Unit V

WBAN application in healthcare

 Mobile health technologies
Mobile nutrition tracking
Accessing existing virtual electronic patient record
Mobile personal health records,
Monitoring hospital patients,
Sensing vital signs
Transmission using wireless networks
Continuous monitoring
Patient Monitoring and wearable devices
Patient Monitoring in Diverse Environments
A framework for Capturing Patient Consent in Pervasive Healthcare Applications
M-health application
Context aware sensing
Technology Enablers for context-Aware healthcare Applications
8 channel ECG using Ultra wide band WBAN
Pulse generator using Ultra wide band WBAN
Multichannel neural recording system
Electronic pills
 Evaluation of Two Mobile Nutrition Tracking Applications for Chronically Ill Populations with Low Literacy Skills
➢ Chronic diseases, such as chronic kidney disease (CKD) and heart disease, are among the leading causes of death and
disability in the world. At least half of the chronic disease related deaths could be prevented by adopting a healthy lifestyle,
such as good nutrition, increased physical activity, and cessation of tobacco use. Researchers believe that the world must
put a higher priority on interventions to help prevent and successfully manage chronic illness.
➢ Current interventions to help chronically ill populations improve their nutritional health and self-manage therapeutic diets
include paper based food diaries, 24 hour recalls, and food frequency questionnaires. Patients who use these interventions
must have high literacy and memory recall skills.
➢ Developing a mobile handheld application to assist CKD patients on hemodialysis monitor and maintain their nutritional
intake. The personal digital assistant (PDA) would be the best solution for health professionals and patients.
➢ Participants could scan barcodes on food items for their primary input or select items from an interface as a secondary
input. These input mechanisms are ideal for low literacy populations because there is no reading required. participants only
have to identify a barcode or select a picture. Health professionals could easily administer the intervention and evaluate
data without intermediate steps of electronic transcription.
➢ The low literacy chronically ill participants benefit from using the application because they can use the application anytime
they consumed a food item, receive immediate visual feedback on their nutritional intake, and make decisions on a
prospective basis.
Case study 1 :BARCODE
AND UNSTRUCTURED • Screen shots from Barcode Ed. (a) Home Screen; (b-c) Voice
recording and playback screens; (d-e) Barcode Scanning
VOICE RECORDING feedback screens
Hardware
➢ The study done with off-the-shelf Palm OS Tungsten T3 PDA. The Tungsten T3 has an expandable screen, large buttons,
voice recorder, SDIO slot, 52 MB of memory, and Bluetooth.
➢ The Socket In-Hand SDIO card scanner (Socket Scanner) was chosen as the barcode scanner because it was small, easy to
use, and gave visual and audio feedback to users. Participants must press the predefined scanning button, line up the
scanning light perpendicular to the barcode, and hold the PDA and object steady. The PDA beeps and shows appropriate
feedback when participants have successfully scanned a barcode.

Application Design
The created application, Barcode Ed, because we wanted to isolate participants’ ability to scan and yet have an alternative
input mechanism (e.g., voice input) to record all food items consumed. In initial interviews, half of the CKD patients said they
did not eat any foods with barcodes. However, once they were prompted, we found they primarily ate frozen, scanned, and
prepared foods. Thus, for participants to use an easy input mechanism like scanning, they would have to learn how to identify
barcodes and use the scanner. We only used scanning and voice recording in this study. Barcode Ed consists of five screens.
➢ When participants turned on the PDA, they would view the Home screen. Participants could choose to voice record by
pressing the Voice button or scan a barcode by pressing the Scan button. As soon as participants pressed the Voice button,
the application would begin voice recording and show participants how many minutes and seconds they recorded on the
Voice recording screen.
➢ When participants were finished recording, they could press the Stop button and play back their recording on the Voice
recording play back screen. When participants were satisfied with their recording, they could return to the Home screen.
➢ When participants pressed the Scan button, participants could see a red laser line emitted by the scanner. Participants lined
the scanner line perpendicularly across the barcode they were attempting to scan. If the food item was successfully
scanned, a green check mark would appear on the Barcode scanning success screen.
➢ The application recorded the time the participant first pressed a Scan or Voice button, the barcode number or voice
recording, and the time the recording was saved. The recording was done how many times participants played back their
voice recordings.
➢ The participants were asked to participate in the study during their dialysis session. Four times during each phase of the
study for approximately 30 minutes. During the first session, we collected background information and taught participants
how to turn the PDA on, insert the scanner, and use the application.
The key findings of our study were:
• Participants preferred voice recording once they mastered the application
• Participants with low literacy skills needed extra instruction on how to sufficiently describe food items for voice recordings
• Participants reported more individual food items with the Barcode Ed application than what they thought they consumed
• Electronic monitoring provides researchers with ways to identify participant compliance

Graph of the number of voice recordings and barcode scans participants input over the two barcode education study phases (dotted line
denotes study break). Faces underneath each day denote when researchers met with participants
CASE STUDY 2: BARCODE AND IVR

The only difference in the application was that participants did not have the ability to record unstructured voice recordings.
If the food item did not have a barcode, the participant could not record the food item.
The IVRS that could be accessed with any phone to test participants’ ability to use structured voice input.

Integrated voice response system overview

The key findings of our second case study were:
• Participants spent less time recording input with the IVRS
• Participants performed better with the scanner application on non-dialysis days and better with the IVRS on dialysis days
• Participants can record more items consumed with the IVRS, but the scanner application is more usable for a larger audience.
• Input mechanism preference is not always linked with the participants’ performance with the technology
 Accessing an Existing Virtual Electronic Patient Record with a Secure Wireless Architecture

➢ Virtual electronic patient records (VEPR) enable the integration and sharing of healthcare information within large and
heterogeneous organizations by aggregating known data elements about patients from different information systems in
real-time.
➢ There are usually some constraints in terms of physical location as well as technology in order to access it. Healthcare
professionals need to access a terminal in order to get information about the patients they are treating.
➢ The use of wireless technology tries to take this integration further. It allows access to patient data and processing of
clinical records closer to the point of care. The access to information can minimize physical as well as time constraints for
healthcare, enhancing users’ mobility within the institution.
➢ Wireless technology adds a higher level of security issues. Disruptions and attempts to access information can be more
common and easier to try, and less simple to detect and control; so security needs to be studied and analysed thoroughly
before wireless networks are implemented in a larger scale within a hospital.
➢ This study proposes a wireless architecture in order to model access to an existing VEPR within a university hospital that
can provide an extra security layer to the wired system.
Architecture

➢ This VEPR allows the collection, integration and availability of clinical reports providing an upto-date overview of a patient
medical history at all points of care. The system uses a traditional three layered approach composed by presentation,
business and data layers.
➢ The presentation layer is composed by a web application (VIZ) and a package of graphical user interface components to be
used by third party applications.
➢ The application layer is composed by an integration engine (Multi-Agent system for Integration of Data – MAID), and a set
of web-services that allow access to the data layer.
➢ The data layer includes all repositories, that comprises the VEPR database and clinical documents file system, the central
patient system (SONHO) and the hospital statistics system.
➢ MAID collects clinical reports from various hospital Departmental Information Systems (DIS), and stores them on the
central repository (CRep) consisting of a database holding references to these clinical reports and a file system where
reports are stored.
VEPR generic architecture

UML sequence diagram of the VEPR

Integration and Communication
The integration of hospital data in VEPR is accomplished with the use of different agents assigned to different tasks.
Security and Monitoring
➢ VEPR present many security challenges namely the need to provide protection to patient’s sensitive information. The
implementation of security mechanisms was thought from the beginning of the project’s development and
implementation, allowing for its better integration and acceptability.
➢ Three main security characteristics: integrity, confidentiality and availability. The main security issues relies in the
information collected in the stored patient reports. Digital signatures are security mechanisms that provide the integrity of
a report by enabling the detection of unauthorized modifications. If the digital signature does not match the report
contents then this report is marked as not valid.
Security Requirements
Three main security issues to address:
▪ Authentication and authorization from the wireless to the wired network.
▪ Secure communications of information in transit.
▪ Integrity & trust in the information that is requested and visualized by the users.
Proposed Wireless Architecture

Healthcare environments would greatly benefit with the availability of information anywhere through a wireless local area
network (WLAN). Usually, the healthcare institution where the WLAN is going to be deployed has already a LAN in use.

Authentication architecture
➢ The 802.1X three main processes are the mutual authentication between the client and the server, the cryptographic keys
dynamically generated after authentication and the centralized policy control.
➢ 802.1X is not a protocol; it is an authentication and key management process. In a wireless network it defines
authentication and the dynamic generation of cryptographic keys. The ciphering is accomplished using any of the wireless
security protocols.
➢ IEEE 802.1X (IEEE 802.1X, 2004) is a network security specification initially developed for wired networks, with its concepts
and utilization extended afterwards to wireless networks. 802.1X defines a network access control based in ports. It was
developed to deny or accept requests based on user authentication information.
WPA – Security and Architecture
➢ WPA (“(Wi-Fi Protected Access)”) was developed with the aim of decreasing the problems associated to Wired Equivalent
Protocol. WPA is based on the principles of the IEEE802.11i standard.
➢ WPA is intended to be implemented in a home/office environment and is available in all Access Points (APs) and Network
Interface Cards (NICs) currently available.
➢ RADIUS server authenticates the WLAN user and determines the session key to be used. RADIUS is only used to
communicate between the AP and the authentication server.

802.11i Security and Architecture

IPSec – Security and Architecture
This protocol, though intended to protect Internet communications and wired networks, has some characteristics that make it
suitable to protect wireless communications.

Wireless Architecture Proposal

The proposed architecture, secure access to the current system is increased due to the wireless connectivity advantages (e.g.
mobility, everywhere access and access to wider range of devices). This access provides secure authentication and
authorization, secure communications and also maintains the integrity of the retrieved information, thus preserving the
security goals of the VEPR. This is very important and justifies the need for similar studies when implementing wireless
solutions.
 Personal Health Records Systems Go Mobile

Information technology (IT) is dramatically transforming the delivery of healthcare services. This can be seen through the
increased activity in Mobile Health (M-Health) and promotion of the Electronic Health Record (EHR) systems in the healthcare
industry and the recent attention and increased activity in the adoption of Personal Health Record (PHR) systems.

Concept map of personal health records research from literature

1.Consumer subscription model: The consumer is responsible for an
ongoing service fee to access the data and related systems.
2. Consumer purchase model: With this approach the consumer pays
a fixed fee to purchase the software that provides the core
functionality of the PHR outright. This type is typically a desktop
application. The subscriber may also have the option to purchase a
support contact.
3. Free model: With this model the PHR is free to consumers
because the service is supported by advertising.
4. Employee support model:With this model, an employer or health
plan will contribute part or all the fees to run the service. This is
seen as preventative medicine as there is strong evidence that they
could save money on health care costs in the long run.
5. Combination: There is also the possibility that a combination of
these various models could be in effect. For example a PHR service
paid for by an employer or health plan may allow advertising.
Personal health records categories Categorization of PHRs based on storage medium
 Challenging questions
• PHRs are institution-based and patients will want a single PHR
that works with all their sites of care – how can this be achieved?
• Should PHRs support electronic data input from outside
institutions?
• How do you allow patients to integrate knowledge sources on
the Internet with their PHRs?
• How do you connect patients using social networking tools?
Patients with specific diseases may want to connect to
Mobile personal health record functional overview communities of others with similar diagnoses.
• Patients may wish to participate in clinical trials, post market
pharmaceutical vigilance, or public health surveillance via their
PHR– how is this possible without compromising
security?
• How do you securely incorporate the concept of mobility in a
PHR system?
Mobile personal health record functionality
Information infrastructure components
Wireless networks
Evaluting three commercial MPHR Systems
 Monitoring Hospital Patients Using Ambient Displays

➢ Hospital work is characterized by intense mobility, a frequent switching between tasks, and the need to collaborate and
coordinate activities among specialists. These working conditions impose important demands on hospital staff, whose
attention becomes a limited and important resource to administer.
➢ The pervasive technologies for hospitals are increasingly supporting heterogeneous devices that range from handheld
computers that can be used to capture and access limited amounts of information, to PCs that can be used at fixed sites
for longer periods of time, and semi-public displays located at convenient places that can be used to share and discuss
information with colleagues. Carrying out a single activity typically involves the use of several systems that call for the
user’s undivided attention.
➢ To overcome such difficulties is to develop ambient displays that could be embedded into the environment to provide a
getaway for that information that could be displayed by objects already placed in the physical space instead of the
traditional computer displays.
➢ Objects already known and used by hospital workers could be augmented with pervasive sensors making them capable of
extending their capabilities beyond its primary role while still constituting a part of the user’s environment. For instance, a
mirror augmented with infrared sensors and an acrylic panel could detect human presence and act as a message board to
display relevant information when a user faces the mirror.
THE IHOSPITAL: THE HOSPITAL AS A SMART ENVIRONMENT
▪ Providing Awareness of People and Artifacts
▪ Supporting Collaboration through Context-Aware Communication and the Seamless Interaction among Heterogeneous
Devices
▪ Using Context to Adapt and Personalize the Information
▪ Supporting Multitasking

AMBIENT DISPLAYS

➢ The physical environments where we live and work are saturated with ambient information, such as sounds or lights, that
we use as peripheral cues to discover contextual information relevant or that we manipulate to convey information to
others.
➢ Many types of ambient displays have been built to augment physical objects allowing users to manipulate or access
information. For instance, as part of the Ambient Room project, several displays using light, sound or motion have been
developed to augment a user’s office. Such displays provide users with awareness of the activity executed by a distant
loved one and the physical presence of others.
UNDERSTANDING HOW HOSPITAL STAFF MONITORS PATIENTS: A CASE STUDY

▪ Activities of Daily Care

▪ Activities Monitored are Classified

▪ Activities are Monitored Based on Contextual Information
▪ Activities Monitored are Distributed
▪ Activities are Monitored to Collect Information
AUGMENTING NATURAL OBJECTS WITH DIGITAL SERVICES AND AMBIENT DISPLAYS FOR PATIENT MONITORING

▪ A Mobile ADL Monitor

The mobile activity monitor. (a) A nurse uses the activity-aware bracelet; (b) the mobile activity-aware assistant shows
information related to an activity being executed by a patient; (c) a nurse uses her cell phone to assign colors; and (d) a nurse
associates contextual information with an activity.

▪ Monitoring the ADLs Conducted by Patients

▪ Sensing the Contextual Information Required to Monitor

patients

▪ Designing the Mobile ADL

▪ Monitoring Patients’ Urine Outputs

The bracelet electrical components. (a) The transmitter used in the
▪ Sensing the Contextual Information Required to Monitor
activity-aware server; (b) the receiver embedded in the bracelet.
Patients
 Sensing of Vital Signs and Transmission Using Wireless Networks
➢ People living with chronic medical conditions, or with conditions requiring short term monitoring, need regular and
individualized care to maintain their normal lifestyles. Mobile healthcare is a solution for providing patients’ mobility while
their health is being monitored. Existing studies show that mobile healthcare can bring significant economic savings,
improve the quality of care, and consequently the patient’s quality of life.
➢ Telemedicine as “the use of remote medical expertise at the point of need, which includes two major areas: Home care, as
care at the point of need through connected sensors, hubs, middleware and reference centers, and co-operative working,
as a network of medical expertise linked together”.
➢ Tele-health is the use of information and communication technology to deliver health services, expertise and medical
information over a distance. Whereas, e-Health is broader than either Telemedicine or Tele-health and can be described as
an emerging field composing medical informatics, public health and business, which enables health services and medical
information to be delivered or enhanced through the internet or other related communication technologies.
➢ The Study intends to explore the state-of-the-art of the wireless and mobile technologies applied in an M-Health service
and the most important issues in design and implementation of mobile and pervasive healthcare services for sensing vital
signs; suggesting improvement approaches for more reliable, more secure, more user-friendly and higher performance of
an M-Health system
 A simplified sketch of a telemedicine system

The structure of an M-Health system; (1) Bluetooth Pedometer or Step Counter. (2) Bluetooth Monitoring Device for home
telemonitoring of patients with chronic diseases. The device is able to measure: Blood Oxygen saturation, Pulse rate,
Breath rate and Body acceleration. (3) Bluetooth Blood Pressure Monitor. (4) Bluetooth Precision Health Scale. (5)
Bluetooth and GSM/GPRS enabled Network Access Point e.g. a smart mobile phone or a personal digital assistant (PDA)
device applying mobile communication network, remote server at hospital and a monitoring device (presentation unit).
(A) Bluetooth enabled Precision Health Scale and a Bluetooth Blood Pressure monitor using mobile access point to
communicate with a public communication network and/or Internet. (B) The same Personal Area Network (PAN)
establishing Bluetooth connection to a fixed access point (AP) to communicate with a public communication network
and/or Internet.

The necessary steps to take when a patient’s unit

using the Bluetooth protocol finds the correct
NAP in order to establish a connection to the
remote monitoring centre for medical data
transmission
 Patient Monitoring in Diverse Environments

➢ Recording of physiological vital signs in patients’ real-life environment could be especially useful in management of
chronic disorders; for example for heart failure, hypertension, diabetes, anorexia nervosa, chronic pain, or severe
obesity.
➢ The monitoring patients in diverse environments, by a mobile health system, is one of the major benefits of this
approach, however at the same time the demands and challenges for improving safety, security and integrity increase.
➢ Most research activities have been focused on achieving common platform for medical records, monitoring health
status of the patients in a real-time manner, improving the concept of online diagnosis, enhancing security and
integrity of the patients, developing or enhancing telemedicine solutions, which deals with remote delivery of health
care services applying telecommunications, etc.
➢ Recent advances in embedded computing systems have led to the evolution of wireless and mobile health services,
consisting of small battery-powered entities with computation and radio communication capabilities.
➢ The advancement permits data gathering and computation to be deeply integrated in the patients’ daily environment.
The technology has also the potential of automatically collecting vital signs to be fully integrated into the patient care
record and used for real-time triage, correlation with hospital records, and long-term observation.
➢ The trend of providing more and more wireless health care solutions is especially visible, because going wireless is
supported by the telecommunications service providers as well as by the end-users. For users, wireless means being free
from inconvenient cables and thereby more mobility plus easier and more flexible access to healthcare services. For
operators and providers, wireless means cheaper access, more users on the network and more benefit.
➢ Recording of physiological vital signs in patients’ real-life environment could be especially useful in management of chronic
disorders; e.g. for heart failure, hypertension, diabetes, anorexia nervosa, chronic pain, or severe obesity. This could also
be used to provide feedback about someone’s health in the form of behavioural feedback in order to prevent diseases.
➢ Monitoring patients in diverse environments, by a mobile health system, is one of the major benefits of this approach,
however at the same time the demands and challenges for improving safety, security and integrity increase.
Type of study

Study 1:Security and Privacy in a Wireless Remote Medical System for Home Healthcare Purpose

Study 2: Elderly Comfort and Compliance to Modern Telemedicine System

 Study 1

Principal sketch of the wireless remote monitoring system consisting of an ECG device, Bluetooth module attached
to ECG device, mobile phone, GSM/GPRS network, mobile modem server and a central monitoring station.
 Study 2

Principal sketch of the wireless remote patient monitoring system containing ECG device, Bluetooth module,
mobile phone, GSM/GPRS network, router, data interpreter and a graphical ECG monitoring system
 A Framework for Capturing Patient Consent in Pervasive Healthcare Applications

➢ A new framework for pervasive healthcare applications where the patient’s consent has a pivotal role. In their
framework, patients are able to control the disclosure of their medical data. The patient’s consent is implicitly captured
by the context in which his or her medical data is being accessed. Context is expressed in terms of workflows. The
execution of a task in a workflow carries information that the system uses for providing access rights accordingly to the
patient’s consent.
➢ Healthcare Applications are characterized by the integration of software systems in healthcare environments.
Healthcare applications seamlessly assist patients and carers in performing their tasks and provide them ubiquitous
access to required information.

Overview of our consent-based framework

 Mobile Health in Hospitals
Mobile phones because of their high levels of penetration hold tremendous potential as they provide opportunities, never
imagined before.

GROWTH OF MOBILE PHONES AND POTENTIAL OF MOBILE HEALTH

➢Cell phones are used by 76% (929.37 million) people in India. Monthly cell phone addition is nearly 8.35 million in 2012.

➢ India has third largest number of mobile phone users in the world next to China and United States of America.

➢Health sector till date has been slow in adopting mobile technologies into routine
operations to benefit patients and providers.

▪In a study shows that mobile healthcare business in Asia is growing at the rate of 80%/year. Ageing and tech-friendly
population is likely to give a thrust to mobile
healthcare business.

Applications developed in the process were for remote patient monitoring, mobile nursing, access to mobile medical records
and free access to healthcare information via mobile phones.
MOBILE HEALTH AND ITS APPLICATIONS

➢Mobile health is a term coined for medical and public health practice supported by mobile devices, e.g. mobile phone,
patient-monitoring devices, personal digital assistants
(PDAs) and other wireless devices.

➢Application of mobile health (m-health) in hospitals can contribute greatly to the management of health and disease of
inpatient, outpatient and emergency patients.

➢Healthcare provider satisfaction can be the observed outcomes. Innovations in smartphones need to address the
following concerns of health:

▪Contact information of healthcare provider.

▪Directions.

Tools that can be built strategically in the smartphones for the same are:

▪ Preregistration, registration for healthcare consultations.

▪ Appointment scheduling, fixing appointments and informing the clients. This is likely to reduce waiting time and cut
short long lines for consultations.
▪ Medical information such as prescriptions, medical history, allergies, etc.
▪ Information on health insurance and tracking.
 Wireless transmission of data

➢Calling

➢Short Message Service

➢Access and Updating the EMR System

➢Newer Wireless Devices and Technology

➢Motion Computing® C5 Mobile Clinical Assistant (MCA)

➢Advertising

➢Medication Adherence and Treatment Monitoring

 Information and Communication Technology in Healthcare Services

Technology is a big enabler and differentiator that has revolutionised the delivery of quality healthcare.

It improves the overall operational efficiency, speeds up workflows, curtails turnaround time (TAT), reduces medication
errors and improves clinical outcomes.

Low-cost and high-impact information and communication technology (ICT) solutions

reduce overall cost in a healthcare organisation and average length of stay (ALOS) of patients in the hospitals.

Applications using mobile telephone and telemedicine can greatly enhance the accessibility and penetration of
healthcare services, and overcome barriers in delivery of equitable
healthcare.

➢CHALLENGES IN IMPLEMENTING INFORMATION AND COMMUNICATION TECHNOLOGY IN HEALTH

➢MEASURES TO ENHANCE ICT ADOPTION IN HEALTHCARE

➢INVESTING IN ICT APPLICATIONS IN HEALTHCARE

 IT in healthcare ecosystem

ADVANTAGES OF ICT ADOPTION IN HEALTHCARE

ROLE OF ICT IN PUBLIC HEALTH

FUTURE GROWTH OF ICT USE IN HEALTHCARE

The current Indian healthcare IT market is USD 3 billion and is likely to grow at 15–20%
annually.
According to Economic Times (ET) and National Association of Software
and Service Companies (NASSCOM) report, the future IT growth will be driven by power,
media and healthcare sectors in short and long term.
➢ Each workflow is defined according to a medical protocol or administrative
process. It consists of multiple tasks. Each task is associated with a set of policies.
The policies define the constraints for executing the task. Policies can be defined
by both the hospital and the patient.
➢ Subject is an entity who needs to access a medical record, e.g. a doctor, a nurse.
Each subject has a set of attributes. The attributes can be used for authorisation
decisions. A role is a named collection of subjects. Unlike in RBAC, which assign
permissions directly to roles, in our framework roles are associated with a set of
workflows.
➢ Permissions define the access right the subject has on the medical records when Steps executed for granting a permission
they are executing this task. The permissions define what actions can be operated
on which part of a medical record by the subject who is executing the task. A
medical record is the container of a patient’s healthcare information. Most
current electronic medical record standards define hierarchical substructures
which help organising the information and make it possible for us to define fine-
grained permissions on these substructures.
 Authentication phase when the nurse’s device is detected
Representation of a sheltered home domain using ponder
in the sheltered home domain
YAWL provides a very powerful workflow language together with a workflow execution engine, and an editor for creating
workflow specifications. YAWL can be customized to export to external components certain events that occur in the
life-cycle of workflow instances.
A managed object has a management interface that the object has to implement in order to be managed by the interpreter.
Carers are represented by means of Subject Managed Objects (SMO) that could be assigned to the respective domain
according to the subject’s role.
Record Managed Objects (RMO) represent specific instances of medical documents, such as the record of allergies, the list of
current and past medications, an MRI picture, and so on.
The sensors and devices that are deployed in the environment are represented by means of Sensor Managed Objects (SeMO).

Controlling the enactment of tasks

 Context-Aware Task Redistribution for Enhanced M-Health Application Performance

➢ Building context-aware mobile healthcare systems has become increasingly important with the emergence of new medical
sensor technologies, the fast adoption of advanced mobile systems, and improved quality of care required by today’s
patients. A unique feature of our mobile healthcare system is a distributed processing paradigm whereby a set of bio-
signal processing tasks is spread across a heterogeneous network.
➢ Telemedicine has been receiving more and more attention due to its potential amongst others to tackle the resource
challenges to the healthcare system posed by the aging society, by improving the quality of diagnosis and treatment and
by reducing the costs of delivering healthcare.
➢ On top of the platform, multiple applications, such as tele-monitoring and tele-treatment services, can be operated to
provide continuous (24/7) mobile services to patients.
➢ The performance of m-health systems can be seriously affected by context changes and scarcity of the platform resources,
e.g. network bandwidth, battery power and computational power of handhelds and to solve this mismatch between
application demand and resources, an appropriate context-aware adaptation mechanism should be embedded into the
system.
➢ Approaches : (1) Task adjustment - this is to automatically change task behavior to use less of a scarce resource, e.g. scalable
video transmission over wireless network; (2) resource reservation - this is to ask the environment to guarantee a certain
level of a resource, e.g. QoS (Quality of Service) management and reservation techniques; (3) user notification - this is to
suggest a corrective action to the user.
➢ The fundamental model common to remote monitoring systems consists of a set of bio-signal data processing tasks
distributed across a set of networked devices.
Questions:
1. What are the requirements for task redistribution in m-health systems?
2. What are the QoS performance measures relevant for the m-health application and which performance characteristics can be
improved by a “more suitable task assignment”?
3. How can an optimal task assignment be computed given one particular performance measure?
4. What is the impact of the redistribution of tasks on the continuity of the services and what are the potential techniques to
minimize these disruptions?
Section 2 motivates our research by presenting a context-aware m-health system and its application scenario, which allows
us to further study the requirements on task-redistribution and relevant performance measures. In Section 3, we formulate
the problem of task assignment in m-health in order to support task redistribution. Section 4 classifies the task assignment
problem into several groups based on the model setting and presents the solutions. Section 5 presents the design and
implementation of a component-based infrastructure to support the task redistribution. Section 6 provides some further
discussions relate to both technical outcomes and non-technical outcomes.

The M-health system enables a remote health professional to view processed bio-signals and take appropriate
action for the patient
Distributed bio-signal processing tasks in a epileptic seizure detection algorithm studied in the AWARENESS project (Tönis,
Hermens, & Vollenbroek-Hutten, 2006): Raw ECG and movement information (obtained by accelerometers) are processed
in distinguished steps to estimate the chance of a seizure attack
MADE – a task redistribution based adaptation middleware that can dynamically redistribute the application tasks
across platform resources
 Technology Enablers for Context-Aware Healthcare Applications
➢ The increasing availability of mobile devices and wireless networks, and the tendency for them to become ubiquitous in
our dally lives, creates a favourable technological environment for the emergence of new, simple, and added-value
applications for healthcare.
➢ This study focuses on how context and location can be used in innovative applications and how to use a set of solutions
and technologies that enable the development of innovative context and location-aware solutions for healthcare area. It
shows how a mobile phone can be used to compute the level of familiarity of the user with the surrounding environment
and how the familiarity level can be used in a number of situations.

The context manager that manages the context and interacts with a set of external entities
CONTEXT AND CONTEXT MANAGEMENT

AVAILABLE TECHNOLOGIES AND SOLUTIONS

IMPROVING CONTEXT WITH TODAY’S TECHNOLOGY

DETECTING THE USER MOVEMENT

CREATING A PERSONAL SPACE MODEL

INFERRING THE FAMILIARITY OF A USER WITH A PLACE

8-channel ECG using ultra-wide band WBAN
• What Is Ultra-wide Band WBAN
8-channel ECG using ultra-wide band WBAN
• https://www.diva-portal.org/smash/get/diva2:1305601/FULLTEXT01.pdf
Pulse generator using Ultra wide band WBAN
• https://urresearch.rochester.edu/fileDownloadForInstitutionalItem.ac
tion?itemId=5583&itemFileId=8626
• https://www.sabanciuniv.edu/mdbf/telecom/eng/RWL/uwbpg.pdf
 Ultra-wideband (UWB) technology has many medical
applications, including:
•Breast tumor detection
•Bone cancer detection
•Brain hemorrhage detection
•Position and localization
•Noncontacting medical imaging
•Heartbeat and lung movement detection
•Detection of vascular pressure
•Vital sign monitoring
•Patient motion monitoring
•Monitoring of medicine storage
•Allergy and asthma crisis monitoring
•Chest imaging
•Obstetric imaging
https://www.intechopen.com/chapters/74473
Multichannel neural recording system
 MICROELECTRONIC PILL
• A “Micro electronic pill” is a basically a multichannel sensor used for remote biomedical
measurements using micro technology.
• This has been developed for the internal study &detection of diseases in GI tract.
• The pill is 16mm in diameter& 55mm long weighing around 5 g.
• Record parameter like pH, temperature, conductivity & dissolved O2.
WORKING
 Working Conti…….
• All Microelectronic pill is powered by a battery in order to utilize the device in internal
remote location.

• Receiver capture RF signal through antenna.

• A computer system is required for the control data acquisition unit

• & also stored it.

BLOCK DIAGRAME
 1. RADIO TRANSMITTER
➢ Size of transmitter = 8 × 5 × 3 mm
➢ Modulation Scheme = Frequency Shift Keying (FSK)
➢ Data Transfer Rate = 1 kbps
➢ Frequency = 40.01 MHz at 20 °C
➢ Bandwidth of the signal generated 10 KHz
➢ It consumes 6.8 mW power at 2.2 mA of current.
2. TWO SILVER OXIDE
BATTERIES
➢ 2 SR44 Ag 2 O batteries are used

• Operating Time > 40 hours.

• Power Consumption = 12.1mW

• Corresponding current consumption = 3.9mA

• Supply Voltage = 3.1 V .

Observation on receiver computer
3.CAPSULE
 3.1.SILICON DIODE
• It measures the body core temperature.
• Also compensates with the temperature induced signal changes in other
sensors.
• It also identifies local changes associated with Tissue Inflammation &
Ulcers

3.2.ISFET
➢ The ISFET measures pH.
➢ It can reveal pathological cnditions associated with abnormal pH levels
➢ These abnormalities include :
1. Pancreatic disease
2 . Hypertension
3. Inflammatory bowel disease…..
 3.3. ELECTODE ELECTROCHEMICAL CELL
• The three electrode electrochemical cell detects the level of dissolved
oxygen in solution.
• It measures the oxygen gradient from the proximal to the distal GI Tract
• It investigates :
• Growth of aerobic or bacterial infection
• Formation of radicals causing cellular injury & pathophysiological
conditions like inflammation & Gastric ulceration.
• It develops 1st generation enzymes linked with amperometric
biosensors.
 3.4.DIRECT CONTACT GOLD
ELECTODE
• The pair of direct contact Gold electrodes measures conductivity by,

1. measuring the contents of water & salt absorption,

2.bile secretion & the breakdown of organic components into

charged colloids etc. the GI tract.

• Since the gold has best conductivity among all the

elements, Therefore it gives true value of

conductivity as measured.
 4.CONTROL CHIP
• The ASIC (Application Specific Integrated Circuit) is the control unit that
connects together other components of the micro system.

• It contains an analogue signal –conditioning module operating the

sensors, 10-bit ADC & DAC & digital data processing module.
• The temperature circuitry bias the diode at constant current so that
change in temperature reflects a corresponding change in diode voltage.
• The pH ISFET sensor is biased as a simple source at constant current
with the source voltage changing with threshold voltage & pH.
 Conti…..
• The conductivity circuit operates at D.C. It measures the resistance
across the electrode pair as an inverse function of solution conductivity.

• An incorporated potentiostat circuit operates the O2 sensor with a 10 bit

DAC controlling the working electrode potential w.r.t the reference

• Analogue signals are sequenced through a multiplexer before being

digitized by ADC.

• ASIC & sensors consume 5.3 mW power corresponding to 1.7 mA of

current.
Sensor chips
 Range & Accuracy
RANGE :
• Temperature from 0 to 70°C
• pH from 1 to 13
• Dissolved Oxygen up to 8.2 mg per liter
• Conductivity above 0.05 mScm-1
• Full scale dynamic Range analogue signal = 2.8 V
ACCURACY :
• pH channel is around 0.2 unit above the real value
• Oxygen Sensor is ±0.4 mgL.
• Temperature & Conductivity is within ±1%.
 ADVANTAGES
• It is being beneficially used for disease detection & abnormalities in
human body.
• Adaptable for use in corrosive & quiescent environment
• It can be used in industries in evaluation of water quality, Pollution
Detection, fermentation process control & inspection of pipelines.
• Power consumption is very less.
• It has very small size, hence it is very easy for practical usage.
• High sensitivity, Good reliability & Life times.
• Less transmission length & hence has zero noise interference
 LIMITATIONS(The Dark Side)
• It cannot perform ultrasound & impedance tomography.
• Cannot detect radiation abnormalities
• Cannot perform radiation treatment associated with cancer & chronic
inflammation.
• Micro Electronic Pills are expensive & are not available in many
countries.
• Still its size is not digestible to small babies.
• Further research are being carried out to remove its draw backs.