ABSTRACT
This thesis has to do with the transfer of medical records taken
remotely to a doctor via GSM wireless communication link.
Specifically it makes use of the Short Messaging System (SMS) of the
Global System for Mobile communication (GSM). The records will be
taken by a nurse and stored in the hospital database via a visual basic
developed user-interface. Whenever the threshold for a certain
parameter set by the doctor is exceeded an SMS alert is sent to the
doctor indicating an emergency to which the doctor sends back a reply
giving directives to the caregiver on procedures to undertake pending
his arrival. On the doctor’s visit, the history of records taken during
his time of absence can be accessed by him for proper prescriptions
for the patient which is equally stored in the database. Also if there is
a new patient, the record is sent automatically to the doctor.
x
TABLE OF CONTENTS
Pages
TITLE PAGE i
UNIZIK LOGO ii
CERTIFICATION iii
APPROVAL iv
DEDICATION v
ACKNOWLEDGEMENT vi
ABSTRACT viii
TABLE OF CONTENT ix
LIST OF FIGURES xiii
LIST OF TABLES xiv
CHAPTER ONE: INTRODUCTION 1
1.1 Background of the study 1
1.2 Aims and objectives 4
1.3 Justification of the project 5
1.4 Scope of the work 8
1.5 Block diagram overview of the project stages 9
xi
1.6 Project report organization 10
CHAPTER TWO: LITERATURE REVIEW 12
2.1 Principles Applied in the Project 12
2.1.1.1 Principles of telemedicine 12
2.1.1.2 Types of Telemedicine 14
2.1.1.3 Benefits and Uses of Telemedicine 16
2.1.2 Wireless mobile telephone communication principles 17
2.1.2.1 Brief History of Wireless Communication 20
2.1.2.2 The Evolution of Mobile Telephone Systems 21
2.1.2.3 Generations of Mobile Telephone Systems 22
2.1.2.4 Software and Applications 26
2.1.2.5 SIM card 28
2.1.2.6 Global System for Mobile Communication 29
2.1.2.7 The GSM Network 30
2.1.2.8 Short Message Service 33
2.1.2.9 AT commands 37
2.1.3 Database management Principles 38
2.1.3.1 DBMS building blocks 39
2.1.3.2 Modeling Language 41
2.1.3.3 Data Structure 45
2.1.3.4 Data Base Query Language 45
xii
2.1.3.5 Transaction Mechanism 46
2.1.3.6 Features of DBMS 47
2.2 Technologies available 50
2.2.1 Overview of Remote Patient monitoring system 50
2.2.2 Remote Patient Monitoring Technologies 52
2.3 Applications of Remote Patient Monitoring System 55
2.3.1 Chronic Disease Management 55
2.3.2 Post-Acute Care Management 57
2.3.3 Patient Safety Monitoring and Injuries 59
2.4 New trends 60
2.5 Related works 63
CHAPTER THREE:METHODOLOGY AND SYSTEM ANALYSIS 69
3.1 Methodology 69
3.1.1 Structured Systems Analysis and design method 72
3.1.2 Problem Identification 76
3.1.3 Feasibility Studies 76
3.2 Bottom-up and Top- down Design Approach 77
3.2.1 Top-down design 78
3.2.2 Bottom-up design 80
3.2.3 Choice of design approach 81
xiii
3.3 System Overview 82
3.3.1 System Analysis / Description 83
3.4 Limitations of existing systems 87
CHAPTER FOUR: SYSTEM DESIGN 89
4.1 Specification 89
4.1.1 System Specification 89
4.2 Hardware Sub-system 90
4.3 The software sub-system 91
4.3.1 The control algorithm 92
4.3.2 Description of the Software sub-system 94
4.3.3 Database Specifications 95
4.3.4 Requirement Analysis 96
4.3.5 System Database 100
4.3.5.1 Database files 101
4.4 Input / Output Specifications 102
4.5 Choice of Programming Language 103
CHAPTER FIVE: SYSTEM IMPLEMENTATION 106
5.1 Hardware and Operating System Requirement 106
5.2 Implementation Arrangement 108
xiv
5.2.1 The database implementation 111
5.3 System testing 113
5.3.1 Software subsystem testing 113
5.4 Performance evaluation 116
5.5 Bill of Engineering Materials and evaluation 119
5.6 Deployment 119
CHAPTER SIX: SUMMARY AND CONCLUSION 124
6.1 Summary of achievement 124
6.2 Problems encountered and solution 127
6.3 Areas of Application 128
6.4 Contribution to the Body of Knowledge 129
6.5 Recommendation 130
6.6 Suggestion for further improvement 130
6.7 Conclusion. 132
References 133
Appendix A 139
xv
LIST OF FIGURES
FIG1.1 Block Diagram Overview of the Project Stages 9
FIG2.1 Typical mobile phone SIM card 28
FIG 2.2 Remote Patient Monitoring Processes 50
FIG3.1 Block diagram of the top-down design approach for the system 82
FIG4.1 Control Algorithm 92
Fig 4.1 The Log in Interface design 97
Fig 4.3 Remote Patient Monitoring System first user page 97
Fig4.4 General Patient’s Record Interface design 98
Fig 4.5 Doctor’s Prescription Interface 98
Fig 4.6 Interface for Patient History 99
Fig 5.1 The Log-in Interface Implementation 108
Fig 5.2 Remote Patient Monitoring System first user page Implementation 109
Fig 5.3 General Patient’s Record Interface Implementation 109
Fig 5.4 Patient History Interface Implementation 110
Fig 5.5 Doctor’s Diagnosis/Prescription Interface Implementation 111
Fig 5.6 General Patient Record Database Implementation 112
Fig 5.7 Patient History Database Implementation 112
Fig 5.8Doctor’s Diagnosis/Prescription Interface Implementation 113
Fig 5.9 File System Window 122
xvi
LIST OF TABLES
Pages
Table2.1 Self Management Capabilities in RPM Devices 54
Table2.2 Roles and Benefits of RPM Technologies in Chronic Disease Mgt57
Table2.3 Comparison of continuous cardiac RPM technologies 65
Table 4.1 Controls for the Different Items used in the User Interface 99
Table4.1 General Patient Record Database Table 101
Table 4.2 Patient History Database Table 102
Table4.3 Doctor’s Prescription Database Table 102
Table5.1 System Testing 115
Table5.2 Performance Evaluation 118
Table5.3 Bill of Engineering Materials and evaluation 119
Table6.1 Problems encountered and solutions 127
1
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Worldwide, people living in rural and remote areas struggle to access timely,
quality specialty medical care. Residents of these areas often have access to
substandard specialty healthcare, primarily because specialist physicians are
more likely to be located in areas of concentrated population. There is also the
challenge of having very few experts especially those managing chronic
diseases even in the urban areas. Effective management of diseases especially
chronic diseases can result in improved health outcomes and increased quality
of life since more than 80% of primary care visits and two thirds of medical
admissions into hospital emergency departments are related to chronic
diseases. For example, controlling a parameter such as blood pressure in
people with diabetes and hypertension has been shown to reduce mortality and
incidence of severe and costly complications such as renal and cardiovascular
disease.
2
Health care systems are now changing due to the dynamic nature of
technological and scientific medical practices. The health care providers are
now swiftly adopting these technologies into their health care procedures.
Because of innovations in computing and communication technologies, many
elements of medical practice can be accomplished when the patient and health
care provider are geographically separated. The separation can be as small as
across a town, across a state or even across the world.
Remote patient monitoring is relatively a new area of interest which enables
medical professionals to monitor a patient remotely using various
technological devices. It is primarily used for monitoring chronic diseases or
specific diseases like heart diseases, diabetes mellitus, and hypertension e.t.c.
These services can provide comparable health outcomes to traditional inpatient
encounters, supply greater satisfaction to patients and is cost effective.
Monitoring a patient at home or in a clinic without a resident expert using
known device like blood pressure monitors, glucose meters e.t.c. and
transferring the information to a caregiver is a fast growing emerging service.
In developing countries like South Africa, Primary Remote Diagnostic
3
Consultation [1] not only monitors an already diagnosed chronic disease but
has the promise to diagnosing and managing the disease a patient will
typically visit a general practitioner for. Remote patient monitoring can also be
applied in electrocardiography, radiology, to mention but a few.
The transfer of these medical data can be done through a variety of
telecommunication technologies including ordinary telephone lines, ISDN,
internet, intranets, satellites and mobile phones to mention but a few. This
project has to do with the transfer of medical records taken remotely to a
doctor via GSM wireless communication link. Specifically it makes use of the
Short Messaging System (SMS) of the Global System for Mobile
communication (GSM). The records are taken by a nurse and stored in the
hospital database via a visual basic developed user-interface. Whenever the
threshold for certain parameters set by the doctor is exceeded an SMS alert is
sent to the doctor indicating an emergency to which the doctor sends back a
reply giving directives to the caregiver on procedures to undertake pending his
arrival. On the doctor’s visit, the history of records taken during his time of
absence can be accessed by him for proper diagnosis and prescriptions for the
4
patient which is equally stored in the database. Also if there is a new patient,
the record is sent automatically to the doctor.
1.2 AIMS OF THE PROJECT
The major aim of this project is to make health care services available to
isolated communities and remote regions like military bases, ships and the
like. It is also aimed at reducing mortality rate especially in developing
countries like Nigeria where the needed expertise is limited. The system
should be able to significantly reduce the time taken in making health care
accessible to them. The burden of inferior healthcare will be taken care of
through this system. This system can be extended in its application to areas
like fine-tuning the management and allocation of rural health care emergency
services by transmitting images to key medical centres for long distance
evaluation by appropriate medical specialists, permitting physicians doing
clinical research to be linked together despite geographical separation, sharing
patients’ records and diagnostic images. Generally speaking, this project is
aimed at transmission of medical data for diagnosis or disease management
and also health advice by telephone in emergency cases.
5
Finally since the cost of complete remote patient monitoring system which
incorporates the sensors used for capturing biometric data is very high, this
system goes a long way in making remote monitoring accessible to the
common masses who cannot afford the cost of services rendered by those
complete systems as they can take their readings manually.
1.3 JUSTIFICATION OF THE WORK
The system does not require any prior computer knowledge for the user to be
able to implement it. The requirement is basic understanding of English
language, it is user friendly. Taking of the medical measurements are easy
procedures that can be easily undertaken by anyone after simple explanations.
Moreover in a nation like Nigeria where there are few experts especially those
managing chronic diseases like diabetes, hypertension etc. this systems comes
as a big relief to those in the regions where the experts are not located as they
can still access the expertise of those experts. Recently there was a case of
relocation of many doctors from a city in Nigeria because of frequent cases of
kidnapping. The result of course was poor health care services to those in that
6
locality. With a system like this, doctors can still offer healthcare services to
their patients from a secure location. Also this work will help to sensitize the
populace on the usefulness of remote patient monitoring using mobile phones
which according to a study by Boston University School of Public Health [2]
is yet to be embraced by the developing countries. This work can be further
justified by the following advantages of using a mobile phone as a health care
intervention.
Low start-up cost: – living in resource-poor environment is not a
barrier to the use of wireless system for several cultural and economic
reasons. The existence of a so-called “digital divide” along the socioeconomic
gradient is less pronounced in mobile phones than in other
communication technologies such as the internet. To make the system
affordable to all especially those in the remote villages of Africa, the
system was built independent of the instruments for measuring the
needed parameters.
Functionally mobile phones are easier to use for people with lower level
of skills.
7
User friendly-SMS: Pricing polices may enhance certain mobile uses in
particular use of short message system (SMS) text. Text message is less
expensive than a phone call and can reach people whose phones are
switched off. It is silent which means it can be sent and received in
places where it may not be practical to have a conversation
Forms of payment: In developing countries a prepayment system is
used, this involves buying cards which provide phone time from five
minutes to an hour. Customers can use credit as they like over a period
of week and so keep control over their spending and enjoy a very cheep
service. Once the pre-paid outgoing call budget is exceeded, the user
can still receive SMS and calls. Thus the doctor does not need to have
credit in his phone to receive alerts and the system does not cost much
to send an alert.
Finally, the rate of mortality in remote places due to lack of adequate
monitoring by medical experts especially for chronic disease which is
increasing at an alarming rate justifies the need for the system which is not
limited by distance so far there is a telecommunication network available in
that area. With this system doctors spends less time going to see patients and
8
utilises more time treating them. It also means real time monitoring without
high staff or capital cost.
1.4 SCOPE OF THE WORK
This system will be able to manually capture doctor-specified vital health data
like heart rate, blood pressure, temperature, and plasma glucose level of a
patient which is stored in the hospital database and can be transmitted to a
doctor when a set threshold is exceeded for better management of diseases.
+The system will monitor patients diagnosed with chronic or long-term illness
such as diabetes or cardiovascular diseases and stable victims. It can acquire
vital information about a patient who lives far away from a medical expert. It
can alert medical staff if there is a change in patient’s status that is critical.
The system will have a user interface to be developed using VB.net through
which the nurse or caregiver feeds in the data to the system which is stored in
the database. The database will include a medical data manager (MDM) that
automatically checks patient’s new data against patient’s record and doctor’s
comment. If there is a disturbing change in the patient’s vital signs, for
9
example high blood pressure for a hypertensive patient, an alert is sent directly
to the physician. This ensures rapid response by a doctor or medic to any
problem that arises. The database stores all patients’ data. The workflow
system controls overall system processes while the user interface dynamically
format and presents the patient’s data. The SMS alert is sent through a GSM
modem connected to the computer.
1.5 BLOCK DIAGRAM OVERVIEW OF THE PROJECT STAGES
The system has five major sub-sections: the user who feeds in the data which
in this case may be the caregiver/nurse, the user interface which will be
designed using visual basic.net through which patient information is fed into
Care-Giver or
User inputting
records
DATABASE
SUB-SYSTEM
Patient
VDU
Mouse
CPU
GSM Network
Doctor’s
GSM Phone
Care-Giver’s
GSM phone
GSM
MODEM
DOCTOR
FIG1.1 BLOCK DIAGRAM OVERVIEW OF THE PROJECT
10
the database by the user and through which the doctor accesses patient’s
record and feeds in his own comments, the database sub-system for the
storage of patient’s information, the GSM interface through which
information in the database is communicated to the doctor’s phone which is
the last sub-system for receiving SMS alerts by the doctor and also through
which directives are sent to the caregiver.
1.6 PROJECT REPORT ORGANISATION
This project work is organized as follows: Chapter one will deal with the
background of the study, aims and Objective of the work, Justification for the
project, Scope of the work and ended with the block diagram overview of the
project stages. Chapter two will deal with review of some related literatures; it
will also discuss general principles, available technologies, and applications of
remote patient monitoring systems. The chapter will end by briefly stating the
new trends in technology. In chapter three, methodology used will be stated
and system analysis done based on the chosen method. It will also contain an
elaborate block diagram of the entire system. It will conclude by discussing
the limitations of existing remote patient monitoring system. In chapter four
11
we shall be dealing with the system design and specifications, the design of
input subsystems, output subsystems, and the control subsystem. The control
software design statements, the corresponding control algorithm and database
design will also be discussed here. The chapter five of this work will deal with
the implementation of the hardware and software designs, Data-base
implementation, testing the system, and performance evaluation. The chapter
will conclude with Bill of Engineering Measurement and Evaluation and the
system deployment. The last chapter (six) will summarize the achievement of
the project work, state problems encountered and proffer solutions to them, as
well as make recommendations and suggestions for further improvement,
conclusions and contribution to knowledge.
CHAPTER
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