Development and Demonstration of a Prototype e-ecg System for Telemedicine Application

Transcription

1 Development and Demonstration of a Prototype e-ecg System for Telemedicine Application G.M.A Ehsanur Rahman 1, Md. Abdul Mukit 2, Raqibul Mostafa 3,*, K. I. U. Ahmed 4, Murtaza Ali EEE Department, United International University #80, Road 8/A Dhanmondi, Dhaka, Bangladesh 5 Distinguished Member of Technical Staff, Texas Instruments Inc, Dallas, Texas, USA 1,3,4 {ehsan, rmostafa, kiua}@eee.uiu.ac.bd, 2 abdul.mukit64@gmail.com, 5 mali@ti.com Abstract Telemedicine is being widely studied and implemented to make healthcare accessible to remote areas. This paper presents development and demonstration of ECG measurement prototype system designed for telemedicine application. The prototype e-ecg system is based on MDK board from Texas Instrument (TI) and has been augmented with transmission/reception capability through GPRS modem. Software for ECG recording, display, transmission to remote server and downloading has also been developed. Recorded ECG plots can be made readily available to a consultant in an urban hospital and diagnosis can be provided to the patient in a very short span of time. The system has been successfully demonstrated in different environments. Keywords Telemedicine; ecg; prototype; demonstration I. INTRODUCTION The existing health care facilities in Bangladesh are grossly inadequate to provide for the health care needs of the huge population of this country. About 39% of the nationwide privately owned hospitals or clinics are located in the capital Dhaka alone, whereas the percentage of inhabitants of Dhaka city sum up to only 8% of the total population with a staggering figure of millions [1]. Adding to this major asymmetric distribution of medical facilities, only 25% of the total population resides in urban areas [1]. This clearly points out the acute deficit of proper health care facilities in this country and the irrefutable need for a complementary health care system to elevate the existing famine. Health care service in rural areas of Bangladesh is very poor mainly due to lack of proper infrastructure to support medical facilities. Recent survey shows that there is only one doctor and one nurse for every 3333 patients [2]. The nurse to doctor ratio is 0.9 [2], which raises question about the allocation of tasks in health care delivery. Due to the asymmetric distribution of medical facilities described earlier, patients from rural areas often have to travel long distances and for long hours to go to city hospitals to get proper medical treatment or even to do a simple diagnosis test. Furthermore, the cost of travelling, lodging and meals of these patients and their companions add up in the list of inconveniences. The urban regions have their own challenges in offering adequate health care to its inhabitants. Firstly, ever worsening traffic congestion in metropolitan city areas hinder patients to commute to healthcare facilities in a timely fashion. Strenuous commuting and long queues at the healthcare facilities pose a risk of exposure to other diseases. Secondly, low income segment of urban population are deprived from basic healthcare from existing facilities due to increasing cost. This situation is not unique to Bangladesh. Many countries around the world suffer from asymmetric health care between urban and rural areas. Telemedicine is a timely solution to address all the problems mentioned above. The concept of Telemedicine or E- health is based on providing interactive health-care in the form of remote monitoring or diagnosis through systems that support communication between a health-care facility and a remotely located patient [3]. Through telemedicine city hospital doctors coverage can extend the footprint of quality health care coverage. Thus the availability of medical facilities can be made more uniform and easier to access. The operation of the telemedicine devices requires little training and as such, these can be carried out by locally trained technicians. This does not only create employment opportunity but also provides a complementary solution to the doctor and nurse to patient ratios. The proposed framework in [4] presents telemedicine based solutions to the problems related to getting adequate healthcare. However there is a need to focus on specific devices that are more important than others. For example, telemedicine centers need to host ECG devices since it can serve a large number of cardiac patients across the nation. Various forms of frameworks are proposed for supporting telemedicine centers, but none have fully demonstrated the specific functionalities and operations of key equipments [5-7]. Authors in [8-11] demonstrated the operation of the wearable ECG telemedicine system. However, its affordability and possible contribution in healthcare facility of third world countries have not been addressed. It is to be noted that ECG measurement and diagnosis services are not available in central hospitals in all the districts. Hosting ECG services in telemedicine centers will provide a major benefit to the cardiac patients that otherwise will have to make trip to urban healthcare facilities. Keeping this in mind, the implementation and demonstration of e-ecg, an ECG system tailored for telemedicine application has been presented in this paper. The complete end-to-end system development and operation are based on ECG MDK (medical Development Kit) from Texas Instruments that has been augmented with mobile network access facility. The system has been successfully demonstrated in various operating scenarios. The outline of this paper is as follows. The description of setup and software interfaces is presented in Section II while operation methods, data structure for storage and database orientations are /14/$ IEEE

2 presented in Section III. Possible deployment scenarios are discussed with clear explanation in Section IV. The demonstration of the prototype ECG based telemedicine setup is described in Section V. II. DESCRIPTION OF THE SETUP The setup for the proposed telemedicine service can be divided into two main parts: the patient side and the doctor side. At the patient side, the setup is used to acquire ECG data from the patient and transmit it using the internet to a remote server. At the doctor side, the setup enables doctors to download the recorded ECG files from the remote server and diagnose. The overall setup block diagram is depicted in Fig. 1. Fig. 2. MDK hardware overview Fig. 1. Block diagram of the system At the patient side, ECG probes, ECG front-end board connected with a DSP are used to extract ECG signal form a patient into a computer connected to the DSP. Then the recorded patient ECG data is uploaded to a remote server. This entire process of data acquisition and uploading is done with the assistance of an ECG PC application provided for this telemedicine service. This application runs on the computer connected with the DSP. At the doctor side, the setup consists of a computer with modem or internet connectivity and with the ECG PC application installed in it. In this setup, the doctor uses the PC application and internet connectivity to download the patient ECG files from the remote server, and then uses the same ECG PC application for diagnosis. Technical details of the key elements of the setup are described in the following subsections. A. Data Acquisition and Transmission The ECG collection system is composed of an analog front end board ADS1298ECG-FE mounted on a TMS320C5515 DSP EVM. The overall block diagram is depicted in Fig. 2. ECG probes which are connected to the front end board (Fig. 3) are used to collect analog signal form human body. This board performs analog signal processing and analog to digital conversion on the signals received by the sensors. Then, the digital signal is sent to the C5515 EVM (Fig. 4) where the C5515 DSP performs signal processing algorithms for the application. After connecting the EVM to PC with a RS232 cable, the signal processing results can be transferred to a PC for further display, analysis, and storage using the PC Fig. 3. ECG Front-End Fig. 4. ECG Front-End Mounted on the C5515 EVM application software provided with the MDK. After the results are being saved in the computer they can be uploaded in a remote server via internet using the same PC application software. The type of internet connectivity at the patient side of the setup is dependent on the location of its deployment. In case of deployment of the patient side in an urban area, the internet connection can be made via ADSL, LAN, WLAN, WiMax or GPRS provided by cellular network providers. In case deployment in rural areas, the internet connection has to be made with GPRS connection provided by cellular network providers, and by ADSL or GPRS in case of deployment in suburban areas.

3 Fig. 5. Different aspects of the GUI for online and offline mode. B. Data Reception Data reception part resides in the doctor s side. Data reception part consists of a laptop with internet connection and the PC application software. For receiving the data, the doctor has to run the ECG PC application form his/her computer and use it to download the recorded ECG files from the remote server. After that the doctor can do diagnosis of the ECG signals using the same PC application. In our proposed setup, as the doctor side resides in an urban area hospital, so the internet connectivity in this case can be made with ADSL, LAN, WLAN, WiMax, GPRS. C. Patient Side and Doctor Side Interface of the ECG PC Application: At the patient side, when the required hardware setup is completed and the PC application is run then a graphical user interface (GUI) appears in which the user has to select the mode of operation of the application. The GUI provides three mode: online mode, offline mode and remote mode. To obtain ECG signal from the patient, the user has to select the online mode. Once online mode is selected another GUI appears in which now the user has to select the Com Port number through which the PC is connected with the MDK. After that the GUI in Fig. 5 appears. Acquired ECG signal can be seen in real time in this GUI. Also the status of the nine leads connectivity can be seen on the upper right portion of the GUI. The HR represents the heart bit rate. This GUI provides twelve types of ECG signals, which are, Lead-1, Lead-2, Lead-3, V1, V2, V3, V4, V5, V6, avr, avl, avf. These signals can be navigated using the navigation arrow buttons in the bottomleft corner of the GUI. The scaling on amplitude button changes the mm/mv along the Y axis of the signals visible. The scaling on time button changes the mm/sec scale along the X axis. The start recording button allows the user to record the ECG signal. Once start recording button is pressed, the software starts recording the live ECG signals. After recording for a while when the user presses the stop recording button a popup window comes up and asks the user to enter patient details. Once the user fills up the required information and

4 presses ok, the software will save the ECG data as a.ecg extension file in a predefined path in the host PC. In order to upload the recorded.ecg data the user has to access the offline mode of the application. Once offline mode is selected now the user has to browse and open the.ecg file of the desired patient. Now another GUI as in Fig. 6 will appear. This GUI will show the all the information that was previously recorded in online mode. Now in this GUI the user will press the upload button which will upload the.ecg file of the patient in a predefined remote server. At the doctor side, the doctor will first enter the application in the remote mode. At this mode a GUI will appear which will allow the doctor to download any patient s file from the remote server. After the desired patient s file is downloaded he/she can open the.ecg file using the offline mode of the application. III. OPERATION For the effective functioning of the proposed ECG based telemedicine system, storage of patient data must be done in a well organized manner. The data structure of the patient data, sent from the remote diagnosis centers is described in this section. Additionally the full database structure for the telemedicine service provider to maintain all data effectively is presented. A well designed database structure is essential to maintain large amount of data regarding numerous remote diagnosis centers and their nurses, hospitals and their consultant doctors and finally large number of patient reports. After diagnosis, patient report has to be sent to the central/remote server of the proposed telemedicine service provider (TSP). The patient data structure will contain patient name, patient age, date, time, description, General Diagnosis File (.txt), Nurse Id, local diagnostic center/hospital id and ECG file (.ecg). The General Diagnosis File is a standard text file which contains data regarding general diagnosis results of the patient, for example: blood pressure, blood glucose level, temperature. This file is optional, and sent only when the patient did a general checkup at the remote diagnosis center. The Nurse Id is the identification number of the nurse who performs the diagnosis. The Nurse Ids are assigned by the TSP to nurses serving the proposed telemedicine service. Local diagnostic center/hospital Id is the registered identification number of the remote diagnostic center/hospital/clinic where the diagnosis is being done. The.ecg file is the one which contains ECG information of the patient. Additional details are optional and it can be used by nurse to mention anything important about the diagnosis or patient. Except for the.ecg file every other information mentioned here will be inserted by the nurse in a form in the ECG PC application. The central server of TSP will have five databases or tables. The database structure created in MySQL Workbench software has been proposed in Fig. 6. The tables/databases are: Remote Diagnostic Centers: In this database information of all registered remote diagnosis centers are kept. This information includes local diagnosis center s id, address, contact and address (optional). Nurses: In this database information about all the nurses working in all registered remote diagnosis centers are enlisted. The information includes nurse id, name, address, contact number and the id of the remote diagnosis center in which the nurse is currently working. Urban Hospitals: This is a database which contains information about the serving hospitals in this telemedicine program. Doctors of these hospitals are participating in the program. The information include hospital id, hospital name, address, contact number, address. Consultant Doctors: In this database information about the doctors working in this telemedicine program is enlisted. This information include doctor s id, name, address, contact number, designation and the urban hospital id from which he diagnoses the patients. Reports: In the database the reports of patients from all over the country will be saved with the help of previously mentioned four databases. Each row of this table represents a single unique report of a patient. Among the information of each row the patient name, patient age, data and time of diagnosis, description of the diagnosis, Nurse Id, remote diagnostic center id are filled in automatically by backend functions working in the server. This information is filled in according to the patient report sent from a remote diagnostic center. Whenever a.ecg file is sent to the server along with a patient report, the server automatically assigns that file a unique id, and saves it. Also it fills up the ECG file id column for that specific report accordingly. The consultant doctor id and urban hospital id columns are left unfilled, until a doctor from a registered hospital downloads the patient report for diagnosis. Fig. 6. Remote/Central server database structure. IV. DEPLOYMENT This section describes the deployment requirements and strategies for the proposed e-ecg system in rural and urban environments. Fig. 7 depicts a generic system comprising a basic healthcare unit termed herein as a Remote Diagnostic

5 Centers (RDC) that hosts telemedicine devices within the compounds of the RDC. The equipments can be basic or advanced depending upon the deployment type. The type of service provided can be offline diagnosis or real-time consultation from a medical professional. The RDC will be manned by one or more trained technicians to operate the installed equipments. Due to contrasting patient base and medical requirements, deployment of RDC can be categorized into urban and rural area deployment. For both the cases the RDC will be deployed by the TSP, and employment and training of local nurses or technicians will be done by the TSP as well. The urban area hospitals which will be participating by engaging their qualified doctors to serve in this program, will first sign into a contract/agreement with the TSP. Below given is brief description of deployment in these two major environments. Fig. 7. E-health system components. A. Rural Area Deployment This can be done by setting up one RDC for a group of villages. The main medium of internet access is through GPRS network of cellular network providers. One RDC per group of villages can easily host e-ecg system. Also the cost of the telemedicine service has to be carried out or subsidized by government or NGOs through signing appropriate contracts with the TSP. B. Urban Area Deployment The urban deployments are classified into two categories based on the economic condition of the target population-base. These are firstly low income slum areas and the secondly for middle or upper class population. Deployments in slum area will be similar to deployment for a group of villages. On the other hand deployment for the upper class population can again be categorized into individual deployment and group deployment. Firstly, individual deployment means deploying a RDC in a person s home. In this case the entire cost of the RDC will be carried out by the home owner via a service pack agreement with the TSP. RDC can include e-ecg among other devices depending upon the agreement with TSP. Secondly, group deployment represents deployment of a RDC per apartment building or a group of apartment buildings. In this case the concerned group of people has to sign an agreement or contract with the TSP. The expense will be borne by the apartment residents who will use the RDC. V. DEMONSTRATION This section describes performed demonstrations of the proposed e-ecg system. The proposed e-ecg system was first demonstrated to the TI Bangladesh Diversity Initiative (BDI) representatives on 2011 [12]. In this demonstration entire operation of the system was practically performed live. The setup included two laptops with internet connectivity through GPRS modems. After setting up the probes the application was run from the laptop connected to the MDK and then live data was shown to the audiences through a projector. For demonstrating the doctor side part, another laptop was used to access the remote mode of the application and download the recently uploaded ECG file from the remote server. The same demonstration was performed in the Basis Soft Expo 2014 [13]. VI. CONCLUSION The e-ecg prototype system presented in this paper has been designed for reliable recording of ECG signals and getting the subsequent diagnosis from a expert consultant. The recording of the ECG signals will be at remote patient side and the recordings will be presented to the consultant for supporting telemedicine services to the patient. Necessary data collection and storage and the required support system to deploy the e-ecg system have also been proposed. The overall system has been verified in lab settings and has been successfully demonstrated in different scenarios. It is expected that the practical deployment of this prototype will provide the much needed healthcare to patients in remote rural areas as well as for timely response and intervention for residents in urban area. ACKNOWLEDGMENT The authors would like to acknowledge the valuable support from the BDI group of Texas Instruments, Inc. REFERENCES [1] Statistical Pocketbook 2008, Bangladesh Bureau of Statistics, [2] OECD/World Health Organization (2012), Health at a Glance: Asia/Pacific 2012, OECD Publishing. [3] [4] R. Mostafa, G.M.A Ehsanur Rahman, G. M. Hasan, A. Kabir, A. Rahman, S. Ashik, Proposed deployments to provide healthcare in Bangladesh: urban and rural perspectives, 12th IEEE International Conference on e-health Networking Applications and Services (Healthcom), 2010, pp [5] H. Chih-Jen, Telemedicine Information Monitoring System, 10th International Conference on e-health Networking, Applications and Services, 2008, pp [6] P. Siddiqul, M. A. Awa, A Portable Telemedicine System in the Context of Rural Bangladesh, International Conference on Informatics, Electronics & Vision (ICIEV), 2012, pp [7] C. Hu, J. Liao, P. Jin, W. Lin, G. Wang, A Portable Telemedicine Monitoring Information System based on Mobile Internet Networks,

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