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Figure 1. Structure of EPI-MEDICS project.

To offset the relatively slow speed of technologys transmissions (which depends onthe quality of the transmission and the trafficintensity and may take from 30 seconds up toa few minutes), we designed an applicationsoftware running on the call center personalcomputers that displays the incominginformation as soon as received [4]. The datatransmitted by the PEM are sent in thefollowing order:

(1) alarm message indicating the reasonand the severity of the alarm;

(2) patient demographics and localization;(3) ECG that triggered the alarm

(hereafter called the last ECG);(4) the patients PHR, especially his

cardiac history and risk factors;(5) if available, the most recent baseline

ECG (also called the reference ECG);(6) clinical symptoms (if the patient or an

assisting person had the time todocument them); and

(7) the second last ECG (if available andspecified in the settings).

The coordinating physician in the ambulancecoordinating center and the cardiologist in theemergency center can display or print ondemand any received information, call back

the patient on his mobile phone, and forwardthe received ECGs and the PHR to the

relevant cardiac center for action or advice[13]. In case of a medium alarm level(suspicion of ischemia or atypical arrhythmia),all information is sent to and temporarilystored on an alarm server as show in Figure 2,that automatically sends an SMS to theattending health professional cardiologist orgeneral physician stored in the patientscontact list of the memory card. The SMSprovides information about the reason and thelevel of the alarm, the patients mobile phonenumber, the URL of the alarm server. Thestructure of hospitals monitoring centre isillustrated in Figure 2 and block diagram inFigure 9. If medium alarm scenario, the PEMsystem sends the alarm message together withthe last recorded ECG, the reference ECG, andthe patients electronic health record (EHR) to

the PEM alarm server, which in turn sends anSMS to the attending physician. The latteraccesses the alarm server that automaticallyformats the data according to the type of equipment (PC, Notepad, etc) used to connectto the alarm server and takes the appropriateactions.

WSEAS TRANSACTIONS on BIOLOGY and BIOMEDICINE S. Noimanee, T. Tankasiri, K.Siriwitayakorn, J. Tontrakoon

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Figure 2. Structure of hospitals monitoring centre.

2. System ImplementationWe have developed a portable measuringsystem that combines the heart rate, bloodpressure, body temperature, ECG and SPO 2.This system let the physician able to knowpatients scenario on the computer screen byGPS engine board as show in Figure 4. It alsoincludes emergency help function. When thepatient feels uncomfortable, he could press the

emergency help button for help and asking forthe physician prompt assistance. In the sametime, the vital signs data recorded will be sentto hospitals monitor centre in the physicianscomputer via UHF radio transmitter or GSMcellular mobile phone. In Figure 3 indicatedthe monitoring and transmission system of thevital signed data of chronic patient at homesite.

Figure 3. The structure of overall system.


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The system measures vital signs such as theheart rate, blood pressure, SPO 2, ECG andbody temperature of the patient and save themin to computer memory. Later, all the vitalsigns data will be sent to the physicians

computer at the hospitals monitor centre bycellular mobile phone. The vital signs data inthe physicians computer will be rearrangedand kept in the vital signs data files. It willbecome useful information for the physicians.

Figure 4. GPS receiver engine board for report the position of patient.

2.1 PEM StructureThe overall structure of PEM system is shownin Figure 5. The vital signs monitor is locatedat the users home and the central monitor atthe hospital. Information exchange betweenthe home user and the treating physicians isvia the cellular mobile phone network. Thehome unit consists of four components areECG detector and transmitter that is carried bythe user, a body temperature monitor, heartrate monitor, and a personal digital assistant(PDA) monitor. The vital signs detectors aredevelopment by our researcher group atChiang Mai University but the PDA monitorand GPS engine board are commercialproducts. The ECG detector used in thissystem is a three-lead wireless device, capableof transmitting ECG signals within a 1 kmradius, which is the typical apartment size inChiang Mai University. The heart rate monitorwas project from R-R intervals of ECG graphand calculated by computer software, and itstores in memory the last 10 measurements,including the time. The PEM monitor has anGPSs antenna to receive the navigation signal

from 3 satellites and send signal transmittedfrom the PEM carried by the user. There are 3input and output ports on the PEM: the inputbody temperature wire, the communicationwire for the cellular phones network, and theECG data input wire. The prototype of thePEM home monitor is illustrated in Figure 6.The data stream of this monitor in physiciancomputer screen is shown in Figure 7. Whenthe monitor receivers the vital signs signal, itfirst digitized. Then, the digitized vital signs

such as ECG data are displayed and processedby an arrhythmia analysis algorithm to searchfor abnormalities in the current ECG. The on-line arrhythmia analysis algorithm is able torecognize seven abnormalities. A set of alarmthresholds is predetermined for the individualuser. Whenever an abnormality of the ECGdata currently being analyzed exceeds thealarm threshold, the data transmission processis initiated. This transmission process includespacking the data into a specified format andinitiating the modem that transfers the datapacket via cellular phones network to thehospitals monitoring centre at the hospital.


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For heart rate monitoring, it had calculatedfrom R-R time interval and send to thehospitals monitoring centre in the same timewith body temperature. After receiving theboth heart rate data and body temperature data,

the monitor packs the data into a specifiedformat and transfers the packet to thehospitals monitoring centre. The patient canswitch the working status of the monitor via apush buttons.

Figure 5. Overall structure of PEM monitor. Figure 6. The prototype of the PEM monitor.

2.2 GPS Navigator SystemThe GPS navigator system consist of 4 pathsof electronic circuits are:

1. GPS receiver engine board.2. digital to Analog converter (DAC).

3. clock circuit for DAC4. frequency of 930 MHz Transceiver/GSM

cellular phones

Figure 7. Block diagram of GPS transmitter System


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2.2.1 GPS receiver engine boardThe GPS receiver engine board is commercialproduct. It used in this system is around 1.575GHz frequencies in super high frequency(SHF) band, (model MTI-1/D3350), capableof receiving positioning signals from 3satellites within a 1 m tolerance, which is the typical apartment size in Japan. The picture of theportable GPS receiver engine board is shown inprevious Figure 4.

2.2.3 Clock circuit for DACThe clock signal that drives the DAC produces aconsiderable amount of signal at the fundamentaland overtone frequencies. Depending on thecrystal being used, the clock frequency canoscillate range of 4MHz. This can interfere withthe sampling of higher frequencies, resulting inthe clock being coupled with the data signal.Capacitor will reduce the effect, but it will stillexist to some extent.

2.2.2 Digital to Analog converter (DAC)The output of a GPS engine board consists of digital voltage waveforms form MAX232 ICthat is RS232 standard voltage. This digita lwaveform is received by the digital-to-analogconverter (DAC) which translates it into a

sequence of analog, each representing themagnitude of the voltage at a particular instantof time. The analog signal can be eithertransmitted immediately to the host computerin the case of direct observation, or stored inthe on memory chip for analysis at a latertime.

2.2.4 Frequency of 930 MHzTransceiver/GSM cellular phonesThe structure of GPS transmitter system is shownin Figure 7. The GPS receiver engine board hasantenna to receive the position signal from thesatellite transmitted that signal to hospitals

monitoring centre. Before transmitting GPSsignal, it first digitized. Then, the digitizedposition data are converted from digital intoanalog signal carried by the PIC familymicrocontroller. And reconverted to digital forfeeding to GSM cellular phones or UHFtransmitter.

Figure 9. Block diagram of receiving system at hospitals monitor centre.

Figure 9 shows the block diagram of receiverpath at the hospitals monitoring centre. Theyconsist of UHF receiver or GSM cellularphone, 10 analog to digital converter (usedPIC family microcontroller), PCcommunication IC, and serial port of personalcomputer.

2.3 Structure of SoftwareComputer software for vital signs plottinggraphic and display position of the patient

consist of 3 paths of component are:1. receiving all vital signs data and display

on the physicians computer screen atthe hospitals monitor centre.

2. display latitude, longitude and correctedof GPS data

3. current scenario position of patientshows in map at computer screen

1. Receiving all vital signs data and displayon the physicians computer screen at thehospitals monitor centre.


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Figure 10. Algorithm receiving vital signs from hardware and display at the physicians computerscreen.

2. Display latitude, longitude and corrected of GPS data

Figure 11. Algorithm of word cutting from GPS data from GPS receiver engine board.


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3. Current scenario position of patient shows in map at computer screen

Figure 12. The algorithm of position displayed of patient in the main map and sub map

3. Result and ConclusionA generic PEM circuit has been developedwhich acquires data from a medical transducer

and transmits it locally to the home-basedsystem. To date wireless vital signsmonitoring over the cellular phone network have been implemented and a demonstrationblood pressure monitoring system will shortlybe available. Authorized users (medicalpersonnel) may remotely access this system toview and edit multiple windows that illustratecurrent data as monitor graphs, longer termmedical charts, patient care plans, currentmedication and a critical-limits file for alerts.It is also possible to provide automatic

notification of unusual changes in monitoreddata. If certain parameter trigger levels are

breached, then alert messages may be initiatedand displayed to appropriate medical staff.Because the increasing numbers of the chronicpatients, it becomes an important topic todevelop a complete system. Having PCMsystem not only let the patients physicalcondition is under control, but also candecrease the coast of taking care of thepatients. It will also give the patient family arelief. How ever, there are many kinds of long-term illness. The physical condition of the chronic patients is quite different from oneanother. Our future prospect is to inventdifferent kind of supervising systems fordifferent kinds of long-term illness patients.


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Figure 13. Volunteer patient with wirelessPEM. Figure 14 Vital signs waveform display

Figure 15 . The vital signs data stream output.

Figure 15 shows the relationship of datastream of direct measurement (upper) vital-signed and poor condition when modulatedwith transmitter (middle), and good condition(lower) on the computer screen when usingcomputer program for edited. To ease ECGsignal analysis and decision-making upgrades,we developed a multiplatform ECGprocessing software laboratory. Decisionmaking may also be researcher group by

adjusting the rule-based logic outputthresholds to the patient specificities in

function of the history of false alarms ormisdiagnoses.


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Figure 16 . Show current position of patient at monitoring centre.

Figure 17 . Map displaying of patients position

Figure 14 and 16 shows the majors map withGPS navigator on physicians computer screen

at hospitals monitoring centre (model inApplies computer for Biomedical EngineeringLaboratory at Chiang Mai University). This

system included GSM cellular phone, PEMreceiver, and desktop computer. Figure 17 and

18 shows the minors or sub-map with GPSnavigator on physicians computer screen.


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Figure 18 . Virtual map display of patients

4. CONCLUSIONThe Wireless PEM System provides a wireless

solution to the conventional method of measuring vital signs from a patient. Thesystem allows for remote monitoring of patients which provides numerous advantagesto both patients and to those whom areoperating the logging of vital sign signals. Thesystem designed by the team however doesnot fulfill the criterion of a real-time vitalsigns display. However the wireless link implemented (Physical Layer implemented bythe author) does provide a reliable and robustcommunications link to the transfer of data.

Results achieved with the system implementedpresent promising future development anddesign to obtain a completely wireless system.This research demonstrates that the finalsolution is achievable where a completelywireless PEM system would solve theinconvenience of attaching a patient to anECG machine. Benefits of such a systeminclude:

Monitoring patients from home,minimizing hospital admission

Cost More elegant system leading to a less

cluttered bedside

ECG data in digitized form can be used

as records Ease of attachment to patient . easier formedical staff (less complicatedplacement)

And giving patients the freedom to movearound, minimizing the risk of bed-bound complications.

As it can be seen, such a system would be of benefit to society, physicians and mostimportantly, the patients. After decades of development of information systems andtelemedicine applications dedicated to

hospitals and health professionals, medicalinformatics is evolving to take account of newelectronics health requirements, especially inthe domain of home care, self-care, and cybermedicine. We can imagine a near future inwhich citizens and patients will use, as in thisresearch, smart wearable technologies toproduce, transmit, or access informationanywhere and anytime and, above all, to act ashealth consumers who are responsible of theirown health. They will be able to performmedical tests at the early stage of the onset of their symptoms without involving skilledpersonnel and call for assistance only when


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needed. Additional services like the flowmanagement process of the PEM alarmmessages requests to and between healthprofessionals are also being implemented inemergency call centers or in the informaticsdepartments of several hospitals. All oursoftware components will be driven byintelligent mobile agents to facilitate theircommunication via the XML format and toupdate the databases storing the patients datawith new data collected at home or inambulatory recording conditions and forefficient data retrieval. A new era has started:electronics health will become personalized,wearable, and ubiquitous.

5. Acknowledgments

The authors thank National Electronics andComputer Technology Center (NECTEC) forhis invaluable assistance in funding my everyresearch, This work was supported byDepartment of Computer Engineering andBiomedical Engineering Center, Chiang MaiUniversity, Chiang Mai, Thailand.

6. References[1] Jerris Hedges, MD Vital Signs Chairs

Report, MS Chair, Department of Emergency Medicine, Oregon Health

Sciences University, pp. 1-8, Winter 2001.[2] Shaou-Gang Miaou* and Heng-Lin Yen

Multichannel ECG Compression UsingMultichannel Adaptive VectorQuantization, IEEE Transactions onBiomedical Engineering, Vol. 48, No. 10,pp. 1203-1207, October 2001.

[3] Hanwoo Lee and Kevin M. BuckleyECG Data Compression Using Cut andAlign Beats Approach and 2-DTransforms, IEEE Transactions onBiomedical Engineering, Vol. 46, No. 5,pp. 556-564, May 1999.

[4] Borivoje Furht and Alex Perez AnAdaptive Real-Time ECG CompressionAlgorithm with Variable Threshold,IEEEE Transactions on BiomedicalEngineering, Vol. 35, No. 6, pp. 489-494,June 1988.

[5] Kevin Hung , Member, IEEE, and Yuan-Ting Zhang , Senior Member, IEEE Implementation of a WAP-BasedTelemedicine System for Patient

Monitoring, IEEEE Transactions onBiomedical Engineering, Vol. 7, No. 2,pp. 101-107, June 2003.

[6] Vasant Padmanabhan, John L. Semmlow,Accelerometer Type Cardiac Transducerfor Detection of Low-Level HeartSounds, IEEEE Transactions onBiomedical Engineering, Vol. 40, No. 1,pp. 21-28, January 1993.

[7] J.Presedo, D.Castro, J.Vila, M.Fernandez-Delgado, S.Fraga, M.Lama,S.Barro Wireless Interface forMonitored Patients in Coronary CareUnits, Proceedings of the 22 nd AnnualEMBS international Conference, pp.1942-1945, July 23-28, 2000, Chicago IL.

[8] S.Vasudevan and K.J. Cleetus Low CostTelemedicine for Home Health Care,IEEE Concurrent Engineering ResearchCenter, West Virginia University,

Morgantown, WV, pp. 39-40, 2001.[9] KY Kong, CY Ng, K Ong Web-BasedMonitoring of Real-Time ECG Data,National University of Singapore,Singapore, pp. 189-192, 2000.

[10] Alfredo I. Hernndez, Fernando Mora,Guillermo Villegas, GianfrancoPassariello, and Guy CarraultReal-Time ECG Transmission ViaInternet for Nonclinical Applications,IEEE Transaction on InformationTechnology in Biomedicine, Vol. 5, No. 3,

pp. 253-257, September 2001.[11] Seung-Hun Park, Jung-Hyun Park, Se-

Hyun Ryu, Taegwon Jeong, Hyung-HoLee and Chu-Hwan Yim Real-timemonitoring of patients on remote sites,Proc.20th Annu. Int. Conf. IEEE EMBS ,vol. 20, no. 3, pp. 13211325, 1998.

[12] Gerassimos D. Barlas,* Member, ZEEE and Emmanuel S. Skordalakis A NovelFamily of Compression Algorithms forECG and Other Semiperiodical, One-Dimensional, Biomedical Signals, IEEETransaction on Biomedical Engineering,Vol.43 , No. 8, pp. 820-828, August 1996.

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