Android Based Body Area Network for the

Evaluation of Medical Parameters

Matthias Wagner
1
, Benjamin Kuch
2
, Carlos Cabrera
1
, Peter Enoksson
3
, Arne Sieber
4
1
FH Frankfurt am Main - University of Applied Sciences, Germany
2
Scuola Superiore SantAnna - RETIS Lab, Pisa, Italy
3
Chalmers University of Technology, Gothenburg, Sweden
4
Institute of Micro and Nano Technology (IMEGO AB), Gothenburg, Sweden
AbstractThe telemedical system focuses on the measurement
and evaluation of vital parameters, e.g. ECG, heart rate,
heart rate variability, pulse oximetry, plethysmography and
fall detection. Based on two different designs of a (Wireless)
Body Area Network connected to an Android smartphone the
Real-Time system features several capabilities: Data acquisition
in the (W)BAN plus the use of the smartphone sensors, patient
localization, data storage, analysis and visualization on the
smartphone, data transmission and emergency communication
with rst responders and a clinical server. In the rst ZigBee
based approach smart and energy efcient sensor nodes acquire
physiological parameters, perform signal processing and data
analysis and transmit measurement values to a coordinator
node. In the second design sensors are connected via cable to
an embedded system. In both approaches data are transferred
via Bluetooth to an Android based smartphone.
Several challenges are discussed: Measuring, analysing and
visualizing medical parameters characterize the system as safety
critical, requiring special development procedures and adherence
to safety standards. Reliability of wireless data transmission
has to be optimized. Handling medical data requires security
measures on each level of the system hierarchy.
I. INTRODUCTION
Monitoring and recording of physiological parameters
of patients outside the clinical environment is becoming
increasingly important in research as well in applied
physiology and medicine in general. Environmental
physiology as one important example, is a scientic discipline
[1] that gained signicance with the continuing advances in
technology exposing humans to greater extremes and extreme
environmental conditions. For instance extreme sports like
endurance running, climbing and high altitude mountaineering
are more popular also in recreational settings. Presently very
little is known about acute adaptation mechanisms, and
especially about long term changes in physiological function,
e.g. in professionals which are regularly exposed to extreme
environmental conditions such as divers, astronauts or pilots.
How age and gender inuence these adaptations is also largely
unknown. A sound understanding of human physiology in
such environments is however the basis for being able to give
recommendations and draft guidelines on how and to what
extent exposures to extreme environments can be tolerated
in a safe way with minimized health risks considering short,
medium as well as long term effects. Technology is advancing
but knowledge of physiology is lagging behind thus there is
an urgent need for rapid advances in these research topics.
Environmental Physiology is the area of life science that
describes the human physiological and behavioral changes,
in particular, acute responses, adaptations, habituation,
acclimation and acclimatization. The main obstacle to the
assessment of physiological changes in extreme environment
is the fact that most ndings have been collected during
laboratory conditions with frequently bulky instruments. In
eld measurements outside laboratory are not feasible, simply
as suitable instrumentation that can withstand such harsh
environments was not available. Thus research is far away
from the real eld conditions when different environmental
factors could act synergistically or vice versa an individual
response to environmental stimuli is complex. Moreover,
in the general context of the reductionistic (cellular and
molecular) wave that has swept over biomedical research
during the last 20-30 years, many fundamental physiological
mechanisms still continue to be poorly understood [2].
Applying laboratory measurement equipment in eld is not
enough, as measurement equipment and the measurement
setup are also subject to cross interferences caused by
environmental stressors. Instrumentation developed especially
for application in extreme environments is the key for
rapid advances in environmental physiology. Physiological
parameters of paramount interest are among others: O
2
saturation (SO
2
), arterial blood pressure, heart rate and
variability, breathing parameters, etc. Diving is one example
of an extreme environment and as such a research eld
of environmental physiology. Medical concerns about such
activities derive from two major shortcomings: scanty
knowledge of diving physiology and lack of monitoring
of vital parameters during diving. Both deciencies are
virtually related to the absence of instrumentation suitable for
underwater measurements of simple but crucial physiological
parameters. First prototypes were developed in the past by
our team. [3], [4]
Another important medical eld, where autonomous data
recording and real time wireless data transmission is of
benet, is in preventive medicine and post treatment/survey
of patients with cardiac heart failure (HF) pathology and/or
10th International Workshop on Intelligent Solutions in Embedded Systems, 2012
~
33
cardiovascular diseases. HF represents a diffused pathology in
the industrialized countries with high morbidity and mortality
risk and a subsequent high request for hospitalization. In
fact, in these countries, the rst mortality cause is related to
the cardiovascular diseases: in 2005 the US AHRQ (Health
and Human Services Agency for Healthcare Research and
Quality) reported the costs of the top ten morbid conditions:
76 B$ for cardiovascular pathologies (48 B$ related to the
necessary hospitalization), 69 B$ for cancer, 39 B$ for
diabetes and 39 B$ for osteo-articular diseases. The incidence
and the prevalence of HF, as nal status of all the chronic
cardio-pathologies, are continuously growing. In the USA
a 300% increase of HF in 15 years has been related with
the improving of cardiology knowledge and care, and to the
aging of the population. It has been estimated that in 2020
HF and atrial brillation will represent the most important
hospitalization causes. Furthermore it has been estimated that
in Italy 10% of the over 65 population is affected by HF
[5]. The difculty of management of HF is not only related
to its diffusion, but also to the typical clinical course of the
disease characterized by frequent and cyclic haemodynamic
instability related to age, co-morbidity, cognitive decay,
therapy effectiveness, ambient and social factors.
Literature reports the clear and effective advantage of
specic patient monitoring well tuned to the patients clinical
condition. Reported results of a metanalysis on 5000 patients
by Alister [6] point out that specic assistance programs like
a phone hotline to medical staff (for example a nurse) or
by outpatient medical follow-up assure both a reduction of
re-hospitalization and also mortality.
In daily practice, management of patients with HF relays on
relatively simple physical signs such as the ones mentioned
above plus body weight which however need to be carefully
monitored in order to optimize the efciency of treatment, to
prevent the relapse of HF and the need of hospitalization.
A user wearable breathing recorder was already described
in [7]. There the acquired data are transmitted to a nearby
installed computer. Young [8] presents an oximeter with
wireless data transfer. Both approaches may be useful for
clinical applications, but for continuous monitoring of patients
outside the clinical environment, a wearable and miniaturized
recording system is necessary. Previously our team has
developed a GSM based data logger, which was able to
record breathing rate and SO
2
and transmit relevant data to
the clinical server [9].
Technical solutions enabling the eld of Telemedicine
promise to mediate the impact of changing population statis-
tics. Most important is the eld of on-line monitoring and
analysis of vital parameters. Different kinds of wireless tech-
nologies promise to ensure patient compliance. Especially
Body Area Networks (BAN) coupled with these wireless tech-
nologies [10] allow the setup of a comprehensive telemedical
infrastructure. Depending on the environment two different
subsystems are central to a BAN:
1) An embedded system as a sensor platform.
2) A Wireless Sensor Network (WSN) tailored to the
specic task. In this case the BAN is usually called a
Wireless BAN or WBAN.
With respect to WBANs ZigBee/IEEE 802.15.4 is widely
used in WSN. 2008 a standardization of WBANs near to the
human body has been started [11], [12]. The IEEE 802.15
Task Group 6 (BAN) is developing the communication
standard optimized for low power devices and operation on,
in or near the human body [13].
Smartphones and Tablet PCs take over tasks of the traditional
PC, once again changing the hardware base of computer
science. Therefore it is a natural development to use
smartphones as mobile sinks for WSNs (e.g. [14], [15]), and
integrate them as central modules of a telecare system (cf.
[16], [17]). In addition to a (W)BAN a typical smartphone
features around a dozen internal sensors, some of them may
be used in a medical application (e.g. [18]).
Telemedical Systems are by denition Safety Critical
Systems (SCS), whose development is governed by national
and international safety standards (e.g. IEC 60601 based
standards). In addition to functional safety concerns security
in the (W)BAN (cf. [19], [20], [21], [22]), between the
(W)BAN and the smartphone (e.g. via Bluetooth [23]), its
operating system [24] and a wider infrastructure is a serious
issue.
The main idea for the current project is to develop an
Android OS based data collection platform, that can collect
physiological data from multiple sensors, perform signal pro-
cessing and analyses, store data in an internal memory and
transmit data via a UMTS connection to a clinical server.
This paper describes two BAN approaches: 1: The WBAN
architecture is based on the ZigBee/IEEE 802.15.4 stack. 2:
The BAN architecture uses an Atmel board as sensor platform.
Both BAN designs are connected via Bluetooth to an Android
smartphone, which features apps for analysis and visualization
of vital parameters. Example sensors foreseen in the rst
prototype include sensors for O
2
saturation of the blood, ECG
and heart rate variability. In addition smartphone sensors (e.g.
accelerometers) are used to gather additional information, e.g.
fall detection. All information may be transferred to a medical
database for further distribution and analysis.
II. DESIGN NO. 1: WBAN
A. ZigBee/ IEEE 802.15.4
Sensor nodes usually do not require high bandwidth for
typical applications (hundreds of bits/s). For a WBAN design
some requirements on the communication should be imposed:
Resistance to interference, adequate throughput and security
[25]. Therefore communication protocols such as Bluetooth,
ZigBee, and IEEE 802.15.4 are serious candidates for the im-
plementation of a WSN. ZigBee is a standard communication
protocol for low-cost, low-power, wireless sensor and control
34
networks [26]. Just as Bluetooth, ZigBee operates on the 2.4
GHz radio frequency but with a maximum data rate of 0.25
Mbps [27].
Fig. 1. OSI vs. ZigBee/IEEE 802.15.4 Stack
In addition the ZigBee Alliance group has developed ZigBee
Health Care to be used by medical and non-medical devices
in order to establish a universal communication standard in a
health care environment. A major objective is to allow an indi-
vidual to perform tasks that otherwise would be very difcult
due to a disability or medical condition. To accomplish this
ZigBee Health Care fully supports standards like ISO/IEEE
11073 [26].
B. WBAN Architecture
Figure 2 shows the WBAN architecture. In this architecture
the primary data processing is done by the sensor nodes,
including the physiological signal processing in the micro-
controller of the nodes. The secondary data processing is per-
formed in the smartphone. This includes data representation,
data ltering, graphical interface and data synchronization.
Finally the last and most demanding data processing together
with the database management is performed in the medical
server. The medical server allows local and remote access for
medical personnel via the Internet.
Our design encompasses communication protocols like the
ZigBee/IEEE 802.15.4 stack for intercommunication within
the WSN, Bluetooth (Serial communication via RFCOMM) to
link the WSN with the smartphone, and WiFi or UMTS com-
munication between the smartphone and the medical server.
Our mote design uses the Atmel ZigBit
TM
2.4ATZB-
24-A2/B0 [28], which features an ATmega1281V C,
AT86RF230 Transceiver, 16 GPIOs, I
2
C Bus, 222kHz data
rate [29], 1-wire interface 15.4
kBit
s
125
kBit
s
[30], 4 ADCs
10 Bit.
Wireless data transmission results in a higher patient com-
pliance because there are no uncomfortable wires. On the
other hand may the fear of electromagnetic radiation lower the
acceptance. This served as a motivation for the IEEE 802.15.6
Fig. 2. WBAN Architecture
working group, with the goal of minimizing transmission
power, range and SAR [13]. Future WBAN architectures will
use the new standard.
III. DESIGN NO. 2: BAN WITH ATMEL BOARD
In terms of the sensor nodes and the gateway, Atmel solu-
tions promise to provide an ideal platform for Telecare devices,
reliable communication together with power efciency, in a
compact design [31]. For this a high-performance, low power
8-bit Atmel Microcontroller is available. It features a 8-bit
AVR CPU, a maximum operating frequency of 32 MHz,
128 KB In-System Self-Programmable Flash, 8 KB internal
SRAM, 2048 bytes EEPROM, 2 Universal Asynchronous
Receiver Transmitters (UART), 1 Serial Peripheral Interface
(SPI) and 16 channels ADC with a resolution of 12 bits and
2000 kSps speed, 4 channels DAC with a resolution of 12 bits.
IV. WIRELESS PLETHYSMOGRAPH/ PULSE OXIMETER
MODULE
A. Pulse Oximetry Overview
Due to restricted space only the pulse oximetry module
will be described. The ECG hardware was inherited from a
previous project and can be found in [32]. Pulse oximetry is
an optical method to measure oxygen saturation, heart rate
and heart rate variability. It is based on light absorption.
Oxygenated Hemoglobin (Hb) has different light absorption
spectra than deoxygenated Hb. Thus the wavelength of red
light (660nm) is compared with the wavelength of infrared
light (940nm). The red/infrared light is received by a photo
detector, which converts light into current. The output current
of the photo detector is proportional to the light intensity of
each light source. The light sources are switched on alternately.
Each source is switched on for a certain period and the current
is measured and converted into a voltage. The output signal
35
Fig. 3. BAN Architecture
lies between 1 Hz and 2 Hz [33] and consists of a small AC
component ( 1V) and a large DC component ( 10mV peak-
to-peak) [34]. The AC component is caused by the arterial
pulse. The DC component is caused by scattered light, residual
arterial blood, venous blood and bloodless tissues. The SpO
2
level is calculated by taking the Root Mean Square (RMS)
of the red/infrared AC values, computing the ratio between
the red and infrared RMS values and applying the ratio value
into a 3
rd
order polynomial t of the calibration curve for
oximeters [35].
B. Design Outline
In order to tailor the system to specic application needs
the puloximeter application report SLAA274A from Texas
Instruments (TI) [34] was used as basis and adjusted. Instead
of using the TI MSP430FG437 microcontroller, an Atmel
ATXmega128A1 is used with the following advantages:
Direct Memory Access Controller
Fast 12 bit programmable (amplifying) ADC, which can
read 8 ADC channels in parallel (up to 2 MSps sample
and conversion rate)
Event system
Interrupt handling with congurable priorities
8-bit RISC architecture with max. frequency of 32Mhz
128 kBytes Flash, 8 kBytes SRAM, 2 kBytes EEPROM
In addition to the microcontroller the hardware includes an
analog circuit, consisting of a LED drive circuit, photo diode
output processing and a ChipOx MiniMed ngerclip sensor.
The rmware of the device is developed in C (GNU C com-
piler WinAVR 20100110) and AVR Studio 4.18. The rmware
of the module consists of four major parts: LED control,
signal amplication, LED data handling and processing and
data transfer. Data is transferred via serial interface. The DMA
controller of the ATXmega128A1 is used to allow high speed
data transfer with minimal CPU intervention. In this way, the
whole data transfer can be processed in 200s CPU load.
V. ANDROID SMARTPHONE
A. Android Smartphone
An Android based smartphone has been chosen because
of its powerful and Java-based development kit, Android
SDK, its excellent documentation and library including classes
like BluetoothHealth, and the possibility to develop on many
platforms, like Linux, Mac Os and Windows [36]. For devel-
opment different smartphones are being used with Android
2.3.5 and 4.03.
B. Android Apps
As mentioned in the System Architecture the smartphone
should manage not only data acquisition from the W(BAN),
but also synchronization and provide a Graphical User
Interface (GUI), among other tasks. In order to do so
an Android application is necessary, this application
should feature several functions, among these are: Data
acquisition from the (W)BAN via Bluetooth; data analysis,
i.e. comparison with medical norm values; GUI for
conguration, data visualization, and communication;
data transfer (synchronization) to a medical server via WiFi
or cellular network.
Android applications are divided into Activity classes. An
Activity is both a unit of user interaction, and a unit of
execution which provide reusable, interchangeable parts of
the ow of UI components across Android Applications [37].
In essence the application is responsible to detect the
Bluetooth gateway and establish a full duplex communication,
including device discovery, pairing, debugging and
communication, and to be able to connect to the medical server
through the Internet enabling data synchronization between
the server and the W(BAN) in soft real-time. The application
features numerical analysis and graphical representation
of the captured physiological data, an activity for the
patients prole, physical condition, disease history, etc., and
activities for the connection with the medical server. For this
project some interesting packages available in the Android
SDK are [36]: Android.Bluetooth, Android.database.sqlite,
Android.net, Android.webkit, javax.net.ssl, Android SDK tool
[17]. The use of third party libraries is optional keeping the
validation effort for a Safety Critical System in mind.
The app is also responsible to present a GUI, whose design
represents the captured data in an understandable way.Together
with the basic requirement of a state-of-the-art Android app,
the GUI has therefore three principal modes: Conguration,
display for patients, display for medical personnel with re-
stricted access.
For the proposed application internal smartphone sensors,
e.g. accelerometer, GPS, etc., provide additional opportunities,
i.e. patient localization and possible detection of a fall. Based
on the evaluation of the acquired data the app starts
36
Fig. 4. Android Prototype Application
communication to predened rst responders.
Android based on Linux lacks a real-time kernel and cannot
support hard real-time requirements. Based on the measure-
ments of Mongia and Madisetti [38], tests of the complete,
layered system are being conducted.
VI. SECURITY ISSUES
Security in Wireless Sensor Networks is of major concern
(cf. [19], [22]). The security issues in a WBAN differ in
several aspects from those in other applications. In a WBAN
for medical applications there are only a few motes, as in our
design. Nevertheless a typical problem is to distinguish an
attack from a network failure. Therefore detection mechanisms
are required. Guided by the OSI model layering-based attacks
[22] on the ZigBee/IEEE 802.15.4 stack (cf. g. 1) may be
countered by the combined ZigBee/IEEE 802.15.4 security
model (cf. [19]). Currently evaluations are under way to
assess the permissible overhead introduced. In a BAN based
on sensors attached to an embedded control system security
issues are much simpler.
Both approaches communicate with an Android smartphone
via Bluetooth. Because of the widespread use of Bluetooth
in mobile phone communication numerous threats exist
(cf. [39]). Threat mitigation involves properly designed
communication between the (W)BAN and the smartphone,
e.g. a dened software engineering process, use of the
encryption and authentication mode, comprehensive testing.
Android is one of the most popular operating system for
smartphones. Despite this fact the Android security model is
in need of further enhancements. Shabtai et al. [40] identied
the major threats to the operating system. The Android soft-
ware stack is built on a Linux kernel. The Android security
framework is based on the Linux security system, the cellular
network provider and Android specic security mechanisms,
i.e. application permissions, component encapsulation and
signing applications [40]. Shabtai et al. propose enhancements
to the Android system to increase protection.
VII. RESULTS
First reliability test runs with a WBAN prototype with a
scalable number of ZigBee motes resulted in a 4-6.5 % packet
loss (s. Table 1). In the rst and third setup data were sent
from a ZigBee endpoint via a router to the coordinator. In the
second setup the endpoint sent data directly to the coordinator.
Run-Time Payload Packets sent Packets lost Security
[Days] [Bytes]
10 10 1.26 10
5
5 % none
10 10 1.26 10
5
4 % standard
10 10 1.26 10
5
6.5 % standard
TABLE I
ZIGBEE/IEEE 802.15.4 RELIABILITY TESTS
Trade-offs are necessary with respect to battery life,
data rate and ZigBee/IEEE 802.15.4 security settings.
Unfortunately increasing security does not only introduces
a secure way to send and receive data, but also introduces
an impact on the performance, and battery life of the sensor
nodes and the phone running the android application. With
standard security only 54.54% of the usable payload is
available. Battery life was reduced by 14.28% in a node
functioning as a coordinator. In order to mitigate the data loss
re-transmitting information in slow sampling rate nodes can
be used, and interpolation techniques for nodes with faster
sampling rates. Higher level encryption resulted in a drastic
reduction of the data rate.
Range is not an issue for medical WSN with the used motes.
Range tests revealed sufcient range for the application. A typ-
ical setup for research in environmental physiology comprises
three motes. ECG and Plethysmograph/Pulse Oximeter data
have been acquired, transferred and displayed in an Android
App. Two different smartphones, a HTC Desire HD with
Android 2.3.5 and a Samsung Nexus S with Android 4.03,
have been used to collect and visualize the WBAN data. In
addition the Android App features the input of user/patient
data and the UMTS/WIFI data transfer to a medical server
database.
37
VIII. CONCLUSION AND FUTURE WORK
The rst design approach, a WBAN, fullls the basic
requirements. Reliability and range are sufcient. Due to fears
with respect to transmission power of wireless systems the
upcoming standard IEEE 802.15.6 will be considered for fu-
ture designs. The combination of the WBAN with an Android
smartphone offers a large functionality. Vital parameters can
be stored, analyzed and visualized with GUIs designed for the
end-user. Security on all levels of the layered system must be
further investigated, especially to dene trade-offs with respect
to performance and comfortable use. Certication according
to medical safety standards is currently impossible due to the
different components used, e.g. the Android operating system.
The rst version of the proposed system will therefore be used
in different research applications of environmental physiology,
i.e. HRV measurement, heart rate, breathing rate, etc.
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