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+
+
+
+ 20231121T143049-254e1f19c5645f32b9ad52fc470dfe5bf35f7e25
+ 20231121143049
+
+ JOSS Admin
+ admin@theoj.org
+
+ The Open Journal
+
+
+
+
+ Journal of Open Source Software
+ JOSS
+ 2475-9066
+
+ 10.21105/joss
+ https://joss.theoj.org
+
+
+
+
+ 11
+ 2023
+
+
+ 8
+
+ 91
+
+
+
+ OpenTera: A Framework for Telehealth
+Applications
+
+
+
+ Dominic
+ Létourneau
+ https://orcid.org/0000-0001-7825-7533
+
+
+ Simon
+ Brière
+ https://orcid.org/0009-0000-1224-8001
+
+
+ Marc-Antoine
+ Maheux
+ https://orcid.org/0000-0002-3983-8754
+
+
+ Cédric
+ Godin
+
+
+ Philippe
+ Warren
+ https://orcid.org/0009-0008-4466-0963
+
+
+ Gabriel
+ Lauzier
+
+
+ Ian-Mathieu
+ Joly
+
+
+ Jérémie
+ Bourque
+ https://orcid.org/0009-0008-5868-9724
+
+
+ Philippe
+ Arsenault
+ https://orcid.org/0009-0003-0772-1177
+
+
+ Cynthia
+ Vilanova
+
+
+ Michel
+ Tousignant
+ https://orcid.org/0000-0001-7561-1170
+
+
+ François
+ Michaud
+ https://orcid.org/0000-0002-3639-7770
+
+
+
+ 11
+ 21
+ 2023
+
+
+ 5497
+
+
+ 10.21105/joss.05497
+
+
+ http://creativecommons.org/licenses/by/4.0/
+ http://creativecommons.org/licenses/by/4.0/
+ http://creativecommons.org/licenses/by/4.0/
+
+
+
+ Software archive
+ 10.5281/zenodo.10078847
+
+
+ GitHub review issue
+ https://github.com/openjournals/joss-reviews/issues/5497
+
+
+
+ 10.21105/joss.05497
+ https://joss.theoj.org/papers/10.21105/joss.05497
+
+
+ https://joss.theoj.org/papers/10.21105/joss.05497.pdf
+
+
+
+
+
+ Open rehab initiative: Second development
+iteration
+ Freitas
+ International conference on virtual
+rehabilitation (ICVR)
+ 10.1109/ICVR.2017.8007524
+ 2017
+ Freitas, D., Paulino, T., Badia, S.
+B. i, Llorens, R., & Deutsch, J. E. (2017). Open rehab initiative:
+Second development iteration. International Conference on Virtual
+Rehabilitation (ICVR), 1–2.
+https://doi.org/10.1109/ICVR.2017.8007524
+
+
+ Design and development of a customizable
+telemedicine platform for improving access to healthcare for underserved
+populations
+ Goel
+ 39th annual international conference of the
+IEEE engineering in medicine and biology society (EMBC)
+ 10.1109/EMBC.2017.8037404
+ 2017
+ Goel, N. A., Alam, A. A., Eggert, E.
+M. R., & Acharya, S. (2017). Design and development of a
+customizable telemedicine platform for improving access to healthcare
+for underserved populations. 39th Annual International Conference of the
+IEEE Engineering in Medicine and Biology Society (EMBC), 2658–2661.
+https://doi.org/10.1109/EMBC.2017.8037404
+
+
+ OpenTera: A microservice architecture
+solution for rapid prototyping of robotic solutions to COVID-19
+challenges in care facilities.
+ Panchea
+ Health & Technology
+ 2
+ 12
+ 10.1007/s12553-021-00636-5
+ 2022
+ Panchea, L., A. M. (2022). OpenTera:
+A microservice architecture solution for rapid prototyping of robotic
+solutions to COVID-19 challenges in care facilities. Health &
+Technology, 12(2), 583–596.
+https://doi.org/10.1007/s12553-021-00636-5
+
+
+ Principled design of the modern web
+architecture
+ Fielding
+ ACM Trans. Internet Technol.
+ 2
+ 2
+ 10.1145/514183.514185
+ 1533-5399
+ 2002
+ Fielding, R. T., & Taylor, R. N.
+(2002). Principled design of the modern web architecture. ACM Trans.
+Internet Technol., 2(2), 115–150.
+https://doi.org/10.1145/514183.514185
+
+
+
+
+
+
diff --git a/joss.05497/10.21105.joss.05497.jats b/joss.05497/10.21105.joss.05497.jats
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+
+
+
+
+
+
+
+Journal of Open Source Software
+JOSS
+
+2475-9066
+
+Open Journals
+
+
+
+5497
+10.21105/joss.05497
+
+OpenTera: A Framework for Telehealth
+Applications
+
+
+
+https://orcid.org/0000-0001-7825-7533
+
+Létourneau
+Dominic
+
+
+
+
+https://orcid.org/0009-0000-1224-8001
+
+Brière
+Simon
+
+
+
+
+https://orcid.org/0000-0002-3983-8754
+
+Maheux
+Marc-Antoine
+
+
+
+
+
+Godin
+Cédric
+
+
+
+
+https://orcid.org/0009-0008-4466-0963
+
+Warren
+Philippe
+
+
+
+
+
+Lauzier
+Gabriel
+
+
+
+
+
+Joly
+Ian-Mathieu
+
+
+
+
+https://orcid.org/0009-0008-5868-9724
+
+Bourque
+Jérémie
+
+
+
+
+https://orcid.org/0009-0003-0772-1177
+
+Arsenault
+Philippe
+
+
+
+
+
+Vilanova
+Cynthia
+
+
+
+
+https://orcid.org/0000-0001-7561-1170
+
+Tousignant
+Michel
+
+
+
+
+https://orcid.org/0000-0002-3639-7770
+
+Michaud
+François
+
+
+
+
+
+Interdisciplinary Institute for Technological Innovation
+(3IT), Université de Sherbrooke, Canada
+
+
+
+
+Research Center on Aging (CDRV), Université de Sherbrooke,
+Canada
+
+
+
+8
+91
+5497
+
+Authors of papers retain copyright and release the
+work under a Creative Commons Attribution 4.0 International License (CC
+BY 4.0)
+2022
+The article authors
+
+Authors of papers retain copyright and release the work under
+a Creative Commons Attribution 4.0 International License (CC BY
+4.0)
+
+
+
+Python
+Microservices
+Tele-Health
+Rehabilitation
+Robotics
+Telepresence
+
+
+
+
+
+ Summary
+
OpenTera is a microservice-based framework primarily developed to
+ support telehealth research projects and real-world deployment. This
+ project has 20 years of experience linking at-home participants to
+ remote users (such as clinicians, researchers, healthcare, and
+ professionals) with audio-video-data connections and in-the-field
+ sensors, such as biometrics, wearable, and robotics devices.
+ Applications of the OpenTera framework are not limited to research
+ projects and could exist in clinical environments.
+
Most telehealth-based research projects require a common data
+ structure: data collection sites, projects, participants, and
+ sessions, including various recorded data types from sensors or other
+ sources. They also require standard features: user authentication
+ based on various access roles, the ability to add new features based
+ on specific project needs, ease of use for the participant, and secure
+ data hosting. These features are also shared between research
+ projects: videoconferencing with specific health-related features
+ (e.g., angles measurement, timers), surveys data collection, data
+ analysis, and exportation.
+
Many available solutions are costly, feature-limited, proprietary
+ (e.g., can hardly be adapted for research purposes, and raw data is
+ more complex to access), or hard to deploy in telehealth. OpenTera was
+ built for extensibility to provide research projects complete control
+ over their data and hosting.
+
+
+ Statement of need
+
From our research experience, standard features between the
+ different telehealth projects emerged:
+
+
+
Data structure. Store data in a structured way to
+ ease data extraction and analysis.
+
+
+
Ecological data capture. Collect data not only in
+ laboratories or controlled environments but also in homes or
+ institutions.
+
+
+
Project adaptability. Develop project-specific
+ dashboards and user interfaces while reusing previous
+ implementations as much as possible to reduce development time.
+ Rehabilitation projects may require implementing serious games or
+ exergames, while teleoperation projects may require real-time
+ navigation tools. Adapting already existing open-source software
+ when possible is often the key.
+
+
+
Cost-effectiveness. Most commercial cloud
+ telehealth applications are subscription-based and do not offer
+ the flexibility needed. Each vendor provides its approach tailored
+ to its products and services. We often have data collection from
+ dozens of participants and users, and paying subscription fees
+ would be prohibitive.
+
+
+
Security. Store and transfer data in a secure and
+ controlled way. Access control to information depends on specific
+ project requirements. The ethics committee must approve research
+ projects involving participants, and they often require servers
+ hosted locally or within a particular region.
+
+
+
Uniformity. Avoid using multiple applications and
+ tools requiring the user to navigate between them (minimizing and
+ restoring them as needed) and focus on the current task.
+
+
+
Ease of use. Implement an easy-to-use solution for
+ users and participants at all process steps, I.e., authentication,
+ data collection, and data management.
+
+
+
Synchronous and asynchronous sessions. Support
+ real-time sessions (synchronous) or on-demand pre-recorded or
+ application-based sessions (asynchronous) with multiple users,
+ devices, and participants.
+
+
+
No installation. Connecting through a web browser
+ with a personalized link is favored, avoiding complicated
+ installation of apps and login/password/registration steps, which
+ are not accessible for everyone, depending on their technological
+ literacy. In healthcare establishments, support of deployed apps
+ often requires long-term planning and discussions with the
+ Information Technology team, as opposed to web-based
+ applications.
+
+
+
Long term availability. Research projects can be
+ conducted over a long period, and software versions, data
+ structures, APIs, and used features must be stable. There is no
+ guarantee that a commercial system with features will be supported
+ for the required duration.
+
+
+
Server deployment and management. Installation on
+ low-cost hardware (e.g., Raspberry Pis), local servers, and cloud
+ infrastructure can be required, depending on the scale of the
+ projects and their location. Deployments should be manageable by a
+ small team.
+
+
+
+
+ Existing Open-Source Solutions
+
Open-source projects like Big Blue Button, NextCloud Talk, Jami,
+ OpenVidu, Jitsi Meet, and Kurento offer excellent videoconferencing
+ solutions; however, they still need to meet telehealth requirements
+ fully. While there are open-source rehabilitation-oriented
+ applications available, such as the OpenRehab
+ (Freitas
+ et al., 2017) project, which offers multiple rehabilitation
+ tools for upper limbs, mobility, fitness, cognition, and balance, they
+ often focus on specific domains and primarily contain pre-recorded
+ videos or games prescribed by physiotherapists. Most of these
+ applications lack teleconsultation features and remote access to
+ research data. Open-source Electronic Health/Medical Records (EHR,
+ EMR)
+ (Goel
+ et al., 2017) can meet some research requirements, but storing
+ personal and sensitive information on participants could be better. We
+ prefer to use or connect to existing systems that comply with local
+ regulations like the Health Insurance Portability and Accountability
+ Act (HIPAA).
+
+
+ OpenTera Features
+
OpenTera is specifically designed to address the previously
+ mentioned and required features for research. It leverages a
+ microservice architecture based on recognized standards and best
+ practices. This architecture provides scalability, flexibility,
+ resilience, maintainability, and technology diversity, all needed in
+ research.
+
OpenTera contains the base server (TeraServer) offering a REST API
+ (Fielding
+ & Taylor, 2002), which helps manage users, participants,
+ devices, sites, projects, sessions, and supports multiple
+ authentication methods via user/password, certificates, or tokens.
+ TeraServer also manages authorizations for users, participants, and
+ devices, providing fine-grained access control on resources and
+ assets.
+
OpenTera also includes base services: Video Rehabilitation,
+ Logging, and File Transfer. They are used to conduct audio/video
+ WebRTC sessions from the web along with appropriate logging and file
+ transfer capabilities. Structured sessions enable organized
+ information such as survey data, sensor data, metadata, analytics, and
+ facilitate the retrieval of information and key statistics. Developing
+ new microservices allows developers to add new features to the system,
+ such as serious or exergames, exercise coaches/videos, and participant
+ calendar/portal.
+
+
+ Related Projects
+
Table 1
+ shows OpenTera-related open-source projects currently under active
+ development, implementing new OpenTera services or underlying
+ libraries. Preliminary implementations have been deployed for robot
+ teleoperation during
+ COVID(Panchea,
+ 2022). The current paper presents the implementation and design
+ choices for a more generic OpenTera framework focusing on open-source
+ implementation. Code quality, documentation, examples, and usability
+ have been greatly improved between these versions.
+
+
+
OpenTera Related Projects
+
+
+
+
+
+
+
+
+
+
GitHub Project Name
+
Description
+
+
+
+
+
opentera-webrtc
+
WebRTC library in C++/Javascript/Python with signaling
+ server to allow audio/video/data sessions.
+
+
+
opentera-teleop-service
+
OpenTera Service managing robots fleet and web front-end
+ for tele-operation.
+
+
+
opentera-webrtc-teleop-frontend
+
Robot teleoperation front-end made with Vue.js.
+
+
+
opentera-webrtc-ros
+
OpenTera robot device client and ROS integration for
+ remote control and monitoring of mobile robots.
+
+
+
openteraplus
+
Qt Frontend to manage OpenTera configuration and
+ data.
+
+
+
+
+
+
+ Acknowledgements
+
This work was supported by the Natural Sciences and Engineering
+ Research Council of Canada (NSERC), the Fonds de recherche du Québec –
+ Nature et technologies (FRQNT) and the Network of Centres of
+ Excellence of Canada on Aging Gracefully across Environments using
+ Technology to Support Wellness, Engagement, and Long Life
+ (AGE-WELL).
+
+
+
+
+
+
+
+ FreitasDiogo
+ PaulinoTeresa
+ BadiaSergi Bermúdez i
+ LlorensRoberto
+ DeutschJudith E.
+
+ Open rehab initiative: Second development iteration
+ International conference on virtual rehabilitation (ICVR)
+ 2017
+
+ 10.1109/ICVR.2017.8007524
+ 1
+ 2
+
+
+
+
+
+ GoelNeha A.
+ AlamAmal A.
+ EggertEmily M. R.
+ AcharyaSoumyadipta
+
+ Design and development of a customizable telemedicine platform for improving access to healthcare for underserved populations
+ 39th annual international conference of the IEEE engineering in medicine and biology society (EMBC)
+ 2017
+
+ 10.1109/EMBC.2017.8037404
+ 2658
+ 2661
+
+
+
+
+
+ PancheaLétourneauA. M.
+
+ OpenTera: A microservice architecture solution for rapid prototyping of robotic solutions to COVID-19 challenges in care facilities.
+ Health & Technology
+ Springer
+ USA
+ 2022
+ 12
+ 2
+ 10.1007/s12553-021-00636-5
+ 583
+ 596
+
+
+
+
+
+ FieldingRoy T.
+ TaylorRichard N.
+
+ Principled design of the modern web architecture
+ ACM Trans. Internet Technol.
+ Association for Computing Machinery
+ New York, NY, USA
+ 200205
+ 2
+ 2
+ 1533-5399
+ https://doi.org/10.1145/514183.514185
+ 10.1145/514183.514185
+ 115
+ 150
+
+
+
+
+
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