JOURNAL OF TELECOMMUNICATIONS, VOLUME 31, ISSUE 1, JULY 2015

13

Patient Monitoring Using Bluetooth and

Wireless LAN: A Review
Obianuju Assumpta Ezugwu and Aneke Stephen
AbstractThere are several publications on health related issues, which are the primary concern of everybody. This paper is targeted at
investigating and critically analyzing such publications which borders on Monitoring and Tracking of Hospital patients using Bluetooth and
Wireless LAN. We looked at the technologies suggested in the research paper and found out the limitations and the areas that need to be
improved upon.
Index Terms Bluetooth, Wireless LAN, Data transfer, Access point, Sensor, Availability and Reliability.

1 INTRODUCTION

HIS research paper under investigation is an IEEE

journal paper. They Opportunistic Medical Monitoring Using Bluetooth P2P Networks. Journal papers and
conference papers sometimes are just good for head
knowledge and not that they are good to be solutions to
problems they claim to be. Some of the information provided are insufficient to be a solution and one of the essence of research work is for another person to repeat the
process and come up with the same result the way most
of the publications end and jump to conclusion, leaving
the reader in suspense and gasping for information.
D. Cho eta al [1] reflects on how the current technology can be harnessed to be beneficial to the health sector. In talking about patient monitoring, they were firm in
suggesting the use of Bluetooth technology as a means of
data transmission rather than WiFi, some other technologies such as P2P ad hoc network was also involved to accomplish this. They identified with two main reasons for
embarking on the research work. One of them was to look
into the appropriateness and the efficacy of using Bluetooth in an ad hoc network to gather information on patients and the second objective was to come up with a
design on how Bluetooth can be used to generate alarm
signal for a patient that needs urgent and emergency attention.
Cheng and Zhuang [2] in their research work also
advocated for the use of Bluetooth technology in enhancing patient monitoring which they demonstrated in a
building in Canada. They were more concerned in using
Bluetooth to trap the physical location of the patient rather than in sickness monitoring and diagnosis in order to
improve on the health of the patient. Alzheimer is a disease that has to do with mental reasoning, their research
work did not cover or tell us how the causative symptoms
can be monitored technologically though pattern of patients locomotion is a sign of either improvement or deterioration. They also looked into some advantages Bluetooth has over others which include cost, power saving,
availability of materials and most convenient for in-house
operation due to its short range nature and connectivity.
Since Bluetooth cannot operate alone, they talked about
others like sensors, access points, and database which will
have their respective roles to play in the monitoring.

REVIEW OF RELATED LITERATURE

2.1 Wireless LAN

The choice of WLAN media was to provide mobility support to the patient, [4] apart from this the comfort and
environmental serenity patients enjoy because of the use
of WLAN approach to patients monitoring is an edge
over the wired approach. [3] Lightweight (centralized
architecture) and autonomous (distributed architecture)
WLAN architectures are the two approaches in WLAN [5]
but in making choice of architecture, scalability and future
proof should be considered. WLAN suffers security
threats [6] as one of the major problems facing the confidentiality of information prevalent in hospital environment. Another issue of utmost interest in this is the
centralised management of the WLAN [6] due to increase
in patronage and usage coupled with the mobility of
users.WLAN

Fig.1: WLAN Physical Network Layout.

Source: http://hqwww.panduit.com/panduit/groups/MPMWC/documents/Articles/107242.pdf

makes use of radio frequency (RF) due to the the presence

of access points (AP), it has been suggested that the
utilization of this RF be optimised [7] in order to
accommodate many other access points that might be
present. The reason for many access pointis is that, in a
typical WLAN, it is not certain that only one device will
be trasmitting at the same time but many other divces will
as well be transmitting, therefore these access points are
strategically positioned to receive signals from devices
they are meant to communicate with. As we said before,
WLAN need RF to operate but there are other substitutes

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for RF, they include microwave and infrared

transmission[8]. The essence of these is to provide
communication between the node (device attached to the
patient in order monitor the patient) and the doctors
computer (device) via the hospitals database. The actual
data trasmission is done using either Frequency Hopping
Spread Sprectrum (FHSS) or Direct Sequence Spread
Spectrum (DSSS) or the Infrared (IF) [8,9], the APs role is
transmitter and receiver.

quency standard (uses SSFH technique) for transmission

of data from one node to the other, on the protocol level it
provides agreement among the products on when bits
should be sent, how many should be sent at a time and
the number of parties that should participate in order to
be sure of message integrity [10,11].

Fig 2: Physical Operations of IEEE 802.11a/b/g

Source: http://rt5vx6na7p.search.serialssolutions.com

IEEE802.11a/b/g standards support WLAN communication and this communication requires interfaces at both
transmitter and receiver ends for linkage with the radio
front end [8]. The data generated at the node end have
digital properties and cannot be transmitted in that form,
it has to be brought to the transmittable format. Before the
data is transmitted, it has to be first of all be converted
into a baseband waveform, then into an analog format
before transmission is done. The same thing happens at
the receivers end where the received analog waveform is
converted into baseband format and then into bits (0s
and 1s) format for the receiving node to use and or store
[8].

2.2 Bluetooth Overview

Fig. 3: Bluetooth Wireless PC Card

Source: http://electronics.howstuffworks.com/bluetooth1.htm

It is a type of wireless technology that provides support

for local area network of devices.. It operates in such a
way that it does not require intermittent user interventions for transmissions and it expels minimal energy during operation [10]. Bluetooth works within a small area
network, on the physical level it is essentially a radio fre-

Fig. 4: Architecture of Bluetooth Protocol

Source:
http://ieeexplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.jsp?t
p=&arnumber=6202154

The above diagram demonstrates a typical architecture

of Bluetooth technology which basically operates on the
principles of Radio specifies the air interface, including
the frequency, Baseband which provides connection
within the piconet, addressing, packet format, timing
and energy (power) control, Link Manager Protocol
sets up the link between Bluetooth devices and the
management of the link, Logical Link Control and Adaptation Protocol causes the upper layer protocol to
operate on the baseband layer [9].
Bluetooth technology is preferred to Infrared (IR) technology because of the shortfalls prevalent in IR. These are
mainly the mode of connection which is on the basis of
line of sight [9] which is not good in a hospital environment because if an object blocks the line of sight, connection will not be established thereby inhibiting data transmission. Another tradeoff is that IR provides support just
for one device at a time [9] which is not cost effective and
the purpose for establishing the WLAN would be defeated since it is possible for more than one patient to be monitored at the same time. Unlike Infrared, Bluetooth is cost
effective, easily available in the market from day to day; it
operates beyond obstructions within a distance of 10m
radius making it possible for patients tracking irrespective of the patients location within the building and again
Bluetooth does not consume much energy during opera-

15

tion rather it consumes as low as 1mW of power and can

be sustained by a 3V battery [10,11].

2.3 Disadvantages of Bluetooth Technology

Bluetooth Technology has been used extensively in wireless network application because of the cost implication
and it does not require much expertise to implement.
Apart from the encouragement it brought, there some
issues with the Bluetooth. One of the issues found in Bluetooth Technology was identified as [12] Bluetooth pollution. It has been demonstrated that Bluetooth pollution
occur as a result of proliferation of Bluetooth devices.
Many of these devices despite being within the Bluetooth
frequency range, but these are known to be noncooperating Bluetooth devices. It affects the basic Bluetooth operations such as inquiry, paging and connection
setup.
Bluetooth devices that are involved in networks do not
need to disclose their private inputs to other networking
devices for computation. This phenomenon is known as
[13] Secure Multiparty Computation (SMC). The reason
for this is because of the security issue associated with
Bluetooth technology. In ad hoc networks, there is no
predefined network boundaries, the nodes are free to join
and leave the network at any time. This has given room
[13] to some of the nodes to compromise the security of
the network, an attacker can equally find it easy to join
the network unnoticed. In this network, there is no central
control facility with which activities on the network can
be monitored. Other issues include limited energy resource for communicating nodes and deterministic network scalability [13].
In Bluetooth technology, [14] signals and noise are inherent. One node transmits at a time and another node
receives at a time. Therefore, in order to have a smooth
network communication, the receiving node should have
a way of separating the unwanted signals from the desired ones. This is determined by the ratio of the signal
strength of the desired signal to the noise strength at the
receiving antenna, the ratio is known as Signal to Noise
Ratio (SNR).

METHODOLOGY USED IN THE PAPER

3.1 Patient Monitoring and Record Management

In this section, the researchers identified two scenarios
(Military hospital and old peoples home) and adopted
the techniques to support them. They also mimicked
NurseNet and BlueAlert modes of data communication.
NurseNet has to do with sending patients data to the
central database for storage. NurseNet architecture is
shown in the diagram below.

Fig. 5: NurseNet Architecture

Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

The NurseNet architecture is composed of three (3) components which are: Patients, Nurse and
AccessPonts/Central Database/Doctor. Information on the patients were gathered through the aid of sensors that were
attached to their bodies. The nurses in attendant were
given a mobile (hand held) devices that were connected to
patients devices and the central database. The patients
device transfers data to the nurse device then from there
through a Bluetooth P2P to the central database. The delivery of the patients data to the database can either be
done directly by the nurse who received the data or other
nurses can as well assist in doing that. To illustrate how
this architecture works, two scenarios were considered.
Considering a field hospital that contains 20 40 patients
in a row, 5 10 meters apart, and nurses who take turns
in attending to them. As the nurses are attending to these
patients, their devices are downloading information on
the patients. These information are later transferred to the
database, it is also shared among the nurse through the
P2P manner of which nurse aids take part in doing. Another case is that of the Nurses taking care of elderly people, the monitoring device also help the nurses in gathering data on these elderly people through their respective
devices. The nurses also upload the data to the central
database, or share it among themselves.
BlueAlert technique is an emergency alarm protocol but it was built on the strength of Bluetooth 2.1.This
protocol works on the principle that the signals being sent
by the sensors should not exceed certain threshold. But if
this threshold is exceeded, the propagation mode changes
from BlueTorent to BlueAlert, this will cause steady sending of alert messages to other peers that help in the dissemination of this message

3.2 Experiment
This experiment was carried out in a parking garage of
size 75m x 75m in order to mimic the hospital and battle
field environment, it was carried out in the night to ensure accurate result.

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Fig. 7: Number of Packets received by different entities

Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

The diagram above shows the contribution of each node

to the delivery of the patients medical data to the BT-AP.
Nurse nodes exchanged their packets with neighbours to
decrease packet delivery latency.
Fig. 6: Experiment Scenario (Parking Garage)
Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

The components involved in this experiment were Patient, BT-AP (Bluetooth Access point), and three nurses.
The patient puts on two different sensors (ECG and purse
oximeter, both fabricated by Alive Technology). Each sensor transmits 1143 Byte-sensor packet every 240ms on the
Bluetooth channel to the patients gateway(a laptop was
used in this case). The gateway generates about 70 Kbytes
of medical data per minute. The patients node begins to
inquire in order to discover nurse upon which the gateway starts to send list of its data blocks to the nurse.
BT-AP- It was only this component that has the
ability of providing internet service which enables it to
transmit patients data to the Doctor via the internet. The
BT-AP periodically performs inquiry to discover the nurse
gateway for update on the patients records.
Nurse- Three nurses were interconnected using
P2P network. Their role was to collect medical information from the patient and then upload them. The nurses walked randomly in the experiment area with their
respective laptop at the speed from 0.5 to 1m/s. Bluetooth
2.0 was used for the nurses, patient and the AP. The piece
size was set to 500-Bytes making a total of 140 pieces/file,
the test was ran for 20 minutes for a total of 5 tests.

3.3 Result

Fig. 8: Number of hops travelled by patients file.

Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

From this diagram, there is a display of the fraction of

hops the patient file traveled before getting to the destination and the effects of the number of hops on the delivery
time of the file. The researchers has shown that more hops
reduce the delivery time.
Identified problems- The researchers identified the limitation of their equipment. Again the inability of the system to disconnect the connection with the AP as soon as
the mobile node moves out of the range. Another problem
identified was other nodes trying to connect to a failed
node.

Table 1: Packet Delivery Time

Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

The table above shows the statistics on the delivery of

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patient data in the experiment. It has an average delivery

time of 334.89secs for 100Kbytes of data. On normal circumstance, an average of 300secs is fine but not in case of
emergency.

3.4 Simulation
Aim: To investigate through simulation NurseNet and
BlueAlert. The reason for this simulation is because at the
time of this experiment, Bluetooth 2.1 was not yet out and
the researchers wanted to show that it can be used to generate emergency alerts for the patients.
NurseNet (Scenario 1)

Table 2: Simulation for scenario1

In this scenario, every patient (50 in number) had
body sensors and Bluetooth-enabled gateway. The sensors
kept generating and transmitting medical data on the patient. Five (5) nurses were involved moving around the
area, each having a list of patients to visit. While walking
at the speed of 1m/s for 20 secs, a patient is visited and
the nurse spends 5mins with the patient. As the nuse is
walking to visit a patient, her device gathers information
on nearby patients. A record of 100Kbytes were downloaded within 10secs, 10meters contact window. Once a
patient record is read by the nurse, a new record is created by the patients body LAN. As soon as the nurse gets
to the office, she will upload those medical records and
resumes patient visitation.

3.5 BlueAlert (Scenario2)

This is to demonstrate how emergency alarm can be
propagated. Patients are assumed to move in a 100 by
100m2 area. One of the patients needs emergency attention, the Bluetooth gateway on the patient;s body LAN
detects the emergency and propagates an emergency
alarm message to all the neighbours. The number of hops
and the delay before the emergency larm gets to the nurse
is measured.

Fig. 9: Collection Delay

Fig.10: Uploading Delay
Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

The diagrams above show collection and uploading delays in the simulation. P2N represents patient to nurse
communication. This took place when the nurse was collecting patients data. From the result, there was no patients data exchange among the nurses. The delay was
3,000secs. N2N represents nurse to nurse communication.
But a situation of P2N +N2N there should be subsequent
influence but in this case there is none because the N2N

has nothing to do with patient data collection. Coming to

the uploading result, we can notice that in P2N, the delay
was 1,000secs and N2N 700secs which suggests N2N
communication which reduced the latency.

Fig. 11: No. of Nodes vs Delay

Fig. 12: No of Nodes vs No. of
Hops
Source:http://ieeeplore.ieee.org.ezproxy.mdx.ac.uk/stamp/stamp.js
p?tp=&arnumber=4594895

Above are diagrams showing that as the number of patients increases, the number of hops also increases and
further reduction in propagation latency by factor of 10
(for 100 nodes).

DISCUSSION

In the first scenarios that illustrate how NurseNet works

have so many flaws when viewing from security perspective. From the illustration, It was noticed that an attacker
can easily play masquerade, man in the middle, modification and non repudiation. Since the nurse opportunistically start to download information on the patient, it then
means that anybody with that type of device can as well
opportunistically download information on the patient
without restrictions. Again the person who claims to be
nurse, how truth is it, anybody can pretend to be nurse
and do whatever he/she wants to do and get away with
it. The idea of either uploading the patients data to the
database directly or indirectly should not occur. When
such duties are delegated, nobody is responsible for mistakes or divulging confidential information. Another
problem here is high tendency of information duplication
which can cause confusion later on. Again the idea of P2P
is wrong in such a situation. The principle of P2P is such
that no server controls the communication among peers,
an attacker can easily sneak in without notice thereby
having access to the patients medical information
The ideal thing should be the introduction of
some security measures to help checkmate the activities of
attackers. In such a locality, in order the ensure the confidentiality of the patients information, the transmitted
data should be encrypted to make it unintelligible if an
attacker eavesdrops on it, it is also wise to introduce authorization mechanism to ensure that the right personnel
assess the patient information.. Authentication and authorization will take care of masquerading and man in the
middle, modification, and non repudiation attacks. The
issue of delegating either another nurse of nurse aid to
upload information for another nurse should not come,
every nurse should be responsible for his/her duties. Every nurse should upload the information he/she collected
on the patient and the device should be able to append
timestamp to the information and the identity of the nurse
on duty for accountability sake. The P2P approach should
be replaced with client/server approach and instead of
nurses uploading the captured medical records, the patients devices should communicate directly with the database, then to the medical personnel. In case of emergen-

18

cy, the server can generate an alert message and forward

it to the medical personnel in charge.
Though the experiment was carried out in the
night but Bluetooth operates on the frequency of free license band of ISM and many other devices compete for
this frequency, there is no guarantee that there were no
other devices competing at this time of the night since
Bluetooth is always on. Again for this idea to be adopted,
in real life is it ideal that patients should be monitored
only at night to guard against interference of other competing devices. If collision avoidance technique is introduced in the base of the AP, it will reduce interference of
other devices. Multiple transceivers should be installed
instead of having one transceiver which is just a single
point failure. The introduction of multiple transceivers
will not allow transmission to fail if a single transceiver
fails.

OBSERVATION

The idea of using Bluetooth to monitor patients remotely

is a good one but the most of the problems encountered
which limited the experiment were mainly Bluetooth
based. Employing the services of Bluetooth alone is not
enough to give the performability needed in a health environment. However, there are areas that need to be addressed; they are the incorporation of other technology
such as 3G, WLAN and real time operating system in patient monitoring. Another issue that should be looked into
is the effect of patients body temperature on the sensor
node and the effect of the signals emitting from the Bluetooth on the patients health.

CONCLUSION

The researchers were able to prove the contribution of

Bluetooth to the health sector. Making use of the short
range coverage nature of Bluetooth and ability not to be
obstructed by the presence of barriers such as walls facilitates reaching out to patients not minding their location
within a building. However Patient monitoring using
Bluetooth with P2P network technology is not an ideal
setup for hospital service rather there should be a way to
integrate a more recent technology like 3G or 4G so that
patients data are not restricted to data transmission only
but voice and multimedia should be transmitted equally.

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Obianuju Assumpta Ezugwu is a lecturer at the

Department of Computer Science, University of
Nigeria Nsukka. She has B.Sc in 1998 and M.Sc
in 2008, Computer Science from University of
Nigeria. Her research interests are Software
Development and Research Support System. She
is a member of Nigeria Computer Society, Computer Professionals, Nigerian Women in Information Technology, and
Organisation for Women in Science for the Developing World.

Aneke Stephen apart from currently lecturing at

the Department of Computer Science, has worked
with SchoolNet Global (2006) and Microsystems
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