A ZigBee-Based Telecardiology System for Remote Healthcare Service Delivery

Katherine Ernest, Christina Lamei, Sarah Mohamed, Mariam Shakshuk and Islam Badreldin Cairo University, Cairo, Egypt Department of Systems and Biomedical Engineering Katherine.m.ernest@gmail.com

Inas ElBabli Concordia University, Montreal, QC, Canada Department of Electrical and Computer Engineering ielbabli@encs.concordia.ca
requires high bandwidth and involves concurrent activity on both the host and the remote site, while the store-and-forward category requires low bandwidth [2]-[3]. Myocardial infarction, Percarditis, and heart failure are examples of heart diseases that mandate frequent ECG measurements [6]-[8]. In our proposed system, the patient, at the comfort of his home or office, will attach the ECG electrodes, press some buttons and in a few minutes the doctor at the medical center can see the patients ECG in real time and can save a record as well. The system is composed of a hardware device responsible for acquiring the vital signs of the patient; this is done utilizing a multi-parameter module. ZigBee kits are used to transfer the data wirelessly across the patients house to his PC. We implemented a software program that works on the patients PC; it acquires incoming data from the attached ZigBee kit. It then extracts and draws the data and connects to the server for real-time viewing. This is all done by pushing a single button to start the session. After finishing the session, the patient pushes another button to create a SCP-ECG record for this session. A notification is then sent to the physician, if he is still online, informing him that the session has ended and a that SCP-ECG record is created in case the physician wants it. SYSTEM DESCRIPTION The overall system is shown in Fig. 1. The system is divided into three phases. The first is the acquisition phase, the second phase is the wireless transmission of the data to the patients computer using ZigBee or ZigBee transmission, and the third phase is data acquisition, viewing and sending. The work flow of the system is shown in Fig. 2. The device used in the acquisition phase is CSN801 MultiParameter Module Fig. 3. This module is responsible for acquiring ECG, SPO2 (saturated percentage of oxygen in blood), respiration, heart rate and temperature, through the use of specific leads attached to the patient during the session. It transmits data in the form of packets; each packet length is 20 bytes with 2 bytes header. The data is in hexadecimal format. Each packet contains ECG, SPO2 and respiration data, while the rest of the data parameters are transmitted individually, each data parameter is

ABSTRACT Patients with heart disease suffer much to have diagnostic ECG sessions especially in rural areas and areas with high population. This is mainly due to the remoteness of distance between patients and the medical units, as well as traffic congestion. Doctors also need a fast and reliable way to be able to check on their patients and provide a diagnosis irrespective of where they are. In this paper we describe the design and implementation of a telecardiology system using ZigBee. Our proposed system will provide doctors with the ability to monitor, and diagnose their patients remotely over the Internet. The system is capable of receiving a serial stream of data and extracting relevant packets from the measurements of the patients vital signs. The implemented software allows patients to easily connect with their doctors and to send their data via Internet. The ECG signal is monitored in a real-time mode with the ability of keeping records through SCP-ECG (Standard Communication Protocol) standard. INTRODUCTION Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients health status [1]. It is also known as the ability to produce interactive healthcare utilizing modern technology and telecommunication [2]. The term telemedicine refers to communication between a host and a remote site, mainly the patient and the physician [3]-[4]. It enables physicians to expand their reach, thus eliminating the distance barrier and bringing better healthcare services. There are numerous benefits involved in public health delivery using internet connectivity. Internet enables flow of up-to-date information in real time, which facilitates centralized control but decentralized operations, ensures quality of health information and elicits citizens feedback on the quality of the service provided [5]. Nowadays telemedicine is used in various specialties like cardiology, psychiatry, ophthalmology and orthopedics [2]. Telemedicine is categorized into real-time or videoconferencing and store-and-forward. The Real-time category

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sent continuously and sequentially after each other, When all data parameters are sent they are sent again and so on. Acquisition is done simply by attaching all the required leads and transducers to the patient then plugging the other end to the module slots to start the session.

applications that need long battery life, and networking security. Another feature of the ZigBee is the self-heal that is if a radio in the path between two points is removed, the message follows any other route to reach the target end point [5].

Figure 1. System Description.

Another important feature is being inexpensive, while supplying adequate networking security. The device we used for this phase is IEEE 802.15.4 XBeeTM OEM RF Modules by MaxStream. The following steps show how the configuration was done: We start by connecting both modules to their respective kits Fig. 4, one kit is connected to the CSN801 module and the other to the receiver computer through serial port connection. Using X-CTU program (provided by the manufacturer to configure the kits), we adjusted the PC settings and modem configuration. The settings used are: baud rate: 19200, flow control: none, data bits: 8, parity: none, and stop bits: 1. The last step is repeated for both ZigBee kits. To check the data received, we used the Terminal tab and to test the range we used Range Test tab in the same program.

Session Starts
Acquire Data from Patient via CSN801 Module

Wirelessly transmit Data using Zigbee via XBee Modules

Receive, segment, and view Data on PC

Real time transmission of current session in case physician is online-

The data acquisition, viewing and sending phase is done at patients PC. We used Microsoft Visual Studio 2008 and C# programming language. At the patients side Fig. 5 the following is done upon starting the session by pushing Start button: Connection with the server is established, the patient is notified whether the connection succeeded or not. The port, which the ZigBee kit is connected to, is opened and a thread is initiated to keep reading the incoming bytes from this port. This is done with a class called Producer. These incoming bytes are then segmented by searching for the header packet. If the header was found then the following packet is taken from which the data of interest is extracted and saved into an array at a class called Buffer. At the Consumer class, another thread will be consuming the extracted data from the Buffer. When the physician logs online, the patient is notified and the data is automatically sent over the net for Real-Time viewing When it is time to end the session, the patient simply pushes the End button to inhibit events responsible for real-time viewing and the SCP button is activated UPON pushing the SCP button,

Session Ends
Implement SCP-ECG record & notify physician

Upon physician request a SCP-ECG record is sent Figure 2. System Work Flow. To send the data wirelessly to the computer we used ZigBee. ZigBee is a high level communication a protocol using small, low power digital radios that are based on IEEE 802.15.4.standard that adds networking and routing functionalities and that is used for wireless personal area networks (WPANs). It is used in the RF

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a. A SCP record is automatically created & saved on the patients PC. b. Notification is sent to the physician that the session ended and a SCP record is available. c. The record is sent to the physician upon his request. Synchronization of the operations done on the Buffer data arrays is done by using Semaphores, while protection of classes accessed by several threads is accomplished by using Mutex.

A typical sections layout is shown in Fig. 7. There are 3 mandatory sections, which are section (0), section (1) and section (3). The rest of the sections are optional to implement [9]. Section (0) is pointer section; it holds a pointer field to every implemented section Fig. 8. It is a flexible way of section management [9]. Section (1) holds the information of patient data and ECG acquisition data while section (3) holds the ECG lead definitions [9]. We implemented only those three mandatory sections. For implementation we downloaded a dll file from OpenECG website. This dll file is then added into our C# program and we used its functions to implement those three sections. As for the patients information part, we succeeded in saving his full name, ID, race, sex, weight, height, full birth date, height unit and weight unit. Regarding the diagnosis part, we succeeded in saving the physicians name, acquiring institution, free text part, diagnosis and medical history. As for the ECG information, we saved the number of ECG leads, baseline filter value, low pass filter value, sampling rate, acquiring day, month and year. Finally we took the ECG leads value from our patient.

Figure 3. CSN801 Multi-Parameter Module.

For viewing our SCP-ECG record we downloaded a program called ECGViewer, this program is available at: www.ecgsoft.com. There were defects in the signal on the SCP viewer which arise mainly from the CSN801 Multi-Parameter Module. This necessitates the use of signal processing.

Figure 4. Connecting the XBee module to the kit. At the doctors side the following is done upon pressing the Connect button: Connection with the server is established, the physician is notified whether the connection succeeded or not. If there is a patient online, the physician is notified and he will witness an ongoing session. A link will appear at the physicians side when the SCP record is ready. Upon clicking, the SCP record will be transferred and saved at his PC. A message will appear telling the physician that the SCP is saved providing its path- and asking if he wants to see it. If the answer is affirmative, then the viewer Fig.6 will be opened allowing the physician to open the record. When the physician signs out, a notification is sent to the patient. At the server, like any other server, it listens to clients requesting to connect, accepts them, and delivers requests and data from requesting hosts to receiving hosts. SCP-ECG standard Implementation For the data to be recorded and viewed with annotations, SCPECG standard was followed and implemented to record both the patients data and the ECG data. SCP-ECG standard provides a lot of features such as: saving 12-lead ECGs, patients information, acquiring devices information, data compression, physicians information and more. These features are implemented in the form of sections. SCP-ECG standard is composed of 11 sections [9]. Each section consists of: 1) A Section Identification Header (Section ID Header). 2) A Section Data Part. Figure 6. SCP-ECG viewer.

Figure 5. Patients side program.

Figure 7. SCP-ECG section layout.

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Figure 8. Pointer section data part. Network Application Communication over a network is done by three means: Client/Server application, Peer-to-Peer application and hybrid application. We chose Client/Server application to work with mainly for its independence and simplicity. By independence we mean that the physician is able to get his patients records any time independent of the patients status, whether he is online or not. This is achieved by using a Client/Server application, where the server holds all records. Regarding its simplicity, it is much easier to have an invariant common place for the physicians and the patients to meet. Also the server handles all requests from both sides. Client/Server application is software that runs on the clients computer - patient or physician - and sends requests to a remote server - hospitals server [10]. The patients program runs upon pushing Start button, while the one at the physician is triggered upon pushing Connect button. We built our network application part on TCP/IP (Transmission Control Protocol / Internet Protocol). It is a communication protocol that defines how computers communicate with each other on the internet [11]. TCP/IP is a connectionoriented and reliable transport [12]. Connection oriented (analogous to phone call) means a handshake is done first before establishing a connection Fig. 9. Its reliable transfer ensures the data are sent correctly and in order. Another important feature is that TCP/IP provides full-duplex service [12] which means two processes can communicate with each other at the same time. Also TCP/IP is a persistent connection [12]; upon responding the connection is kept open and there will not be any need to open a new connection for each new request. From the above we can be sure that the data are sent over the network correctly. Through the implementation of network application, real time ECG monitoring was achieved. Thus the patient can have a session and the doctor can see the signals at the same time. A shortcoming here is that the signal at the doctors side is slower.

Figure 9. Connection-oriented and connectionless services. CONCLUSIONS Through our system we enabled the patient to have his diagnostic session at the comfort of his own home or office. He is also not restricted to sit beside his PC till the end of the session. Furthermore we enabled the physician to access the server from remotely to monitor his patients and get their records as well. During the implementation of this system, we came to realize the importance of telemedicine. We believe that it is very important to establish such a technology especially in developing countries like Egypt. Reduction in effort and cost, with increased efficiency, and ease of use are some of the benefits telemedicine provides patients with in the process of improving their access to quality. Of course the system needs further work to improve its functionality and to be able to manufacture it and market it. Being extremely cost effective, gives the system very good edge when compared with other products available in the market. REFERENCES
(2010) American Telemedicine Association, What is Telemedicine & Telehealth. [Online]. Available: http://docs.google.com/gview?a=v&q=cache:tOLrhdryngJ:www.americantelemed.org/files/public/abouttelemedicine/ What_Is_Telemedicine.pdf+%22what+is+Telemedicine%22&hl=en &gl=eg [2] (2010) Telemedicine [Online]. Available: http://www.telemedicine.com/whatis.html [3] Jonathan B. Perlin, David A. Collins, Lisa G. Kaplowitz. State of the Art: Telemedicine. Available: www.turner-white.com [4] Huimin She, Zhonghai Lu, Axel Jantsch, Li-Rong Zheng, Dian Zhou. A Network-based System Architecture for Remote Medical Applications. Network Research Workshop, 27 August 2007, Xian, and Peoples Republic of China. [5] S Gupta and S Papagari, Information Economy and Healthy Citizenry: Role of Internet in Implementing India's Health Policy, Internet Health, vol. 3, 2004. Available: www.internethealth.org/ih200431e04.html [6] (2010) Myocardial Infarction. [Online]. Available: http://www.medicinenet.com/heart_attack/article.htm [7] (2010) Pericarditis. [Online]. Available: http://www.medicinenet.com/pericarditis/page3.html [8] (2010) Heart Failure. [Online]. Available: http://www.nhlbi.nih.gov/health/dci/Diseases/Hf?HF WhatIS.html [9] (2010) SCP-ECG standard, Health informatics, Standard communication protocol, Computer-assisted electrocardiography. [Online]. Available: http://www.openecg.net [10] (2010) Client / Server Applications. [Online]. Available: [1]

http://toastytech.com/guis/remotecliserver.html
[11] (2010) TCP/IP Introduction. [Online]. Available: http://www.w3schools.com/tcpip/tcpip_intro.asp [12] James F.Kurose, Keith W.Ross. Computer networking A top down approach-.

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