DE102006048110A1 - Telemedicine system, especially for chronic diseases - Google Patents

Abstract

The invention relates to a so-called telemedicine system, with which medical data, analyzes and services are communicated by information systems. The object of the invention is therefore to provide a telemedicine system that allows a full and permanent care of the patient in addition to a diagnosis and / or treatment. In doing so, the patient should be actively involved, informed and controlled or supervised by enabling a continuous, differentiated access of all participants to specific files. The telemedicine system has a database for data management with separate data rooms for the medical and personal data of the patients as well as for the medical services and medical applications. Data processing is performed on at least two physically separate computing units. The database contains files for encryption and graded access rights depending on the user. The Datarooms each have online accessible modules so that patients and medical staff can gather information from the database and submit it to them. The patient's data storage, sending and receiving unit contains at least files for a reminder journal, automatic encryption and data transfer to the database.

Description

The The invention relates to a so-called telemedicine system with which medical Data, analyzes and services provided by information systems become. Patient and medical staff no longer need to be rejoined locally, resulting in save considerable costs.

Telemedicine systems can from devices for diagnoses, for training u. a. in the case of patients, data transmission and data processing equipment Patients and / or medical staff and a central Data storage for Consist of patient records.

[State of the art]

It Various telemedicine systems have become known for special purposes Services are designed.

In the DE OS 102 33 651 an individual training support by means of a central computer and a local computing device is described. The solution according to the EP 04030252.3 contains a system for monitoring and controlling a diet episode.

Further proposals include televisite procedures ( DE OS 102 50 954 ), telemetric ECG transmission ( DE Gbrm 201 18 817 ), electronic health record ( DE OS 101 26 138 ) etc.

There are already known inventions that allow a general treatment of a patient with the help of telemedicine. In the DE PS 101 63 095 is z. B. discloses a system for remote diagnosis and remote treatment of emergencies. The patient file is assigned here either to the patient's telemedicine device or to a database at the physician's consultation center.

The requires comprehensive, lasting medical care for many patients frequent, Alternate and differentiated accessibility of patients and patients medical personnel to the patient file and other data collections, as well as other specific capabilities of the system. there the data security and functionality are constantly to be guaranteed.

The is not possible with the known telemedicine systems so far.

OBJECT OF THE INVENTION

task The invention therefore is to provide a telemedicine system. that except a diagnosis and / or treatment, a complete and permanent care allows the patient. The patient should be actively involved, informed and controlled, or monitored become, in which a lfd., differentiated access of all involved to specific files becomes.

Further Tasks are to ensure the Security of data during transmission and management, high reliability of the system, connection to the practice management systems and health card and the variability to enable further services.

Is solved this task by features of claim one.

The Telemedicine system has a database for data management with separate datarooms for the medical and personal Data of patients, as well as for the medical services and medical applications. The data and -processing takes place on at least two physically separate computing units.

The Contains database Files for the encryption and graded access rights depending on the user. Own the data rooms each online accessible modules, allowing patients and medical Obtain personal information from the database and submit it to them can.

The The patient's data storage, sending and receiving unit contains at least Files for a diary with reminder, automatic encryption and transmission the data to the database.

This System allows through the separate data spaces in conjunction with physically separate arithmetic units a high Security, reliability and variability, as well as inclusion of further services. On the database own the Patients and the medical staff each have a defined, adjustable access.

Special Enable online modules a variety of specific services for patients and medical Personal, such as diary, e-learning, info module, service, etc.

Of the Patient has one Data storage, sending and receiving unit, so anytime Transfer data to and from the database can be which in turn has medical personnel access. Various Enable online modules a comprehensive information of the patient. The diary with reminder function increases the quality the patient data.

The dependent claims 2 to 5 relate favorable ge versions for data security in the transmission, storage and management and access. These solutions allow a higher security than in the known methods.

According to the subclaims 6 and 7, the telemedicine system has special online modules with them the data management and information for the medical staff and the patients are improved.

To Claim 8 is the data storage, transmission and reception unit at the patient a PDA or notebook. Especially the PDA allows one good mobility with sufficient storage and processing capacity for the diary and the online services.

Of the Claim 9 relates to interfaces in the system to bring this into the current and future unified electronic systems of the health system.

(Examples)

following the invention is based on an embodiment be explained in more detail.

1 shows a scheme of the general interaction of patient, general practitioner and medical competence network in the telemedicine system,

2 the general levels of the telemedicine system,

3 the architecture of the telematics platform

A so-called telematics platform (TMP) realizes the data management of the database and the interaction with the various users. The Telematics Platform (TMP) is suitable for coping with a variety of data processing tasks. It is an essential aspect of the system architecture not to press the functional scope in a monolithic application body, but to provide a flexible module structure. The realized modular construction is in 3 clarifies:
Virtual device layer; kernel; D1 D2 D3 Dn.

The Modules, here referred to as device D1 ... Dn, symbolize different Function blocks that individual specialized methods, libraries as well as complete ones Encoding applications. The virtual device layer becomes the opposite individual modules virtualized to the kernel, d. H. as abstract black boxes by means of published a defined communication interface. This interface identifies a module and provides a set of commands through which the built-in methods can be called by the kernel or other modules. This Concept is therefore not the usual in the application development Procedures via DLL's, ActiveX-Interfaces or NET technologies comparable in their basic form only ever a point-to-point connection realize.

In contrast to a client application, the telematics platform (TMP) represents itself as an agreed command set via a defined communication interface. In the standard case, an application module is published in the function space of the TMP for this purpose. Depending on the complexity of the application, the processing of the client requests involves various modules whose implementation remains hidden from the client and the other modules. This procedure goes so far that the participating software components except the module API (command set) neither host (physical location of the module) nor other parameters must be known. This enables favorable ways of clustering and load distribution. The TMP uses modern client-server technologies throughout. This technology is commonly understood to be the partitioning of application implementation between the front end (client) and the backend (server). The embodiment of the TMP goes beyond the classic 3-layer model, such as 3 seen.

The actual data storage is by conventional database systems (eg. SQL server, XML server) accomplished. A database abstraction layer virtualizes the concrete database compared to the other modules. To Beyond the known techniques like ODBC or ADO / NET additional Implements interfaces that show the differences of the different ones Balance database implementations. This procedure allows a large extent independence from specific manufacturer-dependent Variants. The individual function modules use the databases always over the way kernel and database abstraction layer. This allows the Access controlled exactly according to authorization become. The modules need no knowledge about Database parameters or access identifiers. That means an extra Security_level.

The Client's communicate via the Communication layer with the assigned function modules via standard protocols. The communication layer physically separates client and server. The client only has access to the function space assigned to him. He needed no database access. Therefore, unauthorized data manipulation largely excluded.

• – Schaffung von Redundanz bei Systemversagen
• – Lastteilung
• – Erhöhung der Rechenleistung

The TMP is designed to handle many concurrent client accesses and concurrent data processing processes. One on egg A single server-centric model would quickly reach its limits as demands grow. Although additional hardware can increase the performance of a system, but only within the scope of the available technology. In practice, two ways are known to increase the computing power. On the one hand, these are the so-called "supercomputers", which are predominantly used for simulation tasks (eg weather forecasts) or, on the other hand, the interconnection of several individual computers into a cluster (cluster) .The TMP includes the path of clustering, because it is much finer to itself For some time now, operating system manufacturers have been offering clustering methods, such as Windows 2003 Advanced Servers, which can use the TMP but are not limited to it, but provide its own additional mechanisms Follow goals:

• - Create redundancy in case of system failure
• - load sharing
• - Increasing the computing power

The The basic principle of clustering in the TMP is that with help the virtual device layer the individual function modules on one or multiple members of the cluster network can be hosted.

The Inquiries of client applications are made through the communication layer forwarded to the virtual device layer. This decides on the basis the type of request and the current utilization of the cluster server, which server should process the request. In addition to the achieved Distribution of the fluctuating load currents also becomes a redundancy mechanism implemented.

The Client's communicate generally over different Protocols with the TMP. The choice of the protocol is of the type depending on the application.

Of the Client signals first the server his connection request. With the help of a mutual known key the authentication of the client (password and / or biometrics) is performed. at successful login will be an encapsulated on the server side Session object generates which the permissions, dynamic communication keys etc. managed.

The TMP provides the individual applications with a protected data area to disposal. As a rule, XML documents are stored in the databases. One important feature, resulting directly from the privacy policy can be deduced is the separate storage of personal and medical data. By the virtual database technique described above can be implement this requirement. Therefore at least exist in the TMP two physically separate databases, based on different Systems are located. Another requirement is encrypted storage medical records. Independently of whether the connected application independently processes their data self-encrypted, TMP always saves the set documents with a patient-specific one Key.

The together the personal with the medical data may not be readily possible. The data stocks are therefore physically hosted on different systems, the more ideal wise also spatially operated separately. Each patient has his own (TMP-internal) key, which his datasets additionally across from delimits others. This method has the advantage that when known become a key not the entire database would be readable. The key ingredients are stored in 2 separate databases, which are reciprocal have to certify. That means that for decrypting medical data needed key is composed of two mutually dependent parts, the only during the Expiration of the encryption process physically exist in the memory of a system. The whole key will therefore never be transported at the same time, which is listening techniques difficult.

Base Internet connections for the data transmission is the Internet Information Server (IIS), which is the default service (http, SSL) reliable to disposal provides. The requests from the internet are via one or more IIS via special module that uses the ISAPI technology into the Forwarded TMP cluster network. Thereby a configurable check of the Inquiries take place to filter out inadmissible data packets from the outset (eg buffer overflows or content prechecks). According to the target application of the requests these will be sent to the associated Cluster server and routed by this to the competent process.

outsourced Processes are another feature of the TMP according to the invention to be safety relevant Tasks started in a special permission level Process to process.

The main data element in the TMP concept is XML documents. XML documents allow the storage and transport of almost any information without depending on platforms or file formats. For this purpose, XML defines a simple framework that can be adhered to by all participating systems. In the medical In particular, the HL7 and CDA / Sciphox standards have prevailed.

With Help of the software module "Coding and matching feature records at the database level " biometric functions successfully integrated into the TMP. To each Users can several characteristic data sets (Templates) are deposited. These are treated much like medical data So basically encoded saved. The biometric functions were based on the module concept the TMP integrated into a separate process room. The responsible module is able to make a 1-1 comparison or perform a 1-n comparison. This can then be User completely without manually entering an identifier. The default case is the confirmation of a user by identifier and fingerprint. This can be a significant increase the security of the logon process.

The Application Patient Diary Offline is a PC-based Diary for chronically ill patients to collect self-control data and their secure transmission to the TMP who provided the data for the attending physicians and medical service providers.

• – Alle Daten werden in XML-Formaten gespeichert und transportiert.
• – Die Daten werden auch auf dem lokalen Datenträger verschlüsselt gespeichert.
• – Für die Kommunikation mit der TMP wird das TMP-HTTP-SOAP-Protokoll eingesetzt.

The application uses a large part of the technologies described above:

• - All data is stored and transported in XML formats.
• - The data is also stored encrypted on the local disk.
• - The TMP HTTP SOAP protocol is used for communication with the TMP.

The Medical System Online as another building block within the TMP is the direct access of the family doctor to the self-control data of his Patient over the Internet. The doctor can here, assuming the patient has his data for released him, view the diary entries and reports. This access is intended for doctors, who do not use a practice management system or this incompatible Among the methods used is the TMP. In addition to the self-control data, to which the doctor only has a read access, can also the reports and treatment recommendations prepared by the centers be viewed. The doctor system thus offers the possibility quickly and comprehensively with the disease course of the patient to deal with.

One even clearer advantage results for the family doctor when the self-control data and the reports directly into the electronic file of his practice management system incorporated. For this Purpose is based on the GDT interface created a module that automates the patient data of the TMP receives, prepared and entered into the file.

The Following TMP concepts, all data transfers take place and stores always encrypted. About the Connection module, the diary data and reports using the secure transport protocol of the TMP into the local database transmitted by the doctor. There they are encrypted stored. Every doctor receives doing an individual key, in a special keyfile or stored in a hardware module (dongle). Thus is the protection of medical data.

The Integration of various diseases in a diary is through a modular program structure possible. The PC diary is used to capture diary data, which z. For example the diseases obesity and atopic dermatitis are relevant. The Patients should do it created a comfortable opportunity to capture their self-control data and about the communications the TMP to use the services of the affiliated partners.

• – Menübereich
• – Datenbereich
• – grafische Darstellung
• – Kalender
• – Statusbar

The patient diary can present itself to the user in a typical Windows interface. The PC Diary is structured by the following elements:

• - Menu area
• - Data area
• - graphic representation
• - Calendar
• - Status bar

The Elements are constantly accessible to the user on the screen. The menu area is through master data management, access management, capture, transfer and custom profile customization. For this offers the diary gives the user the ability to to set its individual parameters. That's how the personalities become and preferences considering Find. The data area and the graphic area are the actual ones Diary. Here all data are displayed one day. In the Main input mask of the data area, the usual diary data are clearly arranged captured, can changed and deleted become. A graphic representation of the values of one day provides for one quick overview. The data on the local data medium is stored in encrypted form. This is a combination of fixed and password-dependent key parts used. This guarantees a high level of security of the data.

With a flexible expandable interface, different device types can be connected to the program. This reduces input mistakes and increases comfort.

When example for Obesity is for the continuous acquisition of self-control data (height and weight), the collection of movement data and meals as well as the recording a drug intake plan necessary.

The information for the movement data should be classified according to the intensity (duration, Type of movement). The indication of a therapy goal (weight desire after treatment) should be in the medical data of the patient be noted. Since the disease diabetes is not uncommon in obese disease Such information is also critical to the physician. These details can by additional Modules are integrated.

• – Erfassung von Gewicht/Körpergröße (wöchentlich)
• – Wochenprotokoll (nach Muster) mit Tageserfassung
• – automatische Berechnung der Nahrungszunahme
• – (Broteinheiten/Kcal)
• – Medikamentengabe (Eingabe der Medikamente, Überprüfung und Abgleich mit Medikamenten-EP)
• – Als weitere medizinische Daten müssen in bestimmten zeitlichen Abständen folgende Daten erhoben werden:
• – Angabe des Therapieziels (persönlicher Gewichtswunsch, Bemerkungen des Patienten)
• – Medikament-Einnahmeplan (Muster in Anlehnung von Praxisverwaltungssoftware)
• – Angabe weiterer Krankheiten (Diabetes, evtl. Integration weiterer Module) und Behandlungsstand

The patients are individually treated by the doctors. Thus, an evaluation in the form of a statistic of several patients is not possible. The specification of certain kilocalories and achieved weight goals is irrelevant and individual in the context of other patients. Thus, a curve can be developed for the evaluation, showing how the weight loss / increase has developed as a function of a specific period of time. In the presentation, the personally indicated treatment goal should be clear. As collecting diary data, the following control data are collected with corresponding day and time information:

• - recording of weight / height (weekly)
• - Week protocol (according to sample) with daily recording
• - automatic calculation of food increase
• - (bread units / kcal)
• - Drug administration (input of medication, review and comparison with drug EP)
• - For further medical data, the following data must be collected at certain intervals:
• - Specification of the therapy goal (personal weight wish, remarks of the patient)
• - Drug intake plan (sample based on practice management software)
• - Indication of other diseases (diabetes, possibly integration of other modules) and treatment status

The Calculation of the BMI value in the obesity area can be done by typing determined by weight and height become. The weight is in a visual representation by a Integrated BMI scale. additional receives the patient himself feedback about the course of treatment.

The Meals can be detected by a BE calculator in bread units. In addition, can a nutritional plan to be created. Deviations in the diet are then signaled and possibly registered in the database as risk factors. The sports activities are detected by the duration and intensity. At every entry the appropriate sport should be chosen or supplemented.

The technical conception of the PC diary for the data storage and data transmission builds on the modern client-server structures of the telematics platform on.

For this will be the medical information of the patients is encrypted in XML documents stored on the client and at certain times aligned with the universal servers of the telematics platform. For the Transport of data will be standard technologies, such as HTTP / SOAP protocols, for the transmission used on the internet. To provide access for third parties to the information to be prevented for used the transport and data storage encryption procedures.

The Master data of the patients are basically physically separated from the medical data saved.

By the high safety requirements and the provisions of the Privacy Policy, is a biometric authentication through passwords Fingerprints or the use of chip cards provided in the PC diary.

The Profile data consists of the fixed master data and the additional data Basic data describing the peculiarities of the patient. To belong to the basic data likewise the entrance data, which for a communication with the Telematics platform are essential.

With The PDA Diary will be for The users of handhelds provided an instrument by using self-control data ortunabhängig can be detected. The content structure of the PDA application differs not from the PC variant, however, due to the downsized Display changes in the menu navigation and Presentation of data will be necessary. Also in this variant is the diary structure for various diseases modular.

The PDA application is adapted for the reduced representation by a navigation bar and pop-up menus. Due to the fixed arrangement of the navigation bar, the areas in the application remain permanently accessible to the user. By doing The "Extra" menu area manages the master data, profile data and access data.The "Data" area can be accessed from the navigation bar for capture, visual display and transmission. The respective selection is called up on the screen. With the diary input mask, the days can be changed quickly by the integration of a flexible calendar.

Of the Data area and graphical area can be called separately and apply to the selected Day. Self-control data can be transmitted via the Input clearly recorded, changed and deleted become. The graphic area is for a clear presentation of the horizontally scrollable throughout the day. The toolbar is for the fast Input and change the control data in the selected File to find again.

As with the PC diary also here the data on the local terminal, from a Combination of fixed and password-dependent data, stored encrypted.

The PDA version of the diary is adapted to the system conditions (Windows CE, SQL Server). The SQL database is set up on the terminals. For the encoding and the authentication on the telematics platform can the to include the mobile phone-bound device ID. The transfer is used by the existing transfer techniques in the device (GPRS, wireless LAN, modem). The relevant medical data are encrypted stored in XML structure in the local databases and through transfer the services of the TMP into these. For the Transporting the data becomes HTTP transfer technologies through SOAP protocols used.

With Online modules should make applications available to the user that will enable him Convenient from home or on the road to extensive services access. The modules include the areas of e-learning, service, Chat as well as an info and call center module. Through these components will give the user the greatest possible interaction given with the system.

E-learning module

technical information and tutorials are in the form of interactive test courses provided to deal with treatments and therapies to deal with diseases largely. The user should hereby a learning platform is made available to professionally to convey the right knowledge. As tutors, specialists and physicians can Create and evaluate courses.

Info module

The Info module provides information about the diseases. To belong Food consulting as well as fitness measures and rules of conduct. The application should protect the patient by preventive and therapeutic measures knowledge convey, to some fears and eliminate prejudice in dealing with the disease. For this will be primary static information pages created with graphics, which by to be coordinated with a specialist.

Service Module

information the hotline and contact data are accessible in this application. Disease-specific offers can be requested in a member area. Important basic settings of the Systems, z. B. the change master data or contract renewals, are managed here. The user can also work in the administration determine which modules are used by him to what extent.

The The service portal is mainly prepared by dynamic pages.

HCC module

The HCC module (Health Care Centers module) will inform the user about the inform specific hotline numbers. It can be a radio connection chosen and be set up automatically. Assistance and information for one proper operation the modules are given by the staff of the HCC. Also The customers receive information about the various treatment options.

Next The possibility To order products in an online shop system, registered members can also use the HCC hotline for ordering.

Chat module

The interactive chat module is used for joint communication between those affected. The interaction can be led by a moderator / expert. The chat allows multiple users to chat in real time. It's a kind of computer conference that does not need any pictures. The patients or their relatives can exchange experiences with each other in dealing with their illness and therapy. The chat is divided into several topics and offered as a stand-alone online module to the diary. The registration is done by the service module. The use of the chat takes place synonymously.

Profile module

in the Profile module will be all individual settings for the diary, set the therapy and the specifics of each person. All Information for the treatment, for example the doctor, important and informative, are deposited here. To the deposited information includes information on weight, height, age, gender, Compulsory drug, other diseases, hereditary diseases, etc. .. The module also stands for the special settings of the therapy are available.

Practice Management System

For the optimal Processing of medical data by the doctor, is a module for the Integration into the practice management system provided. The doctor thereby has direct access to the self-control data of his Patients. The doctor can here, provided the patient has his Data for released him, view the diary entries and reports. The relevant patient data are determined by the authorization module.

The medical self-control data and reports flow through Existing GDT and XML interfaces into the electronic file his practice management system. About the GDT module are the medical data associated with the specific patient and on visualized on the screen.

The Module is automatically retrieve patient data from the TMP, prepare and enter into the file. Furthermore, the module as a service set up, which at certain times during the day the new Retrieving information from the telematics platform.

reminders

The successful and continuous capture of control data be backed up by a reminder function. Special data, like height and weight, have to transmitted to the telematics platform at a fixed time become. Therefore In advance, a note may appear locally in the journal. Will happen until due If no transfer is made, the "Reminder Function" will send a notification mail / SMS automatically generated. The patient is thus reminded of his Continuously capture data and execute the transfer. Become in the further course no data transmissions The Health Care Center can contact the patient by telephone to reach.

reacts the patient does not respond to the reminder messages, it must be assumed be that the therapy can not be completed successfully.

Around Send the information in a uniform structure to the right recipient to be able to Interfaces necessary. The structures to be defined include the Communication interface, the data interface, the online interface, and an interface for Result data.

The Structures, for compatibility purposes and for the international Standard to meet, designed in XML form.

Of the Transport of medical data is done by the diary applications to the telematics platform and vice versa. Furthermore, information from the TMP for other eligible participants provided. The doctor receives, by one special request to the TMP of the practice management module, medical Information of his patients. For the online access of the Patients and doctors the data are prepared in specified structures and in the Portal shown.

For all transmission modern standard technologies are used, which are easy in the different applications are to implement and international validity have. encrypted databases are packed and transported by a SOAP / http protocol. At certain times the documents are sent to the universal Data storage of the telematics platform sent. The communication between the servers takes over the HTTP protocol. The XML documents are available through customization to the SOAP structure for the information exchange of the telematics platform ready.

Of the Online access for the patients is another option for the Users self-control data on the Internet, without use an additional one device, to view and maintain. For access is only a browser (on your own PC, Internet cafe, etc.) needed. Depending on which disease the user is affected is the content of the module for built up the patient.

Of the Patient has through a menu selection the possibility log in and out, make security settings, Posts to add to the diary and change, View evaluations, edit master data and online modules if he is authorized to do so. The patient finds here all the essential elements including the daily chart which the quick visual control serves, again.

The Authentication is provided by the security mechanisms of the telematics platform carried out.

The Online doctor system offers the attending physician the opportunity to view the self-control data shared by patients. On the other hand in this module various evaluations, reports and statistics on the medical information of the patient. Of the Doctor access is similar Access to patients by selecting individual areas in one Menu. Of the Doctor can select from the list of his patients the desired Insight into his diary, week and month increase can.

Technically The same security mechanisms are used in online access the TMP as mentioned in the patient access.

If the doctor has no practice management system available, this online access can be the same possibilities be used.

Out The medical information of the patients can be varied make visual and statistical evaluations. The results should for present the patient and the doctor with helpful tools. The Evaluations are always based on the control data and basic data of the Patient dependent be. Because every patient is treated individually by his doctor is a simultaneous evaluation / comparison of multiple patients or the presentation of specification guidelines does not make sense. Farther are generated by the TMP information, which automatically, sent reminder functions to the terminal. This information are controlled by the platform and expect an answer from Users back.

By the transparent transmission and storage of the information is all data previously available on the Pocket PC or PC local were thus at any time, z. B. in case of loss etc., reconstructable by the telematics platform. Thus, a protected Backup given on the platform and the terminal is not tied to the patient.

The PDA solution helps the patient the services of TMP as uncomplicated and low-cost to be able to use.

Claims (9)

Telemedicine system, in particular for chronic diseases, each consisting of a data storage, transmission and reception unit in the patient and medical staff, as well as electronic data management with digital patient records, characterized in that - the database for data management separate data rooms for the medical and personal data of the patient, as well as for the medical services and medical applications, - the data processing takes place on at least two physically separate processing units, - the database contains files for encryption and graduated access rights according to the user, - the data rooms are online have accessible modules so that patients and medical personnel can obtain and submit information to and from the database, and that the patient's data storage, transmission and reception unit has at least files for a memorandum journal on, automatic encryption and transmission of data to the database contains. Telemedicine system according to claim 1, characterized in that that in the database a universal, transparent data storage based on XML documents, which in particular the Standards HL7 and CDA / Sciphox. Telemedicine system according to claim 2, characterized in that that the data encryption method the universal encrypted storage of XML documents, separate from personal data of patients, on all storage media throughout their life cycle causes the documents. Telemedicine system according to claim 1, characterized in that the authentication method is a combination of client / server certificates, password entries and biometric recognition based on fingerprinting. Telemedicine system according to claim 1, characterized in that that the data transport services are secured by a combination the well-known methods SSL and VPN, as well as implemented online encryption and static encryption. Telemedicine system according to claim 1, characterized in that that this particular online modules / online CMS (Content Management System) for managing control and master data of the patient, e-learning modules for Patients and medical staff and for integration into the practice management systems the doctors has. Telemedicine system according to claim 1, characterized in that that this is a special online module for patients to treat and therapy of their chronic diseases. Telemedicine system according to claim 1, characterized in that the data storage, transmission and receiving unit in the patient is a mobile unit, in the form of a PDA (Personal Digital Assistant) or a notebook. Telemedicine system according to claim 1, characterized in that that this interfaces based on modern integration technologies of the practice management system through GDT / XDT and XML, as well as future technologies for the ePA (electronic patient record), eRezept (electronic prescription) through the integration of the eGK (electronic health card and the HPC (Health Professional Card).