This document discusses technological challenges and opportunities for cardiac telemonitoring. It presents an end-to-end interactive medical mobile monitoring solution that includes wireless body area networks (WBANs) to transport sensor data, a medical hub for initial processing and analysis, and a backend for advanced processing and storage. Key aspects covered are future measurement types, security measures across the system, and data representation and storage. The document concludes that available technology can address needs for easy use, remote configuration, accurate processing, and security in telemonitoring systems.
3. Introduction - IM3 Future Technologies
Goal: study the usability of emerging technologies to
create an end-to-end interactive medical mobile
monitoring solution
Approach:
Theoretical studies and simulations
Proof of Concept
5. End-to-End System
Secure communication
Sensor
Capture
Measurement
Data
6. End-to-End System
Secure communication
Processing
Sensor
Networking
Capture Process Data
Measurement and Transmit
Data Over BAN
7. End-to-End System
Secure communication
Processing Processing
Sensor
Networking Networking
Capture Process Data Process Data
Measurement and Transmit and Transmit
Data Over BAN Over BAN
(n-steps)
8. End-to-End System
Secure communication
Processing
Processing Processing
Sensor Gateway
Networking Networking
(UI)
Capture Process Data Process Data Process Data
Measurement and Transmit and Transmit and Transmit
Data Over BAN Over BAN Over WAN
(n-steps)
9. End-to-End System
Add/Remove processing algorithms
Start/Stop processing
Configure parameters
Remotely over WAN
(Re)Configure
Gateway
Secure communication
Processing
Processing Processing
Sensor Gateway
Networking Networking
(UI)
Capture Process Data Process Data Process Data
Measurement and Transmit and Transmit and Transmit
Data Over BAN Over BAN Over WAN
(n-steps)
10. End-to-End System
Add/Remove processing algorithms
Start/Stop processing
Configure parameters
Remotely over WAN
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
Capture Process Data Process Data Process Data Process Data,
Measurement and Transmit and Transmit and Transmit Store
Data Over BAN Over BAN Over WAN Notify
(n-steps) Present (multi-user)
11. End-to-End System
Add/Remove processing algorithms
Start/Stop processing
Configure parameters
Remotely over WAN
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
Capture Process Data Process Data Process Data Process Data,
Measurement and Transmit and Transmit and Transmit Store
Data Over BAN Over BAN Over WAN Notify
(n-steps) Present (multi-user)
12. WBAN
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
On body transport of measurements
13. WBAN
WBANs are wireless, short range, low power, multihop
networks, to transport collected medical data from the
sensor to a central device
Its application in healthcare requires these networks to be
reliable, having long lifetime and for all be secure.
A hardware and routing software combination achieves
these goals:
NXP CoolFlux Technology:
Ultra Low Power DSP (10MHz, 9kB SRAM, 6kWord
flash)
Magnetic Radio CPFSK 7-15 MHz, ~ 20cm distance
(optimum)
Cidada: Tree based scheduling protocol to efficiently and
reliable collect data within a WBAN
14. Medical hub
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
Medical hub
15. Medical hub
The Medical hub collects data from the WBAN, performs a
first processing and analysis and transmits the data to the
back end.
The Medical hub is a collection of software components,
algorithms and device drivers.
All these components can be remotely managed:
Transparent to the patient: no interaction or contact with
technician needed
Patient does not need to come in
Software is platform independent: Same software runs on
wide variety of smartphone, PDA or PC systems: applicable
to existing devices
Software is lightweight: it must run smoothly on smallest
platform
16. Medical hub – Web Services
Back end interaction using Web services
Goal: perfect interoperability between several service
providers, by the use of distributed middleware
Web service =
Software application
Identified by a URI
Interfaces are defined, described, and discovered by XML
artefacts (WSDL, UDDI)
Interactions with other software applications using XML-based
messages via Internet-based protocols (SOAP)
17. Signal processing
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
Processing of measurements
18. Signal processing
Huge amount of available information due to
continuous monitoring
Automatic processing and event detection gives
medical staff indication of problems
No need to review all date when no events are detected
Simplified algorithm at medical hub
False positives possible
Event processing at backend
False positives get removed
19. Signal processing
Performance of Atrium Fibrilation detector
Comparison of detections (blue) and scoring of cardiologist (green)
21. Security
Wireless communication medium
Appropriate security and privacy protection is
necessary
Threat analysis: identification of security issues
Security requirements:
Confidentiality of medical data
Integrity of medical data
Source authentication of medical data
Mutual device authentication
(Location) privacy
End-to-end security
CICADA-S: secure version of WBAN protocol
Asymetric cryptography has interesting advantages but is energy
consuming
Feasability study of elliptic curve cryptography on WBAN sensor
22. Data representation
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
Data storage and representation
23. Data representation
Website :
Visualisation of the measurements
Download data file for further processing and analysis
Patient information and history
Event notification
25. Future measurements
Objective:
Determine what measurements are important and
economically feasible to include in Remote Patient Monitoring
solutions for
Congestive Heart Failure
Atrial Fibrillation
26. Consolidation CHF
More types of measurements could provide more information, but:
Weight (mainly to determine increase in fluids)
Respiration (correlated to motion)
Both rhythm and volume
Heart beat and heart rate variability (with coupled motion/accelerometer)
are sufficient to measure in telemonitoring.
Additional
Blood pressure
ECG
Lungimpedance
Note:
Other measurements will take place in the hospital
Full ECG not required, but HB and HRV can be derived from it
Measure fluids in lungs can be a measurement in telemonitoring
Should be automatic – no patient action. Can be impedance or sound.
BP and Weight will be done by the patient
ECG (HB/HRT) can be automatic and without patient interference if subcutaneous
Continuous measurement next to the daily BP and weight measurement
27. Consolidation AF
More types of measurements could provide more
information, but:
ECG (with coupled motion/accelerometer) is sufficient to measure
in telemonitoring.
Note:
ECG (HB/HRT) can be automatic and without patient interference
if subcutaneous
28. Observations
Key: Weight (fluids), Respiration and Heart Beat (correlated
to motion)
However
Measurements involve patient action which is not
desired
Errors, discipline, patient stress
Sound/Impedance could replace weight measurements
For both fluids and respiration
For automatic measurement without patient action,
ECG
Sound and/or impedance
Motion
can replace these – preferably subcutaneous – in the
longer term
29. Conclusions
Technological factors which influence acceptance for
an end-to-end telemonitoring system
ease of use for the patient
ease of (re)configuration and installation
accurate automatic data processing and filtering
data representation
overall security
Technology is currently available to tackle these needs!
Actual measurement needs should be defined for
each pathology