CARDIOSMART: Intelligent Cardiology Monitoring System Using GPSlGPRS Networks

M. Elena, J.M. Quero, S.L. Toral, C.L. Tarrida, J.A. Segovia, L.G. Franquelo
Dpto. de Ingenieria Electrhica Escuela Superior de Ingenieros. Camino de 10s Descubrimientos sln 41092 Universidad Sevilla mar@gte.esi. us.es

Abslmd -

Cardiosmart project is based on B eortable terminal for the acquisition, pre-processing and transmission of Cardiac signals and the GPRS network (PAC) used to send the ECG signal to a host computer in the medical services provider centre or a specialist consulting room. The PAC terminal includes a GPRS modem for data transmission, a GPS device to provide an accurate location of the patient, and an intelligent heart pathology detection system. The objective of this project consists of the development of a European Cardiology On-line Monitoring System using GPRSIGSM wireless communication technology. The utilisation of electrocardiogram transmission will improve efficiency of medical care and service for patients if they could be monitored constantly by health care providers. A direct and almost instant medical support is provided, specially to those patients that vanish during the heart attack. This work has been funded by the European Comission IST2001-35073.

hour duty medical centre. This system also includes a QRS detection algorithm for automatic syncope detection without the participation of the patient [3]. Next step consisted of using the new GSM transmission possibilities. A prototype including a GSM data modem has been developed and it has been proved that concept was technically feasible. Nevertheless, despite of the technological evolution, communication infrastructure and advanced hardware needed for complex high-quality telemedicine services, they remain very expensive. GSM transmission cost is related with time of connection, leading to a very expensive continuous monitoring system. Also the power consumption of a continuous GSM data transmission led to a very reduced autonomy. The main conclusion of these experiences was the necessity of joining together portable equipment, continuous monitoring system, power consumption, cost of transmission and optimisation of the amount of data to be transmitted.

Keywords- GPRS, ECG (Electrocardiogram), SMT (Surface Mount Technologv), PAC (Qortable terminal for the acquisition, pre-processing and transmission of cardiac), packets, protocol.

I. INTRODUCTION
Actual cardiology monitoring systems are improved in terms of storage capacity or autonomy. But new mobile communications technology is opening new horizons for new ideas that will improve the quality of life of patients[l-2]. Portability and autonomy are concepts very close to actual mobile communications. So the junction of this concepts led to new applications that could not be exploited some months ago. To our best knowledge, it is the first time that a portable terminal for the acquisition, pre-processing and transmission of cardiac signals (PAC) allows the continuous detection and on-line GPRS data transmission in cardiology environment. Previous researches has been oriented following this perspective during last few years. The first system product developed allowed the patients to transmit their ECG to a 24-

Our proposed solution to solve the transmission problem is the use of the GPRS network [4]. This novel communication protocol is going to allow a non expensive transmission and a cost related with the amount of data transmitted (the user is going to pay the amount of data transmitted, independent of the connection time). Moreover, GPRS provides a bandwidth minimum of 64 Kbytes.
An additional improvement consists of reducing the amount of data to transmit, taking into account that the majority of the monitored information is a normal ECG signal. Nevertheless, the interesting information for the specialist is just the abnormal ECG signal. Instead of doing the signal processing after the transmission, it will he done before. If we combine an intelligent detection system with data compression of information, the amount of data is not only reduced but also optimised [5-61.

The main technical problems to be solved are:

1.

To guarantee the reliability of the components and communication channel. Design, manufacturing and

0-7803-7474-6/02/$17.00 82002 IEEE

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validation of this medical device must comply with medical specifications and obtain European certification. 2. To achieve electromagnetic compatibility between the Signal Conditioning Module and the Communication Module 3. To obtain maximum autonomy (at least, 24-hour) minimising power consumption. 4. To reduce the manufacturing and functioning cost at a minimum, making new technology accessible to any social level. 5 . To achieve a minimum size and weight to guarantee user's acceptability.

PAC terminal, the host center and internet access The main components in the system are:
A portable data-acquisition console (PAC), is connected to every patient in the network and will transmit the ECG. 2. A medical service provider (MSP) uses another GPRS modem to allow communication from several PACs, using only the telephony network to prevent uncontrollable Internet delays. 3. A communication protocol over GPRS is used to transmit a continuous ECG with a minimum delay. 4. A GSM voice channel is used to allow a doctor to 5. establish a direct call with the patient. An internet access to a database host center allows patient monitoring from an authorised European hospital or private doctor.

I.

I? ..

The system will work as an on-line mobile telemedical system, providing autonomy to the patient and real-time cardiac disease diagnostic. Besides, patients require an intelligent system capable of detect heart pathologies, in which they must not be worried about the moment in transmitting the electrocardiogram (ECG) to the specialist. They claim for an automatic detection of the heart dysfunction and the subsequent transmission to the doctor. From the functional point of view, patients will be monitored using a PAC from any hospital of the network in two modes:
1.

Figure 1. A block diagram of network

In this paper the development of a new terminal (PAC) with portability, autonomy, signal acquisition and digital processing, data compression and encryption, and a GPRS link is suggested. GPRS modem provides a data channel and also a GSM voice channel for the direct communication between patient and specialist. ECG information is transmitted to a host computer with a database, so the specialist will diagnose and propose actions to the patient. It also allows a continuity of care, even if the patient is geographically far from the cardiologist. [7].It consists of the integration of three critical blocks in just one device: an electrocardiograph, an efficient digital processing block and a GPRS/GSM modem. I f the medical center cardiologist needs information, he will connect to the medical center to transmit the recorded ECG without the attention of the patient.

2.
3.

Continuous mode. ECG signal is continuously transmitted to the host center and monitored from a hospital. Intelligent mode: Once the processor has detected an abnormal heart activity, it automatically connects with the medical centre to transmit the information. Request mode. A hospital could activate a PAC at any time to receive the ECG of a particular patient.

A) Portable Dala-Acauisition Console /PAC1

Besides, automatic pathology detection is included before the transmission. The idea of this ECG pre-processor is to reduce the amount of data transmitted. Instead of a continuous link with the specialist in which the majority of the information is useless, only the problematic ECG is transmitted.
11. TELEMEDICAL NETWORK
A block diagram of the whole system is showed in Figure 1. It is a basic scheme of the cardiology network based on the
Figure 2. A block diagram of PAC

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A block diagram of the PAC terminal is showed in Figure 2. It must be a portable equipment of small size to allow a 24 hour connection of the patient with the following subsystems:
1.

efficient to reduce the number of packets transmitted (mean compression ratios up to 8.1 in GSM network). The last task of the processor is the encryption of the ECG signal, because national and international regulations force the privacy of this personal information. At last, the final algorithm will be tested using international biomedical databases (i.e. MIT-BIH).

2.

3.
4. 5.

ECG Conditionine Module: Consisting of three or ten electrodes attached to standard patches, amplification and filtering stages. Special instrumentation amplifiers are chosen from previous designs. Simal Processing Module: To implement the whole digital processing stage including data conversion, heart rate detection, pattern recognition, compression algorithm and signal cryptography. GPRS Module: Including a data and a voice channel for the direct communication between the patient and the cardiology specialist. GPS Module: To provide the exact location of the patient. Power Module: To supply the power to all modules with minimum energy consumption.

The previous GSM prototype integrates an 8-bit microcontroller. In this proposal the use of a 32-bit microcontroller from the MCORE Motorola family is suggested. This microcontroller includes all necessary hardware (RAM and Flash memories, coprocessor, Digital and Analog IiO signals, low-power modes...) to fulfil all electronic requirements in this applications. This wireless link is both voice and data GPRSiGSM interface. The communication is bi-directional: the ECG captured can be transmitted to the medical center, and direct calls may he establish from the host. As the voice communication interface of the modem is available, a microphone and a loudspeaker has been included. All the integrated circuits used have the possibility of a shutdown mode, to save battery.

C) Medical Service Provider And Host Center

E) Signal Frocessing Module

Because of the automatic recognition of heart failure is a demand of the patients for improving their quality of life, the digital processor must implement several ECG preprocessing steps. They are illustrated in Figure 3. A QRS detector must he implemented for the heart rate calculation. Supraventricular tachycardia, bradycardia and syncope diagnoses are based on this algorithm [8]. It must be taken into account the noise interference due to the electronics and the GPRS modem. A neural networks for pattern recognition techniques will classify the different kind of beart diseases: blocks, flutter, atrial and ventricular fibrillation and supraventricular and ventricular scape, by comparison with the normal ECG. As GPRS cost is related with the amount of data, a compression algorithm based on wavelets is going to be implemented. They have been demonstrated to be very

The communication system module is used to connect the host with one PAC at a remote location. The database system module saves the patient records along with their ECGs and other relative information such as clinical treatment, symptoms, etc. The schema of the database includes all the fields that requires at the appropriate format. Its open database architecture helps its adaptation from large databases which can use it as a telemedicine gateway to other systems located at rural or isolated areas. This module feeds the communication system and the PAC modules with ECGs and patients data. A direct and almost instant medical support is provided, as a voice channel is included in the GSM connection . A 24-hour duty service detects rapidly cardiac diseases in advance.

Figure 4. A on-line electrocardiogram

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Additionally, the host computer implements an internet site, so the information can be consulted from hospitals or other specialists, even if they are far from the host computer [9]. The system including the portable terminal plus a host

computer with external access may become a complete cardiology network. A RS-232-C serial communication link is needed to provide communication with a persdnal computer. Figure 4 shows an ECG signal transmitted on-line.

Terminal Mobile

Mobile

Application
:
UMTS

Application

GPRS
GPRS

I Tunnel P
Figure 5. GPRS Communication Protoeol

0) GPRSProfocol
The implemented GPRS protocol is showed in previous figure (Figure 5), where communication is established between the patient portable terminal (PAC) and the medical service provider center (MSP). In the high level there is an application layer transparent to user. This application depends on the medical information requirements and data normalization, maintaining a continuous data transmission in a high quality. The data packets size depend on the mobile provider and GPRS technology to guarantee an on-line communication, based on protocol implementation standards. Our preliminay probes establish a data packets of 1500 bytes as maximum, depend on the transmitted message. This packets have attached an errors detection and correction algorithm to each side of communication. After using a data-packets order number and an user identifier, a sliding window protocol allows information recuperation. Once establishment phase has finished, an oriented-connection protocol is used due to needs of information veraciously.

IV.PROTOTYPE
A prototype including a GPRS/GSM data modem (see Figure 6 ) has been developed and it has been proved that concept was technically feasible. This prototype have not still included intelligent mode.

Figure 6 A prototype photo ofPAC .

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From the electronic point design of view (Figure 7), the most critical task has been the integration of an electrocardiograph and the data modem. Special care has been taken in order to minimise the electromagnetic interference that a power RF stage can exert on an electrocardiograph that amplifies signals in the range of mV. This goal has been achieved designing a special shielding scheme to avoid ECG distortion. To improve the quality of the signal, a SO Hz notch filter has been implemented. Power line interference is the main source of noise. Common mode rejection ratio of the differential amplifier, the antialiasing low pass filter and the band reject filter digitally implemented avoid the corruption of the ECG signal. The integrated modem is a product with a SIM connector as well as a standard RF connector type MMCX (Miniature Micro Connector). Board dimensions are (in mm) 81 * 5 5 and the weight is approximately as a mobile phone. The battery supply is 3.6 V and the prototype power consumption is 275-300 mA during packets transmission, descending to 20-25 mA in idle state. Each IS seconds, a new data packet is built and sent in real time, with 2 or 3 seconds duration time. The sampling rate is 360 Hz.

validated with a 99.5% pulse detection succeed during the validation process. The feedback information from the medical center has demonstrated that the algorithm implemented is well suited for the majority of patients.

V. FUTURE WORKS The main target of this project is improving the quality of life of cardiology patients, as they have not to be confined in hospitals. They will feel free of walking or even travelling but keeping contact with their cardiology specialist or hospital. A direct and almost instant medical support is provided, as a voice channel is included in the GPRS connection. Basically, this general objective will be achieved by means of the following detailed measurable objectives: Selection of algorithms for QRS detection and pattern recognition, according to the standards defined in hiomedical simal databases. The result ~~~. must be to detect the maximum number of pathologies. 2. Selection of algorithms for compression and cryptography. The result must be to optimise the amount of data transmission. One of the objectives in the project is to determine a standardization of this kind of on-line ECGs, defining the minimum requirements for their transmission. This objective will b e setting a Spanish GPRS network during the first year, with the collaboration of some hospitals and specialist.
~~~

1.

1~~~
~~~

L-

This system will also set up a novel collaborative environment to share data for continuity of care. The quality of telemedicine services must be kept at high standards. Additionally, telemedicine services in electrocardiography can be offered by keeping the cost in low levels. So, we are working now in developing a technology integration to provide the best balance between performance and cost. The possibility of a GPRS/GSM suppliers collaboration is able to locate the patients inside or outside of buildings if emergencies appear.
Figure 7. A photo ofboard

Notice that the batteries used in this device must not be charged while it is being connected to the patient, and will have to be substituted for their charge. GPS module will be optional in the final application, as it can be substituted by the information provided by the telephony network. Pulse detection algorithm has been tested for these waveforms with patients between 5 and 65 years old in order to set the threshold values. These values has been

Not only the cost of the device is critical, but also the performance of the compression algorithm, because it will drastically decrease the volume of data and therefore the communication cost in GPRS.

To the hest of our knowledge, there is no a similar electronic device cauable of using the current mobile generation, although researches h a v e designed and simulated an integrated mobile telemedicine system using the second generation of wireless network [21.
The need of the data privacy and an efficient transmission bandwidth is directing the study of data encryption algorithms.

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VI. CONCLUSIONS
The design and realisation of a novel intelligent and portable electrocardiograph device with a GPSIGPRS link (PAC) for monitoring the heart activity of patients and the automatic detection and transmission of fundamental heart failures have been proposed with restrictions of space and consumption. The module comprises several subsystems: microcontroller system for data signal analysis, communication subsystem including GPRSMjSM standard links and power subsystem. This prototype can be used autonomously, with the modem GPSIGPRS equipment. The main target of the prototype consist of providing customers a 24 hour medical teleassistance service. The main risk of the project is to achieve a good balance between signal processing capabilities and power consumption, as, to our knowledge, there no exists any intelligent cardiology portable device as the one proposed in this project in the market. Additionally, the host computer could implement an Internet site, so the information will be consulted from hospitals or other specialists, even if they are fax from the host computer. The system including the portable terminal plus a host computer with external access may become a complete cardiology network that will improve the quality of life of people. The experience achieved in this system could be extended to other medical specialties and other European countries during the second year. The adjustments of the system to other countries in Europe will allow to extend the initiative to the rest of the European Community and setting up a novel collaborative environment to share data for continuity of care. To summarise, the main innovation of the proposal is the integration of a set of subsystems using new technologies, such us GPRS data transmission and GSM voice link, to solve the problems of cost and continuous monitoring of the current cardiology devices. This prototype is medical asserting pending.

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