IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 11, NO. 5, SEPTEMBER 2007
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`507
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`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 be effectively prevented and controlled only if the physi-
`ological parameters of the patient are constantly monitored, along
`with the full support of the health education and professional med-
`ical care. In this paper, a role-based intelligent mobile care system
`with alert mechanism in chronic care environment is 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 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 abnormal physiological information to 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 power saving. An alert
`management mechanism has been included in back-end health-
`care center to initiate various strategies for automatic emergency
`alerts after receiving emergency messages or after automatically
`recognizing emergency messages. Within the time intervals 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 conclude that it 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-E-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. Chen is 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:
`f10940@ntut.edu.tw).
`Digital Object Identifier 10.1109/TITB.2006.888701
`
`Index Terms—Alert, Bluetooth, Java programming, mobile care,
`mobile phone, ubiquitous.
`
`I. INTRODUCTION
`
`I 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 diseases is 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 by utilizing traditional public switched telephone
`network (PSTN). Lee et al. 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 become highly feasible [2]. Guill´en et al. 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 home telecare services such
`as teleconsultations [3]. Apart from that, to provide a safer and
`more comfortable inpatient and resident healthcare environment
`and to achieve the purpose of illness prevention, it has been an-
`other trend for development of home telecare 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
`healthcare institute or within the residence area. To provide more
`freedom to patients, it is important to 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 management unit for analysis by medical personnel via
`wireless local area network (WLAN). Home telecare 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 and alert portable
`telemedical MONitor (AMON). In their system, front-end
`wrist-worn monitoring device is connected to back-end
`
`1089-7771/$25.00 © 2007 IEEE
`
`Apple Inc.
`APL1059
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`IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 11, NO. 5, SEPTEMBER 2007
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`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
`processor to 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 emergency alerts 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%.1 It thus becomes feasible to use commercial
`mobile phones as 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 proposes to utilize Bluetooth commercial mobile
`phones as physiological signal processing platforms to con-
`struct a ubiquitous mobile care system to increase the 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 et al. [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.
`The rest 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 can live normally when the health condition is sta-
`ble, while are in desperate need of help and assistance to reduce
`
`1Weekly of business next digital times. [Online]. Available: http://www.
`bnext.com.tw
`
`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 some simple self
`healthcare and monitoring functions via mobile phones through
`our proposed system when health condition is 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 induce an alert,
`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. One is
`“patients do not upload physiological parameters on schedule”
`and the other is “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. 1(a) and is
`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. Wherever the patient goes, he or she will carry a mobile
`phone and a Bluetooth hemadynamometer. When the patient’s
`condition is not good, he or she will feel uncomfortable, for
`example, he or she might have a headache or 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.
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`mobile phone needs to 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 Internet connection are used to develop functions needed
`for healthcare center server.
`
`IV. SYSTEM SOFTWARE DESIGNS
`The software modules in personal mobile phone is 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 2 for final
`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 phone to utilize Bluetooth wireless connec-
`tion to integrate with Bluetooth hemadynamometer to control
`the Bluetooth hemadynamometer to measure and extract blood
`pressure and pulse. The measurement result 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 hemadynamometers easily, and display information such as
`physiological parameter measurement values and alert notices.
`The second function is the Bluetooth application programming
`interface (BT API) to let application programs utilize 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 measurement val-
`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
`
`2Forum Nokia. [Online]. Available: http://www.forum.nokia.com
`
`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 pulse rate,
`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) If some abnormal conditions are identified by simple pro-
`grams that run in the mobile phone, short messages are
`sent immediately to the physicians or the other healthcare
`providers.
`5) If some abnormal conditions are identified by professional
`judgment via 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.
`
`III. SYSTEM ARCHITECTURE
`
`The system architecture deployment diagram of our proposed
`mobile healthcare platform is as shown in Fig. 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 phone integration
`device. The physiological parameter extraction device consists
`of various physiological parameter extraction devices for blood
`pressure, pulse, and ECG with wireless Bluetooth module. The
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`Fig. 2.
`
`System architecture deployment diagram.
`
`Fig. 3. Use case diagrams for (a) blood pressure and pulse monitor software module, (b) ECG monitor software module, and (c) healthcare center server.
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`MIDlet [15] to control and use Bluetooth hemadynamometer to
`realize the physiological parameter extraction function on pa-
`tient ends. MIDlet utilizes JABWT to control hemadynamome-
`ter to accomplish commands such as blood pressure measure-
`ment and parameter setting.
`The methods
`for
`interface DiscoveryListener in
`javax.bluetooth API have to be implemented in programs
`to let MIDlet receive RemoteDevice and ServiceRecord
`found by DiscoveryAgent. Connection address attributes in
`remote device service records are used to setup connection
`to utilize services provided by remote devices. Since RFCOMM
`is provided in the Bluetooth hemadynamometer, the API of
`Javax.microedition.io’s StreamConnection interface can
`be used to set up connection (btspp://). After the connection has
`been set up, mobile phone application programs can easily use
`serial port transmission protocol to communicate with Bluetooth
`hemadynamometer to transmit control commands and receive
`physiological parameter measurement data. Finally, the data can
`be transmitted to physicians or other healthcare providers with
`short messages.
`
`B. ECG Monitor Software Module
`
`The ECG monitor software module utilizes wireless Blue-
`tooth function to integrate with front-end ECG physiological
`parameter extraction devices as a mobile healthcare device for
`cardiac patients. The use case diagram of the ECG monitor
`software module is shown in Fig. 3(b).
`Patients use MIDlets for ECG monitoring to control and ex-
`tract ECG data from front-end ECG extraction device, to trans-
`mit measured ECG data to mobile phones via Bluetooth af-
`ter segmentation, and to calculate real-time variation of heart
`rate (HR) according to R-point positions that are automatically
`computed by using ECG detection techniques. If the calculated
`variation of HR is lower than the threshold (typically 10%) set
`by healthcare providers according to different patients’ condi-
`tions, the abnormal ECG data will be transmitted with multime-
`dia short messages (MMS) via GPRS to physicians, healthcare
`providers, or healthcare center to provide further healthcare and
`treatment. The ECG monitor software module provides three
`major functions: GUI API to display ECG, HR calculated val-
`ues, and to let patients operate and control ECG extraction de-
`vices; BT API to set up Bluetooth connection between the ECG
`extraction device and the mobile phone; SOCKET API to upload
`ECG data to the healthcare center server via Socket connection.
`ECG detection techniques in ECG monitor MIDlet applica-
`tion programs utilize “Modified So and Chan” R-wave detection
`algorithm [16] that needs little computation, and is capable of
`adjusting adaptation detection parameters.
`
`TABLE I
`STRATEGY TABLE FOR DIFFERENT LEVELS OF URGENCY
`
`TABLE II
`PRIORITY TABLE FOR THE ROLE OF HEALTHCARE PROVIDERS
`
`alert mechanism. Three functions are provided: display results
`of queries and status of matching; select candidates of monitored
`roles; and edit content of data tables.
`Role monitoring and alert monitoring functions are the core of
`the healthcare center server software [8], [10]. To execute strat-
`egy matching module, the strategies to be executed should be set
`beforehand, as shown in Table I. The scenario of healthcare in
`Fig. 1(a) can be used to demonstrate the strategies correspond-
`ing to different levels in Table I. The urgencies are classified into
`four levels with corresponding strategies. If the urgency level is
`normal, e-mails will be used for notification. If the urgency level
`is urgent, short messages will be transmitted to patients’ mo-
`bile phones. If the urgency level is critical, short messages will
`be transmitted to patients’ care providers to assist the patients.
`If the urgency level is very critical, with the approval of care
`providers, ambulances will be notified to perform emergency
`rescues. Note that since the physiological information of each
`patient is different, the system setting such as related parame-
`ters of emergency conditions and healthcare services provided
`in different levels are set by care providers according to personal
`condition and medical history of each patient.
`Each strategy sets the roles to be notified first, and then exe-
`cute role matching. The role matching first has to define different
`priorities for each person of the same role as shown in Table II
`and then transmits messages according to the priority.
`The current urgency level can be changed by priority urgency
`module according to the elapsed time. The relationship between
`urgency level and elapsed time can be formulated as priority
`urgency level function as follows:
`
`U(t) =⎧⎪⎨
`⎪⎩
`
`Normal,
`Urgent,
`Critical,
`Very critical,
`
`if t≤T
`if T <t<T + dt1
`(1)
`if T +dt1<t<T +dt1+dt2
`ifT +dt1+dt2<t<T +dt1+dt2+dt3.
`
`C. Healthcare Center Server Program Design
`
`The healthcare center server provides following functions:
`alert mechanism setting, role and alert monitoring, and physio-
`logical parameter uploading. The use case diagram of healthcare
`center server is shown in Fig. 3(c).
`The alert mechanism setting function provides managers a
`GUI, which lets them set the selected monitored roles and the
`
`In the priority urgency level function, t, T , dt1, dt2, and dt3
`represent the elapsed time after alert is transmitted, the default
`deadline, the urgent deadline, the critical deadline, and the very
`critical deadline, respectively.
`The complete operation procedure of alert mechanism is de-
`picted as follows. To start alert mechanism, the strategy match-
`ing module has to be executed first to find adequate strategy
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`Fig. 4.
`
`Sequence diagrams of (a) operation procedure and (b) automatic short message transmission for blood pressure and pulse monitor module.
`
`and subsequently notify corresponding roles. The role match-
`ing module is then executed to transmit notification messages
`to different persons according to different priorities in this role.
`Finally, priority urgency module is executed to change urgency
`levels according to priority urgency level function after specified
`deadline. The operation procedure of alert mechanism can then
`be restarted all over again.
`The physiological parameter upload module mainly provides
`two methods to let mobile-end patients to upload physiological
`parameters, namely, to use Socket to upload and to use SMS to
`upload. If SMS is used to upload physiological parameters, and a
`proposed acknowledgement (ACK) message format is followed,
`the alert can be easily replied and the physiological parameters
`can be easily uploaded using ordinary mobile phones.
`
`V. SYSTEM IMPLEMENTATION
`
`The hardware of our prototype system consists of three main
`portions. 1) Front-end wireless mobile care devices includ-
`ing the Bluetooth hemadynamometer [9] and wireless ECG
`extraction device [11] were designed and implemented. The
`core microcontrollers used in these two devices are Atmel
`Corp.’s ATmega169 V and Texas Instruments (TI) Corporation’s
`MSP430- F449, respectively. Both devices use NIETZSCHE
`Corporation’s UB1-1112 as Class-2 Bluetooth communication
`modules with a maximum communication range of 10 m; 2) A
`commercial mobile phone of model Nokia 7610 was used. 3)
`A healthcare center server, which is a PC with an Intel Celeron
`2.4-GHz CPU and 512-MB random access memory (RAM) was
`developed under Borland C++ Builder 6.0 Windows applica-
`tion programming environment.
`The MIDlet application programs in personal mobile phones
`are first developed on a PC, then executed with a simulator, and
`finally, installed and tested on a mobile phone Nokia 7610 via
`wired transmission or wireless Bluetooth transmission. The test
`results of the two software modules in the mobile phone: blood
`pressure and pulse monitor module and ECG monitor mod-
`ule, and the model of healthcare center server alert mechanism
`are described in the following Section V-A and Section V-B,
`respectively.
`
`Fig. 5. Display of a sample test result of blood pressure and pulse monitor
`module.
`
`A. Implementation of Blood Pressure and Pulse Monitor
`Software Module in the Mobile Phone
`
`The sequence diagram of the operation procedure for the
`blood pressure and pulse monitor module is shown in Fig. 4(a).
`After MIDlet application programs start, patients can
`give various commands to mobile phones. The patients can
`use the bluetoothDiscovery() command to search for
`Bluetooth devices within communication area. If a Blue-
`tooth hemadynamometer is found, the patient can use the
`startServiceSearch() command to search for RFCOMM ser-
`vices provided by the Bluetooth hemadynamometer. The pa-
`tient can then use bloodPressureDetect() command to uti-
`lize the found service to set up connection and transmit control
`commands to Bluetooth hemadynamometer to measure blood
`pressure. The sendSMS() command can be used to transmit
`short messages after the physiological parameters have been
`measured.
`One sample test result of developed and downloaded appli-
`cation programs in the NOKIA 7610 is shown in Fig. 5.
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`Fig. 6. Activity diagram of operation procedure for ECG monitor software.
`
`The results of measurement for systolic pressure, diastolic
`pressure, and pulse are 116, 63, and 75, respectively, and can
`be transmitted via short messages to physicians’ or healthcare
`providers’ mobile phones to provide further healthcare service.
`Beside the function of manual short message transmission
`to physicians or healthcare providers after the measurement,
`functions for automatic short message transmission can also
`be selected. The thresholds for blood pressure can be set with
`five levels: too high (Highhigh), high (High), normal (Normal),
`low (Low), and too low (Lowlow) according to each patient’s
`condition. The care provider can set the blood pressure thresh-
`old level and then store the record. The rest of blood pressure
`measurement procedure is the same as previously described.
`The sequence diagram of automatic short message transmission
`is shown in Fig. 4(b). The result of automatic judgment via
`set threshold will trigger the transmission of short messages to
`healthcare provider’s mobile phone to display warning messages
`such as “Diastolic is low!!” warning that the blood pressure of
`the patient is too low.
`
`B. Implementation of ECG Monitor Software Module in the
`Mobile Phone
`
`Fig. 7. Display of simulator execution for ECG monitor module.
`
`ECG monitor software module utilizes Bluetooth to receive
`ECG data.3 The operation and functioning of Bluetooth connec-
`tion is the same as blood pressure and pulse software module.
`After the Bluetooth connection is set up, we can start receiving
`ECG data. Two normal heart beats can be shown in a default
`display. The sample rate of ECG data is 360 points/s and each
`display contains 500 points of ECG data. The received ECG data
`are shown on the monitor one after another, and at the same time,
`R-wave is detected via R-wave detection algorithm. The HR is
`then calculated and displayed on the monitor. The display of ex-
`ecution of ECG monitor module simulator 4 is shown in Fig. 7.
`
`C. Implementation of Monitor Software Module in Healthcare
`Center Server
`
`To execute healthcare center host software, first the moni-
`tored role has to be selected and the alert deadline has to be
`set. The software then executes record table query and display
`the query results in matching status groups on windows. The
`display of setting for healthcare center server is shown in Fig. 8.
`The activity diagram of operation procedure for role monitor
`software is shown in Fig. 9.
`After the role monitor is initiated, timers will also be initiated.
`If the physiological parameters have been uploaded before the
`timers’ default deadlines, role monitor will continue normally.
`However, if the data has not been uploaded before the deadline,
`then, the alert module will be initiated. After the initiation of the
`
`The activity diagram of operation procedure for ECG monitor
`software module is shown in Fig. 6.
`
`3MIT-BIH Database Distribution. [Online]. Available: http://ecg.mit.edu
`4Sun Microsystems, Inc. [Online]. Available: http://www.sun.com
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`Fig. 8. Display of setting of healthcare center server.
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`Fig. 10. Activity diagram of operation procedure for alert monitor software.
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`Fig. 9. Activity diagram of operation procedure for role monitor software.
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`alert module, the role monitor will continue if it has not ended
`yet or will terminate otherwise.
`The alert monitor will be initiated after the role monitor mod-
`ule initiates the alert module. Activity diagram of operation
`procedure for the alert monitor software is shown in Fig. 10.
`The alert monitor will first execute strategy matching. Ap-
`propriate persons are then found according to the role result of
`strategy matching. Alert notifications are subsequently transmit-
`ted according to each person’s priority. After the transmission
`of alerts, the system will wait for acknowledgments to the cor-
`responding alerts. If there are no acknowledgments, then the
`urgency level for the current strategy will be checked to see
`whether it ends or not. If the urgency level has not yet ended,
`then, the alert will be retransmitted according to priority role
`matching. If the urgency level of the current strategy has ended,
`then, the urgency level will be lifted and strategy matching algo-
`rithm will be executed again until any acknowledgment of the
`alerts has been received.
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`Fig. 11. Display of short message data upload to healthcare center server.
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`If short messages are used to upload the data and the proposed
`short message format is followed to input short message, then,
`the display of received short message on healthcare center server
`can be as shown in Fig. 11.
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`VI. SYSTEM PERFORMANCE EVALUATION
`
`Since an intelligent mobile healthcare system with alert mech-
`anism is constructed in this paper to automatically transmit in-
`formation to the right persons at the right time in order to achieve
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`FITBIT, Ex. 1059
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`Fig. 12. Healthcare scenario for multiple healthcare providers.
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`the function of intelligent healthcare, evaluation of the time
`needed to transmit necessary informat