International Journal of Advanced Science and Technology 18 May, Vol.

18, May, 2010

A Study on U-Healthcare System for Patient Information Management over Ubiquitous Medical Sensor Networks
Randy S. Tolentino1 and Sungwon Park*2 Hannam University1 133 Ojeong-dong, Daeduk-gu, Daejeon, Korea Correspondent Author: Sungwon Park* daryn2004@yahoo.com 1, sungwon@hnu.kr*2 Abstract
The term Ubiquitous Medical Sensor Networks (UMSN) is used to describe networks of intelligent sensor nodes that could be deployed anywhere, anytime, by anyone and anything . Earlier research shows that it is highly suitable for monitoring purposes in military use and also biomedical applications. However, there isnt any flexible and robust communication infrastructure to integrate these devices into an emergency care setting. An efficient wireless communication substrate for medical devices that addresses ad hoc or fixed network formation, naming and discovery, security and authentication, as well as filtration and aggregation of vital sign data need to be studied. This research is aimed at developing a system that is able to provide continuous monitoring of patients outside the hospital environment. Keywords: Ubiquitous Medical Sensor Networks, Home-Hospital Healthcare.

1. Introduction
Todays home healthcare progression is becoming a predominant form of healthcare delivery. The management and coordination of healthcare and medicine throughout the entire range of services, from primary to tertiary care undergo fundamental changes such as more emphasis on prevention and educating users, new ways of delivering care and empowerment of individuals to manage their own health. Advances in telecommunication technology have made possible data transmission over the wireless system. This has enabled remote patient monitoring which collects disease-specific metrics from wireless biomedical devices used by patients in their homes or other settings outside of a clinical facility. Remote monitoring systems typically collect patient readings and then transmit it to a remote server for storage and later examination by the healthcare professionals. Industry has taken notice of the need for remote medical monitoring and several companies have come out with products to remotely and wirelessly monitor a patients ECG. Unfortunately, wireless transmissions have an error rate many times that of a traditional wired network. While theres a desire to decrease the one-on-one time staff has with each patient, it must do safely. A loss in medical data typical of that seen in wireless transmissions cannot be tolerated each piece of cardiac data could carry important medical information. For example, a sudden heart failure may produce an abnormal ECG signal that lasts for only

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a few seconds. The transmission error of such a segment of ECG data is disastrous to the capture of, and response to, sudden heart failure events. Based on these motivations, remote medication and accurate ECG monitoring, there have been a number of attempts to develop medical systems similar to the proposed work in this paper, but they have fallen short. While these systems monitor the dispensing of medication to patients using RFID, Sensor Technologies, etc, they still rely on the labor of medical staff. In addition, such systems employ an expensive communication infrastructure. For nursing homes that are regional areas, expensive wireless local area networks (WLAN) should be avoided. Instead, a low-cost, short-distance tele-health system is preferred. Other devices on the open market that uses sensor technologies to manage medication are not part of any network and do not allow monitoring by healthcare personnel. Finally, in the systems that wirelessly monitor a patients ECG, error recovery is not performed even though transmission errors are likely and cannot be tolerated.

2. Related Works
There are many wireless technologies that existing nowadays that are used for medical care. CodeBlue is one of the technologies that was developed by Harvard Sensor Network Lab. CodeBlue is based on a publish/subscribe model for delivery, allowing sensing nodes to publish streams of vital signs, locations, and identities and nurses can subscribe. To avoid network congestion and information overload, CodeBlue will support filtration and aggregation of events as they flow through the network. Example, physicians may specify that they should receive a full stream of data from a particular patient, but only critical changes in status for the other patients on their watch. The common practice that we have is the use of lancet to prick finger for a drop of blood in order to check the blood glucose levels. The blood sample is placed on a test strip which is analyzed manually or electronically to ascertain the glucose level. This traumatic constant pricking several times a day over a period of years can damage the tissue and blood vessels in a specific area. Over the last few years, there has been a significant increase in the number of various wearable health monitoring devices, ranging from simple pulse monitors activity and portable monitors to sophisticated and expensive implantable sensors. Systems are remain stand alone at the point of use and cannot be put for meaningful applications but the healthcare professionals. Patients may learn overtime the salient values displayed by the state of the art devices but stochastic data is lost for prudent analysis by the respective healthcare specialist. An efficient wireless communication substrate for medical devices that addresses ad hoc or fixed network formation, naming and discovery, security and authentication, as well as filtration and aggregation of vital sign data need to be studied. This research is aimed at developing a system that is able to provide continuous monitoring of patients outside the hospital environment. The potential application outcomes among others; but not limited to the ability to create valuable data to be captured and analyzed for improvement in medical research, hence; cutting the cost of medical services and saves many important lives.

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3. Methodology
3.1. Hardware Implementation ATmega644; a high-performance, low-power AVR 8-bit Microcontroller based on advance RISC Architecture. A powerful set of instructions in a single clock cycle is developed programmed in C language. It enabled the AT-Mega644 to achieve a throughput approaching 1 MIPS per MHz, hence allowing the system designer to optimize power consumption versus the processing speed. AT-Mega644 provides the 64K bytes of In-System Programmable Flash with Read-While-Write capabilities, 2K bytes EEPROM, 4K bytes SRAM, a 8-channel, 10-bit ADC with optional differential input stage with programmable gain. The Continuous Volume Corrected (CVC) technology represents the first noninvasive continuous blood pressure (NICBP) monitor with the potential of real time arterial pressure measurement in the presence of blood volume changes and motion artifact. The improvement and reliability for noninvasive blood pressure measurement afforded in using the CVC technology is striking. The CVC technology has the convenience and ease of use of an inflatable occlusive cuff type monitoring system with the added potential of being able to monitor a patients arterial pressure continuously without the limitations associated with intermittent cuff measurement. Fig. 1 shows ubiquitous sensor platform.

Figure 1. Ubiquitous Sensor Platform

3.2. System Implementation System design allows data flow as shown in Fig. 2 and proceed as follows. The primary goal is to continuously monitor the patients health, either in their home or outside. Patients are required to authenticate themselves prior to proceeding with any new medical data performance assessment as this system is designed to handle multiple user treatment capabilities. Systems will be turned on automatically as the data started streaming in real time such as information on blood pressure through the respective health monitoring system (1) and subsequently send to the hospital via the internet protocol (2). The measured bio-medical data will be transmitted via multiple complementary wireless networks,

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through the Internet, towards the appropriate Hospital Health Monitoring Center, where this data will be integrated with the permanent medical data of the given patient (3). Therefore, the medical personnel at Hospital Health Monitoring Center will be able to monitor various vital signs at any desired time granularity.

Figure 2. System Design Overview

Should the readings suggest any adverse health situations, medical instructions can be given and actions an be taken before the situations deteriorate {4}. If needed, the personnel at Hospital Health Monitoring Center can consult with the patients personal doctor, whose information is kept at Hospital Health Monitoring Database {5}. Depending on the situation, Hospital Health Monitoring Center can coordinate the immediate medical service in the closest or more appropriate local medical facility using the best transportation service available {6}. Hospital Health Monitoring Center can also coordinate a quick location discovery of the patient, in order to minimize the delays in providing the medical help, delays that in many cases make the difference between life and death.

4. Proposed System Architecture

4.1. Home-based System Should the readings suggest any adverse health situations, medical instructions can be given and actions an be taken before the situations deteriorate {4}. If needed, the personnel at Hospital Health Monitoring Center can consult with the patients personal doctor, whose information is kept at Hospital Health Monitoring Database {5}.

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Depending on the situation, Hospital Health Monitoring Center can coordinate the immediate medical service in the closest or more appropriate local medical facility using the best transportation service available {6}. Hospital Health Monitoring Center can also coordinate a quick location discovery of the patient, in order to minimize the delays in providing the medical help, delays that in many cases make the difference between life and death. Smart environments is a technological concept that, according to Mark Weiser is a physical world that is richly and invisibly interwoven with sensors, actuators, displays, and computational elements, embedded seamlessly in the everyday objects of our lives, and connected through a continuous network.

Figure 3. Complexity of Wireless Sensor Networks

The challenges in the hierarchy of: detecting the relevant quantities, monitoring and collecting the data, assessing and evaluating the information, formulating meaningful user displays, and performing decision-making and alarm functions are enormous. The information needed by smart environments is provided by Distributed Wireless Sensor Networks, which are responsible for sensing as well as for the first stages of the processing hierarchy. Fig. 3 shows complexity of wireless sensor networks. A communication network is composed of nodes, each of which has computing power and can transmit and receive messages over communication links, wireless or cabled. Ubiquitous Sensor Platform was designed using Star topologies as all nodes of the star topology are connected to a single hub node. The hub requires greater message handling, routing, and decision-making capabilities than the other nodes. If a communication link is cut, it only affects one node.

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Fully connected networks, as for large networks, the routing problem are computationally difficult even with the availability of large amounts of computing power.

Figure 4. Self-Organizing Wireless Networks with Multi-Hop Ability

Fig. 4 shows possibility of self-organizing wireless systems for mobile terminals to reach the access point (AP) of the Internet over one or - if there is no direct radio connection - over several serially used hops, whereby direct communication between terminals is also intended. Different wireless systems can be dynamically used, if their terminals are suited for this purpose. 4.2. Secure Routing of Biomedical In the ideal world, a secure routing protocol should guarantee the integrity, authenticity, and availability of messages in the presence of adversaries of arbitrary power. Every eligible receiver should receive all messages intended for it and be able to verify the integrity of every message as well as the identity of the sender. All possible attacks could be categorized into two major groups, namely internal and external attacks, based on whether the attack is being provoked by an entity that is part of the network or by an outside entity who has, somehow, gained access to the network. Protection against external attacks could be achieved by securing the data-link layer and by employing techniques such as authentication and data encryption in order to prevent the attacker from gaining access to the network. On the other hand, protection against internal attacks is more difficult to be attained, since every node that is part of the wireless sensor network is presumed to be trusted by all the others. Message encryption and node authentication can also offer some level of protection but there is also a great need for more secure routing protocols.

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Figure 5. E-Medicine Architecture

4.3. Web-Service System There are certain differences between monitoring an in hospital patient and a patient in the home. One such difference concerns the infrastructure (measuring instruments, computer networks, servers, etc.). In a hospital, secure Intranets, and firmly tested and reliable instruments are used. In the home, on the contrary, insecure computer networks (mostly Internet) have to be used. Moreover, equipment, firmly tested at the hospital, has to be re-tested and adapted in the home. Also, in the home environment, disturbing and interfering equipment cannot be controlled as in the hospital. Fig. 5 shows EMedicine Architecture Model. In order for systems to be user friendly, interoperable within different healthcare record system and information systems, a patient oriented approach is needed. Extendible markup language (XML) and web services allow more efficient business processes and also guarantee interoperability and integration with legacy systems. Simple Object Access Protocol (SOAP) allows the sender and the receiver of XML documents over the Web to support a data transfer protocol for networked communication. Decoupling approach of binary data and XML description files will be evaluated as continuous physiological monitoring produce large size of files resulting from XML. Both systems will be implemented in this project as this will establish consistent webbased healthcare monitoring systems.

5. Conclusion
The platform we designed is to present the new capabilities for both remote healthcare and real time monitoring within a healthcare premise. The combination of intelligent data processing for clinical decision making processes and subsequently alert agents and healthcare professionals alike is a step towards optimization of dynamic healthcare monitoring services tailored according to each individual user. The proposed architecture based on multiple complementary wireless communication access networks between the patient and the system, through the Internet is a powerful

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system which warrants further consideration. The biomedical data can now be generated continually by the sensor nodes platform. The proposed system can establish a distributed Health Monitoring System where each patient is connected to the Home Health Monitoring Center. The territory will be covered by a Visitor Health Monitoring Centers in a Wide Area Network. In turn, the needed coordination among the Home and Local Medical Services can quickly respond to any medical service demand in the best and secured way is, thence; resolved.

6. Acknowledgment
This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MEST) (No. 2009-0083700)

References
[1] A. Lymberis, "Progress In R&D On Wearable And Implantable Biomedical Sensors For Better Healthcare And Medicine", Proceedings of the 3rd Annual International IEEE EMBS Special Topic Conference on Microtechnologies in Medicine and Biology Kahuku, Oahu, Hawaii u 12 - 15 May 2005. [2] Loren Schwiebert,Sandeep Ks Gupta And Jennifer Weinmann, Research Challenges In Wireless Networks Of Biomedical Sensor" [3] Chris Karlof David Wagner , "Secure Routing in Wireless Sensor Networks: Attacks and Countermeasures", University of California at Berkeley. [4] http://www.pgselectronics.com/BIOMEDICAL.htm [5] XBee/XBee-PRO OEM RF Modules, Product Manual v1.xAx - 802.15.4 Protocol [6] Smart Environments: Technology, Protocols and Applications. Wiley-Interscience. ISBN 0-471-54448-5. [7] Chris Karlof David Wagner , "Secure Routing in Wireless Sensor Networks: Attacks and Countermeasures", University of California at Berkeley. [7] www.digi.com/pdf/ds_xbeemodules.pdf [8] Michal Setton, Rgis Guignier, Wael Labidi, Bluetooth Sensors For Wireless Home And Hospital Healthcare Monitoring. [9] Christopher Laua, Sean Churchillb, Janice Kima, Frederick A. Matsen IIIb, and Yongmin Kima , "Web-based Home Telemedicine System for Orthopaedics" , Proceedings of the SPIE, Medical Imaging 2001 Display Conference, vol. 4319, pp. 693-698. [10] Daniele Puccinelli and Martin Haenggi, "Wireless Sensor Networks: Applications and Challenges of Ubiquitous Sensing", Ieee Circuits And Systems Magazine.

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Authors
Randy S. Tolentino received the B.S. degree in Information Technology from the Western Visayas College of Science and Technology, Lapaz, Iloilo, Philippines, 2003. Currently, he is on the Integrated Course in Hannam University. His research interests include ubiquitous e-health care, ubiquitous medical sensor network modeling, wireless healthcare network, multimedia system, Multimedia Healthcare, SCADA security and sensor network.

Sungwon Park received the B.S., M.S. and Ph.D. degrees in Nursing from Yonsei University in 1998, 2002 and 2005 respectively. From 2006 to February 28, 2010, she was an assistant professor in the college of nursing at Hyechon University. Since March 1, 2010, he has been a professor in the Department of Nursing at Hannam University, Daejeon, Korea. Her research interests include psychiatric nursing, schizophrenia, social emotion, ubiquitous e-health care, ubiquitous medical sensor network modeling and social cognitive functions.

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