Proof of Concept: JABR Technologies' Consult98 Implementation

December 19, 1998

Lisa Rein and Tim Bray

OceanMed is a service founded by Dr. John Coller, a surgeon at the Lahey Clinic just outside of Boston, along with Mr. David Earley. OceanMed was able to use the Consult98 system to transport live images from across the world to an e-mail-integrated Web server where specialists from the Lahey Clinic and New England Medical Center retrieved the data, consulted it, held conferences and e-mailed their recommendations back to the ships.

"We went live on the ship in the middle of a hurricane in the Gulf of Mexico, and the system worked on the first try," Borden explains. "The first consult was transmitted within one hour of the digital camera arriving on board."

Consult98 allows images and other medical information to be packaged in standard Internet data formats including MIME, text, and JPEG. The information can also be in the DICOM 3.0 protocol, which is the ISO/ANSI standard network protocol for exchanging images between medical imaging devices of the American College of Radiology(ACR)/National Electrical Manufacturers Association(NEMA) Digital Image Communication for Medicine(DICOM). ACR/NEMA DICOM 3.0 is the standard format for transmitting images between, for example, an MRI machine, an image archive, and a medical imaging workstation.

Consult98 receives an incoming "consult" (represented as a multipart MIME message) which is then processed, indexed, converted into an XMTP formatted document, and stored in a database (ideally, the GroveBase, but this can be any kind of lightweight database).

Why e-mail?

One of the initial constraints of this project was that Borden was forced to work with the existing Lotus cc:Mail system already in place on the ships, so in this case plain text was used. This required some additional modifications to Consult98 to enable the plain/text MIME type to transmit the information rather than Consult98's native XML.

"Initially, we realized that we couldn't get a Web connection from the boat," explains Borden. "The only thing available was an e-mail connection. So what we created was the ability to use our system over an SMTP e-mail connection."

"The advantage of e-mail is that it is asynchronous. We created transactional e-mail queues to provide reliability much the same as Microsoft's Message Queue and Exchange. The advantage is that this uses a fully standard messaging protocol, namely SMTP. This allows truly worldwide transactional messaging."

"Without a doubt e-mail is the single biggest application in the medical community," explains Borden. "What we have done is integrate standard SMTP e-mail with XML so that we can index this information." Through the XMTP protocol, e-mail information can be integrated into databases and transformed using standards such as DSSSL and/or XSL.

"We use a hybrid approach," explains Borden. "The message can be either completely XML based or contain an XML header. Parameters are specified by XML tags. If binary data is needed, this fits into a multipart message. Since we are using a combination of MIME and XML we have incredible flexibility and the power to do complex datatype representation."

The intention is to eventually encode the MIME message body in XML rather than text/plain in order to tag diagnostic information. For example:

 <consult> <patient> <lastname>Yeltsin</lastname>
          <firstname>Boris</firstname> </patient> <symptoms>
          <chest>cough</chest> <abdomen>tender</abdomen> </symptoms>
          <allergies>penicillin</allergies> <history>chronic
          pneumonia</history> </consult>