Enabling the E@syCare Telemedicine Platform with Push Notification with End-to-end Acknowledgment

Telemedicine is becoming increasingly important in recent years, especially in chronic diseases treatment. Thanks to these platforms, it is possible to assist patients remotely, being continuously monitored according to personalized care plans as if they were at the hospital. The characteristics of telemedicine platforms resulted extremely useful when Covid-19 pandemic broke out. Intense monitoring of patients at home, social distancing, and resource rationalization provided great help to medical personnel and healthcare systems. This novel disease, however, has posed new challenges, given by the quicker evolution of a patient's clinical status with respect to chronic diseases. In particular, the updates of the care plan performed remotely by doctors need to be immediately delivered to monitoring kits located at the patient's home, in order to adjust the monitoring plan of the target patient. Since this update is a critical operation, acknowledgment strategies are required to guarantee feedbacks upon delivery. Immediate updates can be achieved via a push notification system. In this paper, we present a push notification system based on HiveMQ Community Edition message broker, that provides end-to-end positive (ACK) and negative (NACK) acknowledgments, strict authentication, and authorization of users and messages, security, data consistency, and privacy. The realized system has been integrated and tested in the E@syCare telemedicine platform certified as a medical device, but it can be easily adopted by any other telemedicine solutions, as long as they can perform web service requests to the authentication server and integrate HiveMQ client library in their software components.