Design and Development of Real-Time Patient Monitoring System.

Real-time Patient monitoring system
CHAPTER - 1
PREAMBLE
1.1 Introduction
In todays healthcare practice, physicians have a need to monitor more than one medical parameter for patients that are either hospitalized or leading their normal daily activities at home or at work but in need of constant medical care. Telemedicine (health-care delivery where physicians examine distant patients using mobile communication technologies) has been heralded as one of several possible solutions to some of the medical dilemmas that face many developing countries. The traditional way of providing Telemedicine services is to transmit biomedical signals from a patient to a hospital using landlines, such as the PSTN and integrated services digital network. While examining the current state of telemedicine in developing country India, telemedicine has brought a plethora of benefits to the populace of India, especially those living in rural and remote areas (constituting about 70% of Indias population) [1]. Objective of this project is to propose a wireless stand-alone a novel approach to patient monitoring is introduced.
1.2 Scope of the study

In a country like India, with an exponentially high population growth rate and a historically poor health-care delivery system with few medical facilities exist to serve the large population that resides in the villages. India has 80% of its main health-care centers located in cities that host only 30% of the population. These percentages reveal a dismal health-care scenario where only 20% of Indias quality health-care facilities cater to 70% of Indians confined to rural communities. According to survey [1], Indias rural population is more vulnerable than its urban counterpart based on three particular reasons: late discovery of ailment, transport time to urban health care facilities, and inexperienced primary healthcare providers in rural areas. The rapid growth of mobile communication technologies in India offers the potential to address these concerns and to save the patient extra cost associated with treatment, such as travel and other living expenses. The main objective of the study is to develop an efficient system that monitors and reports the data in real-time. This relieves incapable patients from needing to go in-person to the physicians. It also gives the healthcare professionals, the ability to react promptly to lifethreatening situations, in a proactive way that involves the patients themselves.
VTU Extension Centre, @UTL, Bangalore 1
1.3 Problem Formulation

This is a project that aims to designing a system that will help doctors to monitor crucial parameters of patients like heart beat, body temperature and blood pressure using GSM communication technology. Also demonstrate how the reliability of the system can be enhanced using different design methodologies. The goal of this work is to build a compact and cost-effective monitoring system. The device is developed and implemented based on the existing industry standard communication network and patient monitoring software application is developed to store data that can be used for real time monitoring and later downloaded to a physicians workstation for analysis and diagnosis. It specifically targets assisted-living residents and others who may be benefited from continuous remote health monitoring and decision support system.
1.4 Methodology
The methodology includes consideration of a combination of wireless techniques, particularly the exploitation of cellular networks, types of clinical data for transmission and system memory storage. The system presented here contains GSM/GPRS modem for remote wireless communication and customized E-med software application designed using Microsoft Visual Studio for process the data in management unit. The patient monitoring device is connected to processing unit (computer) using RS232 serial communication, GSM for communication from base station to other mobile telephones and central monitoring unit, LAN to clinicians. This project makes use of health sensors as input to the system is simulated inputs, since actual sensors are costly and the main aim of the project is to bring out the idea that how the control system can be designed to monitor the patient health status. Many sequences of events that take place in development and implementation are explained throughout this report
1.5 Outcome and Limitations

The adoption of mobile technology has led to new applications in health-care provision. There are medical cases that can be managed more efficiently by adopting wireless Telemedicine, such as Emergency and rescue situations etc... Thus medical services can be delivered to any location within the coverage of cellular networks. In this system design we used GSM technology, but the adoption of GPRS is relatively new which allow much more data to be transmitted, like high-resolution digital radiographic images, large volume MR/ CT images, audio and video signals.
1.6 Literature Survey

Literature survey was carried out on available previous published literatures, which lays the foundation and basis for the work in this project. An extensive study has been carried out to understand the Telemedicine Diffusion and Intelligent Healthcare. Thorough study has been made on the Real-time remote system for patient monitoring. Some of the basic concepts has been learnt before going through the telemedicine, they are: remote accessing, cellular networks, wireless technologies, telemedicine Diffusion in India, digital hospital, health care informatics, WAP-Based telemedicine, GPRS based systems(e.g. PDA-Based physiological monitoring) etc. Some of the updates and recent changes are learnt from internet download. Amrita Pal has presented a paper on Telemedicine Diffusion in developing Country: The Case of India (March 2004), explains the current state of telemedicine in a developing country, India. Also explains need for Telemedicine in India [1].Y. Lin and IC. Jan has presented an IEEE paper on PDA-Based Patient Monitoring, in this paper proposes a wireless physiological monitoring system for patient transport and telemonitoring data management techniques [2].Andreas Hein and Oliver Nee propose a system called SAPHIRE-Intelligent Healthcare Monitoring based on Semantic Interoperability Platform-The Homecare Scenario [3]. In this system an intelligent healthcare monitoring and decision support system on a platform integrating the wireless medical sensor data with hospital information systems. In the SAPHIRE system, patient monitoring will be achieved by using agent technology where the "agent behavior" will be supported by intelligent clinical decision support systems which will be based on computerized clinical practice guidelines, and will access the patient medical history stored in medical information systems through semantically enriched Web services to tackle the interoperability problem. There are two main issues of interest to deal with monitoring heart patients. Firstly, the heart patients should be monitored in more natural environment, in their real daily lives, while they are using their heart medicine for a better test and evaluation of the treatment efficiency. Secondly, the hospitalization should be reduced in order to lower the expenses of the health care system and reduce the patients waiting time. Y.Jasemian, E.Toft and L.Arendt-Nielsen was designed a real-time monitoring cardiac patients at distance using GSM network [4].
G. Virone and A. Wood has presented a paper on An Assisted Living Oriented Information System Based on a Residential Wireless Sensor Network for health monitoring explains system architecture for smart healthcare based on an advanced Wireless Sensor Network (WSN) [5]-[6]. It specifically targets assisted-living residents and others who may benefit from continuous, remote health monitoring.
Many patient remote monitoring devices were reported in the literature [7]. A wireless telemedicine procedure was reported in [1], [8]. The unit helps physician to perform a computer-aided bedside patient monitoring is applied in areas where real-time vital function analysis takes place. Modern bedside monitoring requires not only the networking of bedside monitors with a central monitor but also other standard communication interfaces, to monitor the medical condition of a large number of patients. A protocol receives the temperature and pressure of a patient using a mobile device that is attached to the patients body via short messaging system (SMS) message [9]-[10].
The mobile device does not have data logging capabilities, nor does it have download and diagnosis features. The clinical usefulness of a wireless personal digital assistant (PDA) based on a GPRS-capable cellular phone and an Internet application for remote monitoring of real-time vital signs was discussed in [2], [11]-[12]. A wireless PDA-based physiological monitoring system for patient transport that uses wireless local area network (WLAN) technology to transmit patients biosignals in real-time to a remote central management unit was presented in [13]-[28].
Apart from the above mentioned papers and books there are some websites and documents which have gone though and are mentioned in the references (chapter 9). Some of the updates and recent changes are learnt from internet download.
Most of the above systems do not have real-time logging capabilities, and automatic handling of emergency and rescue situations. The medical cases that can be managed more efficiently by adopting wireless Telemedicine.The proposed work is to communicating with their physician and biomedical signals are transmitted in real-time to the physician or hospital network. New technologies are also coming up and research in the above field is still going on. Some noted recent developments and research work are in progress.
1.7 Report Organization

Chapter 1 is used as an introduction on the scope, organization and aim of the thesis. Also reviews the previous published literature, which lays the foundation and basis for the work in this project. The remainder of the thesis is organized as follows. Chapter 2 gives an overview of various wireless telemedicine technologies. Chapter 3 gives the information about which are the methods we follow in our work. Introduction to the GSM communication compared with other communication technique and embedded device design, selection of software language etc..Chapter 4 explains the design and implementation of the Remote monitoring system. In that first unit (acquisition unit) of our system is explained. Chapter 5 explains the other two units (management and monitoring unit) with software design. The results of it are shown in chapter 6. Chapter 6 named RESULTS covers the verification and test plan, snapshots of the customized Emed software with results. Finally conclusion and future work are summarized in Chapter 7 and at the end references are listed.
VTU Extension Centre, @UTL, Bangalore
CHAPTER - 2
WIRELESS TELEMEDICINE
2.1 Introduction
AS FIVE-YEAR-OLD Thejas lay in bed in the consulting room at the Aragonda Apollo Hospital in the remote village of Aragonda, India about 170 km from Chennai, India, doctors first diagnosed a murmur in the heart and he was put on a color Doppler. As the color Doppler images were transmitted to the hospital in Chennai using special electronic communication. Pediatric Cardiologist Prem Shekhar diagnosed the case as Sallots Tetrology (multiple congenital defect of the heart). After a few hours of consultation with the surgeons and the hospital chairman. Dr.Pratap C.reddy, the child was transfferd to the Chenni Apollo Hospital for surgery. Dr.Reddy commented, this facility has heralded telemedicine in India and that as a special case, Thejas would be operated free of cost and all the expenses borne by the hospital.1
This real-life example reflects one of many success stories like Online Telemedicine Research Institute (OTRI, Gujarat) has made a great impact on the lives of people living in the western part of India. On January 27, 2001 an earthquake devastated the western city of Bhuj and left thousands dead and many more homeless. Within a day, the OTRI in Ahmedabad, about 300 km from Bhuj, established satellite telephone links and set up all the equipment necessary to provide emergency medical care through telemedicine.
The telemedicine diffusion in India, where patients in remote areas are diagnosed and treated for numerous medical conditions. Telemedicine is defined as the use of telecommunication technology (involving audio, video, and graphic data) to deliver health-care services, health education, and administrative services to sites that are physically distant from the host or educator. This chapter gives present condition how telemedicine is changing the delivery of medical services in India and then stat-of-art technologies for wireless telemedicine.
This real story is selected from telemedicine diffusion case study in India [1].
2.2 Overview of Indias wireless telemedicine infrastructure

A country with an exponentially high population growth rate. Low teledensity (number of telephone landlines per 100 people), and a historically poor health-care delivery system. Indias telemedicine infrastructure is largely government owned; telemedicine initiatives are constrained by existing state-sponsored networks, varying only in terms of equipment and software applications. Until recently, telemedicine remained contingent upon Indias meager high-bandwidth landline telecommunications infrastructure. The popularity of wireless and Indias home-grown satellite technologies developed by Indian Space Research Organization (ISRO) offers critical infrastructure to support teleapplications. The satellite system having 130 C-band transponders linking many hundred earth stations in remote and rural areas along with thousands on very small aperture terminals (VSAT). This infrastructure enables the country to reach over 65% of the Indian landmass and 80% of its population. The technical infrastructure for typical telemedicine projects in India is shown in figure 2.1. [1].
Typical Telemedicine setup in India Local Connection Remote Connection (Optional) ISRO Supported VSAT connection 2mbps
CHC Cities CHC City...1
Centralized Patient Database
ISDN 128 kbps CHC City...2 Medical Data & Image distribution Client
ISDN 128 kbps Clinical information client
Polycam/ Webcam
CHC City...n Patient data & consultation scheduling
Radiography, MRI X-ray, CT scans, Color Doppler... Telemedicine centres
Figure 2.1: Typical wireless telemedicine service setup in India
2.3 Industry Standard-Based Monitoring Systems

Patient monitors are the most important diagnostic devices in the critical care units (CCUs) of hospitals, providing continuous display and interpretation of the patients vital functions. The rapid evolution of electronics and information technology is resulting in more powerful bedside patient monitors capable of complex biosignals processing and interpretation and usually equipped with some specialized communication interface. During the last decade, centralized patient monitoring systems were installed in the majority of critical care facilities. Centralized patient monitoring provides the networking of several bedside patient monitors with a central monitoring station.
2.3.1 Intelligent Decision Support System (DSS)

As the world's population ages, those suffering from diseases of the elderly will increase. In-home and nursing-home pervasive networks may assist residents and their caregivers by providing continuous medical monitoring, control of home appliances, medical data access, and emergency communication. An intelligent decision support system (DSS) based on established clinical
guidelines is a key component of the most recent idea of monitoring system. This DSS uses agent technology and provides clinicians as well as patients and their relatives with relevant medical information. Its suggestions are based on medical knowledge embedded into the guidelines, on input from the treating physician, on the patients history that is retrieved from the electronic healthcare record. Vital parameters gathered from sensors and transmitted wirelessly, as well as patient feedback are both also used as input for the DSS, If the patients state is identified as a potentially critical one, an alert is generated and propagated, triggering local reactions [3]-[5].
2.3.2 Homecare Scenario

Aim of the homecare scenario is the implementation of the infrastructure for homecare and individual patients by closing the gap between the IT infrastructure of health care institutions and the local infrastructure of the patients home. This is done by integrating the respective hardware and software on the so-called user-friendly multiservices home platform. Within the scope of the project, the multi-services home platform will be used as a residential gateway between the patients home and the clinic.
Additionally, the development of reliable communication protocols according to data privacy requirements, the semantically enriched patient data and their integration into the hospital information system and the electronic healthcare record. The emergence of internet technologies and telemedicine also opens new scales and makes new demands on patient monitoring. Home-care monitoring offers faster, more effective and cost-saving rehabilitation and mobilization of patients. Telecare monitors can provide both halter and on-line, noninvasive monitoring of vital functions. Wireless patient monitoring systems not only increase the mobility of patients and medical personnel but also improve the quality of health care. With respect to the remote monitoring of patients, many groups have demonstrated the transmission of vital biosignals using various wireless technologies. In some methods cellular phones used to transmit vital signs from the ambulance to the hospital, either in store-and-forward mode or in real-time mode.
2.3.3 Real-time and Always-on

With the recent advances of Internet and wireless technology it becomes possible for physicians and care givers to remotely access patient data from anywhere and anytime. Wireless access to the patients vital parameters and signals could greatly benefit the daily routine of caregivers, thus providing around the clock continuous care. This physiological and environmental data can be monitored continuously, allowing realtime response by emergency or healthcare workers.
2.4 State-of-the-Art
Most of existing systems patient monitors belong to the so-called first generation systems with traditional and quit reliable signal interpretation capabilities. Decision support and interactivity as a higher level of signal interpretation are the features of the second and third-generation monitors. These systems provide more advanced, usually knowledge based signal interpretation. From architectural point of view, many existing systems support the networking of bedside monitors to a central monitor via a vendor-specific communication interface. The signal interpretation features of the central monitoring are usually more advanced than the bedside monitors. However, there are several standards for transmitting various types of medical information.
The medical information bus (single communication channel) is the only existing standard that deals with the low level communication technology between bedside medical devices. Although the medical information bus specifies all the seven open system interconnection protocol layers. The medical information sharing was designed in an object-oriented way, considering the most important requirements on bedside networks: plug-and-play and fast reconfiguration, ease-of-use, reliable fault diagnostic and patient safety.
2.4.1 Mobile Technology

The adoption of mobile technology has led to new m-Health applications in health-care provision [7], a sample healthcare network shown in figure 2.2. Although face-to-face consultations between a clinician and a patient will never be replaced, there are medical cases that can be managed more efficiently by adopting wireless Telemedicine. Emergency and rescue situations, and sport science physiological measurements. Medical services can now be delivered to any location within the coverage of cellular networks. Wireless Telemedicine can be categorized in terms of the technology, namely 1)Satellite link, 2)Short-range networks and links, and 3)Mobile cellular networks (e.g.,GSM,GPRS,3G). The use of satellite communications requires expensive equipment, dedicated links, and skilled operators. Wireless local area networks (LANs) [5], [9] and short-rang radio-frequency (RF) Transceivers, as used in hospitals [6],[13], Cannot be used for truly mobile applications, unlike GSM cellular network, which is adopted hear [7],[11]. To allow world-wide connection, a mobile cellular network is also needed; initially this is GSM, while in the future it could be 3G.A comparison of security and encryption for wireless technologies is shown in table 2.1 [8] - [16].
Patient Unit
Figure 2.2: Mobile telemedicine system.
10
Technology Bluetooth WLAN
Security/Encryption 128-bit authentication key and 8-128 bit encryption key [8]. Wired equivalent privacy (WEP) protocol with RC4 Encryption algorithm [2], [15]-[16]. Three tier security with A3 algorithm for user authentication, A8 Ciphering Key Generating Algorithm and A5 Ciphering Algorithm for Data Encryption [2], [12]. f8 UMTS Confidentiality Algorithm and f9 UMTS integrity algorithm [8]. Table 2.1: Security and encryption for wireless technologies
GPRS
3G
Some applications of wireless telemedicine have involved the transmission of data using down-link channels. i.e., from hospital to clinician. There is probably a greater need for uplink channels, e.g., sending signals from a patient during emergency situations or nonemergency situations, in many systems, the implementation principles have been demonstrated earlier but there are limitations that merit further research, including the replacement of an infrared link with a Bluetooth link between the patients monitor unit and the mobile telephone. Most previous wireless telemedicine projects have focussed on the use of GSM, but the adoption of GPRS is relatively new. Its major advantage is that it enables the transmission of both data and speech. It is essential that a patients received data are archived and accessible to clinicians when required. The data includes the international mobile subscriber identification number, which is unique to the subscriber identity model card in the telephone. By using a password, a clinician can log on to access that patients database. GSM is a wireless platform that uses radio frequencies, since the radio medium can be accessed by anyone, authentication of users to prove that they are who they claim to be, is a very important element of a mobile network. Authentication involves two functional entities, the SIM card in the mobile, and the Authentication Centre (AuC). Each subscriber is given a secret key, one copy of which is stored in the SIM card and the other in the AuC.
11
2.4.2 The Internet

The use of the internet by health care provides, and certainly their patients, has seen dramatic increases in past few years. The dramatic increase in the popularity of the internet means that health care providers are left with the decision to either capitalize on the new e-world, or being left behind. For those that choose to integrate the internet into their suite of services, the internet offers several key benefits. These benefits include allowing physicians and specialists from across the globe to share vital health care information. Also, the internet has the capability of allowing patients to self-select themselves to view information on the internet, and apply their own diseases management and prevention. In addition, internet technology allows patients and physicians to communicate with each other with greater flexibility and convenience, via e-mail. A third primary benefit that the internet has to offer the health care industry is its unique ability to enable telemedicine, which brings health care to an entire new level [11],[14].
12
CHAPTER - 3
SYSTEM ARCHITECTURE AND REQUIREMENTS

The chapter includes Overview of the implemented system, GSM communication and consideration of a combination of wireless techniques, particularly the exploitation of cellular networks, types of clinical data transmission and system memory storage and lastly software design.
3.1 Overview of the Implemented System

The aim of this project is to design and implement a mobile system for monitoring vital signs, and to facilitate the continuous monitoring of patients during transport. The telemedicine system consists mainly of two parts: 1. The mobile unit, which is set up around the patient to acquire the patients physiological data, and 2. The management unit, which enables the medical staffs to telemonitoring the patients condition in real-time. The management unit is from either a fixed computer within an existing hospital network or a mobile laptop via LAN. The major design requirements of the mobile unit are follows: 1. It should be portable and lightweight, which means easy to carry. 2. It should have power autonomy of more than 60 min to support patient transport. 3. It should have a user-friendly interface. 4. It should collect and display critical biosignals, including three-lead BT (Body temperature), HR (Heart Rate), and BP (Blood Pressure). 5. It should record patient information and data; and 6. It supports wireless communication. On the other hand, the design requirements of the management unit are as follows: 1. It must have an easy-to-use interface. 2. It must display critical biosignals and analysis of data. 3. It must record, retrieve, and manage patient information and data (local database). 4. It must be connectable to the internet to transmit data and distribute information with authorisation.
13
Furthermore, at the consultation terminals such as wireless PDAs or laptops, the medical staffs can use them either to monitor the physiological parameters and waveforms of a remote patient online or to access his or her case history through the wireless connection to the management unit. Connection in the studied hospital scenario has been established by LAN technology with speed up to 10Mb/s. An access point acts as a bridge for the network data to be transmitted to and received from the existing wired hospital network; it allows efficient sharing network resources throughout an entire building. The transition of data between a mobile unit and a management unit is serves as the client server architecture. In the propose design, the mobile unit, central monitoring unit serves as the client end and the management unit serves as the server end. Communication depends on the transmit ion control protocol for error-free medical data transmission. All users are required to enter a user name and password to the system via a remote authentication dial-in user service server. In addition, a robust algorithm is implemented in the designed C#.Net program, permitting both central unit and management unit to perform end-to-end encryption.
3.2 Wireless Technology

The principal sketch of telemedicine system is as shown in figure 3.1.The system is designed after a careful consideration. in this progress, the technical, data security, practical and economical aspects were taken into consideration to achieve a suitable system design and set-up.in order to select the most appropriate technology for the system realization, properties of the existing modern technologies such as Bluetooth, Short-
rang radio-frequency (RF), GSM and GPRS have been investigated [3], [7]-[8], [17], as shown in table 3.1.
Monitoring Station Modem
Figure 3.1: A principal sketch of telemedicine system

Technology IrDA (Infrared) HomeRF (Home Radio Frequency) Bluetooth IEEE 802.15(Personal Area Network) WLAN (Wireless Local Area Network) IEEE 802.11a IEEE 802.11b IEEE 802.11g MAN(Metropolitan Area Network) IEEE 802.16(line-of-sight) IEEE 802.16a(non-line-of-sight) LMDS(Local Multi-point Distribution Service) DECT(Digital Enhanced Cordless Telecommunication)
Data Rate 4Mbps 1Mbps 723 Kbps 54Mbps 11Mbps 54Mbps <75Mbps <75 Mbps 34-38Mbps 736 Kbps
Frequency IR Spectrum 2.4GHz 2.4GHz 5GHz 2.4GHz 2.4GHz 10-66 GHz 2-11 GHz 26 GHz 1.88 GHz
Max. Range 2m <40m 10-100m <600m
5-10km 3-5 km 300-2500m
Table 3.1: Wireless Technologies
In order to reduce the complexity of the mentioned system and investigate the applicability of that, in the first step a prototype GSM based telemedicine system was designed and developed, which is presented here. It is essential that a patients received data are archived and accessible to clinicians when required. The data includes the international Mobile Subscriber Identity number, which is unique to the Subscriber Identity Module card in the telephone. By using a Password, a clinician log on to access that patients information (e.g. database). The GSM/GPRS modem SIMCOM SIM300 module is used here SIM300 is a Triband GSM/GPRS engine that works on frequencies EGSM 900 MHz, DCS 1800 MHz and PCS 1900 MHz. SIM300 features GPRS multi-slot class 10/ class 8 (optional) and supports the GPRS coding schemes CS-1, CS-2, CS-3 and CS-4 [18]. The project is mainly focused on the use of GSM, but with the evolution of cellular networks from the second generation such as GSM, to GPRS and enhanced data rate for global evolution (EDGE), then to 3G, more services can be designed and modelled for next-generation mobile telemedicine applications, it makes easy to feature enhancement. The maximum theoretical data rates of these technologies are presented in table 3.2.
15
Technology GSM GPRS EDGE 3G/UMTS
Maximum Theoretical Data Rates 9.6Kbps 141.2Kbps 384Kbps 2Mbps Table 3.2: Mobile Technologies
Frequency Spectrum 900/1800/1900MHz 900/1800/1900 MHz 900/1800/1900 MHz 1885 MHz 2200 MHz
GPRS represents an enhancement of GSM. Adoption of GPRS is relatively new [8], [12]. Its major advantage is that it enables the transmission of both data and speech.
3.3Clinical Data and Sensors

The patients health status, the most important parameters that determine the condition of the patient under observation are Body Temperature (BT), Heart Rate (HR), and Blood Pressure (BP). This project makes use of temperature sensors to sense temperature. Pressure and Heart beat input to the system is simulated input since actual sensors are costly and the main aim of the project is to bring out the idea that how the control system can be designed to monitor the patient health status using telemedicine technology. Therefore, an artificial patient was designed and implemented in order to generate the required vital signal. The sources of these biophysical readings are taken from sensors that are interfaced to the embedded system. For body temperature here we us LM35DZ Plastic Package IC, that will sense temperature in Celsius. The LM35 series are precision integrated-circuit temperature sensors, whose output voltage is linearly proportional to the Celsius (Centigrade) temperature. The features of LM35DZ is Linear + 10.0 mV/C scale factor (i.e. for every 1C change it will represents in 10mv variation)[34]. The LM35 does not require any external calibration or trimming to provide typical accuracies of 14C at room temperature and 34C over a full 55 to +150C temperature range. It can be used with single power supplies, or with plus and minus supplies. As it draws only 60 A from its supply, it has very low self-heating, less than 0.1C in still air. The LM35 series is rated to operate over a 55 to +150C temperature range, while the LM35D is rated for a 0 to +100C range. The LM35 series is available packages in different packages. Other two body parameters Pressure and Heart beat are taken by using two square trimming potentiometers (i.e. variable resisters).
16
3.4 Embedded-system Device Design

It is also call as acquisition model. Each of the sensors responsible for measuring these medical parameters must be directly interfaced to the devices embedded system based platform. Adding to this, the device must have the ability to store the measured medical parameter values for a predefined period of time (called the trial period). These values must be transferable through a standard networking interface from the device to a computing device (PC). In order for these values to be displayed by physicians for patient diagnosis purposes and also for communicate software application that is compatible with the device must be developed. Developers and system engineers must have the ability to upgrade the devices firmware as needed or upon request of application that is compatible with the device must be developed. The performance of the device is also of major importance for its users. It should ability to render a Body temperature level reading in a period that does not exceed 30 seconds from the time a patient switches sensor.
3.4.1 Data Acquisition

While designing acquisition model several considerations are taken into account. First, an embedded system-based platform was needed with enough memory to hold the medical parameter readings over an extended period of time. Second, the device must be accurate to make precise conversions from the voltage readings to meaningful biophysical values. Third, the device must have the networking options needed to transfer the data into a computing device as mentioned earlier. The Board contain ADC, microcontroller and above specified sensors. Here microcontroller we use Atmel AT89S8252, is an 8-bit microcontroller with several onchip peripherals and modules [19].
In AT89s8252 microcontroller does not have internal Analogue-to-Digital converter (ADC), thats why ADC0816 8-Bit P Compatible A/D Converters with 16Channel Multiplexer is used. This ADC having 8bit resolution with Conversion Time is 100 s [19]. The sensor output voltage is given to the ADC. The microcontroller receives ADC output, after processing the received data. It will forward it to the computer (management unit) using RS232 serial communication. This makes precise conversions from the voltage readings to meaningful biophysical values.
Using Keil software (IDE for microcontroller) Programming the microcontroller [20]. The device was programmed such that it converts samples of analogue signal data from the sensor voltage terminal into a series of hex values. Another set of functional requirements has been specified for the E-Med software application in computer.
3.5 Software Deign

For this project, a software (E-med software) designed by using Microsoft visual studio 2005, was installed in computer to monitor, data processes and GSM communication purpose. This software includes all required functionality of management unit; this units detailed explanation is there in next chapter. This E-med software includes communication in between Patient and Physician using GSM and GUI design. The application must have the ability to receive the patient monitoring parameters from the monitoring device by using serial communication link. It should also have the ability to read an identification code unique to each Patient. This ID is used to differentiate between the different patients devices when several patients are monitored during the same period of time. After reading this information, the application must have the ability to store the medical parameter readings into a patient-information database in a real-time. For this work, Microsoft SQL server 2005 database system is setup to manage the raw data of Patients information in E-med software. The attributes for each patient record are the patients name, age, deficiency, and a unique ID that serves as the public key. Finally, using E-med software, supervising physician must have the ability to use a variety of plotting options for patient monitoring parameters in real-time as well as GSM communication.
18
CHAPTER - 4
DESIGN AND IMPLEMENTATION

The various wireless telemedicine technologies and which are the methods are used in our system design is discussed in chapter 2 and 3. The architecture of the implemented system is shown in the below figure 4.1. In this chapter the overall implemented unit for Real-time Patient monitoring system view is presented.
4.1 System Architecture

The Architecture of the remote patient monitoring system with communication protocol is as shown in figure 4.1. The principal sketch of telemedicine system is as shown in figure.2.2 on chapter 2. The project work includes following modules: 1. The hardware design for data accusation. 2. Hardware design for data manipulation and transmission. 3. Hardware design for data reception. 4. Software design for graphical user interface presentation. 5. Software data-base management system with providing authentication. 6. Faithful information transmission/reception, through computers connected in LAN, WAN or through internet. 7. Reliability enhancement techniques, for enhancing the reliability of the system this include redundancy management techniques, and implementation of the system using different design methodologies. Each above listed models are explained in upcoming topics. The hardware design for data accusation, data manipulation and transmission are explained in acquisitions unit. Data reception, software design for interface presentation and data-base management with authentication are explained in management unit. The project work is mainly divided in to three units: 1. 2. 3. Acquisition unit. Management unit. Central monitoring unit.
Each of the unit explained in detail with circuit and software data flow diagram.
19
Body temperature Heart pulse rate Blood pressure
Single-Chip Microcontroller
RS-232
Backend Database
Biosensors
E-med Software Application

Trend analysis
Acquisition model
Management unit Data download
PDA
GSM Modem
Laptop Computer
GSM Network Infrastructure Cell Phone GSM Modem
LAN Hospital Server Monitoring station Database
Figure 4.1: Architecture of the patient monitoring system. The development of a monitoring system requires an appropriate analogue source. In reality, the vital signals originate from human parts and are measured with electrodes or catheters. The development of a patient monitor requires a reproducible and easy-tocontrol signal source. The system presented here contains the following links: 1. Monitoring device connected to processing unit (computer) using RS232 serial cable. 2. GSM modem for mobile communication. 3. LAN to central monitor unit, for data share.
4.2 Acquisition Unit

Figure 4.2 shows the diagram of the designed vital-signs acquisition module. The acquisition model consists of sensor signal conditioning circuits, plus analogue-to-digital converter and a microcontroller with voltage level converter for RS232 communication. This model powered by +5v common to all chips. The core control unit of the model is an 8-bit microcontroller, AT89S8252, which does not have in-built ADC, thats way here we use ADC0816. This is an 8-Bit C Compatible A/D Converter with 16-Channel, 8bit resolution. This project makes use of temperature sensors to sense body temperature. Pressure and Heart beat input to the system are simulated inputs, since actual sensors are costly and the main aim of the project is to bring out the idea that how the control system can be designed to monitor the patient health status.
20
21
4.2.1 AT89S8252 Hardware Connection

Microcontroller AT89S8252 is the core control of acquisition unit. This microcontroller is 8051 family member comes in DIP (dual in-line package), having 40 pins that are dedicated to various functions such as I/O, RD, WR, address, data, and interrupts. Figure 4.2 Shows AT89S8252 C pin diagram, note that of the 40 pins, a total of 32 pins are set aside for the four ports P0, P1, P2, and P3, where each port takes 8 pins. The rest of the pins are designated as Vcc, GND, XTAL1, XTAL2, RST, EA, PSEN, and ALE. We first describe the function of some pins. Vcc: Pin 40 provides supply voltage to the chip. The voltage source is +5V. GND: Pin 20 is the ground. XTAL1 and XTAL2: The AT89S8252 C has an on-chip oscillator but requires an external clock to run it. A quartz crystal oscillator is connected to inputs XTAL1 (pin 19) and XTAL2 (pin 18). The quartz crystal oscillator connected to XTAL1 and XTAL2 also needs two capacitors of 22pF value. One side of each capacitor is connected to the ground as shown in figure 4.3. Here we use 11.0592MHz crystal, for 11.0592MHz oscillator frequency. AT89S8252 C supports up to 24MHz. Ports 0, 1, 2 and 3: All four ports P0, P1, P2 and P3 each use 8 pins, making them 8-bit ports. All the ports upon RESET are configured as input, since P0-P3 have value FFh on them. The following is a summary of features of some of the ports. P0: Is an 8-bit bi-directional I/O port; Port 0 also receives the code bytes during Flash programming and outputs the code bytes during program verification. External pull-ups are required during program verification.
C2 XTOL2 XTOL1 C1 GND

GND
Figure 4.3: XTAL Connection to C

P1: Is an 8-bit bi-directional I/O port, Some Port 1 pins provide additional functions that are listed in table 4.1. In our project P1 mainly used as clock generator (P1.0) for ADC (i.e. 1 MHz clock frequency)
Port Pin P1.0 P1.1 P1.4 P1.5 P1.6 P1.7 Alternate Functions T2 (external count input to Timer/Counter 2), clock-out T2EX (Timer/Counter 2 capture/reload trigger and direction control) SS (Slave port select input) MOSI (Master data output, slave data input pin for SPI channel) MISO (Master data input, slave data output pin for SPI channel) SCK (Master clock output, slave clock input pin for SPI channel)
Table 4.1: Port 1 Alternate functions P3: Port 3 is also an 8-bit bi-directional I/O port; Port 3 also serves the functions of various special features of the AT89S8252, as shown in the following table 4.2. In our project P3 mainly used for serial communication and hardware interrupt generate purpose. For more information please refer appendix E.
Port Pin P3.0 P3.1 P3.2 P3.3 P3.4 P3.5 P3.6 P3.7 Alternate Functions RXD (serial input port) TXD (serial output port) INT0 (external interrupt 0) INT1 (external interrupt 1) T0 (timer 0 external input) T1 (timer 1 external input) WR (external data memory write strobe) RD (external data memory read strobe)
Table 4.2: Port 3 Alternate functions
Programming AT89s8252 Intel hex file is a widely used file format designed to standardize the loading of executable machine codes into a ROM chip. Therefore, loaders that come with every burner (programmer) support the Intel hex file format. While in many newer Windowsbased assemblers the Intel hex file is produced automatically (by selecting right setting). In our work Keil Vision3 (IDE and Debugger) is used for debug the program and hex file generate. Keil Vision3 main menu is as shown in figure 4.4.ProLoad software is used for load Intel hex file to chip memory by using Atmel programmer kit (1001-3456 v2).Software program design flow for AT89s8252 C is explained at the end of this chapter. This programming C manly include core control of acquisition unit.
Figure 4.4: Keil Vision3 main menu
4.2.2 Parallel ADC0816

Digital computers use binary (discrete) values, but in the physical world everything is analog (continuous). A physical quantity is converted to electrical (voltage, current) signals using a device called transducer. Transducers are also referred to as sensors. Example in our system sensor for Temperature produces an output that is voltage. Therefore, we need an analog-to-digital converter to translate the analog signal to digital number so that the microcontroller can read and process them. The ADC0816 IC is an 8-bit parallel ADC with 16-Channels, in the family of the ADC0800 series from National Semiconductor [19]. It works with +5V and has a resolution of 8 bits with 100 s Conversion Time it is depend upon the clocking signals applied to the CLKIN pin, but it cannot be faster than 116 s. ADC0816 pin diagram is as shown in figure 4.2. The following is the some of ADC0816 pin description. For more information please refer appendix D. Clock source for ADC0816 The speed at which an analog input is converted to the digital output depends on the digital output depends on the speed of the CLK input. According to the ADC0816 datasheet, the maximum operating frequency is 1.28M Hz.
4.2.3 Programmable Clock Out

The 1M Hz clock frequency to the ADC using T2 (external Timer/Counter 2) clock-out of P1.0 Port pin of the AT89s8252 C. P1.0 besides being a regular I/0 pin, has two alternate functions. It can be programmed to input the external clock for
Timer/Counter 2 or to output a 50% duty cycle clock ranging from 61 Hz to 4 MHz (for a 16-MHz operating frequency). To configure the Timer/Counter 2 as a clock generator, bit C/T2 (T2CON.1)1 must be cleared and bit T2OE (T2MOD.1)
1
must be set. Bit TR2
(T2CON.2) starts and stops the timer. The clock-out frequency depends on the oscillator frequency and the reload value of Timer 2 capture registers1 (RCAP2H, RCAP2L), as shown in the following equation. ...... (4.1)
For to get 1MHz we have to configure RCAP2H = 0XFF; RCAP2L = 0xFD, for 11.0592MHz AT89s8252 C oscillator frequency. The ADC0816 chip allows us to monitor up to 8 different analog inputs using only a single chip. The 16 analog input channels are multiplexed and selected according to table 4.3 using four address pins, A, B, C and D. In ADC0816 requires Vref(+) and Vref(-) set the reference voltage. If Vref(-)= Gnd and Vref(+) =5V, the step size is 5V/256= 19.53mV. Therefore, to get a 10mV step size we need to set Vref(+) =2.56V and Vref(-)=Gnd as shown in table 4.4. From figure 4.5, notice the ALE pin, we use A, B, C and D addresses to select IN0-IN15, and activate ALE to latch in the address. SC is the start of conversion. EOC is for end-of-conversion, and OE is for output enable. Table 4.4 shows the step size relation to the Vref voltage.
Selected Analog Channel IN0 IN1 IN2 IN3 IN4 IN5 IN6 IN7 IN8 IN9 IN10 IN11 IN12 IN13 IN14 IN15 All Channels OFF Address Line D L L L L L L L L H H H H H H H H X C L L L L H H H H L L L L H H H H X B L L H H L L H H L L H H L L H H X A L H L H L H L H L H L H L H L H X Expansion Control H H H H H H H H H H H H H H H H L
Table 4.3: ADC0816 Analog channel selection

Vref (V) Not connected 4 3 2.56
Vin (V) 0 to 5 0 to 4 0 to 3 0 to 2.56
Step size (mV) 5/256=19.53 4/256=15.62 3/256=11.71 2.56/256=10
Table 4.4: Vref Relation to Vin range for ADC0816
Steps to program the ADC0816 The following are steps to get data from an ADC0816. 1. Select an analog channel by providing bits to A, B, C and D addresses according to table 4.3. 2. Activate the ALE (address latch enable) pin. It needs an L-to-H pulse to latch in the address. As shown in figure 4.5. 3. 4. Activate SC (start conversion) by an L-to-H pulse to initial conversion. Monitor EOC (end of conversion) to see whether conversion is finished. H-to-L output indicates that the data is converted and is ready to be picked up. 5. Activate OE (output enable) to read data out of the ADC chip. An Lto-H pulse to the OE pin will bring digital data out of the chip.
26
Figure 4.5: Selecting a channel and Read timing for ADC0816
4.2.4 Sensors
Three-leads of each sensor, LM35DZ for measure Body Temperature (BT), two square trimming potentiometers for Heart Rate (HR) and Blood Pressure (BP) each.
4.2.5 Measuring Body Temperature Using LM35DZ

The sensors of the LM35 series (from National Semiconductor Corp) are precision integrated-circuit temperature sensors whose output voltage is linearly proportional to the Celsius (centigrade) temperature. The LM35 requires no external calibration since it is linearly calibrated. It outputs 10mV for each degree of centigrade temperature. Table 4.5 is a selection guide for the LM35 (For further information see www.national.com. [19]). LM35 terminal diagram is as shown in figure 4.6.
PIN1 +Vs Supply Voltage PIN2 Vout Output PIN3 GND Ground
Vout
Plastic Package
Figure 4.6: LM35DZ Connection Diagrams
Part LM35A LM35
Temperature Range Accuracy Output Scale -55 C to +150 C -55 C to +150 C +1.0 C +1.5 C +1.0 C +1.5 C +2 C 10mV/C 10mV/C 10mV/C 10mV/C 10mV/C
LM35CA -40 C to +110 C LM35C LM35D -40 C to +110 C 0 C to +100 C
Note: temperature range is in degrees Celsius.
Table 4.5: LM35 temperature selection series selection guide Connection Diagrams
Interfacing the LM35DZ to the AT89S8252 The output of the sensor is linear voltage change; we need to convert these signals to meaning full decimal values by using ADC0816. Since the ADC0816 has 8-bit resolution with a maximum of 256 (28) steps and the LM35 produces 10mV for every degree of temperature change, we can condition Vin of the ADC0816 to produce a Vout of 2560mV (2.56V) for full-scale output. Therefore, in order to produce the full-scale Vout of 2.56 V for the ADC0816, we need to set Vref=2.56V. This makes Vout of the ADC0816 correspond directly to the temperature as monitored by the LM35. See table 4.6 for Temperature v/s Vout for ADC0816. Figure 4.7 shows the connection of temperature sensor to ADC0816.
Temp. (C) Vin (mV) Vout (D7-D0) 0 1 2 3 10 30 35 40 0 10 20 30 100 300 350 400 0000 0000 0000 0001 0000 0010 0000 0011 0000 1010 0001 1110 0010 0011 0010 1000
Table 4.6: Temperature vs. Vout for ADC0816 What is body temperature? Body temperature is a measure of the body's ability to generate and get rid of heat. Normal human body temperature, also known as normothermia or euthermia, is a concept that depends upon the place in the body at which the measurement is made. The value of 36.8 C 0.7 C or 98.2 F 1.3 F is the common oral measurement. The sensor will generate this readings by touching black body of the sensor, its requires about 3 to 4 sec reaction time. While during test period normal BT 36C was represented by ADC is 0010 0100 (0x24). A temperature set point is the level at which the body attempts to maintains its temperature. When the set point is raised, the result is a fever (>38 C).
+5V
ADC0816
Vcc 2 MSB
-1
AT89S8252
2-1MSB
LM35 DZ
CH1 CH2 CH3 CH4 GND
Dout
Port 2
2-8LSB 28 CH16 2.56v V [+] REF 20 Address /Control Pins GND CLK GND VREF[-]
2-8LSB
P1.0 (T2)
GND
Figure 4.7: AT89S8252 connection to ADC0816 and Temperature sensor Most fevers are caused by infectious disease. If temperature is raised sensor representation will rise in 10mV for every C. If set point is not raised, then the result is hyperthermia, which can result in heat stroke or related conditions. In hypothermia (<32 C), the body temperature drops below that required for normal metabolism and bodily functions.
4.2.6 Measuring Body Heart Rate (HR) and Blood Pressure (BP)
Blood Pressure and Heart beat input to the system is simulated input by Square Trimming Potentiometer (3296 W - 1 - 103). It is a variable 10K Trimming Potentiometer is as shown in figure 4.8. Its require 25 trimming rotations for full-scale reading. If you rotate clock wise, the wiper position will change, this makes linear change in output voltage of pot, and then Vout is fed in to the input channel 6 of the ADC0816 for measure Heart beat. Another pot Vout is fed in to the input channel 11, for measure Blood Pressure. Output of the ADC is as shown in table 4.7. What is heart rate? Heart rate is the number of heart beats per minute; the times per minute that the heart contracts. when resting, the average adult human heart beats at about 70 beats per minute (bpm) in males and 75 bpm in females.
PIN1 +Vs Supply Voltage PIN2 Vout Output PIN3 GND Ground
Figure 4.8: Trimming Potentiometer Pot output ADC output (D7-D0) 0V 10 mV 20 mV 0000 0000 0000 0001 0000 0010
5V
1111 1111
Table 4.7: Pot Vout vs. ADC0816 output Maximum heart rate, the highest number of times your heart can contract in one minute, or the heart rate that a person could achieve during maximal physical exertion. In our project we taken 120bpm are Maximum heart, as shown in table 4.8. Bradycardia is defined as a heart rate less than 60 beats per minute, here we taken below 50 bpm as a critical condition. While during test period normal Heart beat (HB) 70bpm (beats per mint) was represented by ADC is 0100 0110 (0x46). This normal HB taken as threshold level. If we rotate trimming terminal that varies ADC output. If ADC output is above the 0x78, reading taken as maximum heart rate. Below 0x32 noted as a critical condition. These values are taken without calibration. Category Normal Above normal Below normal Heart beat (HB) in bpm Digital representation (ADC Vout) 70 >120 <50 0x46 0x78 0x32
Table 4.8: HB in bpm vs. ADC0816 output

Blood pressure (BP) is the pressure (force per unit area) exerted by circulating blood on the walls of blood vessels, Today blood pressure values are still reported in millimetres of mercury (mmHg), For each heartbeat, blood pressure varies between systolic and diastolic pressures. Systolic pressure is peak pressure in the arteries, which occurs near the beginning of the cardiac cycle when the ventricles are contracting. Diastolic pressure is minimum pressure in the arteries, which occurs near the end of the cardiac cycle when the ventricles are filled with blood. An example of normal measured values for a resting, healthy adult human is 115 mmHg systolic and 75 mmHg diastolic (written as
115
/75 mmHg, and spoken as "one fifteen over seventy-five"). In our project we only
consider systolic blood pressure, that can represented by second Trimming Potentiometer is as shown in figure 4.8. Category Normal Above normal Below normal systolic, mmHg Digital representation (ADC Vout) 90-120 >120 90 0x5A-0x78 >0x78 0x5A
Table 4.9: BP in mmHg vs. ADC0816 output
While during test period normal BP 115bpm (beats per mint) was represented by ADC is 0111 0011 (0x73). This normal BP taken as threshold level. If we rotate trimming terminal that varies ADC output. If ADC output is above the 0x78, reading taken as high BP (Prehypertension). Below 0x5A noted as a low BP (Hypotension) condition as shown in table 4.9. These values are taken without calibration.
31
5.2.7 Data Flow Diagram of the Acquisition Unit.
Start
Initialize I/O, A/D, sensors and serial communication.
Get the sensor data in hex values using A/D convertor.
No
Enough samples? Yes
Process and frame the data, then forward it to the computer.
Is that sample stop Interrupt is occur? Yes
No
End
Figure 4.9: Data flow diagram of the acquisition unit.
32
CHAPTER 5
MANAGEMENT AND MONITORING UNIT

The architecture of the implemented system and acquisition unit is discussed in chapter 4. In this chapter other two units management and monitoring unit view is presented.
5.1 Management Unit

Figure 5.1 shows the architecture of the management unit. The management unit consists mainly of a fixed personal computer, and the management program (E-med software). The management unit normally located nearby patient and provides a userfriendly interface for telemonitoring a patients vital-sign signals. The management terminal can receive patients physiological data from the acquisition unit via the COM port using RS232-serial communication with having 9600 Baud rate. For more information please refer appendix C.
Data display. Alarm
Data receive from acquisition unit
Data processing unit
Information distribution via Internet
User commands
Database
Figure 5.1: Architecture of the management unit For management unit E-med software is implemented on a Windows XP platform and developed by the Microsoft Visual Studio 2005 windows application builder using C# language , Visual Studio main menu as shown in figure 5.2. The program receives the data from the acquisition unit, displays BT, HR and BP waveforms on the screen, check for parameters criticality and stores the data in the local database. In this work, a MSSQL database system is set up to manage the raw data of BTs, HRs and BPs, patients information, and the doctors diagnosis in a real-time. The database can also be accessed from authorized terminals through GSM network. Moreover the vital-sign signal can be delivered in real-time to a mobile platform for sharing data.
Figure 5.2: Visual Studio Main Menu The waveforms are plotted in a 723 X 373 pixels window, which plots three parameters in a same window with different color-code. The plot is done by amplitude on Y-axis and time on X-axis. Graph is refreshing for every 6 point values of each sensor parameters. The program also supports the selection of leads, the replay of waveforms, analysis of raw data and the scaling of amplitude and time. Both mobile unit and management unit have an alarm setting window which enables the medical staff to set up the alarm threshold of BT, HR and BP individually according to the physiological status of the patient. When the recorded vital signs are beyond the present limits, the mobile unit would trigger an alarm automatically by sending warning SMSs to the monitoring station and a warning window will pop-up the screen.
5.1.1 GSM Communication Module

For end-to-end monitoring system will enable the physician to communicate with several patients via the public GSM mobile network. The physician can send an SMS command to the device, and the device can then respond by sending a SMS message that contains the latest reading all this is done by using E-med software. A communication protocol is devised for this purpose. As shown in figure 5.3, the E-med software takes patient readings from acquisition unit and then reported to physicians monitoring system in the form of an SMS via SIM300 GSM modem. This GSM modem is interfaced to the computer via standard RS232 serial port with having 9600 Baud rate.
Monitoring device at Patients home Normal Readings
Physician Monitoring System
Params. Readings SMS Msg.
Params. Readings SMS Msg. Abnormal Readings Alert SMS Msg. Condition Analysis Time
Persistence Time
Instruction SMS Msg.
Figure 5.3: Communication protocol designed to handle abnormal readings in monitored patients. GSM technology uses Time Division Multiple Access (TDMA) with 8 time slots per frame hence supporting 8 simultaneous users at any given time [33]. GSM modem is programmed by using AT Commands in E-med software [35]. For more information please refer appendix A and B. In abnormal situations, the communication protocol is such that acquisition unit reports unusual readings, such that excessive BT, HR or BP conditions, correlated with time of the day. A persistence time is allotted before reporting an alert SMS message to the physicians monitoring system. This persistence time is necessary to avoid any unnecessary reaction to a sporadic reading that is not representative of the actual patient health condition. The E-med software analyzes the reported data and correlates it to the patients known illness, the previously reported data, and the time of the day the abnormal readings were reported, and may choose to instruct the patient, or alternatively the caregiver, again through an SMS message to take the necessary actions that can be life saving before healthcare professionals intervene. This novel design allows monitoring several patients at the same time, unlike the wireline solution presented in earlier days. The monitoring and data reporting take place nearly real-time. This relives incapable patients from needing to go in-person to the physicians office. It also gives the healthcare professionals the ability to react promptly to life-threatening situations, in a proactive way that involves the patients themselves. Data flow in the CMU is presented at the end of this chapter, section 5.3.
5.2 Central Monitoring Unit

Central Monitoring Unit (CMU) is maybe a single computer or multiple computer network with GSM modem. A typical CMU scenario is as shown in figure 5.4. In CMU for our application purpose, a software (same as E-med software) designed by Microsoft visual Studio 2005 windows application builder on a Windows XP platform using C# language. Software was installed in computer for GSM communication. This software includes all required functionality of CMU; this will store the communicated data on a run-time. All received data is stored in notepad with patient ID file name. The attributes for each patient record are the patients name, age, deficiency, and a unique ID that serves as the public key read an identification code unique to each Patient. Then this file can be shared by local area network (LAN). This software provides real-time communication in between Patient and Physician using GSM.
GSM Network Infrastructure
Hospital Server GSM Modem

Database
LAN
Laptop Computer
PDA
Figure 5.4: Architecture of the management unit
36
5.3
Data Flow Diagram of the Management Unit.
Start
Check for authorization.
Get the hospital and physician contact details for communication and emergency alarm set.
Select monitor parameters, and computer ports for acquisition, GSM communication.
Initialization of acquisition board, GSM modem for communication B Get the sensors data from acquisition model. .
No
Enough samples? Yes A
37
Is that Vital-sign signals cross the threshold level?
Yes
Alert signal generated by sending short message service (SMS)
No Process, plot and store (Database) the data. Peripheral Activation GSM Communication (authorization, real-time data transfer, presents condition, changing prescription clinical guide-line etc...)
Yes Is that requested for communication? No Yes
Do you want continue? No
Stop monitoring? Yes
No
End
Figure 5.5: Data flow diagram of the management unit
38
CHAPTER 6
RESULTS AND SCREEN SNAPSHOTS

The prototype of the remote patient monitoring system was implemented and tested in IntaGlio Systems Pvt. Ltd. The current installation consists of one patient unit (includes acquisition unit and management unit with E-med software) and a central monitor unit.
6.1 Verification and Test Plan

The system was verified in the following phases. 1. Technical verification: first, the developed acquisition unit for in proper signal generation like spikes (noise), then the E-med software test for error free data reception from the acquisition unit. Anyhow Persistence Time methods used for avoid false alarm in E-med software. In second stage of verification is done by GSM communication, as well as the transmission of data between patient unit and CMU were tested. 2. Clinical test: The complete system is tested in a room. In the test scenario Patient unit contain acquisition as well as management unit. In patient unit one computer, GSM modem and vital-sign signal generate board. In other end two computers with LAN, in that one computer is connected to another GSM modem for monitor unit. Three Cell phones for care-giver scenario (for mobile computing). The patient unit transmits both the primary and the derived signals in real-time to the central monitor. The E-med software on hospital and in physician PC, it allows Realtime communication with Patient PC (i.e. present condition of patient, Database accesses, changing prescription etc.) is as shown in figure 6.1 to 6.11. The physician can send an SMS command to the device using E-med software, as shown in figure 6.12 and the device can then respond by sending a SMS message that contains the latest reading, as shown in figure 6.10. The end-to-end monitoring system architecture is shown in figure 2.2 in chapter 2. A communication protocol is devised for this purpose, as shown in figure 5.3 in chapter 5; the monitoring device takes patient readings and stores them to the
39
computer. Normal readings are periodically reported to physicians monitoring system in the form of an SMS via the general packet radio service (GPRS) modem. The GPRS modem is interfaced with the computer via the standard RS-232 serial port. GSM technology uses Time Division Multiple Access (TDMA) with 8 time slots per frame hence supporting 8 simultaneous users at any given time with a speed of 9.6 Kbps. This chapter consists of all the possible snapshots and photos taken during the entire process of implementing Real-time Patient monitoring system. Figure 6.2 shows the Login form for providing data security against unauthorized access. Figure 6.6 shows the Hospital & physician contact details form for communication and emergency alarm set. Figure 6.8 shows the form that contain Patient details include monitoring parameters and prescription. Figure 6.10 Main monitoring and communication form with successful generation of alert signal by sending and receiving SMS. Example Blood pressure parameter is above the threshold auto alert SMS send to the CMU and receive authentication (e.g. prescription change etc...). Figure 6.11. Shows the Patient monitoring parameter Database form. Figure 6.12 and 6.13 shows the snapshot and photos with messages.
40
Project Snapshots:
Figure 6.1: Welcome form.
Figure 6.2: Login form for authorization.
Figure 6.3: Message Box for create new user.
41
Figure 6.4: Admin login form. .
Figure 6.5: New user form.
Contact information
Figure 6.6: Hospital & Doctor contact details form communication and emergency alert.
42
Figure 6.7: Message box (incorrect contact number i.e. it may be GSM modem or Phone number).
Patient description Port selection for GSM communication and acquisition model
Figure 6.8: Patient details form with monitoring parameters.
Figure 6.9: Message box (incorrect contact number i.e. it may be GSM modem or Phone number).
Real-time communication window
Patient Monitoring window
Figure 6.10: Main monitoring and communication with successful generation of alert signal by sending and receiving SMS.
Figure 6.11: Patient monitoring parameter Database form.

Communicated information.
The Central Monitors screen
Figure 6.12: GSM Communication main form.
Display of the Mobile unit with instant message.
Figure 6.13: Instant messages on cell phone.
45
SIM300 hardware connection for GSM Communication
Fig.6.14: Layout of the GSM board.
Sources of these biophysical reading
Fig.6.15: Layout of the acquisition board.
www.intagliosystems .com
Figure 6.16: For dynamic help form.
46
Tools and Specifications:

Microsoft development environment (MDE): Microsoft Visual Studio 2005 Version 8.0.50727.42 Microsoft Technologies: C#.NET, ADO.NET Framework: Microsoft .NET Framework2.0 Version: 2.0.50727 Operating Systems: Windows XP/SP2. Project Type: Windows applications. Database: Microsoft SQL Server 2005(version: 9.00.1399.00) Components used in MS server 2005: Microsoft SQL Server Management Studio Express: (version: 9.00.1399.00) Authentication type: Windows. Types of controls used in c#.net (in this project): Namespace for interacting with hardware: using System.IO.Ports; Namespace for zedgraph control: using ZedGraph;
47
CHAPTER 7
CONCLUSION AND SCOPE OF FUTURE WORK

Conclusion:
Telemedicine can open a world of health-care delivery by building clinical bridges between patient and available health care. The main contribution of the work described above is to demonstrate the present scope and future potential of mobile communications in telemedicine. A modular structured GSM based mobile system is presented to illustrate the concept. The unit carried in patient scenario is acquisition and management unit with a GSM modem. The prototype version is designed to transmit digitalized signals to a (central monitor) unit via the GSM communication network. This
hospital scenario
allows the transmission of medical data in a real-time. As evidenced by the literature outlined in chapter 2, the system is expected to become a novel approach aid to monitoring and diagnosis as well as a convenient means of communication. The main benefit of the system from the signal interpretation point of view is in the design of the central monitor. The central monitoring allows the real-time access of bedside data via standard hardware and software interface. We believe this system design will greatly enhance quality of life, health, and security for those in assisted-living communities.
Future Work:
In this work GSM is used, but the adoption of GPRS is relatively new. A feature telemedicine provides to adopt mobile GPRS, 3G standards, its major advantage is that it enable the transmission of both data and speech, which allow much more data to be transmitted, like high-resolution digital radiographic images or large volume MR/ CT images; audio and video signals.
48
BIBLIOGRAPHY
References: [1] Amrita pal,victor W.A.Mbarika, Fay Cobb-Payton,Pratim Datta and Scott McCoy "Telemedicine Diffusion in developing Country: The Case of India(March 2004) ", Information Technology in Biomedicine, IEEE Transactions on Volume 9, No.1, March. 2005 Page(s):59 64. [2] Y. Lin, I-C. Jan, Ko, P.C.-I., Y. Yu Chen, J.-M. Wong and G.-W Jan, " A wireless PDA-based physiological monitoring system for patient transport", Information Technology in Biomedicine, IEEE Transactions on Volume 8, Issue 4, Dec. 2004 Page(s):439 447. [3] Andreas Hein,Oliver Nee, Detlev Willemsen,Thoas Scheffold,Asuman Dogac Gokce Banu Laleci ,SAPHIRE-Intelligent Healthcare Monitoring based on Semantic Interoperability Platform-The Homecare Scenario, 1st European Conference on eHealth(ECEH06),Fribourg,Switzerland,October 12-13, 2006.Submitted (30.03.2006) Page(s): 1-10. [4] Y Jasemian, E Toft, L Arendt-Nielsen, Real-time remote monitoring cardiac patients at distance, Department of Health Science & Technology, Aalborg University,2nd Open ECG Workshop 2004, Berlin, Germany,S-7-1 Page(s):48-50. [5] G. Virone, A. Wood, L. Selavo, Q. Cao, An Assisted Living Oriented Information System Based on a Residential Wireless Sensor Network, Department of Computer Science, University of Virginia, Proceedings of the 1st Distributed Diagnosis and Home Healthcare (D2H2) Conference Arlington, Virginia, USA, April 2-4, 2006 Page(s): 95-100. Available: http://marc.med.virginia.edu/ [6] G. Virone, A. Wood, L. Selavo, Q. Cao, L. Fang, T. Doan, Z. He, R. Stoleru, S. Lin, and J.A. Stankovic, An Advanced Wireless Sensor Network for Health Monitoring, Department of Computer Science, University of Virginia. Page(s): 1-4. [7] Han-Chang Wu Chao-Hung Lin Kuang-Ching Wang Shao-Cheng Wang , A
mobile system for real-time patient-monitoring with integrated physiological signal processing, Engineering in Medicine and Biology, 1999, IEEE Transactions on Volume 2, October 1999 Page(s): 712 . [8] Mohd fadlee A.Rasid and Bryan Woodward Bluetooth Telemedicine Processor for Multichannel Biomedical Signal Transmission via Mobile Cellular Networks, IEEE Transaction on Information Technology in Biomedicine, Vol.9, No.1, March 2005 Page(s): 35-42.
[9] Taha Landolsi , A. R. Al-Ali and Yousef Al-Assaf, Wireless Stand-alone Portable Patient Monitoring and Logging System, Computer Standards & Interfaces, journal of communications, vol. 2, no. 4, June 2007 page(s) 65-70. [10] GSM standards available on: http://www.3gpp.org. [11] Carlos H.Salvador,Mario Pascual Carrasco,Miguel A.GonZalez de Mingo,Adolfo Munoz Carrero,Airmed-Cardio:A GSM and Internet Services-Based System for outof-Hospital Follow-Up of Cardiac Patients, IEEE Transaction on Information Technology in Biomedicine,Vol.9,No.1,March 2005 Page(s): 73-84. [12] P. Klootwijk, S. P. Nelwan, T. B. Van Dam and S. H. Meij, " Wireless (GPRS-Based) mobile real-time patient monitoring", Journal of the American College of Cardiology, Volume 41, Issue 6, Supplement 2, 19 March 2003, Page 528. [13] Jianchu Yao,Ryan Schmitz and steve Warren , A Wearable Point-of-Care System for home Use That Incorporates Plug-and-Play and Wireless Standards, IEEE Transaction on Information Technology in Biomedicine,Vol.9,No.3, September 2005 Page(s): 363-371. [14] Robert A. Dennis and Sanjiv S.Gambhir,InternetQuestion and Answer (iQ&A):A Web-Based Survey Technology, IEEE Transaction on Information Technology in Biomedicine,Vol.4,No.2, June 2000 Page(s): 116-125. [15] Patrick O. Bobbie, Chaitanya Deosthale, Walter Thain, Telemedicine: a mote-based data acquisition system for real time health monitoring, Department of Electrical and Computer Engineering Technology Southern Polytechnic State University. [16] Sotiris A.Pavlopoulos and Anastasios N.Delopoulos, Designing and Implementing the Transition to a fully digital Hospital, IEEE Transaction on Information Technology in Biomedicine,Vol.3,No.1,March 1999 Page(s): 6-19. [17] SP Nelwan,TB van Dam,P Klootwijk,SH Meij, Ubiquitous Mobile Access to Realtime Patient Monitoring Data, Computers in Cardiology 2002 Page(s): 557-560. [18] Product Manual guide,SIM300 AT Command Set SOFTWARE SPECIFICATION, Version: 01.06, DocId: SIM300_ATC_v1.06, Copyright SIMCOM Limited. 2004. [19] For Datasheets http://www.national.com/ds/. [20] Manual guide of Keil software Users Guide (C51 Microcontroller Development Tools), Vision2 V2.36, Keil Software. Inc 1995-2003. [21] Peter varady, Zoltan benyo and balazs benyo An Open Architecture patient monitoring System Using Standard Technologies, IEEE Transaction on Information Technology in Biomedicine,Vol.6,No.1,March 2002 Page(s): 95-98.
[22] Jianguo Zhang,Johannes,Real-Time Teleconsultation with High-Resolution and Large-Volume Medical Images for Collaborative Healthcare, IEEE Transaction on Information Technology in Biomedicine,Vol.4,No.2, June 2000 Page(s): 178-185. [23] Glen C.Crumley,Noel E.evans,William G.Scanlon,The Design and performance of a 2.5-GHz Telecommand Link for Wireless Biomedical Monitoring,IEEE Transaction on Information Technology in Biomedicine,Vol.4,No.4,Dec 2000 Page(s): 285-291. [24] Keng Siau,Health Care Informatics, IEEE Transaction on Information Technology in Biomedicine, Vol.7, No.1, March 2003 Page(s): 1-7. [25] Kevin Hung,yuan-Ting Zhang, Implementation of a WAP-Based Telemedicine System for Patient Monitoring, IEEE Transaction on Information Technology in Biomedicine,Vol.7,No.2, June 2003 Page(s): 101-107. [26] Vicente Moret-Bonillo,Eduardo Mosqueira-Rey and Amparo Alonso-Betanzos, Information Analysis and Validation of Intelligent Monitoring Systems in Intensive Care Units, IEEE Transaction on Information Technology in Biomedicine,Vol.1, No.2, June 1997 Page(s): 87-99. [27] Miroslav Bojovic and Dragan Bojic, MobilePDR: A Mobile Medical Information System Featuring Update via Internet, IEEE Transaction on Information Technology in Biomedicine,Vol.9,No.1,March 2005 Page(s): 1-3. [28] Matthew S.Brown,Sumit K.Shah,Richard C.Pais,Yeng-Zhong Lee, Database Design and Implementation for Quantitative Image Analysis Research ,IEEE Transaction on Information Technology in Biomedicine,Vol.9,No.1,March 2005 Page(s): 99-107. [29] Robert S.H.Istepanian,Guest Editorial Introduction to the Special Section on MHealth: Beyond Seamless Mobility and Global Wireless Health-Care Connectivity, IEEE Transaction on Information Technology in Biomedicine, Vol.8, No.4, Dec 2004 Page(s): 405-413.
[30]
Muhammad Ali Mazidi, Janice Gillispie Mazidi, Rolin D. McKinlay, THE 8051 MICROCONTROLLER AND EMBEDDED SYSTEMS, Published by Person Education, 2nd edition, 2008.
51
APPENDIX A
GSM Technology
A.1 Introduction
GSM is a wireless platform that uses radio frequencies, currently GSM is one of the worlds most widely deployed and fastest growing digital cellular standard. It is one of the most successful digital mobile telecommunication systems. There are over 250 million GSM subscribers world-wide two thirds of the worlds digital mobile population. The unique roaming features of GSM allow cellular subscribers to use their services in any GSM service area in the world in which their provider has a roaming agreement. GSM-enabled phones have a "smart card" inside called the Subscriber Identity Module (SIM). The SIM card is personalized to the user. It identifies the users account to the network and provides authentication, which allows appropriate billing. GSM has been designed for speech services. It uses circuit switched transmission, reserving one radio channel for the users traffic. It also uses cells which enables it to reuse different frequencies. GSM provides almost complete coverage in Western Europe, and growing coverage in the Americas, Asia and elsewhere. GSM networks presently operate in three different frequency ranges. These are: 1. GSM 900 (also called GSM) - operates in the 900 MHz frequency range and is the most common in Europe and the world. 2. GSM 1800 (also called PCN (Personal Communication Network), and DCS 1800) operates in the 1800 MHz frequency range and is found in a rapidly-increasing number of countries including France, Germany, UK, and Russia. 3. GSM 1900 (also called PCS (Personal Communication Services), PCS 1900 and DCS 1900) the only frequency used in the United States and Canada for GSM. GSM standard circuit is a digital data bearer service offering 9.6kb/s. This data transmission in these networks is regarded as too slow and often too expensive for many applications. The cost is the total time that the user occupied that channel even though he was using the channel all the time. The performance of services such as Internet Applications in a cellular environment is typically characterized by the low available bandwidth, and an inefficient use of the rare air link capacity. Furthermore, long connection setup delay is a problem for bursty services requiring occasional data transfers.
A.2 Architecture of the GSM network

A GSM network is composed of several functional entities, whose functions and interfaces are specified. Figure A.1 shows the layout of a generic GSM network. The GSM network can be divided into three broad parts. The Mobile Station is carried by the subscriber. The Base Station Subsystem controls the radio link with the Mobile Station. The Network Subsystem, the main part of which is the Mobile services Switching Centre (MSC), performs the switching of calls between the mobile users, and between mobile and fixed network users. The MSC also handles the mobility management operations. Not shown is the Operations and Maintenance Centre, which oversees the proper operation and setup of the network. The Mobile Station and the Base Station Subsystem communicate across the Um -interface, also known as the air interface or radio link. The Base Station Subsystem communicates with the Mobile services Switching Centre across the A -interface. A Interface, On the physical level the A-interface consists of one or more pulse code modulation (PCM) links between the MSC and the BSC. Each one has a transmission capacity of 2Mbps. Authentication and security Since the radio medium can be accessed by anyone, authentication of users to prove that they are who they claim to be, is a very important element of a mobile network. Authentication involves two functional entities, the SIM card in the mobile, and the Authentication Centre (AuC). Each subscriber is given a secret key, one copy of which is stored in the SIM card and the other in the AuC. During authentication, the AuC generates a random number that it sends to the mobile. Both the mobile and the AuC then use the random number, in conjunction with the subscriber's secret key and a ciphering algorithm called A3, to generate a signed response (SRES) that is sent back to the AuC. If the number sent by the mobile is the same as the one calculated by the AuC, the subscriber is authenticated. The same initial random number and subscriber key are also used to compute the ciphering key using an algorithm called A8. This ciphering key, together with the TDMA frame number, use the A5 algorithm to create a 114 bit sequence that is XORed with the 114 bits of a burst (the two 57 bit blocks). Enciphering is an option for the fairly paranoid, since the signal is already coded, interleaved, and transmitted in a TDMA manner, thus providing protection from all but the most persistent and dedicated eavesdroppers.
53
APPENDIX B
AT Command set software specification
GSM modems are widely used in mobile phones. The working of the modem can be controlled by AT commands. Modem stands for Modulation and demodulation. For long distance data transfers using communication lines such as a telephone, serial data communication requires a modem to modulate (convert 0s and 1s to signals like audio tones) and demodulate (convert from audio tones to 0s and 1s). The AT command set is the industry standard set of commands used for setting up and communicating with a modem. The AT commands set of the most GSM mobile phones are same. Some of AT command set discussed bellow.
B.1 AT Command syntax

The "AT" or "at" prefix must be set at the beginning of each command line. To terminate a command line enter <CR>. Commands are usually followed by a response that includes.<CR><LF><response><CR><LF>. Throughout this appendix, only the responses are presented, <CR><LF> are omitted intentionally.
B.2 Flow control

Flow control is very important for correct communication between the GSM engine and DTE (Data Terminal Equipment). For in the case such as a data or fax call, the sending device is transferring data faster than the receiving side is ready to accept. When the receiving buffer reaches its capacity, the receiving device should be capable to cause the sending device to pause until it catches up. There are basically two approaches to achieve data flow control: software flow control and hardware flow control. SIM300 (GSM modem) support both two kinds of flow control. In Multiplex mode, it is recommended to use the hardware flow control. Software flow control (XON/XOFF flow control) Software flow control sends different characters to stop (XOFF, decimal 19) and resume (XON, decimal 17) data flow. It is quite useful in some applications that only use three wires on the serial interface. The default flow control approach of SIM300 is hardware flow control (RTS/CTS flow control); to enable software flow control in the DTE interface and within GSM engine, type the following AT command: AT+IFC=1, 1 This setting is stored volatile, for use after restart.
Note: Software Flow control should not be used for data calls where binary data will be transmitted or received (e.g. TCP/IP) as the DTE interface may interpret binary data as flow control characters.
Hardware flow control (RTS/CTS flow control) Hardware flow control achieves the data flow control by controlling the RTS (Ready to Send) / CTS (Clear to Send) signal line. When the data transfer should be suspended, the CTS line is set inactive until the transfer from the receiving buffer has completed. When the receiving buffer is ok to receive more data, CTS goes active once again. To achieve hardware flow control, ensure that the RTS/CTS lines are present on your application platform.
B.3 AT Commands According to GSM07.05

The GSM 07.05 commands are for performing SMS and CBS (Cell broad cast service) related operations. SIM300 II supports both Text and PDU modes.
Command AT+CMGD AT+CMGF AT+CMGL AT+CMGR AT+CMGS AT+CMGW AT+CMSS AT+CMGC AT+CNMI AT+CPMS AT+CRES AT+CSAS AT+CSCA AT+CSCB AT+CSDH AT+CSMP AT+CSMS
Description DELETE SMS MESSAGE SELECT SMS MESSAGE FORMAT LIST SMS MESSAGES FROM PREFERRED STORE READ SMS MESSAGE SEND SMS MESSAGE WRITE SMS MESSAGE TO MEMORY SEND SMS MESSAGE FROM STORAGE SEND SMS COMMAND NEW SMS MESSAGE INDICATIONS PREFERRED SMS MESSAGE STORAGE RESTORE SMS SETTINGS SAVE SMS SETTINGS SMS SERVICE CENTER ADDRESS SELECT CELL BROADCAST SMS MESSAGES SHOW SMS TEXT MODE PARAMETERS SET SMS TEXT MODE PARAMETERS SELECT MESSAGE SERVICE
Table B.1: Overview of AT Commands According to GSM07.05
55
B.4 AT Commands Samples

Profile Commands Demonstration The AT command interpreter is actively responding to input. Display product identification information: the manufacturer, the product name and the product revision information. SMS commands Set SMS system into text mode Unsolicited notification of the SMS arriving. Read SMS message that has just arrived. Note: the number should be the same as that given in the +CMTI notification. Delete an SMS message. Send SMS message AT+CMGF=1 AT+CMGR=1 OK +CMTI:SM,1 +CMGR: REC UNREAD, +8613918186089, ,02 /01/30,20:40:31+00 This is a test OK OK OK Revision:1008B10SIM3 00M32_SPANSION ATI SIMCOM_Ltd SIMCOM_SIM300 AT Syntax OK Expect Result
AT+CMGD=1 text mode (+CMGF=1): +CMGS=1 text is entered <ctrl-Z/ESC> ESC quits without sending
56
APPENDIX C
RS232 serial communication
The IBM compatible series of personal computers use the RS-232 interface as the serial port. The 9-pin serial port pin out is located in the Table C.1 below. RS-232 uses Asynchronous Framing [Known data width, 8bits]. Normally the RS-232 interface is asynchronous. RS-232 is rated to operate up to 20kbps. The maximum RS-232 cable length is a little less than 20 meters. RS-232 Pin out: The RS-232 specification only defines the pin-out for a 25 pin D connector; however, the 9-pin is used more often (defined by EIA-574). The serial port found on personal computer uses a 9-pin connector. Most computer systems have only one serial port. The RS-232 pin out is provided below.
Pin 1 2 3 4 5 6 7 8 9 DB-9 Connector Pin Out Signal Name Signal Description CD Carrier Detect RxD Receiver Data TxD Transmit Data DTR Data Terminal Ready GND Signal Ground / Common DSR Data Set Ready RTS Request To Send CTS Clear To Send RI Ring Indicator
Table C.1: RS-232 Pin out

1 6 2 7 3 8 4 9 5
Figure C.1: DB-9 9-pin connector RS-232 Serial port signal description TxD: Transmit Data; the data sent from the data terminal and received by the data set. RxD: Receive Data; the data sent from the data set and received by the data terminal. DTR: Data Terminal Ready; used by the data terminal to signal to the data sent that it is ready for operation, active high. DSR: Data Set Ready; used by the data set to signal to the data terminal that it is ready for operation and ready to receive data, active high. RTS: Request To Send; used by the data terminal to signal the data set that it may begin sending data. The data set will not send out data without this signal, active high. CTS: Clear To Send; used by the data set to signal the data terminal that it may begin sending data. The data terminal will not send out data without this signal.CD: Carrier Detect; used CD: Carrier Detect; used by the data set to indicate to indicate to the data terminal that the data set has detected a carrier (of another device). RI:Ring Indicator; user by the data set to indicate to the data terminal that a ringing condition has been detected. GND: Ground; the common return for all signals on the interface.
APPENDIX D
D.1 AT89s8252 Microcontroller Features:
Compatible with MCS51 Products 8K Bytes of In-System Reprogrammable Downloadable Flash Memory SPI Serial Interface for Program Downloading Endurance: 1,000 Write/Erase Cycles 2K Bytes EEPROM Endurance: 100,000 Write/Erase Cycles 4V to 6V Operating Range Fully Static Operation: 0 Hz to 24 MHz Three-level Program Memory Lock 256 x 8-bit Internal RAM 32 Programmable I/O Lines Three 16-bit Timer/Counters Nine Interrupt Sources Programmable UART Serial Channel SPI Serial Interface Low-power Idle and Power-down Modes Interrupt Recovery from Power-down Programmable Watchdog Timer Dual Data Pointer Power-off Flag
D.2 Description
The AT89S8252 is a low-power, high-performance CMOS 8-bit microcontroller with 8K bytes of downloadable Flash programmable and erasable read-only memory and 2K bytes of EEPROM. The device is manufactured using Atmels high-density nonvolatile memory technology and is compatible with the industry-standard 80C51 instruction set and pin out. The on-chip downloadable Flash allows the program memory to be reprogrammed In-System through an SPI serial interface or by a conventional nonvolatile memory programmer. By combining a versatile 8-bit CPU with downloadable Flash on a monolithic chip, the Atmel AT89S8252 is a powerful microcontroller, which provides a highly-flexible and cost-effective solution to many embedded control applications.
Figure D.1: Block Diagram of AT89s8252 C The AT89S8252 provides the following standard features: 8K bytes of downloadable Flash, 2K bytes of EEPROM, 256 bytes of RAM, 32 I/O lines, programmable watchdog timer, two data pointers, three 16-bit timer/counters, a six-vector two-level interrupt architecture, a full duplex serial port, on-chip oscillator, and clock circuitry. In addition, the AT89S8252 is designed with static logic for operation down to zero frequency and supports two software selectable power saving modes. The Idle Mode stops the CPU while allowing the RAM, timer/counters, serial port, and interrupt system to continue functioning. The Power-down mode saves the RAM contents but freezes the oscillator, disabling all other chip functions until the next external interrupt or hardware reset. The downloadable Flash can be changed a single byte at a time and is accessible through the SPI serial interface. Holding RESET active forces the SPI bus into a serial programming interface and allows the program memory to be written to or read from unless lock bits have been activated.
D.3 Programmable Clock Out

A 50% duty cycle clock can be programmed to come out on P1.0, as shown in Figure 5.This pin, besides being a regular I/0 pin, has two alternate functions. It can be programmed to input the external clock for Timer/Counter 2 or to output a 50% duty cycle clock ranging from 61 Hz to 4 MHz (for a 16-MHz operating frequency). To configure the Timer/Counter 2 as a clock generator, bit C/T2 (T2CON.1) must be cleared and bit T2OE (T2MOD.1) must be set. Bit TR2 (T2CON.2) starts and stops the timer.
Figure D.2: Timer 2 in Clock-out Mode
T2MOD Address = 0C9H Not Bit Addressable

7 6 5 4 3 2
Reset Value = XXXX XX00B

T2OE 1 DCEN 0
Bit
Symbol T2OE DCEN
Function Not implemented, reserved for future use. Timer 2 Output Enable bit. When set, this bit allows Timer 2 to be configured as an up/down counter. Table D.2: T2MOD Timer 2 Mode Control Register
60
T2CON Address = 0C8H Reset Value = 0000 0000B Bit Addressable

TF2 7 EXF2 6 RCLK 5 TCLK 4 EXEN2 3 TR2 2 C/T2 1 CP/RL2 0
Bit
Symbol Function TF2 EXF2 Timer 2 overflow flag set by a Timer 2 overflow and must be cleared by software. TF2 will not be set when either RCLK = 1 or TCLK = 1. Timer 2 external flag set when either a capture or reload is caused by a negative transition on T2EX and EXEN2 = 1. When Timer 2 interrupt is enabled, EXF2 = 1 will cause the CPU to vector to the Timer 2 interrupt routine. EXF2 must be cleared by software. EXF2 does not cause an interrupt in up/down counter mode (DCEN = 1). Receive clock enable. When set, causes the serial port to use Timer 2 overflow pulses for its receive clock in serial port Modes 1 and 3. RCLK = 0 causes Timer 1 overflows to be used for the receive clock. Transmit clock enable. When set, causes the serial port to use Timer 2 overflow pulses for its transmit clock in serial port Modes 1 and 3. TCLK = 0 causes Timer 1 overflows to be used for the transmit clock. Timer 2 external enables. When set, allows a capture or reload to occur as a result of a negative transition on T2EX if Timer 2 is not being used to clock the serial port. EXEN2 = 0 causes Timer 2 to ignore events at T2EX. Start/Stop control for Timer 2. TR2 = 1 starts the timer.
RCLK
TCLK
EXEN2
TR2 C/T2
Timer or counter select for Timer 2. C/T2 = 0 for timer function. C/T2 = 1 for external event counter (falling edge triggered). CP/RL2 Capture/Reload select. CP/RL2 = 1 causes captures to occur on negative transitions at T2EX if EXEN2 = 1. CP/RL2 = 0 causes automatic reloads to occur when Timer 2 overflows or negative transitions occur at T2EX when EXEN2 = 1. When either RCLK or TCLK = 1, this bit is ignored and the timer is forced to auto-reload on Timer 2 overflow. Table D.1: T2CON Timer/Counter 2 Control Register
D.4 ADC0816
8-Bit P Compatible A/D Converters with 16-Channel Multiplexer General Description The ADC0816, ADC0817 data acquisition component is a monolithic CMOS device with an 8-bit analog-to-digital converter, 16-channel multiplexer and microprocessor compatible control logic. The 8-bit A/D converter uses successive approximation as the conversion technique. The converter features a high impedance chopper stabilized comparator, a 256R voltage divider with analog switch tree and a successive approximation register. The 16-channel multiplexer can directly access any one of 16VTU Extension Centre, @UTL, Bangalore 61
single-ended analog signals, and provides the logic for additional channel expansion. Signal conditioning of any analog input signal is eased by direct access to the multiplexer output, and to the input of the 8-bit A/D converter. The device eliminates the need for external zero and full-scale adjustments. Easy interfacing to microprocessors is provided by the latched and decoded multiplexer address inputs and latched TTL TRI-STATE outputs. The design of the ADC0816, ADC0817 has been optimized by incorporating the most desirable aspects of several A/D conversion techniques. The ADC0816, ADC0817 offers high speed, high accuracy, minimal temperature dependence, excellent long-term accuracy and repeatability, and consumes minimal power. These features make this device ideally suited to applications from process and machine control to consumer and automotive applications. For similar performance in an 8-channel, 28-pin, 8-bit A/D converter, see the ADC0808. Features Easy interface to all microprocessors Operates ratio metrically or with 5 VDC or analog span adjusted voltage reference 16-channel multiplexer with latched control logic Outputs meet TTL voltage level specifications 0V to 5V analog input voltage range with single 5V supply No zero or full-scale adjust required Standard hermetic or molded 40-pin DIP package
Figure D.3: Block Diagram of ADC0816

Temperature range 40C to +85C or 55C to +125C Latched TRI-STATE output Direct access to comparator in and multiplexer out for signal conditioning ADC0816 equivalent to MM74C948
Key Specifications Resolution 8 Bits Total Unadjusted Error LSB and 1 LSB Single Supply 5 VDC Low Power 15 mW Conversion Time 100 s
63
APPENDIX E
E.1 LM35
Precision Centigrade Temperature Sensors General Description The LM35 series are precision integrated-circuit temperature sensors, whose output voltage is linearly proportional to the Celsius (Centigrade) temperature. The LM35 thus has an advantage over linear temperature sensors calibrated in Kelvin, as the user is not required to subtract a large constant voltage from its output to obtain convenient Centigrade scaling. The LM35 does not require any external calibration or trimming to provide typical accuracies of 14C at room temperature and 34C over a full 55 to +150C temperature range. Low cost is assured by trimming and calibration at the wafer level. The LM35s low output impedance, linear output, and precise inherent calibration make interfacing to readout or control circuitry especially easy. It can be used with single power supplies, or with plus and minus supplies. As it draws only 60 A from its supply, it has very low self-heating, less than 0.1C in still air. The LM35 is rated to operate over a 55 to +150C temperature range, while the LM35C is rated for a 40 to +110C range (10 with improved accuracy). The LM35 series is available packaged in hermetic TO-46 transistor packages, while the LM35C, LM35CA, and LM35D are also available in the plastic TO-92 transistor package. The LM35D is also available in an 8-lead surface mount small outline package and a plastic TO-220 package.
Figure E.1: Basic Centigrade Temperature Sensor Features Calibrated directly in Celsius (Centigrade) Linear + 10.0 mV/C scale factor 0.5C accuracy guarantee able (at +25C) Rated for full 55 to +150C range Suitable for remote applications Low cost due to wafer-level trimming
Operates from 4 to 30 volts Less than 60 A current drain Low self-heating, 0.08C in still air Nonlinearity only 14C typical Low impedance output, 0.1 W for 1 mA load
Absolute Maximum Ratings Supply Voltage +35V to 0.2V Output Voltage +6V to 1.0V Output Current 10 mA Storage Temp.; TO-46 Package, 60C to +180C TO-92 Package, 60C to +150C SO-8 Package, 65C to +150C TO-220 Package, 65C to +150C Lead Temp.: TO-46 Package, (Soldering, 10 seconds) 300C TO-92 and TO-220 Package, (Soldering, 10 seconds) 260C SO Package Vapor Phase (60 seconds) 215C Infrared (15 seconds) 220C Specified Operating Temperature Range: Tmin to Tmax LM35, LM35A 55C to +150C LM35C, LM35CA 40C to +110C LM35D 0C to +100C
Figure E.2: Typical Accuracy vs. Temperature Characteristics

E.2 3296 - 3/8 Square Trimming Potentiometer

Electrical Characteristics Standard Resistance Range 10 ohms to 2 megohms (see standard resistance Table E.1) Resistance Tolerance 10 % std. Absolute Minimum Resistance 1 % or 2 ohms max. (Whichever is greater) Contact Resistance Variation 1.0 % or 3 ohms max. (whichever is greater) Adjustability Voltage = 0.01 % Resistance = 0.05 % Resolution = Infinite Insulation Resistance = 500 vdc. 1,000 megohms min. Dielectric Strength Sea Level = 900 vac 70,000 Feet = 350 vac Effective Travel = 25 turns nom.
Figure E.3: Product specification Resistance (Ohms) 10 20 50 100 200 500 1000 2000 5000 10000 20000 Resistance Code 100 200 500 101 201 501 102 202 502 103 203
Table E.1: Standard Resistance Table


Design and Development of Real-Time Patient Monitoring System.

Uploaded by

Copyright:

Available Formats

Design and Development of Real-Time Patient Monitoring System.

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Design and Development of Real-Time Patient Monitoring System.

Uploaded by

Copyright:

Available Formats

What is the scope of the study?

What is the scope of the study?

What is the problem formulation of the project?

What is the problem formulation of the project?

Real-time Patient monitoring system

1.2 Scope of the study

Real-time Patient monitoring system

1.3 Problem Formulation

1.5 Outcome and Limitations

Real-time Patient monitoring system

1.6 Literature Survey

Real-time Patient monitoring system

Real-time Patient monitoring system

1.7 Report Organization

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

2.2 Overview of Indias wireless telemedicine infrastructure

CHC Cities CHC City...1

Centralized Patient Database

ISDN 128 kbps Clinical information client

CHC City...n Patient data & consultation scheduling

Radiography, MRI X-ray, CT scans, Color Doppler... Telemedicine centres

Figure 2.1: Typical wireless telemedicine service setup in India

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

2.3 Industry Standard-Based Monitoring Systems

2.3.1 Intelligent Decision Support System (DSS)

2.3.2 Homecare Scenario

Real-time Patient monitoring system

2.3.3 Real-time and Always-on

Real-time Patient monitoring system

2.4.1 Mobile Technology

Figure 2.2: Mobile telemedicine system.

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

Technology Bluetooth WLAN

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

2.4.2 The Internet

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

SYSTEM ARCHITECTURE AND REQUIREMENTS

3.1 Overview of the Implemented System

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

3.2 Wireless Technology

Monitoring Station Modem

Figure 3.1: A principal sketch of telemedicine system

Real-time Patient monitoring system

Max. Range 2m <40m 10-100m <600m

5-10km 3-5 km 300-2500m

Table 3.1: Wireless Technologies

VTU Extension Centre, @UTL, Bangalore

Real-time Patient monitoring system

Technology GSM GPRS EDGE 3G/UMTS

3.3Clinical Data and Sensors

VTU Extension Centre, @UTL, Bangalore