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SOP TRANSACTIONS ON SIGNAL PROCESSING

ISSN(Print): 2377-0538 ISSN(Online): 2377-0546


DOI: 10.15764/STSP.2015.01005
Volume 2, Number 1, January 2015

SOP TRANSACTIONS ON SIGNAL PROCESSING

Remote Online Vital Signs Processing For


PatientMonitoring and Diagnosis
M. Abo-Zahhad*, Sabah M.Ahmed, O. Elnahas
Electrical and Electronic Engineering Department, Faculty of Engineering Assuit University, Egypt
*Corresponding author: zahhad@yahoo.com

Abstract:
Remote patient monitoring systems are based on a combination of advanced remote monitoring devices,
telecommunication technology, and innovative software and hardware. As mobile phones become more
powerful and perform more complex interactions between mobile devices to resident software and other
server based software, they have been recognized as effective tools for telemedicine. So, the merging
of the Internet and mobile computing, introduce new opportunities and challenges in the telemedicine
sector. This study describes the development and implementation of an Android based smart phone in the
home monitoring health care system. The system utilizes Android devices as mobile access terminals
for patient-monitoring services. The main goal is subsequently divided into two parts: in the first part
we establish a reliable connection between mobile device and a sensor to collect continuous data from
patients. In the second part we provide ElectroCardiGram (ECG) andPhoto-PlethysmoGraphy(PPG) signal
filtering and processing, feature extraction, detection of any abnormalities in ECG and calculating heart
rate using the most familiar and multi-purpose MATLAB software.
Keywords:
Telemedicine Sector; Remote Patient Monitoring Systems; Android Smart Phone; Vital Signs Processing;
Patient Monitoring and Diagnosis

1. INTRODUCTION
Recently, healthcare for patients suffering from chronic diseases or even elderly or lonely people has been an
important research topic. The increase in life expectancy due to improvements in living standards, and medical
treatments, has resulted in aging population diseases in the last few years [1]. Therefore, the modern health caresystem
aims to enhance the safety and comfort of the patientslife while managing chronic diseases. This creates theneed to
develop home healthcare system, which will improve the patient monitoring devices and make them more mobile.
Therapid development of informationand telecommunication technologies has broughtgreat revolutions in that field
[2]. Remote patient monitoring benefits not only the patients who are able to receive health care more efficiently, it
also benefits the doctors who can streamline their efforts to assist more patients.
In healthcare, There are many promising systems for remote physiological signals monitoring and diagnosis have
been developed. all the systems developed and currently used can be categorized by several areas: medical sensors,
data communication, monitoring devices and medical signal processing algorithms [3]. In the area of medical sensors,
research groups have mainly focused on developing sensor devices to be small size [4], maintaining patient mobility
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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

[5] and consume low operating power [6]. A collection of medical sensors were designed for noninvasiveremote
monitoring of the following physiological signals:electrocardiographic signals (ECG) [7, 8], blood pressure [9, 10],
or all patients vital signs [11]. In the area of data communication, the medical staff can get patients physiological
data by connecting medical sensors to other networks such as cellular network or internet [3]. For real-time operation,
several monitoring systems transfers patients medical data through General Packet Radio Service (GPRS) networks
to medical center or hospital [12]. This can be costly when GPRS is used for continuous data transmission. To deal
with this issue other systems consider processing the medical data on a local device before transmission[13, 14]. In
these systems, the raw patients vital signsare transferred to the medical center through internet and only abnormal
cases are transferred through GPRS networks.In the area of medical signal processing and diagnosis, many medical
algorithms were developed in recent telemedicine studies to help in patient diagnosis [15] and early detection of
cardiovascular diseases [16]. Many investigations have proposed monitoring systems that can measure various
bio-signals and provide QRS detection and arrhythmia classification [16], real time ECG classification algorithm
[15], heart rate variability measurement [16].
New features of mobile devices(smart-phones, tablets), create new opportunities to usethem as devices for collecting
clinical data, delivering information to medical staff, researchers and patients. Patients vital signs are monitored in
real time and directly provide health care through mobile telemedicine. the usage of smart phone in patient monitoring
can be classified in two groups:The first group uses smart phones personal digital assistants (PDAs) equipped with
biosensors that record patients vital signs and transmit them to a healthcare center or hospital for analysis [17, 18].
Some solutions can store the signals locally as well [19].Most are capable of recording, viewing and processing ECGs
directly on the smart phone[20]. In [18], Leijdekkers and et al. developed remote healthcare monitoring system
which includes a smart phone, wireless sensors, web servers and IP webcams. The smart phone acts as a receiver
that receives all the data sent by the wireless healthcare sensor and further process the data by sending the data the
healthcare server or calls an ambulance during emergency. The TELEMON remote monitoring system allows patients
suffering from chronic disease to be monitored with a wireless body area network (WBAN) of sensors connected
by radio to a patient personal server (PDA) [12]. The PDA collects the and forwards it to the database server via
one of the WiFi or GSM/GPRS connection. The results of data processing are locally generated alarms displayed
by the software running on the central server. In [17], another system shows us an ECG monitor system based on
android smart phone. ECG signal is transmitted to an android phone and then be forwarded to a remote server.
Using a PC, doctors can view the ECG after logging in the server. The second group aims at building platforms for
real-time remote health monitoring. The platform developed by this second group collects the bio data and sends
it to a care center or a hospital for processing and analysis then showing them on doctors smart phone [21, 22].
Many researchers have done some studies on the application of smart phone in ECG monitoring and processing,
such as [17, 23]. MOLEC [14],provides a solution that analyses the ECG locally on a PDA. It generates alarms to
the hospital in case of high risk arrhythmias. Also There are some researchers proposed the way of alarming, most
of them use the short message service (SMS) or calls such as [23, 24]. In [24], pulse alarms details are described
in a SMS. But for an ECG image, it is hard to describe in a SMS. In [23], author use the multimedia messaging
service(MMS) and email to send the abnormal ECG images. The disadvantage of this way is that MMS is not able to
carry a picture in high resolution, and if using email as the transmitting way, doctors may not see the email timely,
and it also causes inconvenience. Our objective is to investigate and develop a healthcare system for continuous
patient monitoring and diagnosis. With this system the physiological parameters such as electrocardiogram, heart
rate, oxygen saturation (SPO2), PPG and temperature are obtained using mobile care unit attached to the patients
body then transmitted to a remote server via GSM/GPRS network. The key role of remote server here is to process
data in real time and distribute them on the caregivers smart phone. It receives ECG and other parameters data
from the mobile care unit; then filters the data, extract ECG features such as QRS complex, calculates heart rate,
arrhythmia classification and identifies abnormal ECG data using an intelligent data analysis scheme based on a new
cosine similarity measure.Finally patients vital signs and results of ECG analysis will be routed to doctors mobile
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SOP TRANSACTIONS ON SIGNAL PROCESSING

phone via GPRS network and will be displayed using friendly Android application in real time mode.

2. ELECTROCARDIOGRAM SIGNAL AND ARRHYTHMIA CLASSIFICATION


An ElectroCardioGram or ECG is a measure of the electrical activity of the heart, recorded on a graph. It is a
non-invasive diagnostic test that can be easily and quickly performed to help identify and monitor a wide variety of
heart diseases like heart attack and heart failure. A typical ECG tracing of the cardiac cycle (heartbeat) consists of a P
wave, a QRS complex comprising of Q, R and S waves, a T wave, and a U wave, which is normally visible in 50 to75%
of ECGs as shown in Figure 1. These waves become distorted or show changes when the part of the heart from which
they originate is diseased. Therefore, in order to interpret an ECG, a physician will look carefully at the morphology
of each wave generated from each lead.The parameters studied in an electrocardiogram are the shape of the individual
waves, the size of the waves and intervals between the waves. Arrhythmia is a kind of disease which shows abnormal
beats and such abnormal heartbeats may cause increase or decrease in blood pressure which can be dangerous as
it may lead to paralysis or stroke or even sudden death. Cardiac arrhythmias are abnormality or disturbances in
the behavior of the hearts electrical activities. These disturbances leads to abnormality in rate and rhythm hence
referred as arrhythmic. The analysis of the electrocardiogram (ECG) signal is the method available for diagnosing
cardiac arrhythmias. In electrocardiograms, such arrhythmias manifest themselves as deformations or irregularities
in the observed waveform. Modern techniques used for arrhythmia detection purpose based on morphology of the
waveform gives accurate results for cardiac arrhythmia detection [25, 26]. There are tfive types of arrhythmias namely
Bradycardia, Tachycardia, Premature Ventricular Contraction (PVC), Premature Atrial Contraction (PAC) and Sleep
Apnea. Brief explanation of Bradycardia, Tachycardia and Premature Ventricular Contraction (PVC) is given in
Table 1.

Figure 1. One heartbeat ECG signal.

Table 1. Important types of arrhythmias.


Arrhythmia type

Heart rate

QRS duration

P wave

Bradycardia

Less than 60 BPM

Normal

Visible before each Normal


QRS Complex

Tachycardia

More than 100 BPM

Normal

Visible before each Normal


QRS Complex

Greater than 120 msec

Ratio 1:1

Premature Ventricular Normal


Contraction (PVC)

P-R interval

Normal

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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

The complete work is explained in the subsequent sections. Section 3 describes the architecture of the proposed
system including sensor part, server part and mobile part. The details of ECG and PPG filtering, QRS complex
detection algorithm and detection of arrhythmias their characteristics and methodology used for their detection are
explained in sections 4.2.1, 4.2.2 and 4.2.4.The proposed similarity measure for exploring abnormal ECG signal is
discussed in section 4.2.3. And the summary is concluded in section 5.

3. SYSTEM STRUCTURE
The mainobjective of this paper is to design and implement a telemedicine system with intelligent vital signs
analysis. It is based on physiological sensors, wireless communication, World Wide Web and smart phones for vital
signs monitoring, patient diagnosis and homecare. The architecture of the proposed system is shown in Figure 2.
Itmainly consistsofthe following parts.

3.1 Mobile Care Unit


It could be bound to the patients body and it contains set of sensors which could collect data relevant to the
patients health state. Different categories of sensors are currently prepared to measure: ECG, PPG, heart rate,
temperature, blood pressure and SPO2. Then these data are transmitted to the remote server through cellular networks
in real time mode.

3.2 The Remote Web Server


The key role of remote server here is to function as a centralized information exchange and apply ECG processing
algorithms in real time. The data transmitted via GPRS network from the mobile care unit arrives at the server and
becomes a streaming feed that clients of the remote server can subscribe to. After receiving patients vital signs the
remote server applies intelligent data analysis algorithm to diagnosis the health state of the patient. The intelligent
data analysis algorithm is carried out using MATLAB software.

3.3 Monitoring Devices


A mobiledevice has a key role in the system. It allows exchange andvisualization of data to the users. The
processed data from remote server is visualized on the doctors mobile phone using easy to use Android user interface.
Currently, the ECG data are displayed as graphs in real-time. In addition, the heart rate, body temperature, blood
pressure and SPO2 are displayed as readable measured values. Features and details of such device are described in
section 4.3.

4. SYSTEM COMPONENTS
This section details the system components of the proposed Android based telemedicine system for patient
monitoring and diagnosis.
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SOP TRANSACTIONS ON SIGNAL PROCESSING

4.1 Mobile-care Unit


The mobile - core device consists mainly of three parts, namely; set of sensor devices, data control and processing
module (MCU), and GSM/GPRS data communication module. Figure 3 illustrates a block diagram of the mobile
care unit. Also mobile care unit includes local data storage which is used for raw data recording together with signal
processing results.

4.1.1 Set of Sensor Devices


Sensor devices collect data relevant to the patients health state. Different categories of sensors are currently
prepared to measure the aimed ECG, PPG, SpO2, body temperature and blood pressure signals. All of vital signs
measurements will be non-invasive measurement. All sensor data will be fed to processing module for analog to
digital conversion (ADC), filtering and further processing. Figure 4 shows Arduino UNO processing board connected
to the used sensors. As an example,The Pulse sensor is a pulse detecting sensor that uses the principle of transmission
(PPG) to sense the pulse signal from a fingertip. It uses an infrared light source to illuminate the finger on one side,
and a photo detector placed on the other side measures the small variations in the transmitted light intensity. The
variations in the photo detector signal are related to changes in blood volume inside the tissue. In the processing
module this signal is filtered and amplified to obtain a nice and clean PPG waveform, which is synchronous with the
heartbeat.

Figure 2. The architecture of the proposed system.

4.1.2 Processing Module


Processing moduleis responsible for controlling the accurate operation and communication of all other modules.
The data after being acquired by the set of sensors is now digitized, processed and transmitted to GSM/GPRS
communication module. Processing module mainly consists of a microcontroller which is chosen to verify certain
specifications. Micro control unit microcontroller (MCU) with powerful processing and control capability is needed
to adapt a large amount of data acquiring and processing. We use Arduino UNO board shown in Figure 4 which
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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

Figure 3. Mobile care unit.

is based on the ATmega328 microcontroller as the MCU of the medical care unit. It has input-output circuitry and
peripherals built-in, allowing it to interface more or less directly with real-world devices such as sensors. The main
functions of MCU in the proposed system are:

Receiving signals from sensors to collect continuous data from patient.

Processing the received signals using different sorts of processing techniques like filtering and digitizing the
sensor data.

Controlling the operation of GSM/GPRS module.

Figure 4. Arduino UNO board connected to ECG, temperature and SPO2 sensors.

4.1.3 Data Communication Module


The data communication module connects medical care unit to the cellular network. It is responsible for uploading
the received vital signs data to the remote care server through the cellular network to carry out the patients health
condition monitoring and diagnosis. Mobile-care unit transmits all vital signs to the remote server via GSM/GPRS
network in real-time. Vital signs are transmitted through GSM/GPRS networks using EFcom sim900 GSM/GPRS
module shown in Figure 5.
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SOP TRANSACTIONS ON SIGNAL PROCESSING

Figure 5. GSM/GPRS shieldSIM900.

4.2 Remote Web Server


The remote server unit is developed with the purpose of receiving, storing and processing the vital sign data
from patients. Server side should also provide a way to present and to distribute the collected data to the healthcare
specialists. In the proposed system the remote Server supports different services in real-time to the users. It
continuously receives sensor data from the mobile care unit through GPRS network and stores it in a database then
applies a set of processing algorithms. After receiving all vital signs the remote server makes the following functions:

ECG and PPG signal filtering and processing.

ECG features extraction like QRS complex, R-R interval and heart rate.

Identify abnormal ECG data using an intelligent data analysis scheme based on a new cosine similarity
measure.

Distribute vital signs and analysis results on caregivers smart phone.

4.2.1 ECG Signal Filtering and Processing


Generally, the received ECG signal is often contaminatedby noise and artifacts that can be within the frequency
bandof interest and manifest with similar characteristics as theECG signal itself. In order to extract useful information
fromthe noisy ECG signals, we need to process the raw ECGsignals. ECG signal processing can be divided into
twostages by functionality: preprocessing and features extraction.The preprocessing stage removes or suppresses
noise fromthe raw ECG signal and the feature extraction stage extractsdiagnostic information from the ECG signal.
Figure 6 demonstrates this functionality. With MATLAB and related toolboxes, one can conveniently build signal
processing applications for both stages, including baseline wandering removing, noise cancellation, QRS complexes
detection, Identify abnormal ECG dataand etc. ECG signal is liable to following types of noise: baseline wander
(low frequency noise), which arises from respiration at frequencies wandering between 0.15 and 0.3 Hz and other
physiology actions, power line noise HF noise of 50 Hz/60 Hz and muscle noise arises from action of other muscles
in human body. In the preprocessing stage, Baseline wander noise is eliminated by using high pass filter. Cutoff
frequency of the filter is equal to the lowest frequency of the slowest heart rate (about 40 bpm). It is about 0.67 Hz,
so the chosen cutoff frequency is 0.5 Hz.

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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

4.2.2 Features Extraction of ECG Signal and Arrhythmia Detection


For the purpose of diagnosis, we often need to extractvarious features of the preprocessed ECG data, includingQRS
intervals, QRS amplitudes, PR intervals, ST intervals, fetal heart rate, etc. The detection of the R-peaks and
consequently of the QRS complexes in an ECG signal provides information about the heart rate, the conduction
velocity, the condition of tissues within the heart as well as various abnormalities.

Figure 6. ECG signal processing flowchart.


It supplies evidence for the diagnoses of cardiac diseases. For this reason, it has drawn considerable attention in
the ECG signal processing field. However, the presence of noise and time-varying morphology makes the detection
difficult. In the proposed system The ECG signal and its corresponding features are immediately displayed on the
server screen through the developed local software and on caregivers mobile phone screen so that they can be
observed remotely and help in patient diagnosis. In the developed algorithm ECG features like QRS complex, R-R
interval and heart rate are extracted. The real-time QRS detection algorithm (Pan & Tompkins, 1985) was applied to
determine the heart rate and R-R interval. The algorithm detects the peak wave position of a ECG signal, then adopts
the interval time between two peak positions to calculate the heart rate. Figure 7 shows the detailed procedures of
estimating the heart rate. The computational steps are differentiating, squaring, moving-window integration, filtering
out the signal elements with voltage levels 2/3 below the highest voltage level, computing the interval time between
the two peak positions of the ECG signal and estimating R-R interval and the heart rate. The heart rate is estimated
using the following formula:
Heart rate = (1/R-R interval in Sec) *60
After completing the feature extraction process, The ECG signal and its corresponding features are immediately
displayed on the server screen through the developed local software as shown in Figure 8. The top window displays
the overall ECG wave pattern that is being received at that moment. The bottom left window displays the extracted
ECG features, QRS complex, R-R interval and heart rate. The top right window shows the received vital signs like
temperature, spo2, heart rate and blood pressure. Also a description of the current status of monitoring patient and
required medication is provided at the bottom right window. Also The software is able to detect the three types of
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arrhythmias namely Bradycardia, Tachycardia and Premature Ventricular Contraction (PVC).

Figure 7. The computing procedures of heart rate.

Figure 8. Thedeveloped local software at the remote server.

4.2.3 The Proposed Similarity Measure for Exploring Abnormal ECG Signal
ECG signal can be interpreted by an experienced cardiologist to diagnose a wide range of possible arrhythmias.
ECG has been used as diagnostic tool and long been a research area of interest in the physiology field, because the
ECG reflects a persons state of health states. Also the ECG is cyclic signal and changes with time, it belongs to
the sequential data type. So we apply a similarity measure scheme considering sequential semantics to measure the
similarity degree between any the recived ECG signal and aset of stored ECG signals for examining abnormal ECG
sequences. To identify abnormal ECG signals, this study employed the cosine similarity measure to compute the
similarity degree between any two ECG sequences. Suppose two ECG sequences P1 and P2 contain totally k samples.
The similarity degree between two ECG sequences measured by the cosine measure can be formulated as:

sim (P1 , P2 ) = q

kj=1 (s1i s2i )

(1)

ki=1 s1i 2 ki=1 s1i 2

Where P1 = (s11 , s12 , ... , s1i , ... , s1k ) and P2 = (s21 , s22 , ... , s2i , ... , s2k ) represent, respectively the sample
vectors of the ECG sequence P1 and the ECG sequence P2 , s1i and s2i stand for the ith sample in the ECG sequence
P1 and the ECG sequence P2 , respectively. However, the cosine similarity measure cannot identify the similarity
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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

degree between any two sequences well, because it cannot completely identify a symbolic semantics. For example,
the similarity degree of the sequence ABCD and DCBA measured by cosine measure is equal to 1 since both
the sequences include the same set of symbolic terms. This similarity degree evaluated by cosine measure implies
that both sequences are completely identical in terms of semantics, but they have completely different meanings.
In other words, the ECG sample that appears in different positions represents a different meaning. To consider a
samples position for promoting the accuracy when identifying abnormal ECG sequences, the proposed hamming
distance was applied to modify the cosine measure for measuring the similarity degree between two ECG sequences
with increased precision. The proposed hamming distance for both the ECG sequences can be computed using the
following formula:
m

H (P1 , P2 ) = |L (s1i ) L (s2i )|

(2)

i=1

Where L(s1i ) and L(s2i ) represents respectively the location index values of the ith samples that appears simultaneously in both the ECG sequences P1 and P2 , m is the total number of samples that appear simultaneously in both
the ECG sequences P1 and the ECG sequence P2 . To simultaneously consider both similarity degree and sequence
semantics when identifying abnormal ECG sequences, the new cosine measure is expressed as:

nsim (P1, P2 ) =



H (P1, P2)
1
& sim (P1 , P2 )
MAX (H)

(3)

Where Max(H) represents the maximum hamming distance among the ECG sequence P1 with all identifying ECG
sequences. To determine whether the proposed new cosine similarity measure correctly explores abnormal ECG
sequences, this study measured 10 actual ECG signals from 10 different people to compare their similarities to each
other using the original and new cosine similarity measures. The aim of this experiment was to determine whether
the proposed new cosine similarity measure can correctly identify the two most similar ECG patterns from a human
ECG physiological database. This will be helpful for judging whether a measuring ECG is similar to any abnormal
ECG signalsstored in the human ECG physiological database. Figure 9 shows four ECG signals measured from four
different people. Table 2 and Table 3 show the similarities measured using the cosine measure and the proposed new
cosine measure, respectively, for ten ECG signals stored in the server database. The experimental results shown in
Table 2 demonstrate that ECG 1 is the most similar to ECG 3. However, Figure 9 obviously indicates that ECG 1 is
the most similar to the ECG 2, not to ECG 3. The experimental result listed in Table 3 confirms that the proposed
new cosine similarity measure can correctly identify which ECG sequence is the most similar to a comparative ECG
sequence, since the position semantics of ECG sequence are considered.

4.2.4 PPG Signal Filtering and Processing


A photoplethysmogram (PPG) is an optically obtained plethysmogram, a volumetric measurement of an organ. A
PPG is often obtained by using apulse oximeter, which illuminates the skin and measures changes in light absorption.
The change in volume caused by the pressure pulse is detected by illuminating the skin with the light from a lightemitting diode (LED) and then measuring the amount of light either transmitted or reflected to a photodiode. Each
cardiac cycle appears as a peak, as seen in the Figure 10. Because blood flow to the skin can be modulated by
multiple other physiological systems, the PPG can also be used to monitor respiration, heart rate and cardiac cycle,
depth of anesthesia, hypovolemia, and other circulatory conditions. Additionally, the shape of the PPG waveform
differs from subject to subject, and varies with the location and manner in which the pulse oximeter is attached. For
the PPG signal, the developed algorithm reads the incoming PPG samples and processes them to extract the pure PPG
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Table 2. The similarities measured by the cosine similarity measure.


Received
ECG
signals

Stored ECG signals

10

ECG 1

0.9974

0.9987

0.9963

0.9975

0.9976

0.9930

0.9980

0.9970

0.9985

ECG 2

0.9974

0.9963

0.9954

0.9972

0.9961

0.9914

0.9968

0.9957

0.9971

ECG 3

0.9987

0.9963

0.9949

0.9976

0.9961

0.9922

0.9970

0.9957

0.9972

ECG 4

0.9963

0.9954

0.9949

0.9962

0.9950

0.9904

0.9956

0.9943

0.9956

ECG 5

0.9975

0.9972

0.9976

0.9962

0.9974

0.9927

0.9980

0.9972

0.9986

ECG 6

0.9976

0.9961

0.9961

0.9950

0.9974

0.9915

0.9968

0.9960

0.9974

ECG 7

0.9930

0.9914

0.9922

0.9904

0.9927

0.9915

0.9927

0.9912

0.9937

ECG 8

0.9980

0.9968

0.9970

0.9956

0.9980

0.9968

0.9927

0.9966

0.9978

ECG 9

0.9970

0.9957

0.9958

0.9943

0.9972

0.9960

0.9912

0.9966

0.9969

ECG 10

0.9985

0.9971

0.9972

0.9956

0.9986

0.9974

0.9937

0.9978

0.9969

Table 3. The similarities measured by the new cosine similarity measure.


Received
ECG
signals

Stored ECG signals

10

ECG 1

0.0161

0.0155

0.0064

0.0053

0.0014

0.0006

0.0007

0.0089

ECG 2

0.0161

0.0086

0.0069

0.0102

0.0022

0.0003

0.0006

0.0003

0.0100

ECG 3

0.0155

0.0086

0.0028

0.0042

0.0011

0.0102

ECG 4

0.0064

0.0069

0.0028

0.0050

0.0041

0.0011

0.0030

0.0011

0.0036

ECG 5

0.0053

0.0102

0.0042

0.0050

0.0044

0.0003

0.0125

ECG 6

0.0014

0.0022

0.0011

0.0041

0.0044

0.0025

0.0039

0.0011

0.0012

ECG 7

0.0006

0.0003

0.0011

0.0003

0.0025

0.0061

0.0085

ECG 8

0.0006

0.0030

0.0039

0.0061

0.0091

0.0006

ECG 9

0.0007

0.0003

0.0011

0.0011

0.0085

0.0091

ECG 10

0.0089

0.010

0.0102

0.0036

0.0125

0.0011

0.0006

signal. The flow chart in Figure 11 explains the operation of PPG processing. Where the developed algorithm first
reads 600 consecutive samples sent by mobile care unit. Since the sampling rate was 5ms, it takes 3 Sec to read the
6000 samples. The DC component minima of 600 samples are subtracted out from the samples. Next, the range of the
samples is computed. If the range is less than 50 counts, the received PPG waveform is very weak, and is considered
to be a noise. This could happen when no PPG signal is detected through fingertip (sensor is faulty or disconnected)
or the gain of the amplifier on Easy Pulse board is set very low. If the range of ADC samples is greater than 50, it is
considered as a valid PPG signal. The samples are scaled to 1-1023 in full swing of display. Next, a 21-point moving
average filter is applied to remove the unnecessary high frequency components usually noise in the PPG signal.

4.3 Monitoring Devices


This work is focused on the use of a mobile device for the exchange and visualization of data in home monitoring.
Portable device used in the proposed system must have Androidoperating system. Special software wasprepared
which enables, among otherthings, communication with the mobile care unit and carrying outthe appropriate function
for the role.The android monitoring program of the monitoring system is developed on Eclipse 3.5.2 development
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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

Figure 9. The ECG signals sensed from four persons.

Figure 10. The PPG signal.

environment by Java language, and is debugged and run on a smartphone with the Android operating system. The
design and implementation of the Android monitoring application include two aspects: design and implementation of
the android application user interface and android application functional modules. Two application user interface
needs to be designed in this android application, one is used for the control and operation of the application, the other
one is used for displaying analog and digital forms of physiological parameters. When the device is connected to the
mobile care unit of thePatient it will automatically update current basic information about the patient.Additionally,
there is possibility to browse offline basic medicaldata, which are stored in the internal database and access to personal,
electronichealthcare records, which contain the list of actual diseasesand prescribed medications, information about
recentevents and a doctors personal notes about the patient as shown in Figure 12(a). Doctor can add new patient or
modify the stored information if needed as shown in Figure 12(b).There is also a possibilityto carry out test directly
from the application.Figure 13 shows an example of real time measurement for patient basic vital signs (ECG, heart
rate, blood pressure, temperature, spo2).

5. CONCLUSION
In this paper, remote patient monitoring system using android mobile phones is presented which allows doctors
to view his patients vital parameter remotely and dynamically in real time. For the patient side, a mobile care unit
is attached to the patients body to acquire and transmit vital signs to the remote server. At server side, MATLAB
application is developed which monitors the received vital signs and apply a set of analysis algorithms to determine
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SOP TRANSACTIONS ON SIGNAL PROCESSING

Figure 11. PPG signal processing flowchart.

(a)

Figure 12. (a) patient panel view.

(b)

(b) Add new patient window.

the patients status. For doctor side, mobile devices with Android OS were chosen. This is one of the most popular
systems (next to the Apple OSs) used in mobile devices, characterized by the following advantages. An open source
platform based on Java, with multitasking and wider hardware support. Personal mobile devices with Android system
are powerful and flexible in use. It reduces both the time and cost needed for system development. For these reasons,
easy to use android application is developed to view the patients vital signs, personal information and medical
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Remote Online Vital Signs Processing For PatientMonitoring and Diagnosis

Figure 13. Real time monitoring of patient vital signs.

records. Comparing this system with other systems, it has the following features:

Continuously monitor patients vital health conditions instead of the discrete measurements.

Integrates sensor unit, processing unit and communication unit in one chip bonded to the patients body
called mobile care unit so the patient could do his/her daily activities during monitoring.
At server side, it provides ECG and PPG signal filtering & processing, feature extraction, detection of any
abnormalities in ECG, calculating beat rate and so on using the most familiar and multipurpose MATLAB software.
Android based mobile phones, patient monitoring application is developed which allows doctors to monitor
the health status of the patient. This application also provides alerts, reminders and emergency notifications for vital
measurements to help doctors to take timely decisions in emergency situations.

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