An Open Source-based Secure Dermatology Telemedicine Consult System
ABSTRACT A significant area of telemedicine activity focuses on the diagnosis and treatment recommendations for dermatologic conditions. In this area it has become evident that store-and-forward systems are just as effective and less costly than traditional, high-bandwidth videoconferencing technology. We built a secure web-based, low cost store-and-forward system that conforms to anticipated HIPAA privacy regulations. The system is constructed with a combination of Open Source products and a web user interface. In recognition of the sensitive nature of the patient data contained in the system, communications over the public Internet are protected with SSL and the database employs role-based access authorization.
An Open Source Based Secure Dermatology Telemedicine Consult System
Yi-Jung Lin, MS, Stuart Speedie, PhD
Department ofLaboratory Medicine and Pathology
UniversityofMinnesota Medical School, Minneapolis, MN
Abstract - A
activity focuses on the diagnosis and treatment
recommnendations for dermatologic conditions.
this area it has become evident that store-and-forward
systems are just as effective and less costly than
We built a secure web-based, low cost
anticipated HIPAA privacy regulations. The system
is constructed with a combination of Open Source
products and a web user interface. In recognition of
the sensitive nature of the patient data contained in
the system, communications over the public Internet
are protected with SSL and the database employs
role-based access authorization.
Introduction - Typical telemedicine systems make
use of high-bandwidth two-way digitally compressed
video and audio to allow the specialist to interact
with the patient at a distance.
cardiology and psychiatry such live interaction is
essential. However in dermatology it is evident that
asynchronously with much less expensive technology
and at considerable benefit to the patient in terms of
access and time saved .
and-forward") uses either an email system with
attached images, a client-server database application
or a web-enabled database application.
In the store-and-forward approach, the nurse at a
remote site uses a digital camera to capture images of
dermatologist who, at a convenient time, reviews the
images and prepares written diagnostic, treatment and
These comments are then
transmission to the referring physician.
number of proprietary products on the market that
include this function as part of a larger, more
functionality as inexpensively as possible using Open
Implementation - The application was developed
with a combination of Linux, Apache, Open SSL,
MySQL, and PHP - all Open Source software and
distributed free of charge. The hardware platform is
a typical desktop PC equipped with a Pentium III and
a 20 GB drive. The system is designed to be a secure
database application that allows personnel at the
significant area of telemedicine
In specialties such a
frequently be made
This approach ("store-
for viewing and
There are a
is to create
pictures and to view and print the specialists consults.
Similarly the specialist can sign into the system,
review patient data and write their comments using a
secure web interface.
On the server side the system is running under
the Linux operating system with an Apache Web
Server. All data including physician consultations are
being stored in a MySQL database. The application
uses server-side PHP functions to conmunicate with
the database. We also built a role-based authorization
component to specify access rights to the database
system. In consideration of the need to protect the
confidentiality of clinical data, the system employs
SSL for encrypted communications.
On the client side users connect to the system
through current versions of SSL-enabled Internet
Explorer. To facilitate transferring the data from a
digital camera to a local PC, we created an image
auto-transfer program with WinBatch, an advanced
Windows batch language. The user begins
process by double-clicking an icon that automatically
downloads the camera images to the local PC. After
entering a usemame and password, the nurse at a
given remote site completes the patient information
form and then selects the images from the local disk
to upload to the server.
confirmatory display to
information will be uploaded. To retrieve completed
consults, the nurse links to the web site, signs in and
selects from a list ofthe site's patients. This displays
the patient's record including all images and the
results ofthe dermatologist's reviews.
The reviewing dermatologist
system through a web browser and is presented with
a list of patients requiring review.
review they select a case, view the patient data and
all current and prior images and then enter their
conclusions. They may also review completed cases
by selecting from a similar patient list.
to upload patient information and
The system presents a
To conduct a
Linder B, Adams G.
Annual Meeting of the American Telemedicine
Association, April 5-8, Orlando FL, 1998.
This work was supported by a grant from the Office for the
Advancement of Telemedicince, Grant No. 2 H2A TM
Assessing the utility of
with Kaiser Permanente, Third
1067-5027/01/$5.00 © 2001 AMIA, Inc.