Mobile middleware architecture for reliable clinical communication

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University of New Brunswick


Mobile clinical applications are useful in emergency care, to capture patient-care data from remote locations and send them to an electronic health record (EHR) system of a hospital in real-time. The digital form of the medical data collected is called as electronic medical record (EMR). The clinical messages generated to transmit an EMR into an EHR are based on health level seven (HL7) standards. An EMR must be delivered accurately and in sequence to avoid duplication of records. Due to intermittent wireless connection problems and computing limitations with mobile devices, the reliability of a clinical message transmission process is at risk. The inconsistency in messaging instances cause delivery of multiple copies and sometimes, loss of vital information. To prevent communication errors, additional messaging mechanisms are required. In this thesis, these mechanisms are identified and built into a mobile middleware framework. A mobile middleware is defined here as a software component that acts as an interface between clinical applications and network operating systems to provide reliable and loss-free communication of confidential data. The mobile middleware developed from this research is called Agent-based Mobile Middleware Architecture (AMMA). It uses mobile agents for safe message delivery using a unique agent migration protocol (AMP) developed from this thesis. The AMP utilizes a compact message template derived from HL7-Clinical Document Architecture specification for reliable mobile clinical communication. The protocol is designed to guarantee sequence delivery of an EMR, with mechanisms for conformance checking and exactly-once delivery. In addition, an adaptive intelligent user-interface with event controls is included to monitor the battery power of the mobile device, the active wireless network interface, and the location information. AMMA was tested using the electronic patient call reporting tool developed for the 9-1-1 emergency medical services of the Saint John regional hospital. The three key mobility parameters: user mobility, signal strength, and bandwidth availability were used for performance evaluation. Evaluation tests for consistency, conformance, and migration of clinical messages demonstrated a high level of reliability with a failure rate less than 0.2. The test results showed that AMMA delivered the clinical data in exactly-once sequence with a reliability score of 4 in a scale of 1 to 5.