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.

1. Technologische uitdagingen
voor cardiale telemonitoring
Peter De Cleyn
IBBT-PATS-UA

2. Outline
 Introduction
 Future technologies
 Future measurements
 Conclusions
 Demo scenarios
 Demo

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

4. End-to-End System
Secure communication

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)

20. Security
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
End-to-End security

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

24. Future measurements
(Re)Configure
Gateway
Secure communication
Processing Processing
Processing Processing
Sensor Gateway Storing
Networking Networking
(UI) Multiple UI
Actual needed measurements

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

30. Demo Scenario

31. Demo Scenario
 WBAN
 ECG transport
 multihop routing
 Medical HUB
 remote configuration
 signal processing
 event detection
 Backend
 data retrieval
 advanced signal processing

32. Demo Architecture