Proceedings of the 25'" Annual lnlematianai Conference of the IEEE EMBS

Cancun, Mexico * September 17-21,2003

A Low-cost Microcontroller-based Wireless ECG-Blood Pressure

Telemonitor for Home Care
Ricardo Isais, Khoi Nguyen, Gabriel Perez, Roberto Rubio, and Homyoun Nazeran
Department of Electrical and Computer Engineering
The University of Texas at El Paso
El Paso, Texas 79968, USA
E-mail: nazeran@ece.utep.edu
AbstractHomecare is the provision of health care
services to patients in their own home. One of the main
purposes of homecare telemedicine is to develop a wireless,
low-cost and use-friendly system which allows patients to
measure their own vital signs, such as blood pressure and
electrocardiogram (ECG), and provide the health care
professionals with the facility to remotely monitor the
patient's vital signs quickly and easily. There were four major
parts in developing the ECGblood pressure homecare
telemonitoring system. The first part involved the selection or
designing of devices that measure the vital signs. An Omoron
HEM-609 blood pressure monitor was used to acquire the
patient's blood pressure. Since ECG machines or bedside
monitors are expensive to use for this purpose, an ECG
amplifier was custom designed and implemented using
AD624AD to amplify the ECG signal. A PIC 16C774A microcontroller was then interfaced to the wearable blood pressure
monitor and the ECG amplifier to collect the data from these
devices, process them, store them and feed them to a
transmitter. A high performance RF Module TXM-900-HP-II
transmitter and receiver were then used to wirelessly transmit
and receive the vital sign h t a from the micro-controller to a
personal computer at the receiving site. An option was then
built into the system to provide the facility to transmit the
signals via internet. The final part involved development of a
user-friendly graphical user interface using Visual, Basic to
receive the incoming patient data from the receiver, store
them, process them and present them in a clinically
meaningful fashion to the health care professionals.

professionals to provide their services several miles away

from the point of service. With rapid technological progress
in biomedical
instrumentation, telecommunications,
multimedia, and internet, provision of home care to patients
is becoming more popular. With these advancements now it
is possible to envision bringing the security of care that a
medical-nursing team can provide to the patient's home.

Keywords-ECG;
blood pressure; telemonitor; biomedical
inshumentation; telemedicine; microcontrollers.

A. ECGMonitoring
During the development phase,, ECG signals were
generated by a Patient Simulator (model PS-420, Metron
U.S., Inc. MI, USA) [4] and applied to a custombuilt ECG
amplifier. During the testing phase, ECG signals were
picked up by using 3 pregelled AgiAgCl disposable
monitoring electrodes (BIOPAC, Systems Inc., CA, USA)
placed on the subject's extremities with one electrode on
each wrist and one above the right toe. The skin was
thoroughly cleaned by using isopropyl alcohol and the
disposable electrodes were applied firmly to the prepared
sites.

In principle, the technology for instrumentation and

telecommunication-based home health care is now in place.
However, one of the challenges is how to integrate existing
technologies to form a cost-effective and user-friendly
home-care health system. The objective of this study was to
take a step in this direction and develop a microcontrollerbased cost-effective portable telemonitoring system for
ECG and blood pressure waveforms. Therefore, a system
was designed, implemented and tested that is simple to
install at home, is easy to maintain and is cost-effective to
encourage and popularize its use.
This paper describes a wireless microcontroller-based
ECG/BP portable telemonitor which acquires, amplifies,
and transmits these signals to a remote computer for
healthcare professionals to monitor the patient and interpret
the data.
11. MATERIALS AND METHODS

1. INTRODUCTION

Today, the medical field is faced with growing public

concerns and government demands for reform. The outrage
is directed at the high costs of quality health care and the
inability of healthcare specialists to provide adequate
medical services to rural populations. The availability of
prompt and expert medical care can meaningfully improve
health-care services at understaffed rural and remote areas
[l-31. In distant regions of the country the degree of
development of healthcare providing services has not
reached the appropriate level to adequ'ately address the
health care needs of the populations in these areas.

The biopotentials picked up by the electrodes were fed

to the ECG amplifier IC (AD624AD, Analog Devices,
USA.) The,ECG signal was then amplified with a gain of
1000 and filtered. The amplifier was powered by 9 V
batteries. After the amplification and the filtering stage, the
ECG signal was fed to the AID converter in the
microcontroller for data conversion, further processing and
transmission.

For more than three decades, use of advanced

telecommunications and information technologies has been
investigated to improve health care. Telemedicine
encompasses a wide variety of technologies ranging from
telephone to high-tech devices that enable healthcare

0-7803-7789-3/03/$17.00 02003 IEEE

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B. Blood pressure monitoring

The blood pressure signal was monitored using an
Omron HEM-609 wrist blood pressure monitor. The watch
was placed on the wrist and inflated automatically to sense
and display the systolic and diastolic pressures. Figure 1
shows this blood pressure monitor.

Microcontroller
The incoming data from the ECG amplifier and the
blood pressure monitor were fed into a microcontroller
(PIC16C748, Microchip) [6, 71. The ECG signal was fed
into one of the analog-to-digital (AID) converter inputs to
be processed. The blood pressure values were encoded by
priority encoders and directly applied to the pins of the
microcontroller for further processing and transmission.

,---c-P--.-".

Transmission/Reception
The microcontroller was connected directly to a
transmitter (HP Series-1.1 transmitting module, Linq USA)
to send the data to the receiver. The operation frequency of
the transmitter is 900MHz and its range is 1000 feet and it
transmits the data using the frequency shift keying (FSK)
transmission method. Since two different signals are being
transmitted, ECG and blood pressure, the information is
timedivision multiplexed (TDM).

Figure I. The Omoron HEM-609 used in this study [SI.

To make the system more versatile and user-friendly
two options were considered for data entry: manual and
automatic. In the manual mode, the blood pressure values
measured by an Omoron HEM -609 are punched in as high
and low values by the patient (subject) and are encoded by
using two 74HC148 priority encoders. For automatic mode
of operation, the microcontroller interrogates the printer
port o f an Omoron (HEM-705CPN) blood pressure monitor
for systolic and diastolic blood pressure values. The
encoded BP data then enter the microcontroller through
appropriate input pins and are displayed by using three 7segment LED displays (see Figure 2.)

Figure 3 shows the steps performed by the

microcontroller to retrieve the digital representation of
ECG and blood pressur,: waveforms and transmit them to
the receiver using the wireless transmission system outlined
above. In future work more powerful transmitters with
higher range will be uiied and the flexibility to use the
internet to send the data to the leceiving site will be fully
explored

C. Instrumenlation
A block diagram for the complete system is shown in
Figure 2. The telemonitor is comprised of the following
modules:

BPinput
sequence

4
Send
Syst.Pres.

BBQ

QBB -

+n

Get
result fr.

Send
DiasPres

ECG PMplMer

e n TY

PICWC74B

MicrOEontmller

Send
ECGto
TY

<"11111

11111

Checkfor
Clear

M Y la, CPE

Result

- 1-

,,,,,,,,,,

Illl,ll,ll,llllllli:

0 9 0 1

Figure 3. The flow c:hart for the steps involved in

programming the microcontroller to acquire the vital signs
and transmit them to the ]receiver.

Figure 2. The block diagram of the wireless ECG-BP

telemonitor.

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The transmitted vital signs are received by a receiver

(HP Series-I1 receiving module, Linx, USA) connected to a
desktop computer via an RS-232 serial interface (MAX232,
Maxim.)
Display
The patient data are processed and displayed in a
desktop computer using a graphical user interface (GUI)
created in Visual Basic 6.0. The GUI displays both blood
pressure values, systolic and diastolic, as well as a
continuous trace of the ECG signal. In addition, the CUI
has three buttons: reset, start and stop, so the person
monitoring the signs can pause or s a p the incoming signal
for analysis purposes. The CUI also has a scroll bar which
adjusts the amplitude of the ECG incoming signal so
optimal display can be achieved. A provision is being made
to be able to record the incoming data for several hours and
to perform QRS detection and calculate the instantaneous
as well as the average heart rates and display them in the
GUI.

.LA

Figure S. The receiver board of the wireless telemonitor.

Figure 6 shows the graphical user interface developed
for the receiving site of the telemonitor. It shows a
continuous real time trace of the incoming ECG signal as
well as the systolic and diastolic values of the blood
pressure entered by the patient at the transmission site. The
four buttons in the GUI facilitate the inspection of the
incoming patient data by the medical team. A provision was
made to add patient ID. In the next generation of these
telemoniotrs the incoming patient data will be recorded for
further analysis. It is also planned to implement a robust
QRS detection algorithm to calculate the beat-beat and the
average heart rates and display them on the CUI. This
feature would enable the health care team to use the
received data to perform heart rate variability studies [E, 91.

Ill. RESULTS
The
microcontroller-based
ECG-BP
wireless
telemonitor was implemented and tested. Figure 4 shows
the main board of the telemonitor. The main board is
comprised of the input connections for the ECG and BP
signals to the microcontroller, the microcontroller, the
priority encoders, the blood pressure values display, the
transmitter and the antenna. Figure 5 shows the RF receiver
board implemented as part of the microcontroller-based
wireless telemonitor.

Figure 4. The main board of the wireless ECG-BP

telemonitor.

Figure 6. The graphical user interface of the ECG-BP

wireless telemonitor.

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generation of these telernonitors it is envisioned to make

[hem wearable and utilize mobile phone capabilities for
transmission of patient data. It is also envisioned to
incorporate the ability to record the received data and
generate alarms for the cases when the received blood
pressure values and the heart rate exceed or fall below
preset limits. It is also planned to implement a robust QRS
detection algorithm to calculate the heat-heat and the
average heart rates and display them on the GUI. This
feature would enable the health care team to use the
recorded data to perform heart' rate variability studies.

IV. DISCUSSION
During the development phase, an ECG waveform
simulator was used to test the amplification, filtering and
isolation stages of ECG amplifier. During the testing stage,
Ag/AgCI monitoring electrodes were applied to the
subject's skin to acquire the ECG signals. The blood
pressure monitor was used to measure the systolic and
diastolic values. These values were entered manually into
the microcontroller. An alternative possibility was explored
to interrogate the printer port of a blood pressure monitor to
acquire the systolic and diastolic values and read them
automatically into the microcontroller.

ACKNOWLEDGMENTS
The final design was tested and the ECG amplifier had
a gain of 950 against the 1000 theoretical gain. The
common mode rejection ratio was 125 dB, compared to the
130 dB specified in the IC's specifications. The frequency
response was measured to range from 0. I to 110 Hz.

This work was supported in part by a grant from the

Texas Instruments Fund at the Department of Electrical and
Computer Engineering ,at the University of Texas at El
Paso. The authors would like to acknowledge Professor
Sergio Cabrera and the technical staff members at the
Department of Electrical and Computer Engineering for
their support ofthis senior year project.

Transmission of ECG waveforms and blood pressure

values through the internet was explored. The ECG signal
from the patient and the BP values punched in to the
microcontroller, were processed and sent to the remote
computer via a serial port, using a MAX232 IC to step up
the voltages from TTL level to an RS-232 level. All the
ECGlBP data were transmitted correctly and displayed in
the graphical user interface (CUI) created in Visual Basic.
The GUI included the ECG waveform, the systolic and
diastolic pressure values, the IP address from the patient
and the reset, start, stop and clear buttons.

REFERENCES
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eflciency, and expand access in the U.S. health care system
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[4] hno://www.metron.usloroductsheets/~s420
datasheet.htm
[5] hno://www.blood~ressure-monitors-n-blood~res~"~~monitors.com/oroducts/aut1~matic-arm-monitors-hem-705.h~l
[6] htro:lI\nww.microchio.com/lOl
O/oline/oicmicrol

In addition, the RF wireless transmission was tested to

measure the quality of the received signals as well as the
transmitterireceiver range. The specified transmission range
was 1000 R. and the actual measured range was 915 ft. The
transmission was done in a single channel at 900MHz, with
a transmission power of % watt and frequency shift key
(FSK) modulation was used. A correlation analysis was
performed between the transmitted and received signals and
excellent results were observed.

cateeorv/~erictrl/l4kbvtesldevicesil6c765iindex.htm
[7] PIC16C74B User Guidi:, Microchip, 2003.
[8] Nazeran H, Pamula Y, Gradziel A, Ung K, S Vijendra,
Behbehani K (2003). Computer-based Analysis of Heun Rare
Variabiliry Signal for Detection of Sleep Disordered Breathing in
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Conference, Cancun Mexico. Sept. 17-21.

[9] Nazeran H, Magdum \', Vikram B J, Nava P, Maltiwanger E

(2003). A User-friendly Inregruled Sofmore Enuironment f r

V. CONCLUSION

Heart Rate Variubiliry Analysis of Sleep Disordered Breathing,

Proceedings of the 25' IEEEEMBS International Conference,

Cancun Mexico. Sept. 17-2.1.

The Homecare Telemedicine System was successfully

built and tested with all the required specifications. The
system was able to acquire and transmit two vital signs
from the patient: ECG waveform and blood pressure
values, and display them on a remote computer.
The system was also capable of transmitting the signs
through the Internet using a different 1P address for each
patient. The distance of the wireless transmission was 915
feet. The CUI displayed the systolic pressure, diastolic
pressure and the ECG signal on the screen of a remote
computer. In design and implementation of the next

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