Project - Integrate Telehealth

Trust me I tried. RC is difficult to setup and activate where when I tried to get them to certify openemr interface, they bulked. Poor business decision imo. Most these companies get overly concerned with points of responsibility. EFax shut me down as well. Twilio is better in many ways but fax does not seem to be a priority for them.

Any of these features that require outside resource vendors setup does prove to be difficult to implement by day to day users. This is why getting openemr pre certified so user doesnā€™t have to certify their instance is important. Not so easy iā€™ve found however, now that iā€™m an Administrator, perhaps they will take me more serious. So, iā€™ll try again.

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The reason I am interested in WebRTC is the fact that we can host the required services.
WebRTC has the capability to conference and implementing a TURN is fairly straight forward.
Along with video we also create a command driven message server that allows intra app communications as well as off loading reminders and messages as part of its responsibilities. eg get rid of reminder polling in openemr proper.

This doesnā€™t mean the other solutions arenā€™t viable, itā€™s that I prefer to keep as much as we can close to home so to say. Especially concerning any fee requirements.

Regarding NodeJs. Unsure why the misgivings as Node is a terrific tool.

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Yes. WebRTC donā€™t work well when you introduce more than 2 participants in a call. You must introduce media server to make it work.

Itā€™s fairly simple to implement WebRTC calls. Here are the minimum list of things we need (for 1-1 call)

  • Signalling Server (It can easily be implemented in NodeJS)
  • Turn Server (optional but call may not work in different kind of network and firewall settings at host end) - You can host your own using coturn.

That would be fine, I am only interested in myself and the patient.

I second that. having the ability to video communicate with the patient from within openemr is great .

@sjpadgett - How you would like to proceed on this project?

Hi @itsaboutcode and @gutiersa,
First, any implementation should include the ability to conference video and voip.
In practice, the ability to include care team members or groups would be of great benefit.
Consider a mental health practice that may which to consult other providers or even hold group meetings and so forth.

Last time I checked into WebRTC it had ability to do video conference. Did something change?
Also, my preference is to host the TURN and Signalling and looks like coturn could work for TURN.

May be of interest:


@pithonsoft submitted this PR last month. Problem with his implementation is the limited O.S support.

Keeping in mind Hipaa, what do you want to work with?

I came accross this article earlier today:

https://www.goodfirms.co/blog/the-best-10-free-and-open-source-telemedicine-software

@sjpadgett - I have checked these 2 implementations. Both are using 2 different Media Servers.

@ophthal - is using jitisi

@pithonsoft - is using BigBlueButton - which behind the scene is using kurento - I believe itā€™s integrating it from appointment flow.

Question - Where we want to integrate and what?

@gutiersa - I have recently checked https://doxy.me/ from the link you shared. It has a very generous free tier. To integrate it with any EHR, I did not see any API though.

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I have spoken with doxy.me. They have no API and will not offer it. The best you can do with them is an iframe to your room.

Well, is an iFrame not enough?
We need not record the visit really. We just need to document a consent for seeing the patient via a video and document the actual visit exchange. In other words. The clinic note which we do anyway.

If We could integrage doxyme into openemr with something like greasemonkey or tampermonkey, just for ease of use. Then, the documentation regarding the timestamp, browser id, duration of the visit, and the session data, hardware used, can get transferred into the openemer database via an SSL encrypted HL7 transfer, into openemr, wouldnā€™t that be valid?

Perhaps I will create an account.
Hmm

Sandra

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For example,

https://videowhisper.com/?p=PHP+Video+Conference

Would something like this be useful?

It is opensource and distributed via the GNU licence. (I think)

I signed up for a doxy me account today. I was not able to use it as I only had one patient and for some reason my chrome browser was not compatible. It looks like what Doxy me uses is an implematation of webRTC. It requires chrome or firefox to run.
I canā€™t contribute much more as I am not a programmer.
But I am here for testing.

BTW, have you see this:

https://openmeetings.apache.org/

openmeetings is also using kurento and full application on itā€™s own.

My suggestion would be to start with one-to-one calling (on browsers to start with - can build native applications for iOS and Android too) because for that we donā€™t need media server e.g; Kurento.

We need only following.

  1. Client application (Very Simple)
  2. Signalling Server (very simple)
  3. Turn Server - coturn

And it can easily be integrated with openEMR. I am not aware of OpenEMR code base much but I can help in WebRTC part.

I see, that sounds good.
OpenEMR has many developers here.
I will link here more information on architecture.
https://www.open-emr.org/wiki/index.php/OpenEMR_System_Architecture

Might be worth taking a look into big blue button for telehealth, itā€™s like zoom but free and open source.

It uses freeswitch for the backend.

There is a dated version available on dockerhub, and what I believe is a more recent install script available on github.




https://hub.docker.com/r/bigbluebutton/bigbluebutton/

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Integrating a telehealth component base on Node Js, looks like interesting to see if we can use : openvidu (https://openvidu.io/) based on Kurento

Also we can look the Riple Foundation projet at (https://ripple.foundation/2016/08/open-source-telehealth/)

The link about webRTC module for thecripple foundation telehealth project : http://docs.pulsetile.com/angular-webRTC.html

I use bigbluebutton with my Moodle server and with Tikiwiki. It has a straightforward api and can be made secure. I currently run it on a digital ocean server with 4 cores @ 2.30 GHz and 8 Gb of ram. I use it for regular virtual meetings of 4 or more people with little to no issues. Installation is easy and steps can be taken to harden the server it is running on for security.