E-health System for Monitoring of Chronic Diseases R. Ciorap1, D. Andritoi1, V. Pomazan2, L. Petcu2, F. Ungureanu3, and D. Zaharia1 1
“Gr.T.Popa” University of Medicine and Pharmacy, Iaúi, Romania 2 University Ovidius ConstanĠa, ConstanĠa, Romania 3 “Gh. Asachi” Technical University, Iaúi, Romania
Abstract— The actual status of technological development impose the improvement of quality of life through health services, information and communication systems and environment control more efficient in hospitals. This study want to develop a medical device for monitoring some vital parameters on patients with chronically diseases that alongside a software application, it provides an integrated solution of monitoring the evolution of the disease in order to optimize the treatment. We wish to apply this system for the pregnant women with chronically diseases like diabetes or heart disease. The system will monitoring and memorizing on a flash memory the physiological signals and the communication line will be opened at preset periods of time , when the patient has the obligation to actualize the data base or in emergency situation. To offer confidentiality to the patients, the data transmission will be encrypted and the storage of data will be made after the validation of that patient. Keywords— telemedicine, e-health, monitoring, chronic diseases, diabetes
I. INTRODUCTION In WHO report for 2008 is specified that “urbanization, ageing and globalized lifestyle changes combine to make chronic and noncommunicable diseases – including depression, diabetes, cardiovascular disease and cancers – and injuries increasingly important causes of morbidity and mortality”[1]. In the WHO European Region, 86% of deaths are attributable to chronic diseases. With 50–80% of all global health spending related to chronic diseases, health systems that maintain current disease management practices cannot afford to continue caring for the escalating numbers of people with chronic diseases [2].
The task of patient monitoring may be achieved by telemedicine (enabling medical information-exchange as the support to distant-decision-making) and telemonitoring (enabling simultaneous distant-monitoring of a patient and his vital functions) both having many advantages over traditional practice [3]. Monitoring of chronic diseases, such as diabetes and heart disease, is emerging as a practical application of the Internet to directly support patient care [4]. Doctors can receive information that has a longer time span than a patient’s normal stay in a hospital and this information has
great long-term effects on home health care, including reduced expenses for healthcare. This paper presents the initial results and our experiences in developing a device for vital parameters monitoring of pregnant women with diabetes, taking into account some hardware and software aspects regarding parameters measurement, robustness, reliability, power consumption, data rate, security and integration in an e-health network. II. MATERIALS AND METHODS The Home Monitoring Device (HMD) is an embedded system which is addressed to pregnant women who suffer from diabetes or heart disease giving the possibility of long term monitoring of vital parameters. Also there will be made a primary processing of dates for the detection of critical situations with automatic alarm, in the needing case, of the medical assistance centre where the patient is assigned. The entire system includes two essential components: Home Monitoring Device (HMD) and Remote Care Centre (RCC). HMD that takes the results of the monitored parameters with regular “low cost” devices and the reception unit that receives the data through the internet and transfers them on line through the mobile network. This device is connected to the transmitter and allows management of patients remotely. If the value of the biomedical parameters is not normal the system sends an alarm message. The alarm message will be sent to the personal doctor of the patient using SMS services via GSM network. The Remote Care Centre (RCC) receives all data through various communication channels (Internet Protocol link, GSM, GPRS etc). This information from the patient is processed and entered into a database. Also, the module includes a distribution platform based on a network protocol that facilitates the access of this data by the doctor and also has an alarm function. Warning messages are sent to the personal doctor via GSM using the SMS service through an application that is called SMSserver. The general flow scheme is presented in figure 1.
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The on board storage device (SD/MMC card) with FAT32 file system is used for raw data recording together with signals processing results. The radio module Bluetooth [7] designed for short-range communication is used for data transmission between monitoring device and PC or PDA. This module has low power consumption being used only when data transfer is performed. B. The Remote Care Centre (RCC) Fig. 1 General flow scheme
The project allows interactive patient communication and the providers of homecare services, the access to information and a method of health monitoring. The software and the data base that runs in the medical center could be considered the heart of the project. A. Home monitoring device The home monitoring device is build using custom developed hardware and application software. Low power amplifiers and transducers are connected to the device, for vital parameters acquisition [5]. The biomedical parameters acquired are: blood glucose level (GL), oxygen saturation (SaO2), heart rhythm (HR), NIBP, weight (W) and body composition (tissue water content). For patient with heart disease we can replace module for measuring blood glucose level with a custom made 3-lead ECG amplifier. The primary characteristics of the system are: x x x
The hardware items are represented by 2 computers (one with Linux OS provided with a PHP server and a MySQL server, and the other with Windows OS), a serial interface to connect to a GSM module and the device for collecting the biomedical parameters. This application implies the existence of an Apache web server with PHP support configured with a MySQL database server on a Linux OS. All data coming from patients are placed in a database and analyzed. First the application checks whether the medical parameters values fall within the normal range. If these values are outside the normal range the server creates a socket using an address and a default port for communication. This script is designed in PHP using the socket functions. A socket is nothing else but a terminal of a communication link between 2 independent applications running on a network. For the client, if the connection is accepted, it will create a socket, and this application will use this socket to communicate with the server. The client and the server can now communicate in both directions using there own sockets.
minimization – SMD technology implies small dimensions, resulting a low cost per device low consumption of energy modularity – depending on the physiological signals that wish to be monitored and depending on the network communications available, we can build custom HMD.
In this stage of the project we using an ultra low power microcontroller (MSP430 from Texas Instruments) [6] that has a 16 bit RISC core with clock rates up to 8MHz. An important advantage of this family of microcontrollers is the high integration of some circuits that offer the possibility to design devices with open architecture: digital ports, analogue to digital converter (A/D) and digital to analogue converter (D/A). MSP430 microcontroller also has a built in hardware multiplier which is a valuable resource for digital filter implementation. The custom made electronic boards used for data acquisition are all designed with low power circuits. The system is modular: every board is detachable.
Fig. 2 The PHP script If the connection is made, the server following a query and data processing will realize and send some data that contains among others the telephone number of the specialist doctor of the patient, the kind of medical data and sent its value. All data coming from the website are entered into a
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database and analyzed, and if it is pathological a SMS message is send. SMS guarantees the receipt of messages. If the message can temporarily not be delivered, it is kept at a SMSC until the destination becomes available. The SMS server application using the computer and telecommunication networks will notify the doctor about the patient-s medical situation. It is a flexible application that allows the sending of SMS messages via a computer connected to a GSM module. The software for this application was written in Visual Basic (Microsoft Visual Studio 6 interface) and includes the GSM communication module using the serial port and the protocol for communication between the 2 computers of the system. MySQL is used for DataBase management and an user friendly Graphical User Interface (GUI) is offered on a web page, both with tools for rapid query answers and specific statistical calculus returns regarding the parameters status or evolution with respect to time. The GUI activates at request and shows evolution in time for each parameter and correlation significant values [8]. The HMD is build with 2 microcontrollers connected between them through a serial interface. We chose this solution because the big number of operation that we need to do. The HMD must to acquire and measure blood glucose level (GL), oxygen saturation (SaO2), heart rhythm (HR), NIBP, weight (W) and body composition (tissue water content). The HMD must to do also the A/D conversion, UART and SPI communication and save data on SD memory. All this computational effort doesn’t be done by single MCS 430 microcontroller. This structure is presented in figure 3.
x x x
Send data about HR parameter to the Master Send data about SaO2 parameter to the Master Close HR module or/and SaO2 module The coordinator’s tasks are:
x x x x
IEEE 802.15.4 radio network coordinator Initializing the mobile device that are logged to the radio network Assuring the bridge function through mobile device and PC if the memorizing the data are made to the PC. Execute commands from a PC if is connected to one III. RESULTS
The HMD is able to acquire simultaneously the physiological parameters mentioned in the previous section and also to perform rudimentary digital signal processing on board. The signals are continuously recorded in separate files on flash memory for feature analysis. Once pathological abnormality is detected, the monitoring device requests a transmission to the RCC. The communication between tasks is implemented with semaphores and waiting queues allowing a high level of parallelism between processes. Each process may be individually enabled or disabled. This feature is very important in increasing the flexibility of the application: if real time monitoring is desired, then SD Card Process may be disabled and Bluetooth Process is enabled, if only long term monitoring is desired then SD Card Process is enabled and Bluetooth Process may be disabled. This has a positive impact on power consumption because only the resources that are needed are enabled for use. IV. CONCLUSION
Fig. 3 HMD structure Between the two microcontrollers is a master-slave relationship. The master microcontroller is responsable with communication with RCC through another device called coordinator. We use this architecture for having a wide mobility in choosing biomedical parameters for monitoring. In this case if we need to have ECG signal we can add another master module with MCS 430 only for ECG. The master microcontroller sends the following commands to slave microcontrollers:
In conclusion, this paper presents some challenges of hardware and software design for home monitoring device based on low-power medical sensors and microcontroller with a recent tremendous impact in many medical applications. Obviously, the results demonstrate that there is still significant work to be done if the HMD is effectively integrated in a large network of medical sensors.
ACKNOWLEDGMENT This work is supported by Romanian Minister of Education, Research and Innovation in the framework of National Program for Research, Development and Innovation (PNCDI-2) under partnership project no. SIMPA 11-070.
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Radu Ciorap “Gr.T.Popa” University of Medicine and Pharmacy Kogalniceanu 9-13 Iasi Romania
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