Mobile Health Monitoring and Consultation to Support Hypertension Treatment Gitarja Sandi[1], I Gusti Bagus Baskara Nugraha[2], Suhono Harso Supangkat[3], School of Electrical Engineering and Informatics Bandung Institute of Technology Bandung, Indonesia [1]
[email protected], [2]
[email protected], [3]
[email protected]
Abstract—Hypertension is a disease that can lead to heart attack and blood vessel disease. Maintain blood pressure on normal conditions can reduce the risk of hypertension and heart disease. Conventionally, patients can consult the hypertensive condition by visiting hospital then take measurements of blood pressure, doctor will diagnose the condition of a patient's blood pressure, then give advice on what should be done by the patient. This paper will describe the monitoring and consultation system for hypertension treatment using smartphone devices that are integrated with medical sensor device. Keywords—hypertension, telemedicine, telehealth, mobile-care.
I.
INTRODUCTION
Hypertension is a disease that affects many people of Indonesia. Based on [12] the prevalence of hypertension in Indonesia with over 18 years of age reached 31.7%. This is due to the lack of monitoring of patients with hypertension, and therefore required a monitoring system that can monitor the health condition of people with hypertension. Patients only check pressure while visiting health facilities such as hospitals and health clinics. Hypertension can lead to heart attack and blood vessel disease. Health consultation to physicians is one way to determine the condition of our blood pressure. If our blood pressure goes into hypertensive phase, the doctor will advise the patient what to do and what to avoid. Conventional blood pressure measurements are usually performed by physician at the time of patient visits to the hospital. Doctor do not record the measurement results in structured data, so that the blood pressure information is not available in real-time. Patient also does not store information in structured data of blood pressure, this condition causes the patient does not know the condition of their blood pressure. Conditions of hypertensive patients can be monitored by using pattern recognition system of blood pressure that are discussed in [5]. This system will take the blood pressure data from the sensor, which will then be compared with the limit value of normal blood pressure. If the blood pressure value exceeds the normal limit, the system will alert the patient. However, these systems only provide patients with hypertension status, without giving information about the actions that must be done first.
Several researchers have made a system that can provide feedback to the patient [6] [8]. The system can provide feedback to the patient in the form of warnings about the condition of hypertensive patients and give advice how to be able to normalize blood pressure by doing some activity. However, these systems still has limitations in defining advice, because not give specific advice. In this paper we propose the development a mobile monitoring system to support hypertension treatment by providing notification function, so that the doctor can give some advice to patients, and patients can understand the actions to be performed. Blood pressure measurement is done using a digital blood pressure sensor, the data produced by the sensor will be taken by a smartphone and then sent to a server. Information stored on the server will then be processed and diagnosed by a doctor. The doctor will give you a response to that information by sending notification and advise the patient to perform an action. The patient can consult their health condition by sending notification to the doctor.
II.
HYPERTENSION TREATMENT
The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. All patients with hypertension should be encouraged to make lifestyle modifications. Treatment of hypertension can use information technology to provide information to patients about their health condition. Hypertension or high blood pressure is a common disorder in which too much pressure is applied by the blood to the blood vessels. Hypertension can be caused by several factors, but regardless of its origin, high blood pressure must be treated to prevent a serious health risk. Hypertension is a blood pressure measurement above normal scale (140/90 mmHg). According to JNC 7, blood pressure classification is divided into four namely normal, prehypertension, stage 1 hypertension, and stage 2 hypertension. Table 1 provides a classification of blood pressure for adults 18 years and older [10].
TABLE I.
BLOOD PLESSURE CLASSIFICATION[10]
Blood Pressure Classification
Systolic (mmHg)
Diastolic (mmHg)
Normal
< 120
< 80
Pre-Hypertension
120-139
80-89
Stage 1 Hypertension
140-159
90-99
Stage 2 Hypertension
≥ 160
≥ 100
According to JNC 7, pre-hypertension is not a disease category. Rather, it is a designation chosen to identify individuals at high risk of developing hypertension, so that both patients and clinicians are alerted to this risk and encouraged to intervene and prevent or delay the disease from developing. Individuals who are pre-hypertensive are not candidates for drug therapy based on their level of BP and should be firmly and unambiguously advised to practice lifestyle modification in order to reduce their risk of developing hypertension in the future. Moreover, individuals with prehypertension, who also have diabetes or kidney disease, should be considered candidates for appropriate drug therapy if a trial of lifestyle modification fails to reduce their BP to 130/80 mmHg or less[10]. Based on JNC 7, patients can perform the treatment of hypertension by modifying lifestyle. Table 2 contains lifestyle modifications to prevent and maintain blood pressure. TABLE II.
Weight reduction
Adopt DASH eating plan
Physical activity Moderation of alcohol consumption
Remote-monitoring telemedicine is the process of monitoring the condition of patients using medical devices that can be used independently by patients. This method allows patients to transmit health information to a physician or health provider [16]. Real-time telemedicine is a service where patients can interact directly with physicians in real-time such as using telephone technology, using the Internet for teleconferencing, or perform remote surgery [16].
LIFESTYLE MODIFICATION TO MAINTAIN BLOOD PRESSURE[10]
Modification
Dietary sodium reduction
Store-and-forward telemedicine is the process of retrieval of medical data on patient data by medical personnel to be sent to a doctor or medical personnel to diagnose further. Transmitted data can be vital patient conditions such as temperature, blood pressure, weight, and type of multimedia data such as X-Rays and CT-Scan [16].
Recommendation Maintain normal body weight (body mass index 18,5 – 24,9 kg/m2) Consume a diet rich in fruits, vegetables, and lowfat dairy products with a reduced content of saturated and total fat. Reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride) Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week) Limit consumption to no more than 2 drinks
Approximate SBP Reduction (Range) 5-20 mmHg
8-14 mmHg
2-8 mmHg
4-9 mmHg
2-4 mmHg
A. Telemedicine Telemedicine is the use of information and communication technologies to provide some medical services. With the telemedicine enables communication between physicians and patients without meeting physically. There are three categories of telemedicine, the store-and-forward, remote monitoring and real-time services [16].
Figure 1. Subset of telemedicine connecting different people and entities together [13] B. Mobile Application Mobile application (mobile app) is a type of software that run on mobile devices, such as smartphones and tablets. Mobile application has the same functionality as the applications running on the desktop platform, which is conducting a process according to user needs. However, because it runs on the mobile platforms, mobile application is small and has a limited function [14]. Mobile app basically offers general productivity and information retrieval, such as email, chat, contacts and traffic information. However, public demand and availability of developer tools drove rapid expansion into other categories, such as games, entertainment, news, location-based applications, banking applications, and m-commerce. The explosion in number and variety of apps made discovery a challenge, which in turn led to the creation of a wide range of review, recommendation, including blogs, and magazines, and dedicated online services [15]. They are usually available through application distribution platforms, which are typically operated by the owner of the mobile operating system platform, such as the Apple App
Store, Google Play, Windows Phone Store, and BlackBerry World. III.
b) Receive and send information of the patient consultation form. c) Send a notification to the patient. d) Save the application data into a database.
SYSTEM DESIGN
The system architecture of our system is built and adopt the three-tier architecture model of client server. Three-tier architecture is a client-server architecture in which the functional process logic, data access, computer data storage and user interface are developed and maintained as independent modules on separate platforms. Three-tier architecture is a software design pattern and a well-established software architecture. Its three tiers are the presentation tier, application tier and data tier [9]. We build a system that consists of client module and server module. Client module is a module which is oriented to the patient. Server module is a core process, this module will process all information that submitted by patients. A. System Architecture The picture below is the architecture of our system :
3. Database Database is used to store all the data and information generated by the client application and server application. 4. Blood Pressure Sensor Blood pressure sensor is a digital blood pressure sensor that using NFC to communicate with smartphone. 5. Body Weight Sensor Body weight sensor is a digital body weight sensor that using NFC to communicate with smartphone. 6. Activity Monitor Sensor Activity monitor sensor is a digital activity monitor sensor/pedometer that using NFC to communicate with smartphone. B. Use Case Diagram System Member Admin
Member Profile
Data Capture
Member Bill
Patient Data View
Notification
Figure 2. System Architecture The picture explains some of the components that support system : 1. Client Application Client application is a mobile application that interacts with the patient. This application has the following functions : a) Capture the measurement data from the sensor. b) Transmit sensor data to the server. c) View histories of sensor measurements. d) Display notifications that containing the health information from the doctor. e) Provide patient consultation form. 2. Server Application Application server is the core application of the system which has the functions : a) Receive data from the medical sensor through client app.
Login
Doctor
Figure 3. Use Case Diagram Actor definition : Admin : Actor who has the right to regulate the system, such as organizing members. Patient : Actor who take measurements of health condition. Doctor : Actor who diagnose health information from patient. Use case definition : Member (UC01): This is a process associated with the administration of the member, such as new member registration, subscription registration and payment of service. Administrator associated with this process.
Data Capture (UC02): This is the process of collecting data from health sensor. We use a blood
pressure sensor, body weight sensor and activity monitor sensor to monitor health condition of the patient. Sensor is an input parameter to determine whether the patient is in good health with normal blood pressure or in unhealthy conditions. Patient associated with this process
Data View (UC03): This is the process to see the results of sensor measurements. This process will show the condition of blood pressure, body weight and activity of the patient. patients and physicians can view this information. Notification (UC04): This is a process for consultation between physician and patient about the patient's medical condition. physicians can advise patients based on the results of sensor measurements.
C. Application Mockups The pictures below is application mockups :
ACKNOWLEDGMENT The author would like to thank BlackBerry for providing a scholarship and research facility to develop solutions for smart society. REFERENCES [1]
[2]
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[4]
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[6]
[7]
[8]
[9]
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Figure 4. Mockups of Client Application [13]
IV.
CONCLUSION
In this paper we propose monitoring and consultation system design for patients of hypertension. To get maximum results, we use three sensors to monitor the health condition of the patient, so we expect doctor perform a proper analysis. We design a system that allows monitoring hypertensive patients, patient can also interact and consult with doctor what to do with information derived from medical sensors.
[14]
[15] [16]
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