DEVELOPMENT OF AN OPEN SOURCE WEB PORTAL FOR
THE EXCHANGE OF MEDICAL DATA
Benjamin Schneider
1
, Oliver Heinze
1
, Kai Lederle
2
, Gerald Weisser
2
1
Department of Information Technology and Medical Engineering, Heidelberg University Hospital
Tiergartenstraße 15, 69121 Heidelberg, Germany
2
Department of Clinical Radiology, Mannheim University Hospital, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Björn Bergh
Department of Information Technology and Medical Engineering, Heidelberg University Hospital, 69121 Heidelberg,
Germany
Keywords: DICOM e-mail, Teleradiology, Telemedicine, Portals.
Abstract: The Teleradiology/Emergency Medicine Network in the Metropolitan Rhine-Neckar Region (Germany)
enables the exchange of medical data. However, the inclusion is difficult because of technical reasons for
some partners like general practitioners. For that reason a web portal for the exchange of medical data
within the Teleradiology/Emergency Medicine Network is under development. The Digital Imaging and
Communications in Medicine (DICOM) e-mail standard offers the base for the data exchange. The portal
itself will be developed by Java Server Pages (JSPs) and Java Servlets. The data will be saved in a MySQL
database. The external DocCheck authentication service will be integrated additionally to the internal user
administration. The concept has been finished and the portal is under development. The concept foresees
that the web server is located in the demilitarized zone (DMZ) of the Heidelberg University Hospital and the
database is running within the clinical network. The portal offers the possibility to use the
Teleradiology/Emergency Medicine Network without any charge.
1 INTRODUCTION
A Teleradiology/Emergency Medicine Network for
the inter-institutional exchange of medical
information (especially image data) has been in
operation in the Metropolitan Rhine-Neckar Region
for six years (Bergh, Hollerbach, Schall 2005). The
network was built within the scope of a
teleradiology project, it was subsidised by the
ministry for social affairs of Baden-Wuerttemberg in
Germany. The network connects about 27 hospitals
and many more partners like surgeries, research
facilities and home office stations with a steadily
increasing number.
Since 2009 the second stage from that
teleradiology project which is also financed by the
ministry for social affairs of Baden-Wuerttemberg
has been running. This project has two main
objectives. The first one is the interdisciplinary
expansion of the network. The second aim is to
expand the network to get a comprehensive patient
care in Baden-Wuerttemberg. In the following one
component will be presented to succeed in the
second aim.
2 OBJECTIVES
The communication within the
Teleradiology/Emergency Medicine Network is
based on the open DICOM e-mail standard (Weisser
et al. 2006, Mildenberger et al. 2005). The
communication partners require special DICOM e-
mail clients for the data exchange with dedicated e-
mail servers and thus other partners. Especially
installation, maintenance and configuration demand
technical knowledge which low-frequented users
like general practitioners seldomly have and which
538
Schneider B., Heinze O., Lederle K., Weisser G. and Bergh B. (2010).
DEVELOPMENT OF AN OPEN SOURCE WEB PORTAL FOR THE EXCHANGE OF MEDICAL DATA.
In Proceedings of the Third International Conference on Health Informatics, pages 538-540
DOI: 10.5220/0002787405380540
Copyright
c
SciTePress
Figure 1: architecture of the portal.
hence “excludes” them from the
Teleradiology/Emergency Medicine Network.
An open source teleradiology web portal, allowing a
secure and simple alternative to the DICOM e-mail
clients, should be developed to address this issue and
promote the expansion of the regional
Teleradiology/Emergency Medicine Network.
3 METHODS AND MATERIALS
For a preferably optimal result the specification of
the functional requirements were discussed with
radiologists as well as medical informatics during
the development of the web portal. The technical
implementation is based on Java, Java Server Pages
(JSPs) and Java Servlets. The open DICOM e-mail
standard is used for the data transmission within the
Teleradiology/Emergency Medicine Network. The
basic requirement of the portal will be that the used
elements are all open source because several
partners will install the portal in separate
installations. Important components of the portal are
the MySQL database and a directory server (in the
following called Lightweight Directory Access
Protocol (LDAP) server) with all partner
information of the Teleradiology/Emergency
Medicine Network. At the moment the Deutsche
Röntgengesellschaft (DRG) plans to build such an
LADP server and they will provide this server for
the users of the network in future. Additionally the
portal offers the possibility to integrate an LDAP
server for the internal user management.
4 RESULTS
The portal offers the possibility to send medical
information (images and other information) via
DICOM e-mail to any partner within the
Teleradiology/Emergency Medicine Network absent
any prior software installation by the sender. The
architecture of the portal (figure 1) provides three
network areas with different portal components:
The users which want to use the portal as well as
the LADP server from the DRG are located in the
internet (first area). The DICOM e-mails will also be
sent via the internet using the Simple Mail Transfer
Protocol (SMTP) to a partner within the
Teleradiology/Emergency Medicine Network. The
teleradiology web portal itself is located in a special
DMZ of the Heidelberg University Hospital
network. That means there is a firewall between the
portal and the internet. The portal communicates
over the LDAP, Hypertext Transfer Protocol Secure
(HTTPS) and DICOM e-mail protocol with the
actors in the internet area. It communicates also with
the optional LADP server and the MySQL database
which are located in the third area, the internal
Heidelberg University Hospital network. There is
DEVELOPMENT OF AN OPEN SOURCE WEB PORTAL FOR THE EXCHANGE OF MEDICAL DATA
539
Table 1: web portal vs. DICOM e-mail client.
Webportal
DICOMemailclient
Installation
Central installation of the portal
Localsoftwareinstallationrequired
Applicationaccess
HTTPs protocol is used
Localinstalledapplication
Useradministration
Central user administration
Localuseradministration
Configuration
Central Administrator configures the
portal
Localconfiguration
Administration
Central Administrator configures the
portal
Localadministration
Maintenance
Central Administrator maintain the
portal
Localmaintenance
SendDICOMemails
Yes Yes
Receive DICOM e
mails
No Yes(product‐dependent)
also installed a firewall between the internal network
and the DMZ. The LDAP server in the internal
network can be used for a central user
administration, but it is optionally. A MySQL
database saves all data of the portal.
The send workflow will be described in the
following: The user calls the URL of the portal; if he
is already registered he can log on and use the
functionality of the portal. Otherwise he has to
register first and the administrator of the portal has
to check the data given by the user. An alternative is
the login via an account at the medical
authentication service DocCheck. This service
enables enrolled physicians to use the portal without
any prior registration. A logged in user can select a
recipient within the Teleradiology/Emergency
Medicine Network and upload any image to the web
server. Prior to transmission all files are digitally
signed and encrypted on the client side. The web
server wraps the received file data into a standard
DICOM e-mail, which then will be sent to the
recipient.
The teleradiology web portal will be published
under an Open Source licence. The project partners
are very happy about this fact, because every partner
can install his own portals and expand them to
address special requirements.
5 CONCLUSIONS
The web portal of the Teleradiology/Emergency
Medicine Network offers general practitioners and
other low-frequent users within the Metropolitan
Rhine-Neckar region the possibility to use the
advantages of this network for free and to connect to
all partners with a minimal effort.
Table 1 compares the centralized web portal
solution with a local installed DICOM e-mail client.
The comparison of the two solutions show that the
maintenance of the portal is no less sophisticated
than the maintenance of a single client, but the portal
offers the advantage that this effort must be done
once on a central application by a specialist.
Afterwards users of the Teleradiology/Emergency
Medicine Network can use the service without a
complex installation, configuration and maintenance
of a local client. But the portal offers only the
possibility to send DICOM e-mails; it is not possible
to receive e-mails, this functionality is reserved for
the DICOM e-mail clients.
The web portal is an important milestone for the
expansion of the network and thus improves patient
care in the Rhine-Neckar Region substantially. But
the concept as well as the open source software of
the portal can also be employed within other regions.
REFERENCES
Bergh, B., Hollerbach, A., Schall R., 2005. Teleradiologie
mittels DICOM-E-Mail und PACS-Integration. In
Telemedizinführer Deutschland. Jäckel (Hrsg.).
Weisser G., Walz M., Ruggiero S., Kämmerer M.,
Schröter A., Runa A., Mildenberger P., Engelmann U.,
2006. ’Standardization of teleradiology using DICOM
e-mail: recommendations of the German Radiology
Society’, Eur Radiol., 753-8.
Mildenberger P., Kämmerer M., Engelmann U., Ruggiero
S., Klos G., Runa A., Schröter A., Weisser G., Walz
M., Schütze B., 2005. ’Teleradiology with DICOM e-
mail: recommendations of @GIT’, Rofo., 697-702.
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