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`11. R.G.Lee,et al. “A Mobile Care System With Alert Mechanism” was publishedin
`IEEE Transactions on Information Technology in Biomedicine, Vol. 11, Issue 5.
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`Author(s)
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`Ren-GueyLee ; Kuei-Chien Chen ; Chun-Chieh Hsiao ; Chwan-Lu Tseng
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`Abstract:
`
`Hypertension and arrhythmia are chronic diseases, which canbeeffectively prevented and controlled only if the physiological parameters of the patient
`are constantly monitored, along with the full support of the health education and professional medical care. In this paper, a role-basedintelligent mobile
`care system with alert mechanism in chronic care environmentis proposed and implemented. The roles in our system include patients, physicians,
`nurses, and healthcare providers. Each of the roles represents a person that uses a mabile device such as a mobile phone to communicate with the
`serversetup in the care center suchthat he or she can go around without restrictions. For commercial mobile phones with Bluetooth communication
`capability attached to chronic patients, we have developed physiological signal recognition algorithms that were implemented and built-in in the mobile
`phone without affecting its original communication functions. It is thus possible to integrate several front-end mobile care devices with Bluetooth
`communication capability to extract patients’ various physiological parameters [such as blood pressure, pulse, saturation of haemoglobin (SpO.), and
`electrocardiogram (ECG)], to monitor multiple physiological signals without spacelimit, and to upload important or abnormal physiological information to
`healthcare centerfor storage and analysis or transmit the information to physicians and healthcare providers for further processing. Thus, the
`physiological signal extraction devices only have to deal with signal extraction and wireless transmission. Since they do not haveto do signal
`processing,their form factor can be further reduced to reach the goal of microminiaturization and power saving. An alert management mechanism has
`been included in back-end healthcare centerto initiate various strategies for automatic emergencyalerts after receiving emergency messagesarafter
`automatically recognizing emergency messages. Within the time intervals in system setting, according to the medical history of a specific patient, our
`prototype system caninform various healthcare providers in sequence to provide healthcare service with their reply to ensure the accuracy ofalert
`information and the completeness of early warning notification to further improve the healthcare quality. In the end, with the testing results and
`performanceevaluation of our implemented system prototype, we conclude thatit is possible to set up a completeintelligent health care chain with
`mobile monitoring and healthcare service via the assistance of our system.
`
`Published in: [EEE Transactions on Information Technology in Biomedicine { Volume: 11, Issue: 5, Sept. 2007 )
`
`Page(s): 507 - 517
`
`Date of Publication: 10 September 2007
`
`ISSN Information:
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`PubMed ID: 17912967
`
`INSPEC Accession Number: 9632985
`
`DOI: 10.1109/TITB.2006.888701
`
`Publisher: IEEE
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`Sponsoredby: IEEE Engineering in Medicine and Biology Society
`IEEE Computer Society [Technical Go-Sponsor]
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`IEEE Xplore Document - A Mobile Care System With Alert Mechanism
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`IEEE Keywords
`Medical services, Biomedical monitoring, Mobile handsets, Mobile communication, Data mining,
`Patient monitoring, Condition monitoring, Bluetooth, Signal processing, Prototypes
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`INSPEC: Controlled Indexing
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`radio, patient care, patient monitoring
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`Related Articles
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`INSPEC: Non-Controlled Indexing
`mobile care system, healthcare service, healthcare quality, emergency messages, back-end
`healthcare center, wireless transmission, signal extraction devices, information transmission,
`information analysis, infarmation storage, front-end mobile care devices, physiological signal
`recognition algorithm, Bluetooth communication, mobile phone communication, chronic care
`environment, role-basedintelligent mobile care system, professional medical care, health education,
`patient monitoring, physiological parameters, chronic diseases, arrhythmia, hypertension, alert
`mechanism
`
`Author Keywords
`ubiquitous, Alert, Bluetooth, Java programming, mobile care, mobile phone
`
`Cellular Phone, Diagnosis, Computer-Assisted, Electrocardiography, Ambulatory, Feasibility Studies,
`Heart Diseases, Humans, Mobile Health Units, Pilot Projects, Remote Consultation, Taiwan
`
`Authors
`
`Ren-Guey Lee
`
`Nat. Taipei Univ. of Technol., Taipei
`
`Ren-Guey Lee (M'06) was born in 1965, He received the M.S. degreein electrical engineering from
`National Chen Kung University (NCKU), Tainan, Taiwan, R.O.C., in 1989, and the Ph.D.degree in
`electrical engineering from National Taiwan University (NTU), Taipei, Taiwan, R.O.C., in 2000.
`
`Since 2002, he has been with the Department of Electronic Engineering, Graduate Institute of
`Computer and Communication Engineering, National Taipei University of Technology (NTUT), Taipei,
`where he is currently an Associate Professor. His current researchinterests include medical
`informatics, telecare and mobile care systems, and wireless sensor networks for biomedical
`applications.
`
`Kuei-Chien Chen
`
`Kuei-Chien Chen received the B.S. and M.S. degrees in electrical engineering from National Taiwan
`University of Science and Technology (NTUST), Taipei, Taiwan, R.O.C., in 1985 and 1990,
`respectively. He is currently working toward the Ph.D. degree at the GraduateInstitute of Computer
`and Communication Engineering, National Taipei University of Technology (NTUT), Taipei.
`
`» Pervasive, secure
`access toa
`
`Heis currently a Lecturer at Lunghwa University of Science and Technology (LHU), Taoyuan, Taiwan,
`R.O.C. His current research interests include Bluetooth technology,sensor network design, and
`tolamarinrina annlicatiane
`
`http:/Aeeexplore.ieee.org/document/4300837/
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`

`IEEE Xplore Document - A Mobile Care System With Alert Mechanism
`LSPSrout WoeliVi i,
`ee
`
`Chun-Chieh Hsiao
`
`11/10/2016
`.
`:
`hierarchical
`sensor...
`Y.M, Huang; M. ¥.
`Hsieh...
`
`» A wearable point-
`of-care system for
`homeusethat...
`dianchu Yao; R.
`
`Schmitz;...
`
`Chun-Chieh Hsiao received the M.S. degreein electrical and computer engineering from the State
`University of New York, Buffalo, in 1990.
`
`Heis currently a Ph.D. candidate In the Departmentof Electrical Engineering, National Taiwan
`University (NTU), Taipei, Taiwan, R.O.C.
`
`During 1991-1993, he was with the Computer and Communication Laboratory (CCL), Industrial
`Technology ResearchInstitute (ITRI) of Taiwan, where he focused on research and developmentof
`advanced computergraphics systems. From 1993 to 2003, he was with the Department of Electrical
`Engineering, Lunghwa University of Science and Technology (LHU), Taoyuan, Taiwan, R.O.C, Since
`2003, he has been with the Department of Computer Information and Network Engineering, LHU. His
`current researchinterests include telecare and mobile care systems, wireless sensor networksfor
`biomedical applications, and advanced computer systems.
`
`Chwan-Lu Tseng
`
`Chwan-Lu Tseng graduated degree from National Taipei Institute of Technology, Taipei, Talwan,
`R.O.C., in 1985, and received the M.S. and Ph.D. degrees from National Taiwan University (NTU),
`Taipei, in 1991 and 1995, respectively, both in electrical engineering.
`
`Since 2000, he has been an Associate Professorin the Departmentof Electrical Engineering, National
`Taipei University of Technology (NTUT), Taipei. His current researchinterests include signal
`processing, automation, and robust control theory and its applications.
`
`Dr. Tseng is a memberof Phi Tau Phi.
`
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`IEEE TRANSACTIONS ON INFORMATION TECHNOLOGYIN BIOMEDICINE, VOL.11, NO. 5, SEPTEMBER 2007
`
`507
`
`A Mobile Care System With Alert Mechanism
`
`Ren-Guey Lee, Member, IEEE, Kuei-Chien Chen, Chun-Chieh Hsiao, and Chwan-Lu Tseng
`
`Abstract—Hypertension and arrhythmia are chronic diseases,
`which can beeffectively prevented and controlled only if the physi-
`ological parametersof the patient are constantly monitored, along
`with the full supportof the health education and professional med-
`ical care. In this paper, a role-based intelligent mobile care system
`with alert mechanism in chronic care environmentis proposed and
`implemented. Theroles in our system include patients, physicians,
`nurses, and healthcare providers. Each of the roles represents a
`person that uses a mobile device such as a mobile phone to com-
`municate with the server setup in the care center such that he
`or she can go around without restrictions. For commercial mo-
`bile phones with Bluetooth communication capability attached to
`chronic patients, we have developed physiological signal recogni-
`tion algorithms that were implemented and built-in in the mobile
`phone without affecting its original communication functions. It
`is thus possible to integrate several front-end mobile care devices
`with Bluetooth communication capability to extract patients’ var-
`ious physiological parameters [such as blood pressure, pulse, satu-
`ration of haemoglobin (SpO2), and electrocardiogram (ECG)], to
`monitor multiple physiological signals without space limit, and to
`upload important or abnormalphysiological informationto health-
`care center for storage and analysis or transmit the information to
`physicians and healthcare providers for further processing. Thus,
`the physiological signal extraction devices only have to deal with
`signal extraction and wireless transmission. Since they do not have
`to do signal processing, their form factor can be further reduced to
`reach the goal of microminiaturization and powersaving. An alert
`Management mechanism has been included in back-end health-
`care centerto initiate various strategies for automatic emergency
`alerts after receiving emergency messages or after automatically
`recognizing emergency messages. Within the timeintervals in sys-
`tem setting, according to the medical history of a specific patient,
`our prototype system can inform various healthcare providers in
`sequence to provide healthcare service with their reply to ensure
`the accuracy of alert information and the completeness of early
`warning notification to further improve the healthcare quality. In
`the end, with the testing results and performance evaluation of our
`implemented system prototype, we concludethatit is possible to set
`up a complete intelligent healt care chain with mobile monitoring
`and healthcare service via the assistance of our system.
`
`Manuscript received April 8, 2006; revised August 18, 2006 and October
`9, 2006, This work was supported by the National Science Council of the Re-
`public of China, Taiwan, under Contract NSC94-2627-E-002-001 and Contract
`NSC94-2213-F-027-012.
`R.-G, Lee is with the Department of Electronic Engineering, National
`Taipei University of Technology, Taipei 10643, Taiwan, R.O.C.
`(e-mail:
`evans@ntut.edu.tw).
`K.-C. Chenis with the Graduate Institute of Computer and Communication
`Engineering, National Taipei University of Technology, Taipei 10643, Taiwan,
`R.O.C,, and also with Lunghwa University of Science and Technology (LHU),
`Taoyuan 33306, Taiwan, R.O.C.
`C.-C. Hsiao is with the Department of Electrical Engineering, National
`Taiwan University (NTU), Taipei 10617, Taiwan, R.O.C., and also with the
`Department of Computer Information and Network Engineering, Lunghwa Uni-
`versity of Science and Technology (LHU), Taoyuan 33306, Taiwan, R.O.C.
`C.-L. Tseng is with the Department of Electrical Engineering, National
`Taipei University of Technology, Taipei 10643, Taiwan, R.O.C.
`(e-mail:
`£10940@ntut.edu.tw).
`Digital Object Identifier 10.1109/TITB.2006.888701
`
`Index Terms—Alert, Bluetooth, Java programming, mobile care,
`mobile phone, ubiquitous.
`
`I,
`
`INTRODUCTION
`
`N recent years, healthcare for elderly people has been an im-
`portant research topic. The commonly seen chronic diseases
`for elderly people include hypertension and arrhythmia. The cur-
`rent healthcare for such diseasesis still mainly from outpatient
`services. Due to the development of information and commu-
`nication technology (ICT), the feasibility of home telecare has
`been highly raised. In the literature, the telecare services were
`first provided byutilizing traditional public switched telephone
`network (PSTN). Leeet ai. used a cable television (CATV)net-
`work to transmit electrocardiogram (ECG) data to healthcare
`center and to provide function of video conversation between
`healthcare providers and patients [1]. Because of the fast de-
`velopment and popularity of the Internet, the telecare medical
`applications to provide long-term monitoring and healthcare by
`transmitting personal physiological information via the Internet
`have becomehighly feasible [2]. Guillén et ai. have proposed a
`telehomecare multimedia platform utilizing videoconferencing
`standards H.320 and H.323, and a standard TV set based on
`integrated services digital network (ISDN) and Internet proto-
`col to let patients upload their physiological information to a
`healthcare center and to provide hometelecare services such
`as teleconsultations [3]. Apart from that, to provide a safer and
`more comfortable inpatient and resident healthcare environment
`and to achieve the purposeofillness prevention, it has been an-
`other trend for developmentof hometelecare system to integrate
`various miniature flexible noninvasive biosignal sensors inside
`patients’ clothing for ease of daily dressing and for long-term
`monitoring and vital signs extraction of the patients [4].
`However,
`the above-mentioned healthcare systems have
`restricted the activity area of patients to be within the medical
`healthcareinstitute or within the residence area. To provide more
`freedom to patients, it is importantto integrate wireless commu-
`nication technology for modern healthcare systems [5]-{11]. Lin
`et al. [5] have utilized a personal digital assistant (PDA) to
`monitor and collect the physiological parameters extracted by
`a physiological signal module attached to patients. The physio-
`logical information is then immediately transmitted to a remote
`central managementunit for analysis by medical personnel via
`wireless local area network (WLAN). Hometelecare service has
`been further extended to become mobile care service [6]-[11]
`due to the ubiquity of global system for mobile communications
`(GSM)and general packet radio service (GPRS). Anliker et al.
`[6] have proposed a wearable multiparameter medical moni-
`toring and alert system called advanced care andalert portable
`telemedical MONitor (AMON).
`In their system, front-end
`wrist-worn monitoring device is connected to back-end
`
`1089-777 1/$25.00 © 2007 IEEE
`0007
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`508
`
`IEEE TRANSACTIONS ON INFORMATION TECHNOLOGYIN BIOMEDICINE,VOL, 11, NO. 5, SEPTEMBER 2007
`
`telemedicine center via GSM mobile network such that
`healthcare service to patients is not restricted to specific areas.
`Rasid and Woodward [7] designed a Bluetooth telemedicine
`processorto first process extracted physiological signal and then
`transmit the processed physiological information wirelessly to a
`Bluetooth mobile phone, which then uploads the physiological
`information to a back-end medical healthcare institute via a
`GPRS mobile network. It has also been broadly applied to
`the design of a healthcare system to utilize a GSM/GPRS
`mobile network to provide healthcare service with functions
`of emergencyalerts and early warning messages [6], [8]-[11].
`All of the above-mentioned GSM/GPRS communication parts
`are designed and implemented by using commercial modules
`such that the user-end healthcare devices are of larger form
`factor, which subsequently reduces the desire of patients to
`carry the devices and increases the power consumption. The
`popularity of mobile phones has highly increased recently.
`For example, in the U.S., the popularity of mobile phones was
`70% up to 2005 with expected popularity of 87% in 2010,
`while in 2002, the popularity of mobile phones in Taiwan was
`already near 100%.' It thus becomesfeasible to use commercial
`mobile phonesas platforms for physiological signal processing.
`Moreover, some mobile phones provide a Java programming
`design environment and Bluetooth interface. This can reduce
`the form factor of user-end physiological signal extraction
`devices and save power, and thus, increase the patient’s desire
`of usage. The healthcare services of emergency notification
`messages can also be realized by utilizing the commercial
`mobile phones’ GSM/GPRS communication capabilities.
`This paper proposesto utilize Bluetooth commercial mobile
`phones as physiological signal processing platforms to con-
`struct a ubiquitous mobile care system to increasethe feasibility
`of mobile care services and to increase the desire of users. As
`described above, this paper focuses on the advantages of mo-
`bile devices and utilizes Bluetooth mobile network to integrate
`multiple front-end physiological parameter extraction devices.
`It also refers to the alert mechanism of Kafeza etal. [8] to ex-
`tend to each role of telecare to construct an intelligent mobile
`care platform to actively provide healthcare services to multiple
`parties of patients and healthcare providers without spatial and
`temporal limitations and thus improve the quality of healthcare.
`Therest of the paper is organized as follows. Section II out-
`lines the system analysis and healthcare scenarios. Section III
`depicts the system architecture. Section IV describes the design
`of system software. Section V gives the system implementation
`results. Overall system performance and experiments are evalu-
`ated and described in Section VI. Finally, Section VII provides
`some discussions and conclusions based on the implemented
`mobile care system.
`
`II. SYSTEM ANALYSIS AND HEALTHCARE SCENARIOS
`
`Our proposed healthcare system mainly takes care of chronic
`patients who canlive normally when the health condition is sta-
`ble, while are in desperate need of help and assistance to reduce
`
`1Weekly of business next digital
`bnext.com.tw
`
`times. [Online]. Available: http://www.
`
`the probability of deteriorating health conditions or even death
`when their physiological conditions become abnormal or when
`they fall ill. Such chronic patients can perform somesimple self
`healthcare and monitoring functions via mobile phones through
`our proposed system when health conditionis stable. When the
`patient’s health condition becomes abnormal, the proposed sys-
`tem can automatically inform physicians or healthcare providers
`to further provide medical and healthcare services and can thus
`effectively reduce the cost of healthcare.
`In general, a healthcare scenario includes different roles such
`as patients and various healthcare providers. Analysis on infor-
`mation exchanged between different roles can induceanalert,
`which can be implemented via short message technology in
`mobile communication networks [10]. Through implementa-
`tion of alert mechanism, our mobile healthcare system provides
`a general information transmission service to achieve various
`intelligent healthcare functions. We use two healthcare scenar-
`ios to demonstrate the function of our proposed system. Oneis
`“patients do not upload physiological parameters on schedule”
`and the otheris “the result of measurement is abnormal and our
`
`system automatically informs care providers.”
`
`A. Patients do not Upload Physiological Parameters
`on Schedule
`
`In the first healthcare scenario, the subject is a patient with
`hypertension or with cardiac diseases. The patient falls asleep
`at noon. In this healthcare process, the alert message transmis-
`sion process of the alert system is as shown in Fig. I(a) andis
`described as follows.
`
`1) The patient does not upload blood pressure/ECG data on
`schedule.
`
`2) The care center automatically sends an urgent alert to
`notify the patient.
`3) The patient does not receive the alert or does not reply to
`it for some reason.
`4) The care center raises the urgency level of the alert and
`resends the alert to notify the healthcare provider.
`5) The healthcare provider goes to the location of the patient
`to provide necessary healthcare services.
`6) The healthcare provider replies with the result of alert
`processing.
`
`B. Result of Measurement is Abnormal and our System
`Automatically Informs Care Providers
`
`Take the case of a chronic patient with hypertension as an
`example. Whereverthe patient goes, he or she will carry a mobile
`phone and a Bluetooth hemadynamometer. Whenthepatient’s
`condition is not good, he or she will fee] uncomfortable, for
`example, he or she might have a headacheor feel dizzy. In this
`healthcare process, the alert message transmission process of
`alert system is as shown in Fig. 1(b). The process of healthcare
`giving is described as follows.
`1) The blood pressure of a hypertension patient increases for
`some reason and causes headache and dizziness.
`
`0008
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`

`LEEet ul.: A MOBILE CARE SYSTEM WITH ALERT MECHANISM
`
`509
`
`1. No blood pressure value
`/ECGQ data uploaded
`-_-—— /S
`
`-
`
` i
`5,ToOo)help
`2CareProvider
`
`~
`
`2. Urgentalert
`3. No ACK
`
`Interconnection
`
`4. Critical alert
`
`Care Center Server
`
`x,careACK
`
`(a)
`
`Database
`
`mobile phone needsto receive and integrate data from various
`physiological parameter extraction devices and provide com-
`munication link between patients and healthcare center server.
`The mobile phone supports Java 2 Micro Edition (J2ME) [12] in
`software, and Bluetooth and GSM/GPRS modules in hardware
`to integrate functions on personal mobile-end. The software in-
`cludes two major software package modules: blood pressure
`and pulse monitor module and ECG monitor module. Back-
`end healthcare center server consists of a GSM/GPRS module
`that can transmit and receive short messages, and a care cen-
`ter host. The GSM/GPRS module and personal computer (PC)
`with Intemet connection are used to develop functions needed
`for healthcare center server.
`
`IV. SYSTEM SOFTWARE DESIGNS
`
`The software modules in personal mobile phoneis analyzed
`and designed with an object-oriented method, and represented
`by using unified modeling language (UML) [13]. The design
`phases are as follows: requirement analysis, object model de-
`sign, code implementation for software model, simulator exe-
`cution, and upload to real mobile phone Nokia 7610 ? forfinal
`test. While for the healthcare center host, Borland C+-+ Builder
`6.0 software is used to develop window application programs.
`ActiveX data objects (ADO) components are used to access
`ACCESS database, and advance technology (AT) command in-
`struction set is used to control GSM module to transmit and.
`
`receive short message. The function and design of each soft-
`ware module is introduced as follows.
`
`A. Blood Pressure and Pulse Monitor Software Module
`
`Blood pressure and pulse monitor software module provides
`a way for mobile phoneto utilize Bluetooth wireless connec-
`tion to integrate with Bluetooth hemadynamometerto control
`the Bluetooth hemadynamometer to measure and extract blood
`pressure and pulse. The measurementresult can also be dis-
`played directly on the mobile phone, and can transmit short
`messages to physicians or other heath care providers to provide
`proper healthcare. The use case diagram for this blood pressure
`and pulse monitor software module is as shown in Fig. 3(a).
`The physiological parameter measurement application pro-
`gram of blood pressure and pulse monitor module provides
`three functions. The first function is to provide a user graphical
`user interface (GUI) to let the patient operate mobile phones
`and hemadynamometerseasily, and display information such as
`physiological parameter measurement values andalert notices.
`The second function is the Bluetooth application programming
`interface (BT API) to let application programsutilize Bluetooth
`functions. The last function is the short message service (SMS)
`API [14] to let application programs transmit and receive short
`messages containing physiological parameter measurementval-
`ues and alert notices.
`
`To extract the physiological parameters measured with front-
`end Bluetooth hemadynamometer, our presented system uses
`Bluetooth mobile phone with JAVA APIs for Bluetooth Wire-
`less Technology (JABWT)to develop client application program
`
`?Forum Nokia. [Online]. Available: http://www.forum.nokia.com
`
`0009
`
`FITBIT, Ex. 1060
`
`4. Uncomfortable
`Mubite'wire 2. Biosignal
`devices
`Measure
`
`Patient with hyperlension
`Jarthythmia disease
`
`Bluetooth
`Mobile Phone
`
`Physician
`Mobile Phone
`
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`
`
`5. Alert message
`Mobile Phone
`="
`Assistant
`Care Provider
`
`Care Center Server
`
`5
`Database
`
`(b)
`
`Fig. 1. Alert message transmission diagram for (a) not uploading physio-
`logical parameters on schedule and (b) automatic notification of abnormal
`conditions.
`
`2) The Bluetooth hemadynamometer measures the physio-
`logical parameters such as blood pressure and pulserate,
`and then transmits the data to the mobile phone wirelessly.
`3) The mobile phone uploads the physiological data to the
`database in healthcare center server in hospital.
`4) Ifsome abnormal conditions are identified by simple pro-
`grams that run in the mobile phone, short messages are
`sent immediately to the physiciansor the other healthcare
`providers.
`5) Ifsome abnormal conditionsare identified by professional
`judgmentvia the healthcare center server, related person-
`nel such as local officers are informed instantly or an am-
`bulance is dispatched immediately to perform necessary
`rescue in the location of the patient.
`
`TlI. SYSTEM ARCHITECTURE
`
`The system architecture deployment diagram of our proposed
`mobile healthcare platform is as showninFig. 2. The whole sys-
`tem architecture mainly consists of front-end personal mobile
`device and back-end care center server.
`
`The front-end personal mobile device comprises a physiolog-
`ical] parameter extraction device and a mobile phoneintegration
`device. The physiological parameter extraction device consists
`of various physiological parameter extraction devices for blood
`pressure, pulse, and ECG with wireless Bluetooth module. The
`
`FITBIT, Ex. 1060
`
`

`

`510
`
`IEEE TRANSACTIONS ON INFORMATION TECHNOLOGYIN BIOMEDICINE,VOL. 11, NO, 5, SEPTEMBER 2007
`
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`
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`
`System architecture deployment diagram.
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