TOPICS ON COMPUTATIONAL BIOLOGY AND CHEMISTRY
`
`Smartphone, PDA and Embedded devices as mobile monitoring stations of
`Biotelemetric System
`ONDREJ KREJCAR, JINDRICH CERNOHORSKY, PETR FOJCIK
`Centre for Applied Cybernetics, Department of Measurement and Control
`VSB Technical University of Ostrava
`17. listopadu 15, Ostrava Poruba 70833
`CZECH REPUBLIC
`
`Abstract: - Existence of software platform, which will allow us to monitor the patients’ bio-parameters and provide us
`with services which help with full health care, is more than relevant these days. The aim of our project is to provide
`solution which can be used in different spheres of health care and which will be available through PDA (Personal
`Digital Assistant), web or desktop clients. Practically developing system works with an ECG sensor connected to
`mobile equipment, such as PDA/Embedded, based on Microsoft Windows Mobile operating system. The whole system
`is based on the architecture of .NET Compact Framework, and SQL Server. The project was tested in real environment
`in cryogenic room (-136OC).
`
`Key-Words: - Smartphone, PDA, Embedded device, biotelemetry, SQL CE Database
`
`1 Introduction
`In our world society exist widely spectrum of middle-
`aged people like businessmen, CEOs, managers and
`other have very hectic lives with much stress and
`without good ways of living. Sometimes these people
`have a collapse, breakdown or heart attack and must be
`in hospitals or health resorts for a long time to regenerate
`their bodies. The
`time
`that
`they spend
`in
`these
`institutions, is nonutilisable and very long for them.
`Possibilities of today physics are restricted by many of
`prescripts so patients cannot use some of the newest
`techniques (like hyperbaric or arctic chambers), which
`make it possible to reduce the regeneration time by
`weeks or months. For example, these chambers are
`restricted to patients in the first six months after heart
`attack due to no information about patients’ conditions
`during the procedure. Here is the main area of utilization
`of our telemetric system. Of course the use of our system
`is not limited only to businessmen, but it is targeted to
`middle-aged people with some knowledge about new
`technology like mobile phones. The price of client
`devices of our system is not low, so we suppose people
`who can invest to these sorts of assistants.
` Aim of the platform for patients bio-parameters
`monitoring is to offer a solution providing services
`which help and make full health care more efficient
`without limitations for specific country. Doctors and
`other medical staff will not be forced to make difficult
`and manual work including unending paperwork, but
`they will be able to focus on the patients and their
`problems. It helps to better psychological condition of
`both sides. All data will be accessible almost anytime
`
`anywhere through special applications designated for
`portable devices web browser or desktop clients and any
`made changes will be immediately at disposal to medical
`staff based on the security clearance. Nurses will be able
`to find out prescribed procedure of patient treatment
`which was written down by doctor during regular round.
`Doctors will have immediate access to the patients
`newest results of accomplished examinations. In the case
`that the ambulance have to go to some accident, rescue
`team can due to portable devices send information about
`patient health condition directly to hospital where
`responsible doctors and staff will have information
`needed to execute immediate operation without delaying
`by preparation of necessary equipment. Patients who
`need not hospitalization will be able to be treated at
`home due to the system capable of remote transmission
`of information about patients bio-signals, so patients will
`be constantly under medical supervision and doctors will
`be able to make necessary measure if needed. All bio-
`signals data will be stored and automatically analyzed by
`neuronal network. System will evaluate presence of
`critical values which could be the sign of worse medical
`condition of a patient. In the moment of crossing the
`border of monitored bio-signals values inserted by
`doctor, system will inform responsible medical staff and
`provides all information which could help to determine
`the cause and seriousness of the problem.
` The basic idea is to create a system that controls
`important information about the state of a wheelchair-
`bound person (monitoring of ECG and pulse in early
`phases, then other optional values like temperature or
`oxidation of blood ...), his situation in time and place
`(GPS) and an axis tilt of his body or wheelchair (2axis
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`TOPICS ON COMPUTATIONAL BIOLOGY AND CHEMISTRY
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`accelerometer). Values are measured with the existing
`equipment, which communicates with the module for
`processing via Bluetooth wireless communication
`technology. Most of the data (according to heftiness) is
`processed directly in PDA or Embedded equipment to a
`form that is acceptable for simple visualization. Two
`variants are possible in case of embedded equipment –
`with visualization and without visualization (entity
`with/without LCD display). Data is continually sent by
`means of GPRS or WiFi to a server, where it is being
`processed and evaluated in detail. Processing and
`evaluating on the server consists of - receiving data,
`saving data to data storage, visualization in an advanced
`form (possibility to recur to the older graph, zoom on a
`histogram (graph with historical trend), copying from the
`graphs, printing graphs), automatic evaluation of the
`critical states with the help of advanced technologies
`(algorithms) that use Artificial intelligence to notify the
`operator about the critical state and its archiving.
`Application
`in PDA, Embedded
`equipment
`is
`comfortable, with minimum
`time
`-
`the
`first
`configuration, but also configuration after downfall of
`application. The level of visualization will be lower. The
`described system can be used with small modifications
`for monitoring of patients in hospitals or people working
`in extremely hard conditions. The biggest limitation is
`the availability of measuring devices in acceptable and
`adaptable sizes or comfortable enough to have one
`around.
`
`
`
`Figure 1 Architecture of platform
`
`2 Developed Parts of Platform
`Complete proposition of solution and implementation of
`the platform for patients bio-parameters monitoring as it
`was described in previous chapter requires determination
`and teamwork. Every single part of the architecture have
`to be designed for easy application and connectivity
`without user extra effort, but user must be able to use
`given solution easily and effectively. Crucial parts of
`whole architecture are network servers, database servers
`and client applications. Due to these crucial parts
`development is focused particularly on proposition and
`
`implementation of desktop client application, database
`structure and some other important web services.
` Scenario for communication among desktop client,
`web services and Microsoft SQL Server is: desktop
`client runs on user´s computer and connects to web
`services on remote application server. After the desktop
`client is connected, web services connect to remote
`database server. Web services provide methods for users
`so users are capable to work with different data stored in
`database.
`
`
`
`
`
`Figure 2 Desktop Client connections to database
`
`2.1 Mobile part
`The main part of the whole system is an Embedded or
`PDA device. The difference
`in applications
`for
`measurement units is the possibility to visualize the
`measured data in both Real-time Graph and Historical
`Trend Graph, which can be omitted on an embedded
`device.
`
`
`
`
`
`
`Figure 3 Smartphone and PDA/MDA visualization
`
`PDA is a much better choice for Personal Healthcare,
`where the patient is already healthy and needs to review
`
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` Current application is highly specialized and written
`to accommodate specific hardware. Usage of any other
`hardware is not possible. This is due to different
`methods of packet folding, which are unique on each
`device. This is partly caused by the length of the
`Telemedicine branch. Operating of
`the device
`is
`simplified as much as possible with the least possible
`number
`of
`steps
`regarding
`user
`registration,
`measurement device connection and the measurement
`itself. The informations about user, as ID, name,
`surname, address and application properties are stored in
`the
`system
`registry
`(HKEY_CURRENT_USER
`/
`Software / Guardian). Working (saving, reading, finding)
`with registry
`is easier and faster as saving
`this
`informations in file. User registry values are crypted
`with simple algorithm (shifting char ASCII value).
`
`2.2 Server part
`In order to run a server, an operating system supporting
`IIS is needed. IIS is an Internet Information Server
`application allowing users to connect to the web server
`by the well-known HTTP protocol. The web service
`transfers data between the server and PDA/Embedded
`devices. It reads the data, sends acknowledgments, stores
`the data in the database and reads it from there. The
`service is built upon ASP.NET 2.0 technology. The
`SOAP protocol is used for the transport of data, which is
`in XML format. That is an advantage since it allows
`communication of multiple different technologies and
`platforms.
` The Wireless ECG approaches a real professional
`ECG with data rate as high as 800 records per second
`[1]. That makes 48,000 records per minute and
`2,880,000 per hour. Considering 100 patients, the value
`gets to 288,000,000 records per hour. Even if the server
`accepted only 50 records per second, the sum of records
`for 100 patients per hour would be 18 million. That is an
`extreme load for both the server and the database
`system; hence a better way of storing data is needed.
`Methods that devices communicating with the web
`service can use include: receiving measured data,
`receiving patient data, deleting a patient, patient data
`sending. To observe measured data effectively,
`visualization is needed. A type of graph as used in
`professional solutions is an ideal solution. To achieve
`this in a server application, a freeware Zed Graph library
`can be used. For data analysis, neural nets are a
`convenient solution. However, there are problems in the
`automatic detection of critical states. Every person has a
`specific ECG pattern. What is completely normal for one
`person can indicate crisis for another. The Neural net has
`to learn to distinguish critical states of each patient
`separately. To make the specialist’s or operator’s
`intervention possible, the system must be provided with
`a user-friendly interface, possibly imitating those on
`
`his condition, or for multiple person usage. Embedded
`devices can be designed for one user, with the option to
`use an external display used for settings or with the
`possibility of usage in extreme conditions.
`As measurement device is possible to connect several
`device with Bluetooth communication possibility:
`
` •
`
`
`
`ECG – electrocardiogram
`-
`electric hearth activity
`-
`Corscience CorBELT device (bipolar)
`Blood pressure
`-
`informations about hearth activity and
`blood vessels
`-
`pressure gage measurements
`Spirometry
`-
`lungs capacity
`-
`measurement using spirometrs
`Oximetry
`-
`haemoglobine saturation measurement
`-
`oximeters measurements
`
`•
`
`•
`
`•
`
`
`In our application we use an ECG Measurement Unit
`(Corbelt or BlueECG [Figure 4]) through a virtual serial
`port using wireless Bluetooth technology. Then, after
`pushing a button, all necessary parameters are set and the
`communication may begin. Measured data is stored on a
`SD Memory Card in a database in MS SQL Server 2005
`Mobile Edition.
`
`
`
`
`
`Figure 4 12 channel ECG bluetooth module BlueECG
`
`The performance of available devices seems insufficient
`for sequential access; parsing of incoming packets is
`heavily time-consuming. Pseudo paralleling is required.
`If Windows Mobile OS versions 2003 to 5.0 are used,
`the processing of data from a professional EKG is not
`realizable due to thread count limitations. A newer
`operating system (Windows Mobile 6) can be used to
`solve this.
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`is
`
`medical appliances. This area of development
`described in next chapter.
`
`2.3 Embedded mobile device
`Devices based on PDA type have a several limitations
`such as low CPU performance, low battery life or small
`display. These limitations are possible to solve by
`embedded version of such mobile clients. We create a
`special windows mobile based embedded device (see
`[Figure 5]).
`
`
`
`
`
`
`Figure 5 Embedded device Guardian Client
`
`During the development process of this Embedded
`device the several problems occurred. One of them and
`the most important was the need of a new operation
`system creation for our special architectural and device
`needs. We used the Microsoft PlatformBuilder for
`Windows CE 4.2 tools (Figure 6). The created operation
`system based on standard windows mobile has several
`drivers which we need to operate with communication
`devices and measurement devices.
`
`
`
`Figure 6 PlatformBuilder for Windows CE 4.2
`
`2.4 Web services
`
`
`
`Next important parts of the platform are web services,
`which allow us effectively work with medical records or
`other data.
` Guardian web services are:
`patients
`complete
`–
`•
`User management
`management. Provides interface that allows deleting,
`editing and creating records about new patients.
`•
`Data management – operations with measured
`data gained from different devices such as personal
`ECG, manometer or oxymeter.
`provides
`-
`•
`Configuration management
`information about users roles and functions which
`belong to these roles.
`•
`User management – users = doctors, nurses,
`other medical staff.
` Each web service deals with common security
`module, which provides methods for one-way encryption
`and also implementation of methods for authorization
`and other security components is planned.
`
`2.5 Database
`Important part of Guardian is central database. There are
`stored all data of medical staff and patients. Data of
`patients include different records such as diagnosis,
`treatment progress or data which are results of
`measuring by small portable devices designated to home
`care. These data represent the greatest problem, because
`amount of these data rapidly increase with increasing
`amount of patients. Due to this fact database servers are
`very loaded.
` Current version contains 12 database tables. Database
`design is made with Microsoft SQL Server Management
`Studio – graphical application, which provides set of
`quality and powerful tools for Microsoft SQL Server
`administration. There are some interesting tables:
`•
`Patient – table which is used to save information
`about each patient.
`•
`User – this table is used to save information
`about each user (user = member of medical personnel).
`•
`Role – information about user roles.
`•
`Diagnosis – information about patient diagnosis.
`•
`Treatment – treatments associated with related
`diagnosis.
`•
`File – all user files.
`•
`EcgRecord – the measured values of ECG. All
`measured values are saved as byte array.
`
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`Figure 7 Infracamera picture from Cryogenic room
`
`Acknowledgement
`
`The support for this research work has been provided by
`the project 102/06/1742: Experimental
`real-time
`database testing system, provided by Czech Science
`Foundation.
` This work was also supported by the Ministry of
`Education of the Czech Republic under Project 1M0567.
`
` 3
`
` Conclusion
`The measuring device (ECG, plethysmograph) and
`Guardian PDA client was tested in extreme conditions in
`a cryogen room in Teplice (-136°C), where the final
`system will be installed [Figure 7]. Implementation of
`the data transmission security was not solved. The whole
`system is classified as „work in progress“ system and it
`is in a testing phase where we found mistakes and
`repaired them.
`
`References:
`[1] Paulo Reis, Conferencia Telemedicina Onde
`Estamos e para onde vamos, Ericsson – (04.12.2006)
`[2] DCCT – Diabetes Control and Complications Trial -
`http://diabetes.niddk.nih.gov/dm/pubs/control/
`(10.04.2008)
`[3] Krejcar, O., Fojcik, P.: Biotelemetric system
`architecture for patients and physicians – solutions
`not only for homecare, In Portable 2008, 2nd IEEE
`International
`Interdisciplinary Conference
`on
`Portable Information Devices, Ga-Pa, Germany,
`(2008)
`[4] Janckulik, D., Krejcar, O., Martinovic, J.: Personal
`Telemetric System – Guardian, In Biodevices 2008,
`pp. 170-173, Insticc Setubal, Funchal,,Portugal,
`(2008).
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`ISBN: 978-960-474-036-9
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