RESUMEN
Internet application server technologies and browsers make it possible to design and develop a telemedicine application server structure providing a continuum of telemedicine care while reducing the complexity for the end user. Th build many types of "write-once-run-anywhere" telemedicine applications and allow them to dynamically adapt to a variety of platform restrictions, we need a framework to support system services for telemedicine applications. In aims to increase the efficiency of distributed multimedia medical databases in terms of clinical consulting process, we propose to mange external data access using distributed middleware standardizations. In order for our framework to be clinically relevant, we draw on experience and knowledge acquired in the field of urology, dialysis, emergency, and hospice telemedicine in which the Imaging Science and Information Systems Center at Georgetown University Medical Center has undertaken or is undertaking clinical trials. Development of a telemedicine application server for a true continuum of telemedicine care will increase user operability while decreasing the integration complexity.