IMTC 2005 Instrumentation and Measurement

Technology Conference
Ottawa, Canada 17-19 May 2005

Design and Implementation of an Embedded Remote ECG Measurement System

Ying-Wen Bai, Chien-Yung Cheng, Chou-Lin Lu and Yung-Song Huang
Department of Electronic Engineering, Fu Jen Catholic University
Taipei, Taiwan, 242, R.O.C.
Email: bai@ee.fju.edu.tw

Abstract Since an embedded circuit board is lower in cost,
smaller in size, and lower in power consumption than a PC. In this
paper, we use an integrated embedded circuit board instead of
using a PC and interface circuit board with our system, which can
provide the ECG measurement of a patient who is outside of a
hospital. The collected medical information through computer
networks will be stored in the medical information databases for
accessing by the medical doctors, nurse, and other related health
professionals. Our design integrates several modules such as, an
embedded circuit board, a database, a Web server, wireless or
Internet transmission, and remote user devices. Overall, our
system can transmit the heart beat-rate, body temperature and
electrocardiogram to the medical information database from a
remote site.
Keywords: Medical Measurement System, ECG, Embedded
Circuit Board, Web Server.
I. INTRODUCTION
Traditionally, the medical measurement system can be
expensive and a medical measurement system can be difficult
to access for a needed patient. Moreover such a system is
neither compatible with the PC and communication standards
nor is it easily upgraded. In addition, a special patient may
need a medical measurement system to monitor ones body
condition even if that individual is located in the hospital.
Based on these requirements and available technology, our
design provides a convenient operational procedure utilizing
an embedded circuit board and Web server to provide a
remote electrocardiograph measurement.
Typically, an electrocardiogram is generated by a nerve
impulse stimulus to a heart, whereby the current is diffused
around the surface of the body surface. The tiny current at the
body surface will build on the tiny voltage drop, which is a
couple of V to mV with an impulse variation. This very
small amplitude of electrocardiograph, needs to be amplified
a couple of thousand times for recording and displaying.
Simultaneously, the amplified signal is then inputted into an
analog to digital conversion and through the digital interface
inputted into an embedded circuit board. The embedded
circuit board uses client-server network programming to
transmitting this digital medical signal to the remote database
by wireless or wire networks.
Based on the current software and hardware technology,
our design provides a convenient operational procedure to
conduct a remote electrocardiograph measurement from
outside of a hospital. All of the basic modules can be easily
designed and implemented and they can be compatible with
the currently used systems. In 2003, people used a GSM
module to transmit this digital medical data [1], but the
Internet transmission has proved faster than a GSM module.
In our design, we used an embedded circuit board network
module to transmitting this digital medical data. Moreover,
due to the improvement of the current software and hardware
technology of both computer systems and networks, a remote
medical system needs to be redesigned by using more modern
technologies, such as: a Web server, the Internet and wireless
networks and an embedded circuit board. Hence, Our design
includes several modules: an interface circuit board, an
embedded circuit board, the software on the embedded circuit
board for wireless or Internet transmission, and the software
for the remote medical servers. As the embedded circuit
board software is a module design using an ANSI C,
therefore it is compatible with most current computer devices.
Finally, our explanation emphasizes the design of an
embedded circuit board and the remote server software
module of an embedded remote electrocardiogram
measurement system.
The rest of this paper is organized as follows. In Section 2,
a brief overview of a remote medical measurement system is
provided. In Section 3, the hardware modules are discussed.
In Section 4, the software modules are designed. In Section 5,
the implementation and specification of the design are
provided. In the last Section, the conclusion is drawn.
II. A BRIEF OVERVIEW OF A REMOTE MEDICAL
MEASUREMENT SYSTEM
An electrocardiogram is generated by a nerve impulse
stimulus to a heart, whereby the current is diffused around the
surface of the body surface. The current at the body surface
will build on the voltage drop, which is a couple of V to mV
with an impulse variation [2-3]. This very small amplitude of
impulse needs to be amplified to enable the recording and
displaying. Usually, the electrocardiograph needs a couple of
thousand times of amplification. The function blocks of the
interface circuits of a remote electrocardiogram system are
used to amplify the tiny ECG signal with noise reduction. In
our design, the interface circuit is used to pick up the
electrocardiograph and amplify this signal by using noise
suppression and electricity isolation. The amplified ECG
signal is then inputted into an analog to digital converter and
through the digital interface inputted into an embedded circuit

0-7803-8879-8/05/$20.00 2005 IEEE 1401

board. The embedded circuit board uses a LCD to display the rewritten to tighten up and slim down the code base. Overall,
signal in the board at the client site and uses client-server the uClinux kernel used in an embedded system is much
network programming to transmit this digital medical signal smaller than the original Linux 2.0 kernel used in an PC,
to a remote medical Web server by use of wireless or wire while at the same time retaining the main advantages of the
networks. Eventually, the electrocardiograph can be seen at Linux operating system: stability, excellent network
the remote site by Web browsers from different users such as capability, and file system support [7-8].
medical doctors and nurses. Section 3 shows the hardware
block diagram and the function of the embedded remote LAN
electrocardiogram system. The detail of the hardware and Ethernet Networks
Hub
software design will be seen at references [2]. Usually, the
Interface Circuit
Web applications can be designed and implemented by Board Analog To Digital Power connector
Microsoft Active Service Page and the clients can use the B1
Electrocardiogram Ethernet
HTTP protocol to access the medical information from the V in
Heart Beat-rate Port
medical Web server, which can be updated by a way of the Body Temperature

GND
real time. Fig. 1 shows the system architecture of the remote

GPIO
medical information system. There are a few common types ARM CPU

B8
V ref
of medical information such as, the heart beat-rate, body Sign
temperature, and electrocardiogram can be picked up by Embedded
using the measurement circuit boards and the necessary Circuit Board
transmission facility such as a hub, an Ethernet and the
Internet. This medical information can be transmitted into the Fig. 2. The medical measurement interface and embedded circuit
Web server and can be accessed by means of a clients PC boards
Web browser [4-6].
A. Interface Circuit Board
LAN
Hub Ethernet Networks
Signal Sensor AD
Hospital Amplifier Filter Embedded
Internet (Transducer) Converter Circuit Board
Measurement
Electrocardiogram Circuit Medical Information Interface Circuit Board
Heart Beat-rate Board Server

Body Temperature
Wireless LAN Fig. 3. The function of the interface circuit board
Measurement

Interface
Circuit Home PC
Board The operation procedure shown in Fig. 3 can be explained as
follows:

PDA
Doctors
&Nurses
1. In Fig. 3, the ECG sensor is used as the input stage,
which requires very high impedance that is often attained by
Fig. 1. System architecture of the embedded remote medical using a CMOS input circuit in order to both match the
information system
impedance of the ECG signal source and to pick up a larger
III. HARDWARE MODULES amplitude of the ECG signal.
2. Due to the difficulty of the reduction of the noise in the
very small amplitude of an electrocardiogram signal, we need
Fig. 2 shows the hardware design of the medical
to use a differential amplifier to suppress the common-mode
measurement interface circuit board and the embedded board
noise. In addition to preventing any electrical shock to the
used to transmit this digital medical signal to a medical web
tested body, we use an isolated amplifier that can not only
server by networks [5]. The medical signals of patients are
amplify the ECG signal but also provide DC power supply
transmitted in digital form to a medical information server
isolation by means of a magnetic coupling mechanism. To
through an embedded circuit board and Internet. The
amplify the electrocardiogram signal further, we use a main
embedded circuit board comes equipped with a full Internet
amplifier. However, because the DC offset voltage could
interface and its operating system (OS), which is a derivative
saturate the amplifier, we must adjust the DC offset voltage
of the Linux 2.0 kernel intended for microcontrollers without
of the amplifiers very carefully.
Memory Management Units (MMUs). However with this
3. Because the medical signal can induce the noise nearby
kernel multitasking can be hard to execute. The uClinux OS
the location of the ECG, we need to use a 60 Hz band
has a full TCP/IP stack which is Internet-ready, as well as
rejection to suppress this noise and a low pass filter to reduce
support for numerous other networking protocols. Some user
the high frequency noise. In addition, to minimize the error of
applications that run on top of uClinux, however, will not
any component, we shall use an adjustable component in
require any multitasking. In addition, in our design, most of
order to locate the best band rejection frequency. Usually, the
the binaries and source code for the kernel have been

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bandwidth of the medical signal is low frequency; we,
therefore, use a high-order low pass filter to suppress the high
frequency band.
4. The sampling rate of the analog to digital conversion
will decide the resolution of the medical signal. The
embedded circuit board is used to control the analog to digital
converter, to receive the data of conversion, and to send out
the digital data to the embedded circuit board.
B. Embedded Circuit Board
Our embedded circuit board is equipped with the
embedded platform provided in a fully-fledged Linux
development environment by leveraging the generous, free,
and open-sources in Linux world, in which we can focus on
our applications without bothering with low-level
implementation details [12]. The embedded circuit board is
built around a cost effective high performance ARM series
microprocessor unit that provides complete interface
architectures of software and hardware at a very low cost. A
number of versatile applications on Linux can be applied to
this platform such as, FTP server, Web server, database, IP
forward, network applications, controls and communication
functions which are all easily implemented on this board.
With appropriate expansion interfaces, this platform can be
readily connected to an LCD module for further embedded
product development. Finally, this embedded circuit board
can transmit the digital medical signal to a remote medical
Web server by TCP/IP packet [9-10].
DB XDATA0~
Physical Vin CS XDATA7
signal 1
RD
ADC WR XDATA8~
External I/O
A. Programming of the Embedded Circuit Board
Fig. 4 shows the software flowchart of our embedded
circuit board for the remote medical measurement system.
We use the ANSI C of our embedded platform development
environment to design the control program. This embedded
platform programming provides us with a very easy way of
writing the control program. The major functions of this
program are to collect the ECG digital data into the remote
medical server from the embedded circuit board through the
Internet. In addition, our software modules can also store the
digital ECG signal data and display the ECG on the LCD
display of the embedded circuit board, and transmit
information to the remote medical server through either the
Internet or wireless networks. During the transmission, the
embedded circuit board can select the server IP address to
locate the server computer. The basic operational steps of Fig.
4 may be briefly described as follows: (1) Load Operation
System and reset the system; (2) Start the Boa web server; (3)
Analog to Digital Conversion; (4) If Converted, finish; (5)
Store the digital data to buffer; (6) If Continue, convert; (7) If
Data buffer full; (8) Send the digital data from the socket to
Internet; (9) Send finish and wait.
Start
(1) Load OS
(2) Start the
Web Server
Sending
Conversion
(03) Conversion or

INTR XDATA15

DB
XDATA16~ sending
Physical Vin CS XDATA23
signal 2 RD
ADC WR XDATA24~
XDATA31
bank 1

INTR
nECS1
Physical
Vin
DB
CS
nOE
nWBE0 (4) ADC
Conversion
signal 3
RD
ADC WR (8) Data Buffer No
INTR Full ?
DB P0 GPIO
Physical Vin CS (5) Conversion Yes
Finish
signal 4 RD
ADC WR
INTR
ARM7 I/O No
Interface Circuit Board Embedded Circuit Board Yes (9) Send the Digital Data
from the Socket to Internet
(6) Store Data
Fig. 3. The interface circuit board and embedded circuit board IO Port Yes to Buffer
connection.
(10) Send No
Finish
IV. SOFTWARE MODULES (7) Continue
This embedded circuit board provides uClinux No Yes
development environment, which is a generous, free, and End
open source. Our software modules are separated into
embedded circuit board programming and remote medical Fig. 4. The software flowchart on the embedded circuit board for the
server programming. ECG data collecting and sending.

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The Software Flowchart of Embedded Circuit Board for the medical server, then the embedded circuit board will try to
Remote Medical Measurement System (Fig .4) connect to the medical server and transmit the digital medical
data to the remote database by the Internet. The major
(1) Load Operation System and reset the system. function of the embedded circuit board is to collect the
(2) Start the Boa web server. medical measurement signal into the remote medical
(3) Analog to Digital Conversion. information server and then our software can store the
(4) If Converted, finish. received signal in the medical database that can be displayed
(5) Store the digital data to buffer. in the server through accessing either the Internet or wireless
(6) If Continue, convert. networks.
(7) If Data buffer full. Fig. 5 shows the software flowchart of a remote medical
(8) Send the digital data from the socket to Internet. information server. First, the system creates a new form,
(9) Send finish and wait. resets the system, opens the TCP/IP port and selects the user
numbers. If the system receives the medical information data,
then it will store the data in the database and display the data
B. Boa Web server and CGI waveform in the monitor.

We use the Web server to remotely execute the CGI SATRT

program to control the embedded circuit board. Three very
important servers for an embedded system under uLinux are
(1) Create Form
httpd, thttpd and Boa [13]. Such a server is based on the and Reset
HTTP protocol (hypertext transfer protocol) and allows
access via Web browser. By using such a browser, an on-line (2) Open TCP/IP Port
maintenance or a remote configuration for an embedded
system can be implemented. A graphical user interface (GUI) (3)Select User
is often implemented with the help of a Web-server. We Number No Yes
propose an implementation of a remote Web server control
by active Web page. The Web server runs in the background No
(7)Close TCP/IP
and waits for connect attempts by clients. In our design, the (4)IF TCP/IP Port ?
Boa Web server is a single-tasking HTTP server, which is Port Get Data ?
unlike a traditional Web server. It does not fork for each (6)Display
incoming connection, nor does it fork many copies of itself to Yes Medical
Information
handle multiple connections, because the uClinux is a (5) Store Data
derivative of Linux 2.0 kernel intended for microcontrollers To Databsae
without Memory Management Units (MMUs). This OS
internally multiplexes all of the ongoing HTTP connections, Fig. 5. The software flowchart of remote medical information server
and forks only for CGI programs, which must be separate
processes. In the pursuit of speed and simplicity, some The Software Flowchart of the Remote Medical
aspects of Boa are different from the popular Web servers. In Information Server (Fig .5)
no particular order, the remote host environment variable is (1) Create a new form and reset the system.
not set for CGI programs. This is easily worked around (2) Open the TCP/IP Port.
because the IP address is provided in the remote address (3) Select User Number.
variable, so the CGI program actually gets the host by (4) Yes or no receive the medical information data.
address return or else a variant can be used. There are no (5) Storage data in the database.
server sides included in this Web server. The Boa Web server (6) Display the medical information data.
isnt like the traditional Web servers, which are too slow to (7) Yes or no close the TCP/IP Port
parse. Hence, the Boa Web server can be a much more
efficient alternative. V. EXPERIMENTAL RESULTS
C. Programming of the Remote Medical Information Server Fig. 6 and 7 show the measurement interface circuit board
and the embedded platform of our embedded remote ECG
We use the software components of a C++ software measurement system. In this design, we use some low-cost
development environment to design the Graphical User ICs to fulfil the basic functions of the electrocardiogram
Interface (GUI) in the medical server for the embedded measurement system. The embedded circuit board controls
remote ECG measurement system. This design provides us the analog to digital converter, and receives the converted
with a very easy method of learning the execution results. digital data, and sends out the digital data to the memory of
When a remote user opens the TCP/IP port and enables this

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the embedded circuit board. In the measurement interface dB by an optimum adjustment, the bandwidth of ECG signal
circuit board, the high-order low pass filter suppresses the 1~200Hz, and the power dissipation less than 500mW. In
high frequency noise. addition, due to the bandwidth limitation of the ECG signal,
with a transmission rate of 144kbps through a wireless
Body Temperature network, we have demonstrated the real time transmission of
the remote ECG signal through either a wireless or a wire
Circuit
Internet.
ECG
Analog to Circuit
Digital
Converter

Heart
Beat-Rate
Circuit

Fig. 6. The interface circuit board of the embedded remote medical

measurement system.

Fig. 8. The GUI interface of the client PCs by accessing the remote
medical server system
Body
Temperature Table I. The specification of our ECG measurement interface
circuit board

ECG Waveform Symbol Name Conditions ECG System Units

Input
Etherne RIN ~ 1012
Resistance
t ROUT
Output
~ 75
Resistance

VOUT Output Voltage RL10K 12 V

Embedded AV
Amplification
Max. 4103 V
Gain V
Circuit Board
Common-mode- Optimum
CMRR 90 dB
Fig. 7. The embedded circuit board of the embedded remote medical rejection-ratio Adjustment
measurement system. ECG Signal
BW ~ 0200 HZ
Bandwidth
The users or patients can see the ECG waveform both Total Power
PD ~ 500 mW
from the LCD display of the embedded circuit board at the Consumption
client site and from the GUI interface of the client PCs by
accessing the remote medical server system as shown in Fig. VI. CONCLUSIONS
8.
Fig. 8 shows the GUI picture of the embedded remote The special patients may need a medical measurement
ECG measurement system, which provides the basic system to monitor ones body condition even if that
functions of the medical records such as, the ECG signal individual is not in a hospital. This paper proposes a design
viewing selection, body temperature and the heart beat-rate and implementation of an embedded remote ECG
statistics. By using the Internet or wireless to browse the measurement system. In the measurement interface circuits of
medical Web page the doctor can read the patient the medical embedded remote ECG measurement system, we use some
information on the Web page from the Web server. low-cost ICs to fulfill the basic functions of the interface
Table 1 shows the specification of our ECG measurement hardware. The measurement interface circuits pick up a very
interface circuit board. We set the input resistance at more

weak ECG signal and provide amplification, isolation and
than 50M , the CMRR (common-mode-rejection-ratio) 90 noise suppression. Our design also provides a fine-tuning

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mechanism, which has a minimum error rate. In addition, the [12] Embedded Linux/Microcontroller Project, http://www.uclinux.org/
embedded circuit board provides the ECG buffering, [13] The Boa Web server homepage, http://www.boa.org/
displaying and network transmitting, which are supported by
the fully-fledged Linux development environment. The
embedded circuit board is lower in cost, smaller in size, and
lower in power consumption than a PC. The embedded circuit
board controls the analog to digital converter and through the
expansion interface inputs the digital data. We transmit this
digital medical signal to a remote medical web server by
TCP/IP packet. In addition, our software interface provides a
friendly operation, Internet network transmission modules,
and a LCD displaying module at the client site for the remote
embedded ECG measurement.

REFERENCES

[1] Al-Ali, A.R.; Al-Rousan, M.; Al-Shaikh, M. Embedded system-based

mobile patient monitoring device, 2003. Proceedings. 16th IEEE
Symposium Computer-Based Medical Systems, 26-27 June 2003, pp.
355-360.
[2] Ying-Wen Bai, Chien-Yung Cheng, Cheng-Kai Lu, Chuang-Hsiang
Huang, Yuh-Ting Chen and Ya-Nan Lin, Adjustable 60Hz Noise
Reduction and ECG Signal Amplification of a Remote
Electrocardiogram System, Proceedings of the 20th IEEE
Instrumentation and Measurement Technology Conference,
pp.197-202.
[3] Pavlopoulos, S.; Tagaris, T.; Berler, A.; Koutsouris, D. Design and
development of a Web-based hospital information system,
Engineering in Medicine and Biology Society, 1998. Proceedings of the
20th Annual International Conference of the IEEE, Volume: 3, 29
Oct.-1 Nov. 1998, pp. 1188 -1191.
[4] Belardinelii, A.; Palagi, G.; Bedini, R.; Ripoli, A.; Macellari, V.;
Franchi, D.; Advanced technology for personal biomedical signal
logging and monitoring, 1998. Proceedings of the 20th Annual
International Conference of the IEEE Engineering in Medicine and
Biology Society, Vol. 3, Nov. 1998, pp. 1295-1298.
[5] Barro, S.; Presedo, J.; Castro, D.; Fernandez-Delgado, M.; Fraga, S.;
Lama, M.; Vila, J.; Intelligent telemonitoring of critical-care patients,
IEEE Engineering in Medicine and Biology Magazine, Vol. 18 Issue: 4,
July-Aug. 1999, pp. 80-88.
[6] Ratib, O.; Dahlbom, M.; Zucek, J.M.; Kong, K.; McCoy, M.; Valentino,
D.J.; Web-based video for real-time monitoring of radiological
procedures, IEEE Transactions on Information Technology in
Biomedicine, Vol. 4 Issue: 2, June 2000, pp.108-115.
[7] Kyung-Hwan Ahn; Sung-Kwang Kim; Kwan-Pyo Hong; Ki-Jun Han;
Design and implementation of browser/server environment-based
hospital information search system (BS-HISS), TENCON 99.
Proceedings of the IEEE Region 10 Conference, Volume: 2, 15-17 Sept.
1999, pp: 1569 -1572.
[8] Ma Zhongming; Ng Nai Fatt; Medical signal transmission and
analysis based on the Internet, 4th International IEEE EMBS Special
Topic Conference on Information Technology Applications in
Biomedicine, 24-26 April 2003, pp. 74-77.
[9] Kollmann, A.; Kastner, P.; Schreier, G.; Rotman, B.; Lercher, P.;
Scherr, D.; Klein, W.; Web-based telemedical system for collaborative
pacemaker follow-up, Information Technology Applications in
Biomedicine, 2003. 4th International IEEE EMBS Special Topic
Conference on, 24-26 April 2003, pp.314-317.
[10] Gouaux, F.; Simon-Chautemps, L.; Adami, S.; Arzi, M.; Assanelli, D.;
Fayn, J.; Forlini, M.C.; Malossi, C.; Martinez, A.; Placide, J.; Ziliani,
G.L.; Rubel, P.; Smart devices for the early detection and
interpretation of cardiological syndromes, Information Technology
Applications in Biomedicine, 2003. 4th International IEEE EMBS
Special Topic Conference on, 24-26 April 2003, pp. 291-294.
[11] Embedded Linux Platform on ARM of the product development
platforms, http://www.ancher.com.tw/7525b.html

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