregnant women and fetuses. The database server can be placed in the community clinic to share the same microcomputer with a client of the community clinic server. By setting the Windows NT server, the microcomputers in the community can be connected into a small local area network for easy management.
2.2 Software function module composition and implementation
The system software structure is shown in Figure 4.
The core software of the system is a remote dynamic management platform. The registration and login module realizes the registration of community users and community doctors, records the basic situation of patients, and manages the user's information. The electronic medical record module records the patient's previous diagnosis records, examination results and treatment measures. The software and hardware interface module provides data transmission between the system and the remote medical terminal, and can set corresponding parameters as required. The remote consultation toolkit module provides patients with face-to-face consultations with doctors, and doctors can also have a visual understanding of the patient's rehabilitation status through him.
The system work flow chart is shown in Figure 5.
The typical workflow of the system is: patients and doctors first register and log in the database to obtain a user ID, and then log in directly with the ID number and password. After logging in, patients can create their own detailed health files, and fill in some medical data measured at home to the corresponding places, and then submit. After the community doctor enters the system, he can view the data files of the patients in the community, perform asynchronous diagnosis on the medical data measured by the patients, and write the diagnosis results into the patient's medical record. In addition, the system can also provide remote consultation services, and patients can contact the community doctors through consultation appointment services to carry out remote consultation treatment at the appointed time. At present, the education of patients is gradually becoming an important part of the health care system. By passing computer-based training courses through the medical platform, the patient becomes more efficient and effective. Here, the platform can provide some medical training materials to the residents of the community through E-mail or BBS.
3 Conclusion and significance
The purpose and significance of developing a community remote monitoring network system are:
(1) Shorten the distance between doctors and patients. Community clinics are generally established in various communities and are relatively close to community residents. They can provide timely assistance to patients and reduce the travel between patients and medical staff. In addition, remote monitoring of important physiological parameters of patients can not only assist in medical treatment, but also alarm when the condition suddenly deteriorates.
(2) As the number of elderly people in the community increases, the requirements for community health care are also increasing. Remote monitoring of the daily life of the elderly with poor self-care ability can not only improve the nursing level of the medical staff and the quality of life of the patients, but also assess the health status of the monitored objects.
(3) The improvement of modern living standards and changes in lifestyles make the population with chronic diseases such as cardiovascular and cerebrovascular diseases, diabetes, and sleep syndrome more and more huge. Remote monitoring of patients suffering from chronic diseases can not only enable patients to understand their condition in time, but also obtain timely doctor's rehabilitation guidance through the remote network.
(4) Through the community remote monitoring system, establish contact between community clinics and core large hospitals, exchange patient electronic medical records and conduct remote consultations, not only to achieve "two-way referral", but also reduce the core to a certain extent The pressure of medical treatment in large hospitals has realized the "diversion" of patients.
As mentioned earlier, building a community telemedicine network platform is not only beneficial to improve the efficiency and quality of work of existing medical facilities and medical professionals, but also alleviates the contradiction between the lack of medical conditions and people's requirements for medical care. And to a certain extent, a large number of health information resources on the network can be aggregated through the computer network to provide to the community residents to achieve the purpose of health education. Although the system requires little peripheral hardware support and many functions are replaced by software, the current conditions in the domestic community are not very balanced. Therefore, it is necessary to design modules that meet the current community conditions according to the specific situation and add them to the system to make the system further. Perfection.
The long-term development trend of the modern medical industry is to develop towards a networked and intelligent medical system, establish a people-centered and continuously innovative medical service system, and through continuous improvement of the community medical service network, it is possible to gradually achieve "small diseases in the community, serious diseases go to the hospital" Good medical situation. The medical mechanism through the combination of community and family, community and large hospital will become a good model for making full use of medical resources, reducing medical expenses, and realizing that everyone can enjoy medical treatment.
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