遠端居家監看醫護應用之遠距資料存取架構設計與實現

A REMOTE DATA ACCESS ARCHITECTURE FOR HOME-MONITORING HEALTH-CARE APPLICATIONS

林昭宏(Chao-Hung Lin)

指導教授 ： 楊順聰 ； 郭德盛

國立臺灣大學/電機資訊學院/電機工程學研究所/博士(2006年)

https://doi.org/10.6342/NTU.2006.10462

摘要

由於醫學的進步與衛生福利的改善，國人的健康條件與平均壽命均有大幅的增進，連帶影響的是民眾對醫療品質的要求與臨床醫療行為的改變。而台灣在明顯邁向高齡社會的情況下，一些老年與慢性疾病有關的醫療與社會福利制度問題也應運而生。為因應此趨勢之轉變，以及滿足慢性病患希望在居家環境中也能接受到健康照護，有必要提升現有疾病監控技術與設備，加強遠端醫療網的建置與資料傳輸的功能，以及居家看護資訊交換與管理系統之研發。而這些網路系統的研發，主要功能在於透過生理訊息之擷取與分析，協助監控病患之健康狀況，以預防或診斷病患之病程，並在最適當的時間提供醫療行為的介入。

由於網際網路及行動通信網路的流行並普及，使得上述的遠距醫療網路得以逐步落實推廣，包含居家病患生理資訊之自動判別並視情況發出緊急通報訊息，或是監護人員從遠端連線存取居家病患之生理資訊等等之應用。但是網際網路上所存在的安全性問題眾多，而一般大眾對於電腦資訊安全的諸多議題又不具備足夠的知識，顧忌病患資料隱私相關的問題，使得此類遠端醫療網絡不易推廣至一般之居家應用。另外，傳統居家看護醫療網路的設計上，也缺乏考量慢性病患的移動需求，使得病患無法同時兼顧己身的移動性並享受照護系統之監護。這些問題都是遠距看護網路在推廣至一般家庭時所面臨到的障礙。

本篇論文的主要目的在於設計與實作一遠距居家健康監護的系統網路架構，改善傳統架構上所容易產生的系統安全性問題，並規劃可供病患漫遊的機制。在新的架構中我們提出一個中介的伺服器置放於遠端監控裝置以及居家的看護設備之間，這樣的架構除了可避免遠端的網路裝置直接存取居家環境網路，以提升居家系統之安全性之外，中介伺服器本身也實作了漫遊認證及漫遊病患資訊回傳之機制，讓使用者得以在漫遊狀況中仍可藉由其他的網路節點享受健康照護的功能。另一方面，此系統結合各種既有及未來之新興通訊技術，藉以串連病患及其家屬之間的照護網路。在新的架構下，於居家端我們設計無線生理資訊蒐集處理的功能，讓居家患者在不需妥協行動能力的情況下也能享有生理資訊之監護管理。而對遠距監護人員而言，我們設計即時通報以及遠距存取病患資訊的通道，讓病患可以獲得更縝密，及時，以及多樣性的醫療照顧。

關鍵字

居家照護 ； 遠距醫療

並列摘要

Due to the medical advancement and the improvement in hygiene welfare, health conditions and average life span of the people have promoted a lot. The general public then changes the behavior and requires medical services of higher quality. In Taiwan, the society is moving towards advanced age and many problems are found associated with healthcare and social welfare for the elders and the patients with chronic diseases. Therefore, lots of issues regarding medical system, regulations, medical environment and facilities, are worthy to be investigated. For example, to fulfill the requirements of homecare and telemedicine, the technologies and devices for disease monitoring should be improved, the network infrastructure for medical information exchange should be built, and the homecare information and management system should be developed. The requirement of medical equipments is another issue; the elders and the patients with chronic diseases usually need some permanent or temporary medical devices to improve their lives and to treat diseases. These devices can capture and analyze physiological data of the patients, monitor the progress of patients’ health conditions, and diagnose and raise medical care in time.
With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. In addition, mobile healthcare has progressed a lot during the past few years because of the maturity of Internet-related technologies, the high-speed and wide-bandwidth communication networks, affordable and massive storage media, and trustable wireless information exchanges and computer encryption technologies. The wide spread of Internet and personal computer offer people a low cost and efficient platform for information collection, deposition and transport. The popularization of portable devices and mobile communication networks make people able to access various information and mobile services. The integration of Internet and mobile communication will eventually impact the medical environment and management to reorganize different medical services. It is believed that Internet and mobile communication will promote the benefit and value outputs, reduce cost and mistakes, and improve patients’ care and treatment for medical organizations. For the patients, the Internet and mobile communication networks will also make medical care become more rigorous, prompt and diversified.
The mobility of the patients and the dispersion of the medical services are the principal challenge of medical technologies in the future. This results from the change of medical environments and systems, multiple participants of caregivers, and various channels of medical services. Home care and decentralization of medical services will become the major trends because there will be more and more elders and the patients with chronic diseases. Therefore, to establish a network among the elders, the patients with chronic diseases and the medical organizations is an important issue for a modern medical environment. With this network, the caregivers can collect and manage patients’ information for diagnosis and treatment. The patients can also keep appropriate communication with hospitals, and receive suitable information and treatment in time. With this viewpoint we recognize that Internet and mobile communication are playing important roles.
Many remote home-monitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers, reduce visits to hospitals, and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. Another issue is that most of the patients with chronic diseases are mobile and the remote home-monitoring system should take the roaming requirements into considerations. The purpose of our research is to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The broker server also functions as a presence management server to maintain the presence information of the registered devices. With this presence management function, instead of being confined to a single place, the patients can roam across this collaboration network and the remote caregivers can still stay in touch with the patients. The pros and cons of this novel architecture design are also discussed and summarized.

並列關鍵字

telemedicine ； remote surveillance ； home monitoring

參考文獻

[1] Chen HS, Guo FR, Chen CY, Chen JH, Kuo TS, Review of telemedicine projects in Taiwan, International Journal of Medical Informatics. 2001; 61: 117–129.

[3] Doolittle GC, Yaezel A, Otto F, Clemens C, Hospice care using home-based telemedicine systems, Journal of Telemedicine and Telecare 1998; 4: 58–59.

[4] Chisholm SW, Hahn MA, Emerging Veterans Health Administration geriatric and extended care initiatives, Geriatric Nursing 1995; 16: 42–44.

[6] Pavlopoulos S, Kyriacou E, Berler A, Dembeyiotis S, Koutsouris D, A novel emergency telemedicine system based on wireless communication technology-AMBULANCE, IEEE Information Technology in Biomedicine 1998; 2(4): 261 - 267

[7] Crowe BL, Telemedicine in Australia: a discussion paper, Australian Institute of Health and Welfare, Canberra, ACT, 2600, February 1993.