Abstract:
Systems and methods of providing telemedicine services are provided. A system can include a medical device that obtains diagnostic information, a gateway device coupled to the medical device, an application server coupled to the gateway device via wired and wireless networks, a database coupled to the application server, the database storing the diagnostic information, and an analyzing device coupled to the database, the analyzing device analyzes records in the database to identify diagnostic information that exceeds predefined thresholds.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims priority under 35 U.S.C. § 119 to U.S. Provisional Application No. 60/987,563, filed Nov. 13, 2007, the entire disclosure of which is herein expressly incorporated by reference. The present application is related to U.S. patent application Ser. No. 12/110,471, filed Apr. 28, 2008, the entire disclosure of which is herein expressly incorporated by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    A number of factors are driving the health care and wellness industries to move towards comprehensive support of dynamic monitoring of patients and updating their personal records. This new approach to health care, sometimes coined e-health is driven by the need to reduce the cost of patient treatment and the inefficiencies associated with non-critical patients occupying scarce health care resources like hospital beds and nursing among others. The need for e-health is made more urgent by the ageing population in most industrialized countries. 
         [0003]    Electronic transfer of medical records is currently used in hospitals around the world. The Digital Image and Communications in Medicine (DICOM) standard was developed to transfer images and associated patient details between an imaging device (e.g. Ultrasound imaging) and a database. The Health Level 7 standard was developed to track the accounting and visitation records for patients. Other software products are currently used by family doctors to store patient records on their computers. However, with the exception of imaging data, the vast majority of information included in patient records is entered manually. Doctors&#39; and nurses&#39; handwritten notes are often scanned and stored in the patient record. 
       SUMMARY OF THE INVENTION 
       [0004]    A number of medical and wellness devices are currently used by medical practitioners and end users to monitor various bodily functions, for example, blood sugar levels, blood pressure, oxygen concentration in the blood stream, heart rate, etc. There is a clear need for the automation of the process of recording medical information measured by such devices and others. 
         [0005]    On the other hand, there are strict requirements for the mechanisms that may be used for recording such sensitive information. For example, the mechanisms used must be secure, reliable and in many cases, timely. Sharing patient information with third parties must be done based on strict authorization. Storage of such information must be secure. Finally, a number of performance-related requirements exist if this information is transferred over a wireless system. Efficiency of the information transfer is necessary in order to appropriately utilize the expensive wireless resources. Depending on the capabilities of the wireless device used and the service being provided, other information associated with the user may be necessary, like the user&#39;s location and the type of wireless gateway device being used to relay the information from the medical device to the remote server on the Internet. Several other features associated with the authorization of third parties may be needed. 
         [0006]    Exemplary embodiments of the present invention are directed to remotely transferring medical information and updating a patient&#39;s record. The present invention is not limited to the health care industry, but it is equally applicable to the wellness industry where users are not sick, but are monitoring their general health, exercise routines or nutrition. 
         [0007]    An exemplary method for a medical device involves obtaining diagnostic information, discovering a gateway device, establishing a connection with the gateway device, establishing a session with the gateway device, and transferring, by the medical device, the diagnostic information to the gateway device. 
         [0008]    An exemplary system includes a medical device that obtains diagnostic information, a gateway device coupled to the medical device, an application server coupled to the gateway device via wired and wireless networks, a database coupled to the application server, the database storing the diagnostic information, and an analyzing device coupled to the database, the analyzing device analyzes records in the database to identify diagnostic information that exceeds predefined thresholds. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWING FIGURES 
         [0009]      FIG. 1  is a block diagram illustrating an exemplary architecture in accordance with the present invention. 
           [0010]      FIG. 2  is a flow diagram of an exemplary method in accordance with the present invention. 
           [0011]      FIG. 3  is a flow diagram of an exemplary method for connection establishment in accordance with the present invention. 
           [0012]      FIGS. 4 and 5  are flow diagrams of exemplary methods for session termination in accordance with the present invention. 
           [0013]      FIG. 6  is a flow diagram of an exemplary method for session establishment in accordance with the present invention. 
           [0014]      FIG. 7  is a flow diagram of an exemplary method for exchange a wait message in accordance with the present invention. 
           [0015]      FIG. 8  is a flow diagram of an exemplary method for session redirection in accordance with the present invention. 
           [0016]      FIG. 9  is a flow diagram of an exemplary method for session multicasting in accordance with the present invention. 
           [0017]      FIG. 10  is a flow diagram of an exemplary method for session establishment in accordance with the present invention. 
           [0018]      FIG. 11  is a flow diagram of an exemplary method for stream initiation in accordance with the present invention. 
           [0019]      FIG. 12  is a flow diagram of an exemplary method for event subscription in accordance with the present invention. 
           [0020]      FIG. 13  is a flow diagram of an exemplary method for an event notification process in accordance with the present invention. 
           [0021]      FIG. 14  is a flow diagram of an exemplary method for retrieving data from an application server in accordance with the present invention. 
           [0022]      FIG. 15  is a flow diagram of an exemplary method for a redirect process in accordance with the present invention. 
           [0023]      FIG. 16  is a flow diagram of an exemplary method for a multicasting operation in accordance with the present invention. 
           [0024]      FIG. 17  is a flow diagram of an exemplary method for session termination in accordance with the present invention. 
           [0025]      FIG. 18  is a flow diagram of an exemplary method for a command message exchange in accordance with the present invention. 
       
    
    
       [0026]    Other objects, advantages and novel features of the present invention will become apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings. 
       DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0027]      FIG. 1  illustrates the overall system architecture. The system includes medical device  10  coupled by link  20  to gateway device  30 . Medical device  10  comprises hardware and/or software that perform functions related to health care, wellness or nutrition. The device measures biological information about a human or an animal and sends such information out to an application relay function in gateway device  30  via link  20 . 
         [0028]    Link  20  is a wired or wireless link that connects medical device  10  to gateway device  30 . Examples of such link include, but not limited to, Infra-red, Bluetooth, Universal Serial Bus (USB), ethernet, or Wireless Local Area Network (WLAN). Medical device  10  and gateway device  30  may be collocated in the same device, in which case the link  20  is represented by the hardware and software internally allowing those two entities to communicate. 
         [0029]    Gateway device  30  comprises software and hardware components that allow it to communicate, through wired or wireless links, to other devices on the Internet. This device connects medical device  10  to a remote application server  70  using link  20  to a radio antenna  40  connected to Internet  60 . The gateway device also includes the application relay which negotiates the session to the remote application server  70  in order to send information that was earlier sent from medical device  10  or information generated by the application on the gateway device. Gateway device  30  may be connected to the Internet  60  through a wireless network comprising a radio tower  40  and one or many routers  50 . References herein to gateway device  30  in signalling exchanges as a single entity includes the software components inside gateway device  30  that initiates such messages. 
         [0030]    Application server  70  is responsible for receiving and storing information from gateway device  30 , which either originated from medical device  10  or gateway device  30 . The application server also manages the authorization of third parties to view, update, or modify a record. Furthermore, the server is responsible for the management of a session between the server and gateway device  30 , which includes the management of user authentication, authorization, access rights, flow control of data, user profile, among other factors related to a user&#39;s subscription or ongoing data transfer. Storage and retrieval of user records stored in database  1000  is controlled by application server  70 . 
         [0031]    Database  1000  stores the user&#39;s records. Each record is owned by a user, hereafter referred to as the record owner. The database  1000  is populated by application server  70 . The database may contain intelligence that allows it to search, categorise and manipulate entries for statistical purposes. 
         [0032]    Analyser module  1500  is coupled to database  1000 , and searches through the different records in order to look for abnormalities that can be highlighted to a user viewing such records. This includes looking for measurements that are out of normal ranges based on age, race, and sex of a patient. Entries outside normal ranges may be highlighted for better viewing or can be raised as an alert for the record owner and nominated third parties (e.g. family members, health care practitioners, and so on). Furthermore, such alerts, if they cross predefined thresholds, can be used to contact emergency services on behalf of the record owner. Predefined thresholds for different actions can be configured on a per-user basis. Thus, for example, if information provided by medical device  10  to database  1000  indicates an abnormal heart rate, blood glucose level, etc., analyzer  1500  can identify the abnormality and notify a doctor, hospital and/or ambulance service. 
         [0033]      FIG. 2  illustrates an exemplary method in accordance with the present invention. Medical device  10  connects to gateway device  30  via link  20  (step  405 ). During such connection the application generating the information to be sent on medical device  10  announces its properties and identification to the application relaying the information on gateway device  30 . In addition, other data pertaining to the type of information being sent and its requirements can be exchanged. Following a successful connection establishment, the application on gateway device  30  initiates a session with application server  70  (step  410 ). During the initiation, the application performs the necessary security procedures for authentication and authorization. Furthermore, the application on gateway device  30  can exchange information with application server  70  about the type of data being exchanged and its requirements. This may result in application server  70  commanding the application on gateway device  30  to encode the information in a particular manner. 
         [0034]    Following a successful session establishment between gateway device  30  and application server  70 , information can be relayed from gateway device  30  to application server  70  (step  415 ). Such information includes data received from medical device  10 , as well as, signalling information from gateway device  30  to application server  70 . Information can also be sent from application server  70  to medical device  10  via gateway device  30 . After information has been exchanged between application server  70  and medical device  10 , the session and connection can be terminated (step  420 ). 
         [0035]    As discussed above, medical device  10  and gateway device  30  may be two separate physical devices or collocated within the same physical device. In either case communication between those devices involves connection establishment and data transfer steps. The connection establishment step involves the application on gateway device  30  discovering its peer on medical device  10  and setting up a session between the two peers. In doing so, the application on gateway device  30  needs to first discover its peer, discover its peer&#39;s capabilities, then set up a session. The session set up involves exchanging security credentials and the communication port. A communication port may be a logical port on each communicating device, an internet API based socket or any other software module responsible for sending and receiving traffic between the peers. The data transfer step data involves an exchange of data between the two peers. The data encoding and transmission behaviour is exchanged during the discovery and session set-up phases. 
         [0036]      FIG. 3  illustrates the message flow for peer discovery and connection establishment between the application on gateway device  30  and its peer on medical device  10 . The Link_layer_discover  5  message exchange allows the two devices to discover each other&#39;s link layer information, such as the link layer address or hardware identification. This message would only take place on the link layer, directly between the two devices if they were sharing the same link or transparently bridged to appear to share the same link. Some link layers (e.g. Bluetooth links) allow for a more sophisticated exchange of information on the link layer. For instance, the Service Discovery protocol (SDP) in Bluetooth allows devices to discover services supported by their peers. For such links, we introduce a new identifier to indicate the support of health services, for instance, the term “vhealth” can be used by medical device  10  to announce that it runs medical or wellness applications. Upon the exchange of link layer discovery and connection information, both devices become aware of each other&#39;s link layer details and can send information on that level. Note that as a part of this step, some IP layer messaging in order to discover or configure IP addresses can be exchanged. 
         [0037]    The Device_announce  15  message, allows medical device  10  to announce some of the capabilities that are needed in order for the two applications to start communicating. This message contains, at least, the IP address of the device, and types of medical applications supported by the device. 
         [0038]    In one aspect of this invention, this message is sent on the IP layer. In this case, this message can be encoded as a new Neighbour Discovery option (RFC 4861) for IPv6, or a new Address Resolution Protocol (ARP) parameter for IPv4. On point-to-point links, the message can be unicast to the gateway device  30 . However, on shared links, the message should be multi-cast to several nodes on that link. In one aspect of this invention a unique link-local multicast group is used for medical applications. In another aspect of this invention a unique site-local or organisation-local address is used for medical applications. In another aspect of this invention the message is sent to the Well-Known All nodes multicast IP address in IPv6 or broadcast to all nodes on IPv4 links. 
         [0039]    In another aspect of this invention this message is sent by the application layer. Where TCP/IP is used for this communication, the application on medical device  10  can send this message to a reserved, well-known port, or a preconfigured port for the application relay on gateway device  30 . If TCP/IP is not used for this communication, applications on medical device  10  can send this message to a negotiated or preconfigured communication port. In yet another aspect of this invention this message can be added to link layer exchanges during the link layer discovery phase or after configuring an IP address for communication. After processing message  15 , gateway device  30  detects medical device  10  and its application capabilities as illustrated by the device detected block  25 . 
         [0040]    After discovering medical device  10  on the link layer and potentially the IP or application layers, the application relay on gateway device  30  announces itself in the Relay_announce message  35  sent to the medical device. This message serves to acknowledges the reception of message  15  and announce the application relay&#39;s capabilities to medical device  10 . This message includes, at least, the application relay&#39;s IP address and port. The application relay&#39;s IP address is one of the IP addresses configured on gateway device  30 . If no IP address is configured, the link layer and communication port information should be announced instead. The application relay&#39;s port identifies the communication port, represented by name or number, that the application relay expects its peer on medical device  10  to send its information. 
         [0041]    On point-to-point links, the message is sent directly from gateway device  30  to medical device  10 . However, on shared links, the message may be sent gratuitously to a unique multicast group that includes all medical devices. The scope of such group may be link-local, site or organization-local. However, when responding to a specific medical application device, the application relay on gateway device  30  may unicast this message to the medical device in order to include the acknowledgement information for the Device_announce  15  message. This message may be sent on the IP layer (for both IPv4 and IPv6), the application layer, or the link layer. 
         [0042]    In the Authentication step  45  mutual authentication between the two applications takes place. In one aspect of this invention, mutual authentication can be based on preconfigured credentials in medical device  10  and gateway device  30 . In another aspect of this invention, mutual authentication can be performed based on Public keys configured in both applications and exchanged during message exchange  45 . 
         [0043]    The Identification message  55  is then sent from the application running on medical device  10  to its peer application relay running on gateway device  30 . The message includes, at least, the following information:
       The application identifier field, which contains information that identifies the application. The information included in this field would contain at least the following:
           Application type parameter, which indicates the functions supported by the application. For instance, an application may be used to measure an electro-cardiogram, heart rate, kidney functions, and so on. Each application is allocated a name or a number that can be used by the receiver to detect the type of application.   Application vendor parameter, which indicates the vendor of the application. Different vendors may have different formats for the data.   Data encoding parameter, which indicates the data encoding scheme. For instance, the data may be sent in binary format, text format, XML, and so on.   Data compression parameter, which indicates whether a compression mechanism, if any, is used to send the data, and if it is, the mechanism is identified.   Quality of Service (QoS) information field, which includes information about the traffic behavior sent by the application. This includes expected packet inter-arrival, delay tolerance, reliability requirements, packet ordering requirements, and so on.   
           The software version supported by the application. This information allows the relay agent to learn the software supported by medical device  10  application.   The data encoding formats supported by the application on the medical device.   Compression mechanisms supported by the application running on medical device  10 .       
 
         [0053]    The Id_ack  65  message is sent from the application relay running on gateway device  30  to medical device  10 . This message acknowledges the reception of the identification message and informs the application on medical device  10  whether a session can be established. If a session can be established, this message contains a session identifier that can be used by the application running on medical device  10  during data transfer. Moreover, as described below, additional information about attributes for the data flow is included in this message. The session identifier can be included in every message sent from the application on medical device  10  to the application relay on gateway device  30  to allow the application relay to identify the session associated with the data transmitted. The session identifier can also be used as a look-up key when data between the two devices is encrypted on the application layer. This message can be authenticated and encrypted based on the keying material derived after the authentication message exchange  45 . Hence, this message contains, at least, the following information:
       Acknowledgement for receiving the Identification message  55 .   If session establishment is successful, a session identifier is included. The session identifier may be a 64-bit number. This number may be randomly generated or selected by the application relay by other means.   If session establishment failed, an appropriate error code is included.   Authentication and encryption data used to authenticate this message by the receiver.   Selection of the application relay&#39;s preferred data encoding format for data sent by the application on medical device  10 . This is needed when the application on the medical device supports multiple formats while the application relay prefers a specific format or supports a smaller number of formats.   Compression requirements parameter, which informs the application on medical device  10  whether compression should be used and if it is, what compression mechanism should be used.       
 
         [0060]    Now that the discovery and connection establishment processes has been presented, the processes associated with data transmission between the application running on medical device  10  and the relay application on gateway device  30  is discussed in detail below. 
         [0061]    Based on the data format preferences exchanged between medical device  10  and gateway device  30  during the discovery process encompassing the Identification  55  and Id_ack  65  messages, gateway device  30  commands medical device  10  to use one of its preferred formats for data transfer. After a session is established, medical device  10  can start transmitting information to gateway device  30 . Regardless of the data format, each packet contains the following information:
       Source address.   Destination address.   Session identifier.   A message identifier parameter that uniquely identifies a message within a session. This can be represented by a large number used as a counter.   Communication ports.   The application identifier (optional).   Amount of information waiting for transmission.   An urgent alert parameter that alerts the application relay that there may be a medical emergency that needs attention based on the measurements performed. This parameter need not hold binary values. There may be different levels of urgency that need to be communicated. A device may be running out of battery power and needs to send data as soon as possible. Similarly, a device may be lacking other resources and therefore needs to send data to free some of its resources. Hence, this parameter may hold various values depending on the level of urgency experienced.   A data parameter that contains information generated by medical device  10 .       
 
         [0071]    Exemplary embodiments of the present invention employ signalling messages exchanged between the application on medical device  10  and gateway device  30  to convey information about the data exchanged or the session as a whole. 
         [0072]    Session termination may take place due to several reasons, including lack of resources, lack of data to send, errors in transmission, and so on. Either the application on medical device  10  or gateway device  30  can terminate the session at any time.  FIGS. 4 and 5  illustrate how session termination can take place when initiated by either end of the communication. 
         [0073]    When terminating the session, the application on medical device  10  sends the Session_Terminate  75  message to the application relay on gateway device  30 . The Session_Terminate  75  message contains, at least, the session identifier and reason for termination. The session identifier parameter is the same parameter provided by the application relay when the session was established. This parameter is used by the receiver to identify the session being terminated and the resources associated with such session. The reason parameter indicates the reason for terminating the session. There may be several reasons for the termination including: idle timeout, no measurements being done, lack of resources, communication errors, and so on. 
         [0074]    After sending this message, the sender may maintain some of the resources associated with the session in order to identify the acknowledgement message from the receiver. For instance, the session identifier may not be deleted until an acknowledgement is received or a timeout takes place. 
         [0075]    Upon receiving this message, the receiver identifies the session and its resources. The receiver then takes the necessary steps to terminate the session and free its resources. Following that, the receiver then sends the Terminate_Ack message  85  to the sender. The Terminate_Ack message  85  includes the session identifier and status parameters. The session identifier parameter is the same parameter included in the Session_Terminate message  75 . The status parameter indicates the success or failure of the operation and reasons for failure. If the Terminate_Ack message  85  is received indicating failure at the other end, the receiver of such message may ignore such failure and remove all resources associated with the session. 
         [0076]      FIG. 5  illustrates how a session can be terminated by the application relay on gateway device  30 . The same steps described above would apply to the termination initiated by gateway device  30 . 
         [0077]    In some cases, mostly due to erroneous state management in one of the communicating entities, a peer may send a message that contains an unrecognisable session identifier. This situation may also happen if one of the peers lost state due to a reboot or corruption of its memory. In this case, the receiver sends the “Session_unknown” message  90  back to the sender. This message contains the session identifier received. Upon receiving such message, the sender of the original message may remove the session corresponding to that message identifier in order to synchronise states with its peer. This mechanism may be used with a reserved session identifier value to indicate to a peer that the device has lost all states with such peer. Hence, this message can be used by either the medical application or the application relay to communicate general loss of state to its peer. 
         [0078]    The medical application running on medical device  10  may at any time need to create a new session. For instance, this can be useful if such application sends several independent streams of traffic that can be separated under different sessions. In order to do that, the message exchange in  FIG. 6  is performed, which involves sending a New_Session message  95  from medical device  10  to gateway device  30  and receiving a New_Ack response by medical device  10  from gateway device  30 . The New_Session message  95  may also be sent from gateway device  30  to medical device  10 . The New_Session message  95  requests a new session identifier from the application relay. The message includes, at least, the following parameters:
       Source and destination addresses.   Source and destination communication ports.   Session identifier parameter, which is the new session identifier requested by the sender. It includes a suggested session identifier.   Application identifier parameter, which includes the application identifier previously included in the Identification message  55 .       
 
         [0083]    Upon receiving this message, the recipient parses the message to ensure all fields are formatted correctly. If there is no conflict between the suggested session identifier in the message and an existing session identifier, the suggested identifier is accepted. Otherwise, the message is rejected with a suitable error code in the New_Ack message  97 . The New_Ack message  97  includes, at least the following information:
       Source and destination addresses.   Source and destination communication ports.   Result parameter, which indicates success or failure of the operation. Different error codes can be used to indicate reasons for failure.       
 
         [0087]    The protocol between the medical device application and the application relay on gateway device  30  can use a reliable mode of data transfer by using acknowledgement messages. The acknowledgement message can be sent from either the medical application or the application relay in order to confirm reception of one or more data or signalling messages. The acknowledgement message can also act as a negative acknowledgement by including one or more message that was not received. The acknowledgement message includes, at least, the following information:
       Source and destination addresses   Source and destination communication ports   Session Identifier   Message identifier   Acknowledgement type parameter, which indicates whether a positive or negative acknowledgement is included in this message.   Message identifiers parameter, which includes on or more message identifiers that are being positively or negatively acknowledged.   Transmission Window field, which indicates the number of bytes that the sender can receive without sending back an acknowledgement message.       
 
         [0095]    Flow control can be critical for cases where a large amount of information is sent from the medical application running on medical device  10  to the application relay running on gateway device  30 . It is important for the application relay to regulate the flow of traffic to avoid congestion. The Transmission Control Protocol (TCP) provides native flow control mechanisms. However, TCP may or may not be used between the two applications. Furthermore, this invention allows more than one device to be connected to the gateway device. Hence, it is critical that application relay on gateway device  30  prioritizes and regulates flow control from different devices. 
         [0096]    In order to regulate the flow from a single medical application, the application relay includes the Transmission Window parameter in its Acknowledgement messages sent to the medical application. This Transmission Window size informs the medical application that it can transmit the included number of bytes without waiting for an acknowledgement. After sending that number of bytes, the medical application waits for an acknowledgement message. If that acknowledgement message only contains the last received message, it is an indication to the medical application that all messages sent since the last acknowledgement was sent. Upon receiving this, the medical application can reset the window size and start transmitting new data. 
         [0097]      FIG. 7  illustrates an exemplary message exchange used to slow down or temporarily stop the information transfer between the medical application and its peer, the application relay. The Wait message  105  is sent from the application relay to the medical application on medical device  10 . The Wait message  105  commands the medical application on medical device  10  to reduce the rate of information transmission or stop it for a period of time. Hence, the message contains the following parameters:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Message identifier.   Transmission window size parameter, which includes the new transmission window for future messages. A transmission window size of zero indicates that the medical application should stop sending messages and buffer information until a larger value is sent in the transmission window parameter. A new Wait message  105  or an Acknowledgement message can overwrite this transmission window by including a higher or lower value.         
         [0103]    The Wait_Ack message  110  is sent from the medical application on medical device  10  to the application relay on gateway device  30 . The purpose of this message is to acknowledge the receipt of the Wait message  105 . If the medical application is requested to stop transmission for a period of time (by including a value of zero in the transmission window parameter) the medical application may choose to send a buffer-size parameter in the Wait_Ack message  110 , which indicates how long it can buffer packets. The buffer-size parameter can be represented by time units or number of bytes. Hence, the Wait_Ack message  110  includes, at least, the following parameters:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Message identifier.   Buffer-size.       
 
         [0109]    The application relay running on gateway device  30  may command the medical application on medical device  10  to redirect one or more sessions to a new peer using the session redirection exchange illustrated in  FIG. 8 . This may be done for load-balancing, to obtain better access to the Internet, or to send session information to another entity that needs it more urgently (e.g. a physician, paramedic, and so on). The redirection command may be triggered by a command sent to the application relay from a remote entity or due to manual intervention by the user. 
         [0110]    Based on, optionally, an external input  1 , the application relay on gateway device  30  may decide to send the Session_Redirect message  115  to the medical application on medical device  10 , with which a session already exists. The Session_Redirect message ( 115 ) contains, at least, the following information:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Message identifier.   New peer parameter, which includes the reachability information of the peer that the medical application is being redirected to. This may include an address and communication ports.   Redirected sessions parameter, which includes the session identifiers for those sessions that need to be redirected to the new peer.   Authentication credentials for the new peer parameter, which is optional, and includes the credentials of the new peer of the medical application on medical device  10 .       
 
         [0118]    Upon receiving the Session_Redirect message  115 , the medical application checks the session identifier parameter. If the session identifier does not match an existing session, an error code can be included in the Redirect_Ack  120  message. Alternatively, the medical application may send a Session-unknown  90  message including the session identifier. However, if the session identifier were valid, the medical application starts the authentication process with the new peer. If the peer&#39;s full reachability information were not provided the medical application may have to start the discovery phase presented in  FIG. 3 . 
         [0119]    Following the processing of the Session_Redirect message  115 , the medical application sends the Redirect_Ack  120  message. This message includes at least the following information:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Message identifier.   Result field, which indicates whether the redirection of the session was successful or not and the reasons given for failure.       
 
         [0125]    If the redirection was not successful the application relay may command the medical application to try again, or, alternatively, continue receiving traffic in this session. If the redirection was successful, the session is closed. 
         [0126]    The application relay on gateway device  30  may command the medical application on medical device  10  to multicast one or more sessions to several peers, which may include the application relay sending this message. Such data duplication can be useful when several entities need to store or observe particular information coming from the medical application on medical device  10 . Like the Session_Redirect message, session multicasting can take place as a result of a command from a remote server or manual intervention by the user. In order to order session multicast, the application relay on gateway device  30  sends the Session_Mcast message  125  as shown in  FIG. 9 . 
         [0127]    The Session_Mcast message  125  contains at least the following information:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Message identifier.   New peers parameter, which provides reachability information for the peers that the medical application needs to multicast sessions to. This may include addresses and communication ports. The application relay sending this message may also include its own reachability information to indicate that it should continue to receive traffic for the multicast session.   Session identifiers parameter, which includes one or more session identifier that identifies session that need to be multicast to the new peers. An implementation may choose to only include one session identifier per Session_Mcast message. In this case, if multiple sessions need to be multicast, multiple Session_Mcast messages will need to be sent, each as part of the session being multicast.   Authentication credentials for new peer&#39;s parameter, which includes multiple authentication credentials, one for each peer. This parameter is optional.       
 
         [0135]    Upon receiving the Session_Redirect message  125 , the medical application on medical device  10  checks the session identifier parameter. If the session identifier does not match an existing session, an error code can be included in the Mcast_Ack  130  message. Alternatively, the medical application may send a Session_unknown  90  message including the session identifier. However, if the session identifier were valid, the medical application starts the authentication process with the new peers. If the peers&#39; full reachability information were not provided the medical application may have to start the discovery phase presented in  FIG. 3 . 
         [0136]    Following the processing of the Session_Mcast message  125 , the medical application sends the Mcast_Ack  130  message. This message includes at least the following information:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Message identifier.   Result parameter, which contains the result of the operation and indicates success or failure. If the operation failed for some peers, such peers would be included in this message. If the operation failed for entire sessions, those session identifiers would be included.       
 
         [0142]    Now that the messaging between the medical device and gateway has been described, the messaging between gateway  30  and application server  70  will be discussed. Messages exchanged between those two entities can be divided into two categories: 1) Signalling messages and 2) data messages. Signalling messages deal with session initiation, which includes server discovery, session control, and session maintenance. Data messages are packets that include data exchanged between gateway device  30  and application server  70 . 
         [0143]    Initially, gateway  30  employs a server discovery process to discover the address of application server  70  and initiate a new session. This process is illustrated in  FIG. 10 . Gateway device  30  starts the discovery process by obtaining the IP address of application server  70  as represented by block  135 . In one aspect of this invention, this can be done through manually configuring the IP address in gateway device  30 . In another aspect of this invention the IP address can be obtained dynamically using the Domain Name System (DNS) (RFC 1033, RFC 1034, RFC 1035) or the Dynamic Host Configuration Protocol for IPv4 or IPv6 (RFC 2131 and RFC 3315). 
         [0144]    After the IP address of application server is obtained, the application on gateway device  30  sends a session_init message  140 . This message contains, at least, the following parameters:
       The source and destination addresses   The source and destination communication port numbers. This is typically the port number identifying the communication sockets when using the TCP/IP communication suite.   The user&#39;s identifier. This parameter is either a unique alphanumeric string or number that identifies the user that owns an account on application server  70 .       
 
         [0148]    This message starts the authentication process  145  where both gateway device  30  and application server  70  authenticate each other. After a successful authentication phase, the application server sends the init_ack  150  message. This message is authenticated based on the credentials derived from the authentication phase  145  and contains, at least, the following information:
       The source and destination addresses   The source and destination communication port numbers. This is typically the port number identifying the communication sockets when using the TCP/IP communication suite.   The user&#39;s identifier. This parameter is either a unique alphanumeric string or number that identifies the user that owns an account on application server  70 .   The session identifier, which is a unique number chosen by application server  70 .   Record indices. This is an optional parameter sent from application server  70  to gateway device  30  to provide it with the indices used by the server to identify parts of the user&#39;s record. These indices can be used later by gateway device  30  to create or update entries in the user&#39;s record. Indices are essential to inform the server where such entries should be stored (i.e. under what category).   Application server&#39;s address parameter, which may include a different address from that used by the sender of this message. Essentially, this parameter can be used by the sender to redirect the application on gateway device  30 , to another server. This may be done for load sharing, or to separate the servers handling the signalling messages from those receiving payload data.   Authentication and encryption data. This parameter includes the data needed by the receiver to authenticate and decrypt the message.       
 
         [0156]    A session may contain one or more streams that correspond to different types of information being exchanged between gateway device  30  and the application server  70 . When initiating a new stream, gateway device  30  indicates the type of information intended for such stream by including the application identifier parameter. This parameter allows application server  70  to identify the information and allocate the necessary resources for it.  FIG. 11  illustrates the stream initiation process. The application on gateway device  30  sends the stream_init  155  message. This message is authenticated based on the credentials derived from the authentication phase  145 . The message contains, at least, the following information:
       The source and destination addresses   The source and destination communication port numbers. This is typically the port number identifying the communication sockets when using the TCP/IP communication suite.   The user&#39;s identifier parameter, which is either a unique alphanumeric string or number that identifies the user that owns an account on application server  70 .   The application identifier. This is the application identifier presented earlier in the Identification message  55 .   The payload label parameter, which is optionally included in the message and contains an alphanumeric string that includes the label for the payload information sent in this session. The label may be manually added by the user or automatically generated by the application on gateway device  30 . This label can be a readable string that allows users to later distinguish different entries in their records.   The latest version supported by the application on gateway device  30 .   Authentication and encryption data.       
 
         [0164]    Upon receiving this message, application server  70  sends the stream_ack  165  message. This message is authenticated by the credentials derived from the authentication phase  145 . This message contains, at least, the following information:
       The source and destination addresses   The source and destination communication port numbers. This is typically the port number identifying the communication sockets when using the TCP/IP communication suite.   The session identifier.   A stream identifier parameter, which identifies a particular stream within a session. A session may contain one or more streams corresponding to different sets of information being sent by gateway device  30 . The stream identifier is then used by gateway device  30  in each payload packet.   The storage identifier parameter, which identifies the part of the user&#39;s record where the information needs to be stored. The identification of the part of the user&#39;s record that will contain this information may be done manually (by the user) or inferred by the server based on the application identifier information sent in the stream_init  155  message.   Result parameter, which contains the result for the operation which indicates either success or failure and the reason for such failure.   Authentication and encryption data.       
 
         [0172]    Gateway device  30  may at any time subscribe to a particular event. Examples of events include comments that may be added to the profile, messages, alerts of any kind and reminders. In order to subscribe, the gateway device sends a subscription request message  185  to the application server.  FIG. 12  illustrates this message exchange. The Subscribe message is sent from the Gateway device to the application server. It contains the following information:
       Source and destination addresses   Source and destination communication ports   Session identifier   Event descriptor parameter, which includes either an index to a particular event or a string that describes the event.   Authentication and encryption data.       
 
         [0178]    The application server responds with the Subscribe_Ack  195  message to gateway device  30 . This message includes the following information:
       Source and destination addresses   Source and destination communication ports   Session identifier   Status parameter, which includes information that indicates success or failure of the operation. In case of failure, reasons are specified.   Authentication and encryption data.       
 
         [0184]    When a particular event that the gateway device subscribed to takes place, the application server sends a Notify message. Different events may address different needs. Some events address the user, other address the application software and may be transparent to the user. The application server may send a readable message to the user instead of, or in addition to the Notify message. Examples of readable messages include the Short Message Service (SMS) or electronic mail (e-mail).  FIG. 13  illustrates this message exchange. Initially, a Notify message  205  is sent from application server  70  to gateway device  30 . This message informs the gateway device that an event, for which the device has subscribed, has taken place. The Notify message contains the following information:
       The source and destination addresses   Source and destination communication ports   Session identifier.   Event parameter, which describes the event that took place. This can be done by simply including an index representing the event, user readable text for display.   Authentication and encryption data.       
 
         [0190]    The Gateway device responds to the Notify message  205  with a Notify_ack message  215 . The Notify_ack message contains the following information:
       The source and destination addresses   Source and destination communication ports   Session identifier.   Status parameter, which indicates success or failure of the operation. Depending on the content of the message, the server may take further action.   Authentication and encryption data.       
 
         [0196]    The application server  70  may send a readable message  220  instead of, or in addition to the Notify message  205 . Acknowledgement of such message depends on the protocol being used to send the message. 
         [0197]    User records can be retrieved by gateway device  30  or any other viewing device that the user may choose. For simplicity, gateway device  30  is described as the retrieving device. In order to retrieve records, the gateway device needs to request top level indices for the record. This refers to the main sections in the record, each identified with a unique index. The gateway device can then request child records. Child records are subsets of the main sections represented by the top level indices. Each top level index is identified by a name that may be represented as a string. In addition, each entry (including top level and child records) can be associated with a number of attributes that describe the format of the data included in the entry, dates, and other logs associated with such data. 
         [0198]    All types of entries can be retrieved from application server  70  using the Retrieve message  230 . This message requests one or more entries. The message exchange for retrieving records is illustrated in  FIG. 14 . The Retrieve message  230  contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The session identifier.   The stream identifier.   Data retrieval request parameter, which identifies the data to be retrieved by gateway device  30 . This parameter can indicate a request to retrieve a specific entry in the user record, a group of entries (e.g. all parent entries), or all entries in the user&#39;s record.   Authentication and encryption data parameter, which includes data that can be used to verify the authenticity of the message and decrypt it.       
 
         [0205]    Upon processing the retrieve message, application server  70  sends the retrieve_ack message  240 . This message contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The session identifier.   The stream identifier.   Status parameter, which indicates success or failure of the operation.   Entry ports parameter, which informs the gateway device of which entries may need to be retrieved from other communication ports or network addresses. For instance, application server  70  may tell gateway device  30  to retrieve some entries as files, using the file transfer protocol (FTP). In this case, such information would be included in this parameter and the gateway device would then retrieve those entries from the addresses or communication ports provided by application server  70 .   Data parameter, which contains some or all of the entries requested by gateway device  30 . If the requested entries could not be sent in this message (e.g. too long for one message), then the application server will send them in separate messages. These messages are highlighted by the “Data Exchange” line in  FIG. 14 .   Authentication and encryption data parameter, which includes data that can be used to verify the authenticity of the message and decrypt it.       
 
         [0214]    After receiving the retrieve_ack  240  message, the gateway device will be able to receive data from the application server. Data transferred between the application on gateway device  30  and application server  70  takes place after a session and a stream are established. Each packet transferred between those two entities contains information about the sender and the receiver, whose IP addresses was conveyed to the application on gateway device  30  during the session establishment process. In addition, each packet contains the session identifier, the stream identifier, and information about the payload contained in the packet. The type of payload can either be inferred from the application identifier exchanged during session establishment or included in each packet. Additionally, the operation required is included in the packet carrying the payload. The operation may request the application server to create a new entry, update an existing entry, or delete and entry. Other operations can be added to the protocol as needed. 
         [0215]    The data transferred between the application on gateway device  30  and application server  70  can use any transport protocol mechanism, like the User Datagram Protocol (UDP), the Transmission Control Protocol (TCP) or other transport protocols. A payload data packet contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier.   Packet identifier parameter, which uniquely identifies a packet within a stream. When combined with the stream identifier it uniquely identifies a packet within a session.   Operation parameter, which indicates the type of operation requested for the payload. For instance, this indicates: create entry, update entry, or delete entry.   Indication of fragmentation parameter, which indicates whether the payload included is a fragment of larger pieces of information, and if so, its order, or that the payload includes all of the data transferred.   Payload Data field, which includes user generated, gateway device generated, or medical device generated data that is transferred to application server  70 .   Authentication and encryption data.       
 
         [0226]    Data sent from gateway device  30  or application server  70  is acknowledged by the receiver using the acknowledgement message. This message contains, at least, the following information:
       Source and destination addresses.   Source and destination communication ports.   Session identifier.   Stream identifier   Packet identifier.   Acknowledged fragments parameter, which contains one or more fragment numbers that are being acknowledged by the application server. The fragment numbers are obtained from the Indication of fragmentation parameter described above. This parameter may simply contain the last received fragment, which would indicate that every fragment up to the one included in this parameter was received correctly.   Authentication and encryption data.       
 
         [0234]    The application server  70  can order the client to redirect a session to another server. The redirection may order the application on the gateway device to re-authenticate itself to the new application server, or simply continue transmission provided that authenticated acknowledgements are received from application server  70 . Redirection can also be done for a particular request. For instance, the gateway device may request a particular operation that cannot be met by the current application server  70 ; application server  70  can redirect gateway device  30  to another server that can fulfil its request. However, this does not necessarily mean that future request will automatically go to the new server. Hence, the redirection process can be permanent, or done on a task-by-task basis. The redirection message exchange is illustrated in  FIG. 15 . 
         [0235]    The Redirect message  250  can be sent by either gateway device  30  or application server  70 . When this message is sent from application server  70  to gateway device  30  it is based on either an external event, or a request from gateway device  30 . The Redirect message contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier.   Reason parameter, which indicates the reason for the Redirect message. The reason can indicate non-availability of a service, entry retrieval, change in network conditions, and administrative policy among other reasons. This parameter also indicates whether the change is permanent, i.e. redirecting the entire session, the stream, or only for a particular request that can be best met by another server.   Redirection information parameter, which provides the necessary information for the receiver in order to be able to establish a connection with the new entity. Examples of such information include the new entity&#39;s IP address, transport protocol (e.g. UDP or TCP) and the port number that should be used. This parameter also indicates whether a new security association needs to be established.   Authentication and encryption data.       
 
         [0244]    After processing the Redirect message  250 , the receiver sends the Redirect_ack message  260 , which contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier.   Status parameter, which indicates success or failure of the operation. In case of failure, this parameter indicates the reason for failure.   Authentication and encryption data.       
 
         [0252]    Session multicasting involves the request from either gateway device  30  or application server  70  for the other end to send the information to multiple entities. The gateway device may request the server to send data to multiple devices, including itself. The same request can come from application server  70  to gateway device  30  in order to allow other entities to receive information. The multicasting request-response process is shown in  FIG. 16 . For simplicity, we only show the case where the request is made by application server  70 . However, the reverse can also be true. The Mcast message  270  contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier.   Reason parameter, which indicates the reason for the Mcast message. The reason can indicate emergency, multiple viewing devices or administrative policy among other reasons. This parameter also indicates whether the change is permanent, i.e. redirecting the entire session, for this stream, or only for a particular request.   Multicasting information parameter, which provides the necessary information for the receiver in order to be able to establish a connection with the new entities. Examples of this data include the IP address of the new entity, the protocol to be used (e.g. UDP or TCP) and the port numbers. This parameter also indicates whether a new security association needs to be established.   Multicast off parameter, which is used to request that the receiver stop multicasting the session or stream that was being multicast. This parameter is only added when the sender wishes to stop an existing multicast. Stopping a multicast implies that the multicast traffic is unicast to the original receiver before multicasting started.   Authentication and encryption data.       
 
         [0262]    Upon successfully processing the Mcast message  270 , the receiver sends the Mcast_ack message  280  to acknowledge reception. The Mcast_ack message  280  contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier.   Status parameter, which indicates success or failure of the operation. If the operation failed, this parameter would indicate the reason for failure.   Authentication and encryption data.       
 
         [0270]    Either gateway device  30  or application server  70  can terminate a session at any time. Session termination implies the termination of all streams within the session. Termination can also be done for one stream within a session while keeping the rest of the session active. Termination is done by sending the Term message  290 . This message can originate in gateway device  30  or application server  70 .  FIG. 17  illustrates the case where it originates from the application server. The Term message  290  contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier parameter, which is included if one stream is being terminated while the session remains active.   Reason parameter, which specifies a reason for terminating the session.   Authentication and encryption data.       
 
         [0278]    Upon receiving the Term message  290 , the receiver constructs the Term_ack message  300  and sends it. The Term_ack message  300  contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   Status parameter, which specifies the result of the operation. In some cases the termination operation may fail, which results in the sender repeating the process. However, in other cases the sender may ignore the operation&#39;s failure and simply terminate the session at its end.   Authentication and encryption data.       
 
         [0285]    At any point in time after a session is established, application server  70  may send a command to gateway device  30  that can either demand a certain action from the gateway device or from medical device  10 . If the command requests an action by medical device  10 , it is relayed by gateway device  30  to medical device  10 . The command may contain any action deemed necessary by the application server. For instance, application server  70  may need medical device  10  to perform a certain lifesaving action like defibrillation or other actions needed by the user. The command message  320  is illustrated in  FIG. 18 . The Command message  320  contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier parameter, which is included if a stream is established and the Command message is related to the established stream.   Command parameter, which contains a description of the command sent from application server  70 .   Authentication and encryption data.       
 
         [0293]    The Command_ack message  330  is sent from gateway device  30  to acknowledge the reception of the command message  320 . It contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The stream identifier parameter, which is included if it were included in the command message  320 .   Status parameter which, specifies the success or failure of the operation and reason for failure.   Authentication and encryption data.       
 
         [0301]    If the Command message  320  requested an action by medical device  10 , gateway device  30  will relay the command to medical device  10  using the Comm message  340 . The Comm message contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier parameter, which includes the session identifier for the session set-up between medical device  10  and gateway device  30 .   The message identifier.   Command parameter, which describes the command sent from application server  70 .   Authentication and encryption data.       
 
         [0309]    Medical device  10  acknowledges the reception of the Comm message  340  by sending the comm_ack message  350 . The comm_ack message contains the following information:
       The source and destination addresses.   The source and destination communication ports.   The version of the protocol being used.   The session identifier.   The message identifier.   Status parameter, which specifies success or failure and the reason for failure.   Authentication and encryption data.       
 
         [0317]    Exemplary embodiments of the present invention allow application server  70  to detect the presence of a medical emergency that requires alerting a medical emergency service or physician, or a nominated person or all of the above. Detecting an emergency can take place if application server  70  is explicitly notified by gateway device  30  (possibly due to a notification by medical device  10 ) or by analysing the data sent from gateway device  30  and deciding that a medical emergency exists. 
         [0318]    Gateway device  30  can indicate an emergency while sending medical information, relayed from medical device  10  or due to manual intervention by the user. On the other hand, application server  70  can detect an emergency by analysing the medical data coming from gateway device  30 . Such analysis may be routinely made when a stream is set-up for certain types of devices (known from the application identifier) or due to a request by the user, or due to certain configuration on the user&#39;s account. For instance, a user that may need close attention (a recovering patient or a high risk one) may have an account configuration that requires continuous monitoring of all data sent from his or her medical device. 
         [0319]    Depending on the settings in the user&#39;s account, an emergency situation may be handled differently. An application server may alert certain parties of the need for attention to the user&#39;s data. Alternatively, the application server may notify such parties as well as notifying an emergency service, e.g. ambulance service to get to the user. In the latter scenario, the user&#39;s location would be collected from the gateway device. The user&#39;s location can be obtained through the knowledge of the geographical location using a positioning system (e.g. satellite based systems like GPS or triangulation techniques in cellular networks), the Internet topology where the user is located, the access point to the Internet that the gateway device is connected to, or a combination of all of this information. 
         [0320]    User records contain health information that is manually or automatically added by the user or gateway device  30 , respectively. Examples of health information include the following:
       Medical history: including the user&#39;s previous illness, surgeries, accidents or any other event in the past that affected the user&#39;s health.   Medications: including any prescription or non-prescription medication that the user is taking. This also includes allowing the user to renew prescriptions online.   Scans: including any scans received like X-rays, ultrasound information, CT-scans, MRI, and any other types of scans related to cardiology health.   Pathology: including any laboratory results done for the user.   Nutritional diary: including the user&#39;s nutritional diary, food consumption, the user&#39;s height and weight, and the amount of nutrients in the user&#39;s food, including calories. This record may also contain the ingredients of food consumed by the user.   Exercise diary: including the user&#39;s exercise diary, like running, swimming, walking or any other exercise activity. Each exercise session can contain several attributes related to the user&#39;s physical functions during exercise. A simple example of such attributes includes the user&#39;s heart rate. Such measurements can be taken regularly during exercise and sent to application server  70  from medical device  10 , through gateway device  30 .   Measurements: including any measurements related to the user&#39;s health that are added automatically by gateway device  30  or manually added by the user.   Family history: including any hereditary illnesses like heart disease, that affected the user&#39;s family members.   Doctor&#39;s comments: including any comments added by the user&#39;s physicians or health practitioners.   Toddler records: including information about toddlers in the user&#39;s family. This includes any information related to the toddler&#39;s health, height, weight, vaccinations, illness, and so on.   Subscribed Services: including the services that a user is subscribed to receive.   Biometric information: including any biometric information that can be used to identify the user. Examples include retinal scans, fingerprints, DNA information or any other information.   User&#39;s identification: including user identification information like scans of a driver&#39;s license, passport, or any other photographic or non-photographic identification.   Personal settings: including the user&#39;s personal settings and preferences. This may include display settings, language preferences, choice of whether the user wants to receive alerts other than those subscribed, and so on.   Medical library: including interesting articles that may be relevant to the user&#39;s medical records.       
 
         [0336]    Each of the above headings within a user&#39;s record contains zero or more entries. Each entry has attributes that define read and write authorization. In other words, each entry can be read or modified based on the authorization level of the user. Hence, different entities viewing the user&#39;s record may be able to read or modify subsets of the record. As a result of this architecture, the record owner may associate different entities with different levels of authorization. This allows the record owner to allow different health practitioners to view different parts of his or her medical records. 
         [0337]    The foregoing disclosure has been set forth merely to illustrate the invention and is not intended to be limiting. Since modifications of the disclosed embodiments incorporating the spirit and substance of the invention may occur to persons skilled in the art, the invention should be construed to include everything within the scope of the appended claims and equivalents thereof.