See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/261082011

A mobile application for ambulatory electrocardiographic monitoring in clinical

and domestic environments

Conference Paper · April 2013

DOI: 10.1109/PAHCE.2013.6568306

CITATIONS READS

14 101

4 authors:

Alvaro Julian Saladarriaga Jairo Pérez

Universidad Pontificia Bolivariana Universidad Pontificia Bolivariana
6 PUBLICATIONS   24 CITATIONS    12 PUBLICATIONS   27 CITATIONS   

SEE PROFILE SEE PROFILE

J.V. Restrepo John Bustamante

Universidad Pontificia Bolivariana Universidad Pontificia Bolivariana
3 PUBLICATIONS   18 CITATIONS    120 PUBLICATIONS   199 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Development of a biocomposite material View project

Implementación de un Tococardiógrafo digital en FPGA View project

All content following this page was uploaded by Jairo Pérez on 07 April 2016.

The user has requested enhancement of the downloaded file.

 3$1$0(5,&$1+($/7+&$5((;&+$1*(63$+&(&21)(5(1&(:25.6+236$1'(;+,%,76&223(5$7,21/,1.$*(6
,17(5&$0%,26'(&8,'$'20e',&23$1$0(5,&$126&21)(5(1&,$7$//(5(6<(;+,%,&,21(6&223(5$&,Ï1(1/$&(6
A mobile application for ambulatory electrocardiographic monitoring in clinical
and domestic environments
Alvaro J. Saldarriaga1, Jairo J. Pérez1, J. Restrepo1, J. Bustamante1
1
Grupo de Dinámica Cardiovascular, Universidad Pontificia Bolivariana, Medellín, Colombia
Email: juliansaldarriagarodriguez@gmail.com; Ph. (57) 4488388-12403
Abstract ––Computational power and interconnection
capacities have contributed smartphones and tablets to become
an essential tool to medical sector. Developed countries have
demonstrated that mobile devices may be considered as
equipment for tracking, monitoring, reading updating and
treatment assistance; hence, they will be portable health care
support machines. We have developed a mobile application for
ambulatory electrocardiographic monitoring based on Android
and iOS (iPhone Operating System), which contributes to
proceed with accuracy in daily activities connecting different
zones. The application, composed by buttons, switches, sliders
and rotating screens, runs under two scenarios: patient and
doctor mode, allowing medical personnel to define different
configurations. Both modes permit users to visualize in real
time captured readings and tracings. Its advantages have
increased in capabilities and decreased complexities, becoming
one of the main instruments at hospital environments. It has
been proven that such devices have better performance
through the usage of cloud computing services, low power
consumption and low number of connections. This paper aims
to stimulate medical personnel the use of capacities for mobile
devices through medical applications and guide diagnose
procedures with efficiency.
Keywords –– Smartphone, cardiac monitoring, software
application.
I. INTRODUCTION
High power computational mobile devices with the
capability of being programmed to perform different tasks
were not available in the 80’s. Different evaluation tests
were under Palm OS® system with a moderate success rate
[1]. Processors and electronics power requirements were
high enough in early 21st century and the cost of building a
powerful small device was out of reach those days.
Currently, processing machines have communications
based on serial or parallel connections as Bluetooth, Zigbee,
USB and WiFi to perform common tasks. The combination
of medical and mobile devices is rapidly evolving as a
solution for accurate low-cost physiological measurement
used in ambulatory environments. Besides, they also have
become useful and essential tools for organizing
administrative and professional information in health care
practice.
Last year, mobile platforms developed for Symbian
were exported to Android OS and iOS. Using iOS, the most
$35,/±0$<0('(//,1&2/20%,$
 
‹,(((
difficult task was connecting mobile phones through
Bluetooth® since it was protected with licensing clauses
except for Bluetooth 4.0; at that point, hardware had to be
upgraded to this new version. In fact, connecting the
application with a web database is reached since phones are
developed with the Internet as the main hub for data.
Android OS® and iOS® are well known families for
software development on smartphones. Both families started
in 2007 adopting several features from users and companies,
such as connectivity and easy usage. Also, development
tools use standard programming interfaces and syntax,
which allow developers to write software for both platforms.
In case of vital sign monitoring, patients are able to use
Android based and iOS applications to monitor their
physiological conditions and to proceed opportunely.
Healthcare applications running under real-time software are
known as soft real-time systems, in which some latency is
allowed [2]; in this case, for sampling frequencies on ECG
applications above 150 Hz, the maximum latency allowed is
6.6 ms. Data transmissions are permitted only when baud
rates are 1200 bps minimum. Identifying emergency
situations as cardiac diseases or sudden falls, a few minutes
will be suffice for saving lives considering that without them
these conditions will not be identified at all.
Technology innovators are making smartphones
increasingly capable as medical diagnostic tools. For
example, taking an electrocardiogram (ECG)
reading. Alivecor, a company which developed the new
ECG reading heart monitor, based on Apple iPhone, just got
FDA (Food and Drug Administration) approval. This is a
prime example of mobile health (mHealth) technologies and
medical devices helping seniors and patients living at home;
though it is currently approved for medical professionals
only [2].
This project aims to develop an event monitor through
the subroutines of software for Android and Apple devices
from a previous signal-capture hardware design (Kadia) [3];
thus, patients and users may use a friendly graphical
interface able to provide connectivity. We developed a
mobile application for both, iOS and Android OS, to
compare two different technologies and the possibilities of
improving patient monitoring through smart devices by
means of single chip solutions to read non-invasive
signals [4]. We are focused on displaying and analyzing
,6%1
,(((&DWDORJ1XPEHU&)3*&'5
 3$1$0(5,&$1+($/7+&$5((;&+$1*(63$+&(&21)(5(1&(:25.6+236$1'(;+,%,76&223(5$7,21/,1.$*(6
,17(5&$0%,26'(&8,'$'20e',&23$1$0(5,&$126&21)(5(1&,$7$//(5(6<(;+,%,&,21(6&223(5$&,Ï1(1/$&(6
electrical physiological activity in patients to provide a
secure platform capable of link to cloud servers.
II. METHODOLOGY
The integration between Kardia and a software platform
for smartphones was accomplished by transmitting data
through a Bluetooth 4.0 interface when using Apple
products; however, such standard it is not necessary for
Android devices since last generation mobile phones include
that compliance.
Kardia is responsible of acquiring ECG signals,
extracting QRS complex for heart rate calculation with the
Pan and Tompkins algorithm and analyzing them, to detect
arrhythmias. It uses three surface electrodes and transmits
digitalized data through a Bluetooth wireless
communication.
Kadia hardware system is intended to be used in a
variety of medical applications, including pre and in-
hospital emergency care, disaster response, and stroke
patient rehabilitation. Medical acquisition devices are
battery-powered and implemented according figure 1:
Instrumentation
Gain
amplifier
Bluetooth
Communication Digital Processing
Sources
Fig. 1. Instrumentation stages of typical medical devices
Bluetooth 4.0, is a new open standard developed by the
Bluetooth SIG. It is targeted to address the needs of new
modern wireless applications such as ultra-low power
consumption, fast connection times, reliability and
security. Bluetooth 4.0 consumes 10-20 times less power
and is able to transmit data 50 times quicker than classical
Bluetooth solutions. BLE112 module is used, a single mode
device targeted for low power sensors and accessories.
BLE112 offers all Bluetooth low energy features: radio,
stack [5], profiles and application space for customer
applications. The module also provides flexible hardware
interfaces to connect sensors, simple user interfaces or even
displaying directly to the module.
$35,/±0$<0('(//,1&2/20%,$
Google Android OS is an open source operating system,
managed by Google, specially built for mobile platforms,
hosts the ECG application and uses released SDK software
for different developments. It is based on GNU / Linux and
designed for smartphones and tablets; for data storage and
connectivity, uses SQLite, a lightweight database, and GSM
/ EDGE, IDEN, CDMA, EV-DO, UMTS, Bluetooth, Wi-Fi,
LTE and WiMax respectively. It permits applications
written in Java, to be run on Dalvik Virtual Machines
designed specifically for Android and optimized for mobile
devices running on battery with memory and processor
limitations. The SDK includes tools for memory usage,
debugging and performance analysis software. Multitasking
is available for real time applications; i.e., applications
running in foreground do not receive clock cycles. Apple's
mobile operating system (iOS) has four abstraction layers
used in this application: the core layer, "Core Services"
layer, "Media" layer, and "Cocoa Touch" layer. The user
interface iOS is based on the concept of multi-touch
manipulation by gestures needed for zooming in and out.
When running iOS, a male USB dock connector is
necessary integrated with a USB to establish connections
with Kardia work in invisible mode, see figure 2.
Low Pass
Filter
Fig. 2.Bluetooth 4.0 interface for Apple devices
III. RESULTS
The application runs under two modes: user and doctor
modes, both have different privileges over configurations
(settings). User is allowed to view and store ECG data in the
device memory. After the data is sent to the device, user or
Doctors are able to see in real time captured readings;
however, latency is present as well as communication
delays. At this point they are allowed and caused by filling
data buffers during acquisition stage. Refer to figure 3 for
the designed hardware architecture.
The graphical user interface elements consist of sliders,
switches and buttons to allow medical personnel to set
different configurations. The interaction with the operating
systems is done through gestures like swipe, tap and pinch.
Internal accelerometers and gyroscopes are enabled in
rotating function. Booth platforms were programmed under
the same software structure; patient details require to be
verified in a data base to proceed with the real time
readings, the flowchart is shown in figure 4.
 ,6%1
,(((&DWDORJ1XPEHU&)3*&'5
 3$1$0(5,&$1+($/7+&$5((;&+$1*(63$+&(&21)(5(1&(:25.6+236$1'(;+,%,76&223(5$7,21/,1.$*(6
,17(5&$0%,26'(&8,'$'20e',&23$1$0(5,&$126&21)(5(1&,$7$//(5(6<(;+,%,&,21(6&223(5$&,Ï1(1/$&(6

The application receives information (signal), ascertained by direct examination on the part of medical
processing is not supported; at that point, the main personnel.
acquisition board -Kardia- sends the values of the calculated
The application stores memory-limited records and
heart rates and amplitude-time signal. The signal is recorded
alarms to clinical personnel. ECG tracings form part of the
using surface electrodes; data is then transferred to the
application depending on the patient and his or her set of
signal processing unit. In this unit, the ECG signal is
illnesses/treatments
filtered, and converted to digital signal; thus, parameters,
such as: frequencies are calculated, which are useful for
statistical purposes.

Fig. 5. Opening interfaces and log in funtions. From left to right: Log in
Fig. 3. Communication architecture used in the development. From left to window (ID,, Password login button), details window (ID, name, device ID,
right: Kadia, mobile devices and WEB (internet and remote servers) medical history ID, gender, age, phone numbers, email) and event record
(date and time).

The algorithm in Kardia detects ECG amplitude

changes while the application displays the recordings as
shown in figure 6 for apple devices. Doctors can therefore
readily access and analyze this data to check for atrial
fibrillations, the most common type of arrhythmia (irregular
heartbeat) and other types of arrhythmias.

Fig. 4.Application flowchart

The smartphone application requires logging in to start

running, a username and a password are needed to ensure
authorized users access to the service, see figure 5. Fig. 6. Cardiac signal on Apple device

Personal details are also a requirement to fulfill As the application has rotating features, the display does
anamnesisIRU formulating a diagnosis and providing medical it with the ECG signals providing high quality tracing of the
care to the patient, in contrast with clinical signs, which are electrical activity. Such feature allows doctors to quickly
and accurately diagnose atrial fibrillation, refer to figure 7.

$35,/±0$<0('(//,1&2/20%,$  ,6%1

,(((&DWDORJ1XPEHU&)3*&'5
 3$1$0(5,&$1+($/7+&$5((;&+$1*(63$+&(&21)(5(1&(:25.6+236$1'(;+,%,76&223(5$7,21/,1.$*(6
,17(5&$0%,26'(&8,'$'20e',&23$1$0(5,&$126&21)(5(1&,$7$//(5(6<(;+,%,&,21(6&223(5$&,Ï1(1/$&(6
Fig.7. Rotated signal on Apple device
IV. DISCUSION
The arrival of smartphones and tablets to daily human
duties is a step forward from PDAs and, further back, hard
copy books and journals. Rapidly changing clinical
advances on the usage of compatible interfaces have pushed
the trend toward accessing resources via smartphones and
tablets. It is not far away the time for us to be able to carry
out our contouring in a tablet, check number of patients in a
smartphone and observe real time applications.
Medical devices will become a common information
appliance in the contemporary life by the use of Bluetooth
as a standard for peripherals. By using a Bluetooth enabled
ECG acquiring device, the smartphone can be used to record
the ECG waveform. When the users detect relevant aspects
in heart activities, they may initiate the device to start
recording.
It is not possible to predict where the new wave of
products and technology are going to disrupt. If the
resources are available is better to bet in the new ones and
simultaneously on another one. But if not, it is better to wait
and check if the technologies become enough mature.
V. CONCLUSIONS
A new portable ECG application that interfaces with
Android tablets and smartphones has been introduced. The
system uses Bluetooth to connect to Android and Apple
smartphones and tablets or computers. That feature makes it
easy for users to keep doctors informed about the health of
patients.
By using this application, Doctors are able to receive
ECG waveform from data bases in smartphones which may
lead the diagnosis to serious problems. Remote diagnosis
may be reached in real-time for medical care. By early
discovery of diseases, this may alleviate heart attacks and
cardiovascular issues. Thereby, they are now migrating to
$35,/±0$<0('(//,1&2/20%,$
View publication stats
use cloud systems to centralize the information from
patients, showing other extended capabilities including in-
built high-quality camera lenses, mobile apps that aid
productivity, video-streaming as well as connectivity that
enable millions to stay connected while diagnosis
procedures.
Applications on smartphones are universally owned among
the medical profession; the offer real opportunities to impact
the efficiency of working practices and patient care. During
this project, we detected an apparent rise in smartphone
ownership and medical application usage among medical
student and doctor groups, with similar levels of smartphone
ownership and patterns of medical applications use when
comparing these two groups. However, organizations and
developers should be mindful of negative issues surrounding
medical applications used in the clinical environment from
both clinicians and service users. Future work should focus
not only on appropriate application development but also on
the perceptions of health care professionals and users on the
use of mobile technologies in clinical areas.
Technology will change forever the way we obtain and
process medical information and the way we practice
medicine.
ACKNOWLEDGMENT
We would like to express our gratitude to the members
of Wireless Heart Arrhythmia Monitoring (WHAM) and
Monitor de Eventos Cardiacos –CARE- projects for
providing the necessary help during the phases of this
development and provide their valuable suggestions.
REFERENCES
[1] Manhattan Research Inc., “Physicians in 2012: The Outlook for
On Demand, Mobile, and Social Digital Media”, A Physician
Research Module Report ,2009 New York , USA .
[2] Ko, S. Y., Wang, K. M., Lian, W. C., and Kao, C. H. “A portable
ECG recorder”, in Consumer Electronics, Communications and
Networks (CECNet), 2012 2nd International Conference on, pp.
3063-3067, April 2012.
[3] Saddik, B., Barakah, D. M., and Aldosari, B, “A study of PDA
and Smartphone adoption rates at King Saud Medical City
Hospitals”, in Medical Information and Communication
Technology (ISMICT), 2012 6th International Symposium on,
pp. 1-3, March 2012.
[4] Kramer, K. M., Hedin, D. S., and Rolkosky, D. J, “Smartphone
based face recognition tool for the blind”, in Engineering in
Medicine and Biology Society (EMBC), 2010 Annual
International Conference of the IEEE, pp. 4538-4541, August
2010.
[5] Bluegiga Technologies. (2013). Bluetooth low energy
technology. How it works. [Online]. 20(11), pp. 11-13.
Available:www.bluegiga.com/files/bluegiga/LE%20Public/Low
Energy_HowItWorks.pdf

 ,6%1
,(((&DWDORJ1XPEHU&)3*&'5