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Background: The system composed of a wearable patch
equipped with a biomedical sensor placed on the patient skin for
Electrocardiogram (ECG) monitoring and arrhythmia detection. This patch is
connected to Hand Held Device (HHD), which received the transmission through a
Bluetooth wireless link to be analysed in it and temporary saved. Finally, the
recorded ECG will be transmitted to the healthcare provider on the other end
who is tracking the patient’s cardiac rhythm disorders whenever abnormal ECG is
detected and will be alerted in order to follow up with the patient
accordingly.
Method: The wearable ECG system functions by placing
a small patch with biosensor into the patient's skin, this sensor is equipped
with two electrical points that have the automatic capability of detecting any
arrhythmia as an ECG signal and transmits it to the HHD wirelessly via
Bluetooth. Using a wireless Internet as well as the DSL connection, The HHD
sends the received recorded transmission with an alert to the healthcare server
for storing and analyzing the signals. The physician can access the patient ECG
recorded via a client-server web application system in the healthcare center.
The physician will diagnose and evaluate the situation regarding the patient's
condition for taking the necessary actions.
Results: Several previous types of research that
employed the wireless ECG approach had proven that the use of the biomedical
sensor system is soothing and useful. Our proposed system if worked as planned
will benefit the patient with the cardiovascular disorder.
Conclusion: The system discussed in this paper
demonstrates a practical approach, which allows the patients who are wearing
wireless ECG devices to enjoy their daily activities without feeling its
presence. Patients will appreciate a protection sensation at the same time and
increased the level of confidence via this technique, which helps to minimize
the risk of having a heart attack by early detecting it.
Keywords: Home monitoring, Wireless ECG patch, Body
sensor, Long-term monitoring, ECG, Tele-home
INTRODUCTION
Wearable Health Monitoring Systems (WHMS)
capability enabled healthcare providers to change the way healthcare services
delivered. Monitoring patients in their personal environment improve patient
life quality. It helps to concentrate on the early detection of health issues
before it is even happening and contributed in avoiding unnecessary
hospitalizations. And for that, Hence, WHMS became favorable among researchers
and in the health industry during the last years [1]. WHMS allow patients to
maintain and monitor their health conditions and get instant help from their
healthcare providers using affordable technologies.
According to the World Health Organization
report released in 2017, cardiovascular disease (CVD) is associated with
substantial morbidity. It becomes the reason for 45% of all Non-communicable
diseases (NCD)
Healthcare providers are fully aware of the
necessity of monitoring patient with cardiac arrhythmias. Since the 80s,
stakeholders in the healthcare domain were enthusiastic to adopt new technology
that facilitates the 24 h electrocardiographic (ECG) monitoring process, which
was achieved with the (Holter) monitor at that time, regardless of its
limitations.
However, with the technological evolution and
advancement in the IT and medical field domain have made it possible to
overcome the challenges with the traditional Holter recorders which improved
the quality of life and healthcare services. Suave Lobodzinski and Laks [4] had
discussed an updated generation of the cardiac arrhythmias monitoring using a
wearable long-term 14 day patch attached on the patient skin for ECG monitoring
providing maximum convenience with the mobility of the patient due to its
wireless communication ability.
Lin et al. [5] provided a novel system that
can be used for inpatients, outpatients as well as monitoring normal people.
They used a three-lead wireless ECG device, a Java-based expert system
application and a web-based monitoring platform to meet these objectives and
detect the atrial fibrillation (AF), the most common cardiac arrhythmia with
average accuracy, sensitivity and positive predictive performance were 94%,
94.56% and 99.39%.
Senatore et al. [6] investigated the uses of
the transtelephonic (TT) electrocardiographic (ECG) monitoring and compared it
with the standard ECG and 24 h Holter recording to detect the incidence of asymptomatic
recurrences of atrial fibrillation (AF). They recruited seventy-two of 97
patients who underwent catheter ablation of AF. The researchers succeeded in
proofing that long-term TT ECG is better than standard ECG and 24 h Holter
recordings in evaluating AF relapses after RCA which results in changing the
short-term success of ablation from 86% to 72%.
Piorkowski et al. [7] were interested in
doing a comparison between TT ECG every two days and serial 7 day Holter as two
methods of follow-up after atrial fibrillation (AF) catheter ablation for the
judgment of ablation success. TT ECG and serial 7 day Holter were equally
effective to objectively determine long-term success and to detect asymptomatic
patients with the success rate for AF was 70%. Regarding the serial 7 day
Holter it decreased to 50% and on transtelephonic monitoring to 45%. The
purpose of this paper is to provide maximum suitability to the patient during
ECG monitoring in their personal environment, especially for prolonged uses.
The proposed system also provokes an emergency alarming system when abnormal
ECG is detected. This system will be considered as a pilot test for patients
living in Saudi Arabia, Riyadh especially for the areas with STC DSL coverage
[8].
PROPOSED METHODOLOGY
The wearable ECG system functions by placing
a small patch with biosensor into the patient's skin, this sensor is equipped
with two electrical points that have the automatic capability of detecting any
arrhythmia as an ECG signal and transmits it to the HHD wirelessly via
Bluetooth. Using a wireless Internet as well as the DSL connection, HHD sends
the received recorded transmission with an alert to the healthcare server for
storing and analyzing the signals. The physician can access the patient ECG
recorded via a client-server web application system in the healthcare center.
The physician will diagnose and evaluate the situation regarding the patient's
condition for taking the necessary actions (Figure
1).
System configuration
and the alternative solutions
·
The sensor is placed on the patient’ using patch that connects to the
HHD via Bluetooth and transmit the signals. This approach allows the patient to
be mobile.
·
HHD is connected to the internet using STC DSL modem as a primary link.
It transmits the ECG signal and the alarm in almost real time. In case of any
issue with the STC DSL network, STC 4G connections can be used as an
alternative link.
·
DSL approach supported by Moron et al., 2012 study [3].
·
4G approaches are supported by Suave Lobodzinski and Laks, 2012 study
[11].
·
The transmitted data is stored in the healthcare provider server. The
physician accesses the ECG records on the server using a web-application
interface. Physician PC is then connected to hospital network using a
client-server wired local area network LAN with copper cables such as CAT6 as a
medium laid out in two types of topology (Star-Mesh) to make sure that this
computer will not lose access and the wire won’t be affected by electrical interference.
This topology is supported by this study [9].
·
TCP/IP is used as the protocol.
·
The patient can access a private cloud version of the application to
check the data. In case of non-function, they might contact the hospital to
check the data or an email request or text [10,11].
As innovation advancement from our side, and
in order to assure that the patients HHD will be able to send the single
everywhere in their home, we suggest employing this technique with access
points. This will help with overcoming the potential of losing the singles
while the patient leveling up to different floors due to concrete walls. These
access points were then connected to the main DSL modem using wire from the
ground floor of the patients’ homes to assure having the same speed of the
configured modem.
In this approach, we are using the following
architecture tools and equipment:
Patients home
·
DSL modem
·
Access point for each floor, in our example we assume
to use two of them
·
Biomedical wearable sensor placed on patch
·
HHD
·
PC to view and monitor the patient’s collected details
using a web-based interface of the application
Healthcare provider
environment
·
Server to store the transmitted signals and install
the application, which allowed the physician and the patient to view the data.
Also, the data will be backed up on other server and will be switch to in case
of any issue happening to the primary one.
·
LAN network
·
PC to view and monitor the patient collected details
EXPECTED RESULTS
Several previous types of research that employed
the wireless ECG approach proven the use of the biomedical sensor system which
is soothing and useful. Our proposed system if worked as planned will benefit
the patient with the cardiovascular disorder. It will have the following
functionalities:
·
Wireless: All type
of communications between the patient and the HHD, and the HHD with the DSL
modem is performed wirelessly, (Bluetooth/DSL as a primary link or 4G as an
alternative link) which offers the patients with more flexibility.
·
Mobility: The ECG
patch is small, light and can operate for an acceptable period.
·
Timely manner: Near real-time ECG signals are transmitted in seconds, which make it
competent. However, with the use of DSL and the small size of the collected
data, in our case text this may make it in real-time.
·
Alerting mechanism: It is used for detecting abnormal ECG signals which alerts the patients
and the healthcare providers.
To
calculate the approximate time taken to send these data, we used the below
formula assuming that that the text file size will be around 500 Kb; and the
data rate of STC DSL modem connection is minimum as 200 Kbps.
Time taken = file
size / data rate
Time taken = 500 *
1024 byte / 200,000 = 2.56 s
*This
result only an estimate, there will be an added latency time.
DISCUSSION
As per the system configuration previously
mentioned, this paper described a wearable ECG system with almost near
real-time monitoring and alarming functionalities. The data collected from the
wearable ECG system should be kept private. Moreover, during transmission the
data should be encrypted to assure its security and the patient
confidentiality. The system gives reliable recordings of medical data as
following: First of all, a wave signal sent from the sensor to the HHD device
via Bluetooth. Then this wave was converted in the HHD using specific
algorithms to be in text format and sent to the server located at the hospital
through DSL modem with speed up to 200 kbps and a maximum size up to 500 Kb.
Since the patients will be moving around
their home sand to assure the maximum coverage, the configured AP in each floor
will maintain the connectivity and strengthen the signal using the same data
rate of the DSL modem. This will allow the physician on the other end to access
the recoded data of the patient on the server via the hospital LAN and
interfere immediately.
This interference of the physician is highly
important, there will be a backup server used as a mirror for the primary one
in case any thing happened and to avoid the single point of failure of the
primary server. However, if the patients were not able to view the application
interface this will not be an issue, since viewing the data is not vital for
the patients and they can contact the healthcare provider using the phone and
inquiry about any details.
As a general recommendation for enhancing the
connection and improving the quality of this technique, the patients at their
homes needs to pay attention to the surrounding noise that may interfere with
the signals like the use of microwaves. Also, they should focus on the
availability of mirrors and other furniture or objects that might scatter or
sometimes completely prevent the wireless signals. Finally, it would be
advisable if they can select different frequency range to be used than the one
used with their neighbors to avoid the frequency interference. And not to
forget the environmental factors like weather conditions, which can affect the
liability of the signals and connection.
At the end, the healthcare provider should
make sure to test the sensor from time to time and create a maintenance
schedule to examine it or replace it if needed. This will help to avoid any
malfunction that might be caused during the use.
CONCLUSION AND FUTURE WORK
In the last few years, many potentials of
employing technology were witnessed to enhance the healthcare quality, which result
in increasing the patient satisfaction. One of them is the achievement made in
developing contactless, mobile ECG sensors. This technique was widely accepted
due to its small size, low power consumption and wireless communication
functionality.
In conclusion, the system discussed in this
paper demonstrates a practical approach, which allows the patients who wear
wireless ECG devices to enjoy their daily activities without feeling its
presence. Patients will appreciate a protection sensation at the same time and
increase the level of confidence via this technique, which helps to minimize
the risk of having a heart attack by early detecting it [9]. However, proper
clinical trials are required to verify our hypothesis, it therefore seems
reasonable to assume that our ECG-monitoring system will be able to, reliably,
detect the occurrences of cardiac arrhythmias and thus contribute in
facilitating the healthcare provider’ job to able to make correct diagnosis
even under situations where the patient is not hospitalized.
The current technological developments in
this field can be employed for future improvements specially to enhance both
hardware and software designs, which can be useful to obtain more efficiency
and accuracy results. Moreover, future models of this system can be utilized to
cover different areas of Saudi Arabia.
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