23-06-2014, 02:12 PM
Mobile Telemedicine System for Home Care and Patient Monitoring
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Abstract
— Home care services are growing up in the past
years. Contemplating the patient/family pair, it represents a
solution to the medical problems of the modern life. With the
social trends, the senior population has been increasing in the
last years. However, as living is more stressful than ever, there
are more cases of chronic diseases. The difficulties of transport
in the big cities and the scarcity of hospital streambeds turn the
home care an attractive solution. However, its routines can be
switched by telemedicine. This paper describes the
implementation of a telemedicine system for patient monitoring
using mobile telephony. The major aspect about this
application is its generality, which allows the use of any patient
monitor with a RS-232 interface. The system proved to be
quick and reliable. Therefore, it represents an applicable
solution to telehomecare.
INTRODUCTION
Once there are more senior citizens and chronic diseases
than ever, the number of people who need constant
assistance increased a lot. Also, patients are being
discharged from hospitals early and often require additional
health care services and monitoring of their health status [1].
Nevertheless, the current scenery reflects in long patient and
operation waiting lists, shortages in hospital beds,
community care and inadequate medical facilities in
intensive care and emergency units [2]. Additionally, the
high costs involving the conventional internment and the
frequent problems in patient transporting do necessary a
different way of providing good medical care. Thus, home
care services are becoming rather important in the last few
years.
Conventional home care basically involves a fixed and
limited number of visits by a trained nurse to a patient’s
home. All activities during these visits are controlled by the
nurse: they may include vital signals recording, general
assessment of the patient’s therapy progress, medication and
patient’s instruction on particular needs observed during the
visit [3].
Many parties had already proven that these procedures
could be switched by telemedicine applications. The term
telemedicine refers to the utilization of telecommunication
technology for medical diagnosis, treatment and patient care
[4]. It also can be described as the transfer of electronic
medical data from one location to another [5]. This second
definition is mainly relevant once it retrieves to the vital
signals recording and monitoring, which are necessary for
the implementation of a telehomecare system.
Recent breakthroughs in communication technologies
have stimulated the development and demonstration projects
in telemedicine [6]. There have been many studies to
provide a solution to telehomecare. They include GSM,
satellite communication etc. Particularly, mobile
telemedicine is a new research area that exploits recent
advances in cellular telecommunications networks, which
provide the potential for highly flexible medical services
that are not possible with standard telephony [7].
Actually, the mobile phone has been recognized as a
possible tool for telemedicine since it became commercially
available [8]. In fact, the mobile telephony has evolved a lot
and offers new devices with some useful resources, such as
serial ports and Internet connections. Therefore, the phones
can interact with electromedic devices (EMDs) – like patient
monitors, for example – and transmit vital signals through
Internet protocols, such as TCP/IP and UDP.
Indeed, the use of the Internet by health care providers,
and certainly their patients, has seen dramatic increases in
the past few years [9]. The Internet protocols represent
highly tested tools for transmitting general data. Medical
data – such as heart rate, ECG, temperature and other vital
signals – can also be grouped in packets and transported
through TCP/IP and UDP. Finally, employing standards
usually represents a good plan when developing systems
that may interact with other applications.
This paper describes a mobile telemedicine system for
home care and patient monitoring. The system takes
advantage of the serial port available in new mobile phones
to implement a generic interface for patient monitors. The
vital signals are acquired from the EMD using the RS232
interface and transmitted through Internet.
RESULTS
The system was implemented as previously described.
As mentioned, both client and server side utilized Java
programming language. Fig. 2 shows the four screens of the
client application. A XML exported file is presented in Fig.
3. The server application is shown in Fig. 4.
The system guaranteed the transmission of a packet per
600 milliseconds, e.g. the measured baud rate was 3400 bps.
So, an ECG signal sample with 5000 bytes approximately
takes 30 seconds to be transmitted. Other signals, such as
heart rate and temperature, need 2 seconds. Furthermore,
lost packets are tracked, once it is implemented cyclic
redundancy code (CRC).
IV. DISCUSSION
As the transmission is digital, there is no noise in the
signals. It represents an important feature because noise
effects commonly hardly affect telemedicine systems. The
baud rate allows the transmission of vital signals without
problems. The discrete signals (heart rate, blood pressure
and temperature, for example) are quickly transmitted.
Nevertheless, spending 30 seconds to transmit an ECG
signal sample does not represent a big problem.
The system can interact with other applications through
the XML exported files. Using standards represents an
important step for integrating telemedicine systems.
CONCLUSION
Home care represents a growing field in the health
assistance [15]. It reduces costs and increases the quality of
life of patients. As the modern life becomes more stressful
and acute diseases appear, prolonged treatments become
more necessary. The same occurs for the elderly or
handicapped patients. Home care offers the possibility of
treatment in the patient’s house, with the assistance of the
family. It reduces the need of transporting patients between
house and hospital.
Fig. 4. Server application.
As previously explained, the home care routines can be
switched by telemedicine applications. Actually, this switch
is also called telehomecare, which can be defined as the use
of information and communication technologies to enable
effective delivery and management of health services at a
patient’s residence [1].
This paper presented a telehomecare system using
mobile telephony. The application was designed for remote
patient monitoring. Its capability of utilize standard patient
monitors allows the use of telehomecare without deprecating
the current EMDs. This feature makes it an important
platform for future studies and products.
Recent studies conclude that early and specialized prehospital
management contributes to emergency case
survival. The system can also be applied in emergency
telemedicine applications in reason of its mobility. Such
application was done in Greece [16].
The relevancy of standards and codification schemes
has been highly debated. The proposed system utilized XML
and EDF+ for storing acquired data. The implementation of
such features is described elsewhere [14], as mentioned
before. Furthermore, the exportation to XML allows the
possibility of integration with other projects. As an example,
artificial intelligence systems could also monitor patients.