2014 IEEE RFID Technology and Applications Conference (RFID-TA)

Integration of UHF RFID and WSN Technologies in

Healthcare Systems
L. Catarinucci, D. De Donno, L. Mainetti, L. Palano, L. Patrono, M. L. Stefanizzi, and L. Tarricone
University of Salento, Innovation Engineering Department
Via per Monteroni, 73100, Lecce, Italy
E-mail:{firstname.lastname}@unisalento.it
AbstractThis work describes a Smart Hospital System
(SHS) based on the integration of Ultra-High Frequency (UHF)
Radio Frequency Identification (RFID) and IEEE 802.15.4
Wireless Sensor Network (WSN) technologies. SHS is able to
provide patient localization, tracking, and monitoring services
within hospitals or nursing institutes through the deployment of a
heterogeneous network of RFID-WSN nodes relaying data to a
central server. A set of software applications based on RESTful
Java and database Push Notification (PN) technologies has been
designed, implemented, and installed on the central in order to
manage alert events (e.g. patient falls) and promptly inform the
nursing staff through an iOS mobile app which has been
designed ad hoc for the smart hospital scenario.
Keywords RFID; WSN; integration; healthcare; E-health

I.

INTRODUCTION

Improving the efficiency of health care infrastructures and

biomedical systems is one of the most challenging goals of
modern-day society. In fact, the need of delivering quality care
to patients while reducing the healthcare costs and, at the same
time, tackling the nursing staff shortage problem is a primary
issue.
As highlighted in [1], current procedures for patient
monitoring, care, management, and supervision are often
manually executed by nursing staff, which represents de facto
an efficiency bottleneck. The recent achievements in the
Internet of Things (IoT) technologies [2] open up opportunities
to develop innovative, smart systems supporting the
improvement of healthcare and biomedical-related processes,
e.g. the automatic identification, monitoring, and tracking of
both patients and employees in hospitals and nursing institutes.
Such smart systems could spread the application of the wellknown five-rights method, as required by the Joint
Commission on Accreditation of Healthcare Organizations
(JCAHO). According to such method, the right patient should
be treated with the right drug in the right dose in the right way
at the right time [3], [4].
Among the IoT technologies enabling smart, pervasive,
and ubiquitous healthcare systems, the Radio Frequency
Identification (RFID) and Wireless Sensor Networks (WSNs)
represent two of the most promising solutions. RFID is a lowcost, low-power technology consisting of passive and/or
battery-assisted passive (BAP) devices, named tags, which are
able to transmit data when powered by the electromagnetic

978-1-4799-4680-8/14/$31.00 2014 IEEE

289

field generated by an interrogator, named reader. Since

passive RFID tags do not need a source of energy to operate,
their lifetime can be measured in decades, thus making the
RFID technology well suited for many scenarios, including the
healthcare one [5]-[7]. The main drawback of RFID tags stems
from the fact that they can operate solely under the reader
coverage region, thus making the use of RFID technology
limited to object identification in small areas. The integration
of RFID and WSN technologies could be a well-suited
approach to overcome this limit and enable the development
of complex, next-generation applications. Basically, WSNs
consist of a large number of low-cost, low-power embedded
devices, named sensor nodes, which are able to self-configure
and self-organize. These characteristics make them suitable to
be deployed even in harsh environments in order to detect
important parameters (e.g. temperature, light, humidity, etc.)
without human intervention. The collected data are delivered,
in a multi-hop mode, to a central point (sink) for proper
utilization [8]. One of the main issues to be addressed in the
development of complex WSN applications is the power
consumption of sensor nodes. In fact, they are usually batterypowered and deployed in large areas where changing or
replacing batteries is impractical or completely unfeasible [9][12].
Although RFID and WSN were originally designed with
different objectives, the benefits provided by both
technologies suggest the development of an integrated
solution, able to combine identification (RFID) and advanced
communication (WSN) capabilities [13] in order to improve
the effectiveness of both technologies and give new
perspectives to a broad range of novel applications, e.g. in the
healthcare domain.
A lot of initiatives within the field of E-Health have been
launched worldwide in the last few years by hospitals,
pharmaceutical
companies,
public
institutions,
and
governments [14]. Moreover, the European Commission is
continuously stimulating research activities in the field by
promoting the development of sustainable and personalized
healthcare systems (e.g. the ICT Challenge 5, Framework
Programme 7). Many interesting solutions have been already
presented in the literature, however only few of them have
been implemented on real devices. In [15], a wireless
localization network able to track the location of patients in an
indoor environment and also to monitor their physical status is

2014 IEEE RFID Technology and Applications Conference (RFID-TA)

presented. A location-aware WSN to track patients using an

algorithm called REMA (Ranging using Environment and
Mobility Adaptive) filter is proposed in [16].
Another interesting aspect concerns the movements
classification. Several studies have been focused on this topic
in the past [17]. Most of the proposed solutions in the
literature rely on low-cost, small size multi-axial
accelerometers in order to monitor postural orientation of
patients as well as their body movements [18]-[22]. In such
works, the classification of movements is often done using
fixed thresholds, pattern-recognition, and fuzzy logic. In [1], a
smart WSN providing patient localization, tracking, and
monitoring services within nursing institutes is presented. The
localization and tracking engine rely on the Received Signal
Strength Indicator (RSSI) and particle filters while bi-axial
accelerometers are used to classify the movements of patients.

Fig. 1. The proposed architecture of the Smart Hospital System (SHS) based on
the integration of UHF RFID and WSN technologies.

To the best of authors knowledge, only few attempts have

been done to leverage the combined use of UHF RFID and
WSN technologies in healthcare scenarios. In [23], RFID,
WSN, and GSM are exploited together to track patients in
hospitals and monitor their physiological parameters while a
smart system using active UHF RFID, WSN, and GSM for
real-time supervision of patients is presented and discussed in
[24].

capabilities, while the C node collects the received data and

forwards them to the server machine. Referring to the
proposed RFID-WSN integrated system, in which both RFID
readers and RFID tags are physically interfaced with WSN
nodes, two new typologies of nodes can be introduced in the
network (Table I):

This paper describes a smart system based on UHF RFID

and WSN technologies for the automatic monitoring,
localization, and tracking of patients, personnel, and
biomedical devices within hospitals and nursing institutes. In
particular, the system augments standard WSN functionalities
through the deployment of advanced network nodes featuring
both WSN communication/sensing and UHF RFID
identification capabilities. The system is able to collect, in real
time, both patients physiological parameters and
environmental conditions, and, in case of emergency, to
promptly inform the nursing staff via a customized software
application specifically designed for mobile devices such as
smartphones, tablets, etc.

the Router Reader (RR), which is a R node interfaced

with an UHF RFID reader;

the End Device Tag (EDT), which is a typical ZigBee

End Device (ED) node (i.e. a WSN node without
routing and forwarding capabilities) interfaced with an
UHF RFID tag.

As depicted in Fig. 1, the SHS consists of a ZigBee WSN

with several R and RR nodes scattered in the hospital to
monitor environmental parameters, e.g. temperature and
ambient light conditions. Such information is delivered, in a
multi-hop manner, to the C node, which, in turn, stores the
collected data in a database located in the Central Server. The
main function of RR nodes is to track patients, nursing staff,
and biomedical devices labeled with UHF RFID tags. As for
patients, they wear an EDT node capable to detect the patients
status and relay the information to the C node through the
WSN. More specifically, the EDT node periodically logs on
the RFID tags user memory patients physiological
parameters, such as heartbeat, body temperature, breath,
movement characteristics. The stored data are retrieved by RR
nodes deployed in the environment and delivered to the Central
Server, or directly to the nursing personnel equipped with a

The remainder of the paper is organized as follows.

Section II outlines the architecture of the proposed smart
hospital system along with involved hardware and software
components. Section III describes and experimentally
validates a proof-of-concept implementation of the system.
Finally, concluding remarks are given in Section IV.
II.

SMART HOSPITAL SYSTEM

The proposed integration of UHF RFID and WSN

technologies is exploited in this work to implement a Smart
Hospital System (SHS) whose architecture is outlined in Fig 1.
Basically, SHS provides innovative services for the automatic
supervision of both patients and personnel within hospitals or
nursing institutes through the deployment of an IEEE
802.15.4-based WSN able to collect and deliver data to a
Central Server. The controller unit analyses the received
information and sends an alert message in case of emergency.

TABLE I.

TYPES OF NODES MAKING UP THE SHS SYSTEM

Node typology

According to the ZigBee WSN paradigm, the main

components of such a network are Router (R) and Coordinator
(C) nodes. The R node provides forwarding and routing

290

Router Node

Coordinator Node

RR

Router Reader Node

EDT

End Device Tag Node

2014 IEEE RFID Technology and Applications Conference (RFID-TA)

A. Hardware components
The EDT node consists of an UHF RFID tag physically
interfaced to the microcontroller unit (MCU) of a WSN node
via the I2C bus (see Fig. 2). The printed circuit board (PCB)
RFID tag has been prototyped in our labs by using a
photolithography process on FR4 substrate and handy
soldering off-the-shelf discrete components (specifically an
UHF RFID chip and a decoupling ceramic capacitor). The
developed board is equipped with a battery holder (not
exploited in the proposed RFID-WSN integration since the
required power is fed directly from the 3-V battery of the
WSN node) enabling a stand-alone mode of operation as a
battery-assisted passive (BAP) RFID tag [25]. The designed
dipole-like UHF RFID antenna is patterned directly on the
PCB. Note that, depending on the application, a directive
patch antenna could be used to achieve higher performance
(e.g. a longer read range) and platform tolerance [26]. The
input impedance of the antenna has been tuned to achieve a
complex conjugate impedance matching with an Impinj
Monza X-2K RFID chip [27] (Zchip=Rchip+jXchip = 20.83j181.39 ) at 866.5 MHz, i.e. the central frequency of the
European UHF RFID band. The Monza X-2K is a newgeneration UHF RFID integrated circuit (IC), compliant with
the EPCglobal Class-1 Generation-2 (Gen2) standard, with

2176 bits of non-volatile memory (NVM) and an I2C interface.

In our prior works, this RFID chip has been used to develop
computational RFID tags [28]-[30] (i.e. augmented tags with
sensing and computing capabilities) specifically designed for
heterogeneous RFID-based WSNs. As an I2C device, Monza
X-2K operates as a standard EEPROM whose contents can
also be accessed via the Gen2 air interface. In the fabricated
prototype, the small female header exposing the I2C bus is
used to interface the RFID chip with a MB851 board
developed by ST Microelectronics [31]. This board is
equipped with a 32-bit ARM Cortex-M3 MCU operating up to
24 MHz and embedding 16-KB RAM and 256-KB eFlash
ROM. It integrates also a 2.4 GHz wireless transceiver
compliant with the IEEE 802.15.4 standard. The featured
MCU is optimized to provide high performance at very low
power consumption. The WSN board is also equipped with 24
highly configurable GPIOs with Schmitt trigger inputs.
Among the exposed GPIOs, the SDA and SCL lines, the
ground pin (GND), and an output pin (DCI) have been used to
implement the I2C communication with the RFID component
and provide power to the RFID chip. Finally, the MB851
board is equipped with a temperature sensor and a 3-axis
micro-electromechanical system (MEMS) acceleration sensor
which can be exploited for the development of several smart
applications. Details about the power consumption of the EDT
node are reported in our earlier work [32].
The other key component of the SHS is the RR node (see
Fig. 3). It consists of an UHF Gen2 RFID reader interfaced
with the XM1000 sensor board from Advanticsys [33] via the
UART communication bus. The board is equipped with a 16bit ultra-low-power TI MSP430F2618 MCU and embeds 8
Kbytes of RAM and 116 Kbytes of Flash memory. Wireless
communication capabilities are provided by the TI CC2420
transceiver with transmission frequency of 2.4 GHz. In
addition, the board integrates temperature, humidity, and
ambient light sensors. The selected reader is the Sensor ID

Fig. 2. The EDT node physically interfaced with the UHF RFID tag.

Fig. 3. The RR node embedding the UHF RFID reader.

portable UHF RFID reader. In case of medical emergency or

critical situations, such as patients falls or heartbeat
irregularities, the EDT node activates its IEEE 802.15.4 radio
transceiver to send an alert message to the control center. In
such a way, EDT nodes keep their radio off for most of the
time, thus maximizing battery lifetime. At the Central Server, a
patient monitoring application exploiting database Push
Notifications (PN) is used to inform the nursing staff.
Details about the hardware and software components
involved in the SHS are provided in the following sub-sections.

291

2014 IEEE RFID Technology and Applications Conference (RFID-TA)

Discovery Gate UHF [34] which can be easily configured and

controlled by the XM1000 board via the UART interface. The
reader supports standard Read/Write Gen2 commands for
reading/writing data from/to the tag user memory up to
approximately 8 m of distance.
B. Software components
The operating system (OS) chosen to develop the firmware
for the WSN node is the Contiki OS [35]. It is a popular opensource operating system targeted to small microcontroller
architectures and developed by the Swedish Institute of
Computer Science. It provides a full IP network stack, with
standard IP protocols such as UDP, TCP, and HTTP, in
addition to the new low-power standards. Furthermore, Contiki
is highly memory efficient and provides a set of useful
mechanisms for memory allocation. These features make
Contiki the ideal choice for the development of innovative,
smart applications, capable to exploit the new possibilities
offered by the integration of RFID and WSN technologies.
In the proposed SHS, the software aspects concerning the
interfacing between WSN nodes and RFID components have
been implemented in Contiki OS as system drivers.
Specifically, as for the RR node, several functions to set
hardware parameters, configure the UART communication
interface, and manage the user memory of singulated tags have
been developed. As for the EDT node, the implemented driver
includes all the functions needed to manage the Monza X-2K
RFID memory banks via the I2C communication bus.
Furthermore, to store and analyze the patients data
transmitted through the deployed WSN, two different
applications have been implemented and installed on the
Central Server:

Standalone Java Application (SJA), which collects the

data received from the C node by using the jNetPcap
SDK [36], parses and sends them to the RJA
application through RESTful requests. Note that
jNetPcap SDK is one of the most advanced open
source tool for packets capturing at the time of
implementation.

RESTful Java Application (RJA), which analyses the

received information and stores it on a MySQL
database. When the RJA identifies an alert message
from an EDT node, it sends a Push Notification (PN)
on the mobile device of the nearest doctor in the
hospital or nursing institute by using the Apple Push
Notification service. It is a RESTful Java Web
Application running on Apache Tomcat application
server and developed by using the Jersey Framework.

The presented mobile application has been implemented on

the iOS operating system; however, we are currently
developing it on different OSs (i.e., Android and Windows
Phone). It has been implemented by using the Model View
Controller (MVC) design pattern with a Controller module and
two Views: one for the patients list and another for the patient
details.

managing the interactions between the App and the

RJA by using the Cocoa Touch Framework APIs;

parsing the received information.

The use of the Apple Push Notification Mechanism

(APNM) instead of other technologies (e.g. GSM) allows us to
directly interface with the mobile App and, therefore, to access
all the information about the patient stored in the database.
The overall software architecture of the proposed system is
shown in Fig. 4.
III.

EXPERIMENTAL VALIDATION

In this section, a prototype implementation of the proposed

SHS is described and validated. A simple proof of concept has
been developed in order to demonstrate that the proposed
solution can meet the real requirements of a smart hospital
environment.
The 3-axis MEMS accelerometer of the MB851 board has
been used to evaluate a patient fall and generate an alert.
Especially for hospitalized elder, these accidents could give
rise to serious consequences if aid is not given in time.
Although many solutions in the literature propose sophisticated
mechanisms to detect and prevent falls, a simple thresholdbased approach has been considered in this work. The
thresholds have been set based on empirical data obtained
through several tests carried out in our laboratory. It is worth
noting that the aim of this paper is to demonstrate the
feasibility of just one of the several possible use-case scenarios
of the proposed SHS. Therefore, the definition of specific,
optimum algorithms to detect patient falls is outside the scope
of this work.
In Fig. 5, a simple validation scenario is reported. In our
implementation, the RFID tag embedded into the EDT node of
a patient contains, in addition to physiological information
periodically saved by the sensor node, the Electronic Product
Code (EPC), which is used to univocally identify the patient in
the hospital. An RFID tag is also used to identify the nursing
staff. Furthermore, in our scenario, the database stores
information about the location of each RR node in the hospital
(e.g. the RR #1 is placed in Room #21) and important data on
the employed doctors. An Apple iPhone 4S has been used to
validate the system. The mobile App is installed on this device

Fig. 4. The overall software architecture.

More in detail, the Controller module is responsible for:

292

2014 IEEE RFID Technology and Applications Conference (RFID-TA)

(a)

and uses the Wi-Fi or 3G Internet access. When an alert event

occurs (e.g. patient fall), the application receives the PN sent
by the RJA and notifies the doctor with a sound. Moreover, the
mobile App allows the doctor to retrieve all information related
to the event and the patient from the Central Server.

CONCLUSION
We have presented a Smart Hospital System (SHS) based
on a complex hardware/software architecture integrating UHF
RFID and WSN technologies for patient monitoring,
localization, and tracking. The system exploits a heterogeneous
network of hybrid UHF RFID and IEEE 802.15.4-based WSN
devices which can be rapidly deployed in any hospital or
nursing institute. A central server implementing advanced
database management techniques and running RESTful Java
software applications constantly monitors the patients status
and, in case of emergency, promptly sends Push Notifications
(PN) to a smart, lightweight iOS App installed on the nursing
staff mobile phone.

The first part of the considered use case is related to the

patients monitoring system which relies on the following
operations:
1.

the RR node reads the EPC and all the information

about the patients health status stored in the User
Memory of the RFID tag embedded into the EDT
node;

2.

the RR node reads the EPC stored into the RFID tag of
the doctor;

3.

the RR node sends the retrieved data, along with its

identification number, to the C node for a proper
utilization;

[1]

the SJA and the RJA applications running on the

Central Server analyze the received data and store
them in the database.

[2]

The second part of the use case, instead, concerns the

management of emergency situations according to the
following procedure:

[3]

5.

6.

(c)

Fig. 6. Some screenshots of the prototype SHS: (a) the doctor receives the PN
on the mobile phone; (b) the doctor visualizes details about the emergency
situation; (c) the doctor visualizes the list of patients.

Fig. 5. Validation scenario.

4.

(b)

the EDT node detects the patient fall, activates its radio
transceiver, and sends an alert message to the C node.
Such a message contains the patients EPC and the last
physiological information sensed by the node;

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Finally, as shown in Fig. 6c, the developed App is also

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