WIRELESS-ENABLED TELEMEDICINE SYSTEM FOR REMOTE MONITORING

R. Elgharably, E. Marzban, S. Belal, B. Ahmad, I. AbdElLatif , R. Atef, I. ElBabli

Systems and Biomedical Engineering Dept, Faculty of Engineering, Cairo University, Giza, Egypt e-mail: raghda_elgharably@yahoo.com
Abstract- Telemedicine services are increasingly utilized by patients, clinicians, and institutions. In this paper we describe the design and implementation of wireless-enabled telemedicine system using Bluetooth. Our proposed system will provide doctors with the ability to monitor, diagnose and help their patients in case of emergencies remotely over the Internet. The system is capable of receiving a serial stream of data and extracting relevant packets from the measurements of the patients vital signs. The implemented software allows patients to easily access their doctors and to send their data via Internet. The system is fairly low-cost, fully functional and user friendly. Keywords- Telemedicine, multi-parameter module, web-based

I. INTRODUCTION The prosperity of modern communication technology is the main driving force behind telemedicine or delivery of medical care at a distance. Telemedicine has reached around the world [1], and now health professionals can communicate faster, more widely, and more directly with patients and colleagues, no matter where they are [2]. Nowadays the usage of computers and handheld computers is very common within hospitals. The paper based work is in the process of being eliminated and replaced by the documentation of patient information through computers. Also the world became a small village; a doctor in a continent could be monitoring a patients case in another continent. The use of internet made it easy for a patient to send his data and for a doctor to receive it. The use of PDAs added even more flexibility. Patients especially in developing countries stand to benefit from the use of telemedicine as it reduces travel, saves them money, time and effort. I. There are numerous benefits involved in public health delivery due to internet connectivity. Internet enables flow of up-to-date information in real time, which facilitates centralized control but decentralized operations, ensures quality of health information and elicits citizens feedback on the quality of the service provided [3]. Our wireless enabled system offers a two way communication between the patient and the doctor. In this system, we made a package of two systems, one for the patient and the other for the doctor. The patients system provides him with two options. The first option is to transmit his vital signs wirelessly via Bluetooth to the computer where the data is sent through the internet to the health organization database where it can be saved. The doctor can later access this data from his computer. The second option employs the use of a PDA instead of the computers to send the data. So we used mobile phone technology, namely, short message service (SMS) instead of the internet to send the patients information to the doctor. Although similar systems have
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been implemented by other research groups [4]-[6], each system remains unique, especially in the way it has been realized. In the doctors system we allowed him to contact his patients, see their data, know the development of their situation and chat with them. Also the doctor could consult with any other doctor who has this system about his patients state. So this system does not only allow a doctor to monitor his patients any where in the world but also to consult with other doctors. Old people represent a fast growing sector of the population all over the world. In Egypt, the proportion of those who are 60 years of age or older is projected to increase from 6.5 % of the population in 1995 to 11% by the year 2025 [7]. Elderly care or simply eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, and in-home care. The hard social-economic situation in Egypt has an effect upon todays status of healthcare in the country. Using our system, we aim to provide elderly people with means to be easily monitored, diagnosed, consulted and even treated by their doctors without the need to visit them repeatedly in clinics and hospitals, but just remotely over the internet, and at the convenience of their own homes. Supplying elderly people with continuous monitoring and remote care should improve the quality of their lives. Nursing homes for the elderly can also benefit from our system. II. SYSTEM DESCRIPTION In Figure1, the overall system architecture is presented. The network consists of the servers database in the healthcare organization and the clients are the patients and doctors who have to register first through a web site available for the application, thus achieving security for our clients. The system offers two way communication between the doctor and the patient. A patient measures his vital signs through a data acquisition module that is connected to a microcontroller kit that translates the serial data coming from the module into an understood one that will be displayed by an LCD which is connected to the microcontroller. The data is then sent through Bluetooth to the computer. When the data reaches the computer the patient can send it over the internet to the healthcare organization database where it is saved and viewed by the doctor. A doctor on the other side can log in from his computer and see his patients data. When a client request comes, the server first verifies the user and then identifies his authority.
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Figure 1 System architecture. If the user is a patient, he is only allowed to send data, but if he is a doctor then he could see data of the patients and who are the patient he has authority on. In order to do so, both doctors and patients should register first on the server to be able to log in and use the system. Figure 2 shows the block diagram for the system. The first interface with the patient is the data acquisition device. Its main role is acquiring the signal from the human body. Each signal to be measured, including SpO2, heart rate, temperature, blood pressure, ECG, has its own corresponding sensor. We used CSN801 multi-parameter module manufactured in China by Beijing Choice Electronic Technology Co., Ltd. With this module we can measure temperature, SpO2, heart rate, non invasive blood pressure and ECG. Serial transfer is then used to transfer the data from the module to the microcontroller where the data is processed and then sent wirelessly to the computer. We used DS89C430 microcontroller by Maxim which is an ultra-high-speed flash microcontroller. It is an 8051-compatible microcontroller that provides improved performance and power consumption when compared to the original 8051 version. It retains instruction set and objects code compatibility with the 8051, yet perform the same operations in fewer clock cycles. Consequently, greater throughput is possible for the same crystal speed. Thus, the device can be run at a reduced frequency to save power [8]. The microcontroller provides a serial port (UART) that is identical to the 80C52. In addition, it includes a second hardware serial port that is a full duplicate of the standard one. We needed the 2 UARTS in our design so we can send and receive data from and to the
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Bluetooth module without resorting to the use of virtual UART which is more complicated. The microcontroller is connected to the Bluetooth module as the wireless medium for data transfer. There are several reasons for using wireless technology. As the system is intended for patients especially elderly patients, it is convenient to have their vital signs checked in their beds, not near their computers which may be located anywhere in their apartments. In addition, wireless technologies are cost effective, as cables can easily get entangled, lost or broken. Last but not least, the future is heading towards wireless technology. Wireless communication could be accomplished in a variety of ways. The reason for choosing Bluetooth technology is that transmitting medical data, as SpO2, blood pressure, and heart rate which we measure in our system, does not need high data communication bandwidth. In addition, Bluetooths low power demands, limited range, 10 100 meters, makes it better suited for use in embedded systems and mobile devices that exchange smaller amounts of information while conserving power and space [9]. Bluetooth is also characterized by having low interference through the use of the frequency hopping spread spectrum (FHSS) method. Bluetooth is very attractive today and can result in increased efficiency and reduced costs. Regarding wireless synchronization, Bluetooth provides automatic wireless synchronization with other Bluetoothenabled devices. For example, patient information provided from our module can be synchronized between PDAs, laptops, mobile phones, and other devices. When it comes to internet connectivity, Bluetooth is supported by a variety of devices and applications. In our system, a laptop or a home
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Figure 2 Block diagram of the system. PC with internet connection could be reached using Bluetooth. So the patients vital signs could be uploaded. Bluetooth is automatic; it does not require you to think about setting up a connection or pushing any buttons. When two or more Bluetooth devices enter a range, up to 30 feet, of one another, they automatically begin to communicate. Our choice of Bluetooth is based on our system requirements. So we chose the Parani-ESD and Fujistu Siemens for several reasons. First of all, it can communicate with other Bluetooth devices that support the serial port profile. Also, its extensive set of AT commands allows host controllers to configure, and control Bluetooth connections through a UART interface. This Bluetooth has a compact design and can be placed conveniently into devices or equipment. Its detachable antenna optimizes the quality and distance for wireless communications. Another important feature is its suitable price compared to other Bluetooth devices with the same requirements, added to its low maintenance costs. Since the Parani-ESD supply voltage is 3.3V, and the microcontrollers is 5V, so we used a voltage divider to overcome this problem. Thus, our Bluetooth became compatible with the microcontroller. As for the configuration and operating modes of the Bluetooth module, they are adjusted according to a certain criteria. The baud rate is 19200 which is the same as our extracted data. Also we used mode1, for the Parani-ESD to be connected automatically to the last connected device which is a basic requirement for the standalone system option. Besides Parani-ESD supports two security options, authentication and encryption. For the software part authentication takes place for the doctor and the patient. Using a JIG-Board, that we designed and fabricated by SAKR Company, we interfaced the Parani device with the computer, so that the configuration can be easily adjusted and modified. Table1 shows a comparison between the supplierss JIG-Board and the one we used. When the data reaches the computer, it is sent over the internet to the database of the healthcare organization. For the network we used IP to be our network layer and UDP to be our transport layer. UDP was used for speeding up the
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operation of sending data so the system could be evolved to online monitoring. Another reason for choosing UDP is that we have a chatting like program that allows patients to communicate with their doctors and another one that enables doctors to communicate with each other. UDP is best suited for this purpose as in such an application, time is very important and no delay is requirement. The software we developed allows the patient to leave an offline message for his doctor. The doctor can also view and print a chart that was developed by our software, which describes the changes in his patients vital signs over a period that he specifies. The doctor can request to see the records and save them on his PC as well. Although networking was successfully implemented over UDP, it is advisable to either build the network over TCP or to add reliability in the application layer over UDP so as to get rid of the UDP disadvantages of lacking flow and error control. In Figure 3, we present the block diagram of the mobile application system. The patient can send his data through the Bluetooth module to his PDA or mobile instead of his computer. Then he can send this data in SMS to the doctor directly after entering his number. There are no restrictions on the type of the PDA, any PDA that supports windows CE or has windows mobile set up on it will be fine. A prototype of the system was implemented and found to be fully functional and user friendly. The systems network was tested successfully for small number of users, both doctors and patients; data was not lost or altered. Also there was no lack of reliability shown. Further improvements and testing are needed for large networks. Table 1 JIG-Board

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Figure 3 Mobile application block diagram.

III. DISCUSSION

ACKNOWLEDGMENT This work was supported by a grant from Nahdet El Mahrousa, Egypt and ITAC (Information Technology Academia Collaboration), Egypt. REFERENCES [1] S. Edworthy, Telemedicine in developing countries; May have more impact than in developed countries, BMJ, vol. 323, pp.524-525, 2001. [2] Richard Wootton, Telemedicine, BMJ, vol. 323, pp. 557-560, 2001. [3] S Gupta and S Papagari, Information Economy and Healthy Citizenry: Role of Internet in Implementing India's Health Policy, Internet Health, vol. 3, 2004. Available: www.internet-health.org/ih200431e04.html [4] A. Whitchurch, J. Abraham and V. Varadan, Design and development of a wireless remote point-of-care patient monitoring system, IEEE Region 5 Technical Conference, Fayetteville, AR, pp. 163-166, 2007. [5] P. Mendoza, P. Gonzalez, B. Villanueva, E. Haltiwanger, and H. Nazeran, A web-based vital sign telemonitor and recorder for telemedicine applications, Proceedings of the 26th Annual International Conference of the IEEE EMBS, San Francisco, CA, pp. 2196-2199, 2004. [6] S. Paul, B. Majumdar, J. Mukhopadhyay, A. Majumdar and A. Maji, PDA based telemedicine system in a web based environment, 15th International Conference on Advanced Computing and Communications, pp. 170-174, 2007. [7] A. Nandakumar, M. El-Adawy and M. Cohen, Perception of Health Status and Limitations in Activities of Daily Living among the Egyptian Elderly. Data for Decision Making Project, 1998. Funded by the United States Agency for International Development. Available: http://hsph.harvard.edu/ihsg/publications/pdf/No-79.PDF [8] Maxim, Microcontrollers, [Online]. Available: http://datasheets.maxim-ic.com/en/ds/DS89C430DS89C450.pdf [9] Bluetooth, [Online]. Available: http://www.bluetooth.com/bluetooth/
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The information era we live in has created new challenges and opportunities. Telemedicine services are increasingly utilized by patients, clinicians, and institutions. Even though it has great existence in developing countries, telemedicine has no touchable impact in Egypt. In this paper we presented the prototype of a system that allows any patient especially an elderly to be monitored by his far away doctor. The system also allows the doctor to monitor, diagnose and help their patients in case of emergencies remotely over the Internet. A patient could measure his vital signs through a module connected wirelessly via Bluetooth to his computer. The patient could then send his data through the internet to be saved on a database in the healthcare organization. At any time the doctor could log in and access the data of his patient. He could chat with the patient or consult with another doctor. The implemented software allows patients to easily access their doctors and to send their data via the Internet. The system also allows the patient to send his doctor his data through an SMS if the patient does not have a computer around so he could use any PDA for this purpose. IV. CONCLUSION During the implementation of this system, we came to realize its importance. We believe that it is very important to start such a technology in Egypt. Of course the system needs further work to improve its functionality and to be able to manufacture and market it. We could make further improvements by adding the capability of sending and displaying images as well as videos through this system. This will necessitate making the system integrable with HIS, PACS and RIS. Being extremely cost effective, gives the system very good edge when compared to the products available in the market.

Proceedings of the 2008 IEEE, CIBEC'08