Innovative Approach for Wireless Health Monitoring System Using Client-Server Architecture

Transcription

1 Innovative Approach for Wireless Health Monitoring System Using Client-Server Architecture Ms. Poonam Agrawal #1 Department of Computer Science and Engineering, G. H. Raisoni Institute of engineering and Technology for Women, R.T.M.N.U., Nagpur. Prof. S. P. Hingway #2 Department of Electronics Engineering, G. H. Raisoni Institute of engineering and Technology for Women, R.T.M.N.U., Nagpur Prof. B. P. Dharaskar #3 Department of Computer Science and Engineering, Priyadarshini Indira Gandhi College of Engineering, R.T.M.N.U., Nagpur Abstract Real Time Patients health monitoring system with wireless sensor network using soft computing is an innovative idea. It also generates predication on patient s health condition based on summation of all medical records of patient. It offers anytime and anywhere remote monitoring of patients. In this wireless architecture, many to many relationship between client (patient) and server (doctor) are established and various types of communication scheme are used between them. Apart from monitoring patient s health, wrist worn device provide few auxiliary functions that fulfil the living demands of patients and it uses various types of sensors to acquire continuous vital signs of patients including blood pressure, heart rate, SpO2 and body temperature. Transmission of this digital data over internet is done using general packet radio service to web server where database are stored. Generated predication will be displayed on web application. With the help of web application authorized medical staff and doctors can easily access patient s medical graph and generated predication. Based on this the doctor can give advice message to patient instantly using internet service and set new threshold for various medical parameter if needed. A prototype system consist of data gathering, analysis, and emergency detection phase in distributed manner and PHP (hypertext pre-processor) based client server communication in which main server has centralized control over all entities. Keywords Wireless sensor network, Hypertext pre-processor server (PHP), General packet radio service (GPRS), Prediction logic, web server. I. INTRODUCTION A. Overview of wireless e-heath monitoring system The e-health monitoring system with wireless sensor network is used for patient tele-monitoring and tele-medicine. In old days transmitting biomedical signal from patients to hospital was done through telephony network. Otherwise patient was needed to be admitted in hospital for continues observation. Today, wireless sensor network provide mobile telemedicine which allows patients to engage their daily routines while they are monitored continuously anytime, anywhere. In healthcare application wireless sensor network small, lightweight sensors are used to be placed on the patient s body. Benefits of e- health system are used for transmission of blood pressure, heart beat rate, level of oxygen (SpO2), body temperature from patient to a web server using GPRS. Potential applications of wireless e-health system are remote routine checkups, emergency alarm to doctor and caretakers in emergency situation and predication on patient s health condition. So that early detection of patient health condition can help doctor to take necessary action to handle or avoid unusual situation in future. Doctor can continuously monitor patient s health condition from web application and give advice message to patient on the basis of generated graph and predication report. Doctors are also able to set new threshold vales for patient health parameter. Advances in wireless technology have made telemedicine and continuous health monitoring more practical within hospital and between hospital and mobile patients. WRIST WORN DEVICE GPRS WEB SERVER Fig. 1. Gprs Communication through internet B. Design Considerations The aim is to introduce a new wireless e-health monitoring system that comprise of a compact wrist worn device on patient hand, network connected with web server and mobiles via internet as shown in fig.1. Wrist worn device consists of various sensors, microcontroller and GPRS kit. It allows the transmission of any or all of the health parameters of patient in every 15 sec to the web server. The parameters are: blood pressure, body temperature, heat rate, and oxygen saturation. The design of the wrist worn device is very flexible in nature, so that future processing and memory upgrade can be achieved simply by software changes. The hardware is implemented with Win AVR complier that produce object code in machine language are directly dumped into AT Mega 8 bit Microcontroller. Also multichannel analog-to-digital (ADC) convert s boost up the data signal for high bandwidth second generation (2G) networks. The connection between wrist worn device, web server and mobile uses the GPRS, which allows bidirectional data transmission. Php (Hypertext pre-processor) based Web server contain MySql database, predication and graph generation logic. Web application displays generated graph of all four medical parameter of patient s medical record. It also displays ISSN: Page 1343

2 predication on patient health condition in future. Mainly it consists of doctor message sending module. C. Related Work Number of different research projects explores wireless sensor networks for monitoring patient health 24 hours. Few projects are concerned with developing wearable wrist worn belt, while others have developed based for monitoring individual patients during daily activity, at home, or in hospital. Han and Yuo et.al proposed wireless sensor network based e-health system based on radio-active and radio-passive positioning [1]. Authors proposed wireless sensor network application for 24 hours constant monitoring without disturbing daily activities of elderly people and their caretakers. In this system both fixed and mobile body sensors are used. A mixed positing algorithm is proposed to determine the location of elderly person. The purpose of positing is to help the system to determine the person s activities and further to make decisions about patient health condition. U. Anliker, J. A. Ward et.al has developed a wearable medical monitoring and alert system aimed at people at risk from heart and respiratory diseases [2]. The system combines multiparameter measurement of vital signs, online analysis and emergency detection, activity analysis, and cellular link to a tele medicine centre in an unobtrusive wrist-worn device. Mobile health monitoring system for the elderly, called icare, which can not only dynamically monitor the elderly anytime anywhere and automatically alarm to the emergency centre in the emergency situation, but also play a role in acting as a living assistant[3]. At the same time, icare also acts as the personal health information system which allows doctors to view current and history condition of the elderly, set thresholds for sensors and give advices remotely, which is the essential part for tele-monitoring of the elderly. Additionally, the medical guidance that includes the communication platform and the medical knowledge database is designed to serves as the real-time medical guidance for the elderly. Novel wireless, ambulatory, real-time, and auto alarm intelligent tele cardiology system to improve healthcare for cardiovascular disease proposed by Chin-Teng Lin et.al [4]. This expert system can identify five types of abnormal cardiac rhythms in real-time, including sinus tachycardia, sinus bradycardia, wide QRS complex, atrial fibrillation (AF), and cardiac asystole. Novel intelligent telecardiology system is capable of early atrial fibrillation detection, and represents a successful first step toward improving efficiency and quality of care in cardiovascular disease. Alexandros Pantelopoulos [5]et.al also present novel model based on a fuzzy regular formal language to describe the current state of health of the wireless health monitoring system user, which considers symptom ambiguity and causal relationships between various disorders and symptoms to derive a thorough estimation with a certain degree of confidence. Researcher at Taiwan have implemented and tested home telecare system for combine biomedical data, including threechannel electrocardiogram (ECG) and blood pressure (BP), video, and audio into a National Television Standard Committee (NTSC) channel for communication between the patient and healthcare provider [6]. Shihab A. Hameed, Vladimir Miho et.al have built a prototype system using open source technologies for centralized medical patient records that can be viewed and updated by physicians using any web browser[7]. This research project focuses on developing a novel model for an integrated Medical, Healthcare, and Emergency using Internet, wireless, multimedia, and real time technologies. Authors focus on developing a mobile web to enhance patients facilities. It is based on W3C web standards which, allows patients to access their account from any mobile phone with capabilities of connecting to the Internet. A complete real time ECG acquisition, transmission, storage, and visualization system for nonclinical applications proposed by A. I. Heernande and F. Mora, G. Vollegas [8]. The purpose of the system is the provision of extended monitoring for patients under drug therapy after infarction, data collection in some particular cases, remote consultation, and low cost ECG monitoring for elderly. M.F.A Rasid, and B. Woodward et.al [9] focus on the design of a processor, which samples signals from sensors on the patient. It then transmits digital data over a Bluetooth link to a mobile telephone that uses the General Packet Radio Service. A mobile patient monitoring system was designed, developed, and tested by Yuan-Hasiang Lin, I.-Chien Jan et.al [10].Authors integrate current personal digital assistant and wireless local area network technology. At the patient s location, a wireless PDA-based monitor is used to acquire continuously the patient s vital signs including heart beat, 3 lead ECG, and SpO 2. Through the WLAN, the patient s biosignals can be transmitted in real time to a remote centre management unit, and authorized medical staffs can access the data and the case history of patient by the wireless devices. D. Uniqueness of Wireless E-Heath Monitoring system Wireless e-heath monitoring system has following unique features as compare to above mention projects. Uniqueness of Wireless E-Heath Monitoring system Multi-parameter Monitoring Predication generation Large medical database Real time communications All-in-one Wrist worn system Living Assistant & Medical guidance Mobile health monitoring Emergency detection Remote analysis Fig. 2. Unique features of wireless e-heath monitoring system 1) Multi-parameter Monitoring: The E-health monitoring system measure heart rate, SpO 2, body temperature and blood pressure at same time. ISSN: Page 1344

3 2) Real time communications: The gprs connection to the tele medicine centre at web application features very flexible communication channel that can use short message system (SMS). 3) Mobile health monitoring: E-heath monitoring system monitors patients in real time and if any collected values exceed the predefined threshold then it send alert message to doctor and family members. 4) Predication generation: If there is possibility of any unlike situation in patient near future, this module gives predication message to the doctor terminal. So that early detection will helps the patients to avoid uncertainty in future. 5) All-in-one wrist worn system: This system combines all sensors, microcontroller, communication, and processing devices in a single wrist worn enclosure. Overhead of mounting sensors over different location of human body is totally reduced. So that sensor data are more accurate. 6) Emergency Detection: For emergency detection, the analysis can incorporate patient profile and database to reduce number of false alarms. 7) Large medical database and graph generation: All medical history of patients is stored in database on web server and displayed in the form of graph on doctor terminal. It helps doctor in giving medical advice to patients. 8) Living Assistant and Medical guidance: Wrist worn device have some auxiliary functions like displaying real time date and time to assist patients in their daily life activities. This system can offer online medical guidance. 9) Remote Analysis: The wrist worn device can perform an analysis of all sensors collected data online and presenting them in the form of graph to doctor terminal. Main Contribution: The main contributions in this paper can be summarized as follows: System supporting wireless sensor network and Gprs communication between patients wrist worn devices and web server are implemented and tested. Proposed predication generation algorithm automatically generates predication on patient s health in next 24hous. So that early precaution can be taken to avoid any unusual situation in future. Web based telemedicine and tele-monitoring system is implemented which support many to one clientserver relationship between many patients and centralized web server. II. SYSTEM ARCHITECTURE The aim of this study is to design and implement a wireless e- health monitoring system for continuous monitoring vital signs of patients and to facilitate telemedicine system to mobile patients. The main aim of system is to generate predication on patient s health condition, so that early caution can be taken to avoid dangers situation in future. Figure 3 shows the architecture of proposed system. The system can be divided into 3 main parts:- 1) Tele-monitoring and Emergency detection system 2) Remote Analysis System 3) Telemedicine system Tele monitoring system consists of wrist worn devices coupled with Gprs kit. While remote analysis system consists of web server and telemedicine system are called web application. T:112 BP:92/140 HB:60rpm SpO2: 92 SMS: - Take Crocin 1-1 AD Azithromiciane 1-1 BD :11:00am PATIENT-1 T:92 BP:80/120 HB:70rpm SpO2:98 SMS: - Hello :11:00am G P R S PATIENT-N SMS PROVIDER G P R S EMERGENCY SMS FAMILY / DOCTOR WEB SERVER PREDICATION GENERATOR (SOFT COMPUTING) PATIENT S DATABASE WEB APPLICATION GENERATED PREDICATION GENERATED GRAPH SMS SENDING MODULE Fig. 3. Block diagram of the wireless e-heath monitoring system A. Wrist Worn device and Gprs Kit Wrist worn device are designed with low power consumption in mind. This device is highly portable in nature. It consists of six functional blocks: power supply, sensors, analog to digital convertor, display unit, processing unit and communication subsystem. As shown in figure 3 wrist worn device contains sensors are continuously sense different vital signs of patients which are measured in every 15sec and send it to the main server using Gprs. At the same time, Emergency Detection module continuously analysis the data, if any value found to be out of range of predefined set of threshold then wrist worn system send alert message to doctor and caretakers mobiles. So that real time help can be provided to the patients. Power Supply: Several modules run at different voltages levels like microcontroller required V. So that we used 9 V rechargeable battery for providing continues and uninterrupted power supply. Sensors: For mobile patients, the main parameters that are need to be monitored are blood pressure, pulse rate, body temperature and oxygen saturation (SpO2). The main challenge handled by the design at this stage was the method GPRS GPRS ISSN: Page 1345

4 used to derive all the above information from wrist worn sensors and need to maintain the power consumption to a minimum level. a) Blood Pressure Sensor: To perform a measurement, we use a method called oscillometric. The air will be pumped into the cuff to be around 20 mmhg above average systolic pressure. After that the air will be slowly released from the cuff causing the pressure in the cuff to decrease. As the cuff is slowly deflated, we will be measuring the tiny oscillation in the air pressure of the arm cuff. The systolic pressure will be the pressure at which the pulsation starts to occur. We will use the MCU to detect the point at which this oscillation happens and then record the pressure in the cuff. Then the pressure in the cuff will decrease further. The diastolic pressure will be taken at the point in which the oscillation starts to disappear. b) Heart beat rate and SpO2 Sensor: Heart rate is the number of heartbeats per unit of time and is usually expressed in beats per minute (bpm). Normal heart beats about 60 to 100 times a minute. This sensor Count the number of pulses within a certain interval (say 15 sec), and easily determine the heart rate in bpm as bpm= (No. of Heart Beat /15s ) * 4 The measurement of oxygen level in blood is based on heart beat rate of patient by the following formula. SpO2 = (heart_beat * 11) / 10; Working principal of heart beat rate sensor is: This technique measure the heart rate by sensing the change in blood volume in a finger artery while the heart is pumping the blood. It consists of an infrared LED that transmits an IR signal through the fingertip, a part of which is reflected by the blood cells. The reflected signal is detected by a photo diode sensor. The changing blood volume with heartbeat results in a train of pulses at the output of the photo diode, the magnitude of which is too small to be detected directly by a microcontroller. Amplifiers are used to filter and amplify the signal to appropriate voltage level so that the pulses can be counted by a microcontroller. The heart rate is displayed on a 3 digit seven segment display. Fig.4. Working principal of IR sensor c) Temperature Sensor: Analog temperature sensor provides an output voltage proportional to the temperature. Output can be directly fed to the input of an analog to digital convertor for digital processing. Examples of such sensors are LM34, LM35. We are measuring the temperature as Ex: T (f) = 18*T(c) = (18*314) =8852= Display unit: - This unit display the doctor advice in 16 character on 7 segment led. It also show current date and time which are power by 3 V battery. Processing unit: - It consists of 8 bit microcontroller, real time operating system and EEPROM. 8 bit AVR microcontroller with 32kBytes: The 8 bit AVR is a low-power CMOS 8-bit microcontroller based on the AVR enhanced RISC architecture. By executing powerful instructions in a single clock cycle, the ATmega32 achieves throughputs approaching 1 MIPS per MHz allowing the system designed to optimize power consumption versus processing speed. Microcontroller runs the predefined medical algorithm. a) Real time operating system: - Wrist worn device continuously monitor the patient in real time, and send this data to main server. If real time operating system found any emergency satiation then send quick alarm to doctor and caretakers. b) EEPROM:- For storing emergency detection and analysis module. Also it stored the current date and time. Communication subsystem: Wireless communication capability is integrated with wrist worn device in the form of an on-board global system. The General packet radio service of internet enables data exchange with the web server, caretakers and doctor mobiles as shown in figure 1. The prototype uses a 2G airtel sim with internet pack to support high speed and low cost internet connection. a) Communication Scheme: Six schemes are implemented as 1. W to WS: Wrist (W) worn devices can send patients medical data to web server (WS). 2. WS to WA: Graph and predication are displayed on web application (WA) from web server. 3. WA to WS: While doctor send advice message to patient, to retrieve patient mobile number from database stored on web server, web application send the query to web server. 4. WA to W: When doctor send message to be displayed on patient wrist worn unit. 5. W to WS/M s: In emergency situation, alert message from wrist worn unit to doctor and caretaker mobiles. 6. WS to DM: Web server sends predication message to doctor mobile (DM), only when it find any predication contain abnormal parameters. b) Cases: Communication are takes place using Gprs in two cases:- Case 1: Wrist worn and web server are communicate with each other in normal situation as well as in emergency situation. ISSN: Page 1346

5 Case 2: Wrist worn system can support one way communication in emergency situation between wrist worn and doctor, caretaker s mobiles. Algorithm: The initial analysis starts with a comparison of the blood pressure, SpO2, body temperature and Hear beat rate with predefine values. Based on the results of this analysis, four different scenarios are possible. Normal: It indicates that all medical parameters of patient are fine. Error: A re-measurement is performed. Emergency Situation: If any one or all values are diverted from predefined range, then wrist worn device send alert message to doctor and caretakers mobile. The doctor s then perform a detailed analysis of all data further steps are taken. B. Web Server: Php Server Web server can stored all medical data of patients in MySql database called Patients log. Php server runs predefined medical algorithm called CHECK MEDICAL-PARAMETER algorithm:- ALGORITHM: CHECK MEDICAL-PARAMETER Step 1: Receive patient s parameters from the wrist worn device. Step2: Compare received patient medical values to predefined Value, and assigns a risk factor accordingly. Step 3: Prepare graph to reflect the patient health parameter. Step 4: Auto generate the predication for patient health condition in next 24 hours based on the average values derived from the all values stored in patient database. Step 5: If generated predication show high risk in future, then only it send alert message to doctor to avoid any unusual situation in future trough web Sms provider. Step 6: At the same time, it display graph and predication values on web application. As shown in diagram this procedure is carried out continuously for accurate results. PATIENT WRIST Fig. 5. Web Server Operations Predication module execute median filter algorithm to generate predication values. C. Web Application: Tele Medicine Centre At the TMC, doctor careful read displayed predication values and study graph for various medical parameters of patients. This software will allow only authorized doctors to securely access medical records and details of a patient, which enables doctor to reply quickly and appropriately. This makes the TMC to offer the emergency treatment and waiting and travelling time of patient can be saved. Also doctor can set the new threshold values for parameter to handled current medical health condition of patients. Fig. 6. Snap shot of working of Web Application When doctor enter the patient number, message, set new threshold values and press Send Message to Patient button, set of action was performed as shown in figure 7. WEB SEVER Database Graph Display Predication Values WEB APPLICATION Doctor message sending window Abnormal Predication Values SMS Web SMS provider Doctor Mobile Fig. 7.working of Doctor Message Sending Module III. CLIENT SERVER APPLICATION The wireless client server architecture is defined as follows: the client application resides in wrist worn device provides continues remote monitoring, visualization, transmission and receiving of messages to the server and mobile. The server is centralized web server, take care of remote analysis of incoming medical data of patients and if receiving values exceed the predefined threshold then automatically the message will be forwarded to doctor, family friends which ISSN: Page 1347

6 indicate emergency situation. Web server is also responsible for displaying graph, predication logic on web application. Client application is develop using C# and the server is designed using Php language. Database is designed using MySql. General packet radio services are used for wireless connection between client and server. The relationship between clients and server are described as follows:- a. Many to One (M: 1): The wireless e-health monitoring system connects more than one patient s wrist worn devices to the single php server at the same time. Client application can send collected patient medical data to the server. Client Patient-1 Patient-2 Patient-N Php Server Database M: 1 1:1 1: M Fig. 8. Client Server Architecture for e-heath monitoring system b. One to One (1:1): This type of relationship exists between web server and web client. Centralized server has complete control over all system. Server can send data to display on web client. On the other hand, when doctor need to send the message to client side, doctor can enter only patient number and the message. Web client application then send this patient number to the web server for searching of mobile number for particular patient in database index by patient number. Then server returns the mobile number of that patients if records find otherwise error will displayed on web client side. c. One to Many (1: M): At the time of emergency situation, wrist worn device can send the alert message to doctor, family members and whose mobile numbers are stored in database. IV. SYSTEM TEST RESULTS Web Client Tele Medicine Centre Doctor and Caretakers Measurement of wrist worn device is erroneous in two situations: the wave form could not be detected, e.g. too much noisy in the environment and when patient cannot properly placed sensor on body. In calculating predication results, such erroneous results were excluded from consideration. a) Measurement Results: An investigation of the blood pressure data showed 70 % accurate. Due to noise some results showed deflections and were appeared many times. This may result in some cases that they are insufficient for this system to be used with confidence in a clinical environment for measuring blood pressure. Further work is going on to overcome this system. b) Feedback from questionnaire: This system was found 80% comfortable. V. CONCLUSION A wireless health monitoring system is designed, developed and tested and is found efficient and user friendly in all aspects. We have developed a wearable patients monitoring and alert system. The system combines measurement of vital signs, online analysis and emergency detection, predication and graph generation, sending of doctor message, sending of web based predication messages and gprs connectivity between wrist worn, web server, web application and mobiles. A prototype of wrist worn device, web server, and telemedicine centre has been implemented successfully. REFERENCES [1] U. Anliker, J. A. Ward, P. Lukowicz, G. Tröster, F. Dolveck, M. Baer, F. Keita, E. Schenker, F. Catarasi, and R. Schmid, AMON: A Wearable multi parameter medical monitoring and alerts system, IEEE Trans. On Inf. Technol., Biomed., vol. 8, no. 4, pp , [2] Hairong Yan, Hongwei Huo, Wireless Sensor Network Based E-Health System- Implementation and Experimental Results, Member, IEEE Trans. On Consumer Electronics, vol. 56, no. 4, November [3] Ziyu Lv, Feng Xia, Guowei Wu, Lin Yao, Zhikui Chen, icare: A Mobile Health Monitoring System for the Elderly, Member, IEEE/ACM International Conference, November 2010 [4] Chin-Teng Lin, Fellow, Kuan-Cheng Chang, Chun-Ling Lin, Chia-Cheng Chiang, Shao-Wei Lu, Shih-Sheng Chang, Bor-Shyh Lin, Hsin-Yueh Liang, Ray-Jade Chen, Yuan-Teh Lee, and Li-Wei Ko, An Intelligent Telecardiology System Using a Wearable and Wireless ECG to Detect Atrial Fibrillation Member, IEEE Transaction on information technology in biomedicine, Vol. 14, No. 3, May 2010 [5] Alexandros Pantelopoulos, Student Member, IEEE, and Nikolaos G. 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