Med Biol Eng Comput (2013) 51:485–495
DOI 10.1007/s11517-012-1021-6
REVIEW ARTICLE
A comprehensive survey of wearable and wireless ECG
monitoring systems for older adults
Mirza Mansoor Baig • Hamid Gholamhosseini •
Martin J. Connolly
Received: 31 October 2012 / Accepted: 17 December 2012 / Published online: 19 January 2013
 International Federation for Medical and Biological Engineering 2013
Abstract Wearable health monitoring is an emerging
technology for continuous monitoring of vital signs
including the electrocardiogram (ECG). This signal is
widely adopted to diagnose and assess major health risks
and chronic cardiac diseases. This paper focuses on
reviewing wearable ECG monitoring systems in the form
of wireless, mobile and remote technologies related to
older adults. Furthermore, the efficiency, user acceptabil-
ity, strategies and recommendations on improving current
ECG monitoring systems with an overview of the design
and modelling are presented. In this paper, over 120 ECG
monitoring systems were reviewed and classified into smart
wearable, wireless, mobile ECG monitoring systems with
related signal processing algorithms. The results of the
review suggest that most research in wearable ECG mon-
itoring systems focus on the older adults and this tech-
nology has been adopted in aged care facilitates. Moreover,
it is shown that how mobile telemedicine systems have
evolved and how advances in wearable wireless textile-
based systems could ensure better quality of healthcare
delivery. The main drawbacks of deployed ECG monitor-
ing systems including imposed limitations on patients,
M. M. Baig (&)
H. Gholamhosseini
Department of Electrical and Electronics Engineering,
School of Engineering Auckland University of Technology,
Private Bag 92006, Auckland 1142, New Zealand
e-mail: mirza.baig@aut.ac.nz
H. Gholamhosseini
e-mail: hgholamh@aut.ac.nz
M. J. Connolly
Freemasons’ Professor of Geriatric Medicine,
University of Auckland, North Shore Hospital, Takapuna,
Auckland, New Zealand
e-mail: martin.connolly@waitematadhb.govt.nz
short battery life, lack of user acceptability and medical
professional’s feedback, and lack of security and privacy of
essential data have been also discussed.
Keywords Wearable monitoring systems
Wireless ECG
monitoring systems
ECG tele-health care
Mobile
monitoring systems
Expert ECG systems
1 Introduction
Today, researchers and engineers employ advanced con-
cepts and techniques from the field of electrical engineer-
ing, computer science, biomedical engineering and
medicine to collect ECG signal via smart and advanced
monitoring systems using wearable technology. Electro-
cardiogram (ECG) is a diagnostic tool that measures and
records the electrical activity of the heart in detail. Inter-
pretation of these details enables the diagnosis of a wide
range of heart conditions from minor to life threatening.
Wearable monitoring systems involve the use of emerging
and advanced communication techniques to collect and
deliver biomedical signals over long distance. Biomedical
information is transmitted using wired or wireless com-
munication to remote or mobile devices for processing and
monitoring anywhere at any time. The combination of
wearable technology, wireless sensor network, complex
computing and artificial intelligence research produce
novel methods resulting in better health care services.
An objective of this review paper is to focus on moni-
toring systems for older adults and therefore, the majority of
the studies reviewed are related to this group. For the past
two decades, the rapid increase in the older adult population
(65?) has proved to be a major challenge in health care
worldwide and thus, is the main motivation for selecting
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this particular age group. The number of patients now
requiring continuous monitoring has raised proportionally
with this increase in population and, by 2025, this group
will number approximately 1.2 billion. By 2050, there will
be 2 billion of this age group, with 80 % in developing
countries [98]. Moreover, in developed countries the older
adult will constitute nearly 20 % of the overall population
according to the population reference bureau [47]. In 2006,
in the UK, the 75? age group accounted for 41 % of the
population of state pensionable age. However, by 2056,
with the increase in the age for state pension entitlement,
this group will account for 67 % of the pensionable popu-
lation [36]. In June 2010, there were 3.01 million people
aged 65? in Australia [6] and, in New Zealand, by 2031,
one in five New Zealanders will be aged 65?, compared to
one in eight in 2009. It is projected that the proportion of
older adults aged 65?, in New Zealand will increase from
approximately 13.5 % in 2011 to 22.3 % by 2031 and
26.3 % by 2051, respectively [82].
The most common health concern for this group of older
adults is chronic heart failure which is one of the major
causes of mortality, hospitalisation, and overall healthcare-
related cost. Most of health guidelines/practice suggest
ECG signal to be monitored and analysed at the initial
stage of health assessment [54]. Hence, ECG monitoring is
a critical and an essential part of healthcare delivery for
older adults. This paper reviews ECG monitoring of
patients in hospital, home and remote areas using wireless
and/or continues mobile monitoring.
1.1 Previous ECG monitoring system reviews
In this paper, we intend to review the current technology in
the field of wearable ECG monitoring systems with a
summary of current and future challenges. The idea is to
carry forward the review done; in 1970s related to the
mathematical, physical and engineering aspects of ECG
and magnetocardiography by McFee and Baule [61], the
accuracy of a continuous real-time ECG monitoring system
was determined by Frank et al. [103] and an automated
system for ECG monitoring was developed by Nygards and
Hulting [65]. In 1980s, a review of computer-based sys-
tems for the analysis of ambulatory ECG recordings was
reported by Pahlm and Sornmo [69], a historical review of
diagnostics problem solving by computer, from its incep-
tion in the 1950s, was presented by Benjamin [48] as well
as syntactic ECG processing by Skordalakis [81]. A brief
review of the problems pertinent to signal processing of
ECG analysis was carried out by Pahlm and Sornmo [68].
In 1990s, a review of ECG enhancing techniques to elim-
inate noise problems and the comparison of their perfor-
mance on stress ECG signals under adverse noise
conditions was presented by Afonso et al. [2]. In the past
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Med Biol Eng Comput (2013) 51:485–495
Fig. 1 Overview of five-layered smart wearable monitoring system,
where PAN represents personal area network, BAN body area
network, LAN local area network, WAN wide area network and
MAN metropolitan area network
decade, research in the development and implementation
through innovative technology as well as a critical review
of knowledge-based approaches to ECG pattern interpre-
tation [49], reviewed wearable monitoring systems in smart
homes [16], comprehensive surveys and reviews of wire-
less body area networks [93], wireless sensor networks for
healthcare [4] and mobile telemedicine [55] was also
reported. The review of the ECG signal collection, analy-
sis, technologies used, limitations and future recommen-
dations from 2000 to 2007 can be found in [1, 25, 71] and
therefore in this paper we have reviewed related literature
from 2008 to 2011.
A definition of the terminology associated with this
advanced technology is necessary to understand these
state-of-the-art devices and systems which are now domi-
nating and revolutionising wearable monitoring systems
(WMS). In this context, WMS refers to the textile-based
smart systems which monitor, collect or process ECG data
on a wearable garment. Wireless sensor area network
(WSAN), wireless body area network (WBAN), wireless
sensor network (WSN), body area network (BAN) and
personal area network (PAN) are terms for wireless
wearable tele-health monitoring systems for the collection
of vital data from patients by attaching sensors directly to
the body or via a garment (e-textile). Figure 1 shows the
overview of the wearable systems in a five-layered struc-
ture. This model has been developed after studying the
design concept of wearable monitoring systems and the
papers reviewed in the next section represent similar
architectural model and design concepts.
2 Smart wearable ECG monitoring systems
Current trends in wireless ECG monitoring systems
have produced an innovative and versatile approach to
Med Biol Eng Comput (2013) 51:485–495
wearable textile-based monitoring systems. ECG data
have been collated using smart shirts [52] and/or T-shirts
[11]. One of the most important modules of smart wear-
able monitoring technology is wearable biomedical sen-
sors which are attached directly to the patient or to
electrode-embedded wearable garment. Wireless sensors,
in particular, which measure vital parameters, are one of
the fast emerging devices for improving quality of care
whilst reducing costs. LOBIN [58] is a combination of
e-textile and WSN integrated into a smart shirt for ECG
monitoring. A similar wearable ECG data acquisition
system using planar-fashionable circuit board technology
has been developed for a long period (24 h) monitoring
[104]. For measurement of respiratory rate (RR) as well as
ECG, a T-shirt-based wearable system has been developed
[42]. Mobile personal trainer (MOPET) is a wearable
system that supervises a physical fitness activity for better
training and motivating users [15]. BIOTEX, a biosensing
textile sensor, measures physiological parameters and the
chemical composition of body fluids, in particular, sweat.
This system includes sensors for detecting sodium, con-
ductivity, and pH [24].
Blue Box [72] is a novel hand-held device capable of
collecting and wirelessly transmitting key cardiac param-
eters of ECG, photoplethysmography and bio-impedance.
It also measures RR interval and QRS duration, heart rate
(HR) and systolic time intervals, and assesses their values
in correlation with cardiac output measured by an echo-
doppler. Yoon et al. [92] measured the degree of skin
hydration by finding the optimal condition between three
textile electrodes and skin. A commercially available
biofeedback device was designed to enhance heart rate
variability, called StressEraserTM [35]. An e-chair was
proposed to measure physiological signals including blood
pressure, body temperature, HR, height, weight and body
fat percentage by installing these data measurement
modules into a chair which can display the measuring
results and perform simple diagnoses in real time [18].
A similar system was developed using wearable belt for
wireless health monitoring and particularly those patients
staying at home [77]. A smart vest [70] is a wearable
physiological monitoring system, incorporated in a vest
which uses a variety of sensors integrated into the gar-
ment’s fabric to simultaneously collect certain bio-signals
in a non-invasive and unobtrusive way. Furthermore, it is
stated that the ECG can be recorded without the use of a
gel and is free from baseline noise and motion artefacts
due to hardware-implemented high pass, low pass, and
notch filters. In a similar approach towards the remote
monitoring of vital signs, a combination of WBAN and
personal digital assistant (PDA) has been developed,
called MEMSWear [89].
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2.1 Critical analysis
Apart from the advanced technology, LOBIN [58] and
MOPET [15] face the most common challenge of ECG
signal quality and electrodes drying out. In addressing the
issue of electrodes drying out, a textile-integrated active
electrode as opposed to a commercial wet Ag/AgCl elec-
trode has also been developed and tested with the signal
integrity during a five-cycle washing test [62]. Blue Box
[72], an e-chair [18] and wearable belt [77] type of systems
are advancement in the present state of the art e-health
technologies, monitoring vital signs with high real-time
accuracy, such applications addressed some of the common
issues of this technology. In the real-time scenario, vital
data transmission often had some data processing and
network delays. Some of the systems [43, 86] are actually
produced good results when tested offline, and reported
delays when tested in real-time. Table 1 shows the selected
monitoring systems and summarises different scenarios.
From Table 1, it can be concluded that advanced textile/
garment-based ECG monitoring systems are not only
cheap, low in cost but also get high acceptance from
medical professional and patients.
3 Wireless and mobile ECG monitoring systems
Wireless body area network (WBAN) is the essential part
of the wireless ECG monitoring system. A WBAN allows
the integration of intelligent systems, miniaturized com-
ponents, low-power sensor nodes attached to body for
monitoring physiological activities. ECG data collection
has advanced to the extend where several studies have
successfully investigated contactless [106] and leadless
ECG monitoring [78]. Concerns around the adverse effect
of electrodes on the human body are also addressed [97]
with recommendations for the best electrode locations [73].
In recognition of obstructive sleep apnoea, a low-cost, real-
time monitoring system MedAssist has been developed
[14]. Using shimmer WSBN mote, a low complexity
energy-efficient ECG compression has been developed for
compressed sensing, signal acquisition and compression
[60]. Continuous and real-time monitoring and recording of
a patient’s ECG signals have been developed using Holter-
based portable ECG monitoring system as well as two
smart phones for cardiovascular diagnosis [66]. The issue
of accuracy and power has been solved to some extend
using lightweight, power-saving and RFID-based wireless
or USB ECG devices [22], but still there is a constant threat
of data security [23].
Several mobile phone-based ECG feature detection
systems based on wavelet transform were developed [46]
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Table 1 Selected wearable monitoring systems

Reference Platform Sensor/size Modules Implementation Cost Acceptance

LOBIN [58] WSN/PAN Shirt WSNM Hospital/tested Low High

Yoo et al. [104] P-FCB/WSAN Shirt Wearable/mobile Remote/trial Low High
Merritt [62] Electrodes Fabric/textile Wearable Tested Medium High
MagIC [28] WSAN Garment Wearable Trial Low High
BIOTEX [24] PAN/sensors Textile Wearable sensors Simulation trial N/A N/A
BLUEBOX [72] Remote Hand held device Monitoring Remote/trial High Low
e-Caring Chair [18] Remote/LAN Chair Vital signs Trial High Low
Smart Vest [70] Remote e-Textile (shirt) Monitoring Simulation Low High
MEMSWear [89] WBAN Sensor nodes Vital signs Prototype N/A N/A
WSN wireless sensor network, PAN personal area network, WSNM wireless sensor network monitoring, P-FCB Planar-fashionable circuit board,
WSAN wireless sensor area network, WBAN wireless body area network

including a BSN-based context aware QRS detection [96],
an image-guided ECG signal detection [8] and an e-tech-
nology in a unified DICOM format [40]. Such systems
which are completely mobile-based are offering advance-
ment in the technology and processing capacity in a mobile
environment. A new physiological multi-parameter remote
monitoring system based on the browser/server model has
been developed. The system consists of a server monitoring
centre, internet network and PC-based multi-parameter
monitors on the world-wide-web, using MMS (multimedia
messaging service), GPRS (general packet radio service)
and global positioning system (GPS) to transfer ECG data
acquired and stored in the Holter monitor via the Internet.
Medical-embedded device for individualised care
(MEDIC) was developed [99] based on an innovative
software architecture for enabling sensor management and
disease prediction using conventional personal digital
assistant (PDA) or a cell phone [99]. HeartSaver, a mobile
medical device, was developed [76] for real-time ECG
monitoring and automatic detection of several cardiac
pathologies. This is an Android mobile-based application
software that sends a text message related to the patient’s
condition and location to a physician. An attachable ECG
sensor adhesive bandage was implemented for continuous
ECG monitoring system using Planar-Fashionable Circuit
Board technology. It uses a low cost sensor chip which is
bonded on fabric, wirelessly powered for safety, dry elec-
trodes for less skin irritation and suitable for long-term
monitoring [105]. Wireless ECG monitoring using low data
rate ultra wideband transmission was also developed. It is
currently under consideration for a newly formed WBAN
group (IEEE802.15.6) to develop a standard for wireless
vital sign monitoring [37].
Table 2 shows mobile/wireless ECG monitoring sys-
tems which clearly indicates that system stability is high
when implemented on PC or PDA and usually it is low for
smartphones. However, smartphones cost low when
compared with PC or PDA. Time delay is also observed
using smart/mobile phones when compared with PC.
Figure 2 shows the wireless/mobile-based architecture
of a wearable system. Most of the reviewed systems in this
section represent similar design in communication and
transferring patient’s important physiological data and in
this case an ECG signal. Common telemedicine network
mesh consists of patient, physician and caregiver or nurse
or emergency response unit, local station for data pro-
cessing either locally or remotely, analysis and storage.
Usually communication will be carried out wired or wire-
less using mobile data or internet.
3.1 Critical analysis
Mobile tele-monitoring is considered as one of the best
ways to have the vital signs from the remote/mobile loca-
tion, apart from the advantages there are some drawbacks
of this fast emerging technology. The most common issues
with mobile-based systems are delay in providing the
results, alerts due to data loss or buffering delay, network
delay, monitoring delay or processing delay [29]. These
systems were mainly developed for a specific setup (home
or hospital), fixed place or small area to assist patients’
specific need but majority of such systems lack the self-
learning capability [30]. Mobile monitoring systems using
3G data suffer the connectivity, signal strength, low battery
life time, transmission speed; thus, result in delays or low
quality data for short time or high data transmission cost.
Next section will provide an insight of the latest ECG
signal processing, algorithms and software tools used for
better monitoring and diagnosing.
Wireless- and mobile-based monitoring systems often
create data security and low battery life issues. To address
data security problem, a cross-layer framework has been
developed based on unequal resource allocation to support
secure wireless ECG data encryption and transmission

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Table 2 Selected wireless/mobile-based systems

Title or Author HW/SW Modules Medical application Implementation System stability Cost

MedAssist [14] SVM Smartphone Sleep apnoea Simulation N/A Low

MEDIC [99] WSN PDA Individual care Home/RT High High
HeartSaver [76] Microcontroller Mobile Cardiac diagnosis Simulation N/A Low
Oresko et al. [66] LabView/Matlab Real-time Cardio vascular disease Simulation N/A High
Dilmaghani et al. [29] SimpliciTI Remote Chronic Diseases Home/Protocol High High
Dong-Her et al. [30] RFID Mobile Elderly Monitoring Home/Trail Medium Low
Tan et al. [88] Linux based Portable Signal measurement Simulation N/A High
Hsieh et al. [40] XML Mobile ECG and image Hospital/trial Medium Low
Bansal et al. [7] Matlab PC/wireless Digital processing and monitoring Real-time High High
Simulations are N/A due to high stability when compared with real-time testing
SVM support vector model, WSN wireless sensor network, PDA personal digital assistant, RT real-time, RFID radio frequency identification,
XML extensible markup language

Innovative methods for improving ECG signal processing

Fig. 2 Communication networking of wireless/mobile wearable
systems
[39]. The low battery life issue occurs due to continuous
connectivity of smart phones with Bluetooth, WiFi or 3G
systems using OS platform for network connectivity.
Moreover, if the power supply is not an issue then the
mobility of the device will become problematic.
4 ECG signal processing software and algorithms
Computerised ECG signal processing and analysis play a
significant role in wearable and wireless monitoring sys-
tems. However, there needs to be improvement of the
diagnostic of such systems to reduce false alarms and
afford extended continuous monitoring. One of the major
concerns related to these wireless systems is power con-
sumption. Battery-powered portable wireless devices can
be designed to perform most of the signal processing
locally and transmit results remotely but transmission, in
itself, normally consumes more power than processing.
have been developed [13]. Most wireless communications
between a fixed base station and mobile stations take place
within a certain coverage area with an acceptable signal-to-
noise ratio. By reducing the implementation complexities
of the mobile stations receiver, the power consumption in a
mobile terminal can also be decreased. However, this
reduction often conflicts with lowering the signal-to-noise
ratio threshold value. Furthermore, the receiving mobile
station (physician’s mobile) should follow standard medi-
cal protocols for diagnosis accuracy. In the following
section, algorithms and software related to ECG signal
processing are discussed [9].
A novel, unbiased and normalised adaptive noise
reduction system to suppress random noise in ECG signals
has been designed. This system includes two-stage mov-
ing-average filter, an infinite impulse response comb filter,
an additive white noise generator to test the system’s per-
formance in terms of signal-to-noise ratio [100], low cost
online acquisition of ECG signal using Matlab and Lab-
View and time-plane feature extraction from digitized ECG
samples using a statistical approach [19]. A mobile-based
ECG detection and analysis algorithm [63], ARTiiFACT, a
software tool for processing ECG data [45], ECG signal
processing and digital filtering on 8-bit microcontroller
[80] and a mean shift-based self-adaptive model [102] are
some of the latest systems developed for ECG signal
classification and analysis.
4.1 ECG signal compression and enhancement
An ECG signal processing method using quad level vector
consisting of compression and classification flow has been
designed. This software enables for both flows to achieve
better performance with a lower computation complexity.

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The compression algorithm is performed using ECGskeleton
and Huffman coding [41]. Five levels of discrete wavelet
transform were applied to decompose the signal into six sub-
band components from higher order statistics [107]. A new
wavelet-based ECG compression algorithm has been
developed where each signal frame was first transformed by
a DWT and then, the transform coefficients were quantised
with a uniform scalar dead-zone quantiser [21]. ECG com-
pression techniques, using wavelet packets and an embedded
zero tree wavelet [12] as well as a novel system-on-chip
using CMOS technology for ECG signal compression, have
been developed [94] for ECG signal compression for faster
processing and transmission.
Annotated ECG data are publicly accessible to support
research through different resources such as Physionet data
bank (http://www.physionet.org). It offers ECG data from
Medicalgorithmics which have successfully developed an
innovative solution PocketECG as one of the leading
mobile arrhythmia diagnostic technology (http://www.
medicalgorithmics.com/). Various methods and tech-
niques have successfully been adopted for ECG signal
enhancement using adaptive Kalman filtering [95], non-
linear Bayesian filtering [67], adaptive filtering [74], dis-
crete Fourier transform (DFT) [75] and wavelet transform
[27] which resulted in high accuracy and reliable outcomes.
Among other techniques used includes artificial neural
networks [5], Lyapunov exponents [91], fuzzy wavelet and
fuzzy c-means clustering [86], self-organising maps [33]
and independent component analysis [59].
Table 3 shows the selected algorithms or software-based
wearable ECG monitoring systems and shows the real-time
data transfer with accurate results when using PC or
PC-based applications such as Matlab and LabView com-
pared to mobile/smart phone based applications.
4.2 Critical analysis
Advanced signal processing algorithms for faster process-
ing, low power consumption, low cost and less complexity
have been developed. Such algorithms are often tested by
simulation or under fixed conditions. Implementation of
these algorithms in the wearable, remote or mobile moni-
toring environment led to poor results due to an increase in
processing time and delays. A medical grade remote
monitoring system with a reliability exceeding 99 % has
been developed but a 2.4-s initial buffering delay [50] as
well as a small processing and network delay were indi-
cated. On the other hand, some algorithms aim for faster
diagnosis [85] or fast and more secure diagnosis [87].
In the next section, some key factors of the reviewed
technologies and their future challenges are discussed.
5 Discussion
Wearable technology and body area network integrated
into the m-health monitoring systems seem to be the future
of the tele-health care, especially when distance separates
patient and doctor. Imagine an older adult living in a
remote location who requires continuous vital signs mon-
itoring. Wearable, wireless and mobile monitoring systems
can provide the best possible solution because they address
convenience and comfort; reduce cost, time and travel and
enable immediate medical assistance in case of emergency.

Table 3 Selected algorithms/software for wearable health monitoring systems

Name ECG Technology/software Technique Platform Time

Xin et al. [101] Processing CMOS/ASIC chip Wavelet transform Wearable Delayed
Vullings et al. [95] Enhancement Matlab Adaptive Kalman PC Real-
filter time
Sufi et al. [85] Compression MMS and SMS Protocols Algorithm Mobile phone Delayed
Oster et al. [67] Denoising Matlab Bayesian Filtering PC Real-
time
Capua et al. [26] Measurement LabView Algorithm Mobile/web Real-
based time
Kim et al. [41] Compression and Holter system Quad level vector PC Delayed
classification
Marco and Chiari Delineation 32 Bit integer online Wavelet transform Web based Real-
[27] processing time
ARTiiFACT [45] Artefact processing Matlab Detection algorithm PC Real-
time
Tseng [90] Signal analysis Windows OS Fuzzy wavelet Mobile/remote Delayed

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5.1 Signal quality and system reliability
In order to meet a medical standard and clinically accepted
monitoring system, early detection of abnormal conditions,
accurate decision support and high quality and real-time
patient data acquisition need to be considered. Some of the
above discussed systems lack of the important feature of
user acceptability. Furthermore, the monitoring systems
should be user friendly, easy to wear and understand and
have a high acceptability to both patient and clinician.
Several monitoring systems for fast processing [84], low
power consumption [57], small size [52] and smartphone
based [99] have been developed. Wearable technology
consists of various networks, such as WBAN, WSAN,
PAN, UMTS and for data transfer using 3G, 4G, GPRS,
GSM, CDMA, Zigbee, Bluetooth, WiFi, WiMAX, LAN
and WAN. Mobile satellite systems have been also adopted
for optimum medical outcomes of this technology. None-
theless, the review indicates the dependency of wearable
monitoring systems on communication technology and
some studies have reported cost problems when using
GPRS for data communication [17] and coverage problems
when using Bluetooth due to its relatively small range [38].
This small converge range is one of the main drawbacks of
deployed e-Health monitoring systems where patients are
‘constrained’ within smart rooms, smart textiles and beds
fitted with monitoring devices [17].
5.2 User acceptability and medical professional’s
feedback
With the ever growing ECG-related monitoring systems,
end-user acceptability is becoming an important aspect in
the design of such systems. There is still an open research
question to be worked on. Do wireless/wearable-based
ECG monitoring systems make a difference to the patient’s
(end-users) well-being? To answer this important aspect of
healthcare, many researchers have included the patients as
well as medical professional’s consideration at every stage
of design and development [53]. We believe the acceptance
of any system in the health care industry depends on the
user awareness and acceptability. Adaptation of a device
within the clinical field is stuck when they are negatively
perceived. User-centred design is essential to incorporate
these perceptions into the product, especially at the earlier
stages of the project development. When analysing user’s
needs, contextual inquiry, user’s profiling the designer
should consider a number of factors such as task analysis,
surveys, interviews and focus groups to address the user
acceptability issue [79]. We support the proposal of Steele
et al. [83] that future studies should document any atti-
tudes, perceptions and concerns of its users. It is known
that highly sophisticated technology and data analysis
491
techniques become irrelevant if user do not wear the sensor
systems for the allocated periods of time [29].
Low energy consumption is an essential characteristic of
such wearable and battery operated monitoring devices.
Therefore, reducing energy consumption for a longer bat-
tery life is a practical challenge in designing of these
devices. Transmission of raw data to the central processing
unit of a stationary computer requires more energy than
processing of the data. For example a mobile ECG monitor
requires 35 mA/h for data transmission, signal processing
and analysis with more than 50 % of the energy consumes
only for transmission In this case, a 1,000 mA/h AAA
battery is required for 1-day operation of such device.
Moreover, high-quality and real-time data transmission
require in conjunction with multiple devices (PC, laptop
and tablet) [34]. Long-term operational of such systems can
be considered as a serious threat to the battery life and
seriously compromise transmission of essential data [64].
5.3 Security and privacy
Security and confidentiality of patient information are the
most important and critical factors. Al Ameen et al. [3]
attempted to address this issue in wireless sensor networks
and other researchers are currently working towards mak-
ing tele-health care more safe and secure. Jovanov and
Milenkovic [44] have carried out in depth research on
WBAN healthcare applications. In addition, they have
discussed promising new trends, opportunities and chal-
lenges for BAN. Faust et al. [31] proposed development of
a medical networking technology for hospital use, and
Chen and Pompili [20] discussed the transmission of vital
signs using WBAN.
In ‘What do patients and clinicians want?’ by Bergmann
and McGregor [10], the importance of user preferences and
the need for researchers to focus on the implications of user
preferences when designing wearable sensor systems are
emphasised. Latre et al. [51] highlight issues and challenges
related to WBAN by focusing on mobile-based systems and
the design of home-based medical devices [56].
6 Conclusion
Most research in wearable monitoring systems focus on the
older adults (60?), as opposed to younger adults who do
not report any issues in the wearing of such devices. Very
few studies reported a high percentage of acceptance for
wearable monitoring system mainly due to its low-invasive
nature and no interfere in their normal daily life activities
[32]. Although, Bergmann and McGregor’s [10] overall
quality of individual studies was relatively low, participant
numbers small, methodology limited and the reporting of
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research processes were restricted, the authors generally
support their findings. Likewise, we agree with the four
main challenges proposed by Chan et al. [16].
• Smart homes need to fully integrate construction,
computing infrastructure, and service delivery aspects.
• Proposed solutions must match or exceed patient
standard of living.
• Patient and clinician usage and intentions should be
studied in detail and considered.
• Further research is required into legal and ethical
issues, user and provider acceptance, requirements and
satisfaction.
Lin [55] recommends that mobile telemedicine engi-
neers should consider the performance of wireless multi-
media networks according to the health level-7-based
design model. He also advocates the involvement of
medical experts throughout the developmental stage to
facilitate usage by clinicians, and thereby, increase the
quality of medical services delivered [10]. A wireless
sensor network survey conducted by Alemdar and Ersoy
[4] identified the hardware challenges as well as those
related to security, privacy, mobility and user-friendliness.
In this paper, over 120 ECG monitoring systems were
reviewed and classified into smart wearable, wireless,
mobile ECG monitoring systems and related signal pro-
cessing algorithms. We studied the design concept of
wearable wireless textile-based systems, remote/mobile-
based telemedicine systems and identified specifications
and parameters such as cost, power consumption, security,
acceptability, efficiency, reliability and stability that
require attention. In addition, we described how mobile
telemedicine systems have evolved over the last decade
and discussed how advances in wearable wireless textile-
based systems could ensure diagnostic accuracy, prompt
intervention and optimum quality of healthcare delivery.
Conflict of interest The authors declare no conflict of interest.
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