DEVELOPMENT OF AN OPEN SOURCE WEB PORTAL FOR

THE EXCHANGE OF MEDICAL DATA

Benjamin Schneider

, Oliver Heinze

, Kai Lederle

, Gerald Weisser

Department of Information Technology and Medical Engineering, Heidelberg University Hospital

Tiergartenstraße 15, 69121 Heidelberg, Germany

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

 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.



Webportal



DICOMemailclient



Installation



Central installation of the portal

Localsoftwareinstallationrequired

Applicationaccess



HTTPs protocol is used

Localinstalledapplication

Useradministration



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

SendDICOMemails



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

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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