İSTANBUL TECHNICAL UNIVERSITY INSTITUTE OF SCIENCE AND TECHNOLOGY MOBILE TELEMEDICINE AND WIRELESS REMOTE MONITORING APPLICATIONS M.Sc. Thesis by Taner SOYUGENÇ, B.Sc. Department : Electronics and Communication Engineering Programme : Biomedical Engineering NOVEMBER 2006 PREFACE In this project, my main goal is to implement a mobile sample application by defining the related global standards for telemedicine. The work is focused on recommendations of technology associated with a feasibility study. First of all, I would like to thank Assoc. Prof. Dr. Selçuk PAKER for his valuable advice, support and encouragement to accomplish the project. Besides, I would like to thank my family who is always with me giving support at every step of my life. November 2006 Taner SOYUGENÇ iii CONTENTS ACRONYMS vi LIST OF TABLES viii LIST OF FIGURES ix SUMMARY xi ÖZET xii 1. INTRODUCTION 1 1.1. Technology Overview 2 1.1.1. Communication Infrastructure 5 1.1.2. Overview of GSM-GPRS 6 1.1.2.1. Brief History of GSM 8 1.1.2.2. GPRS 12 1.1.3. Mobile Solutions 14 1.1.4. Wireless Medical Sensors 15 1.2. Aim of the Project 16 2. WORLDWIDE APPLICATIONS, VENDORS AND STANDARDS 18 2.1. Available Products 19 2.1.1. ECG 19 2.1.2. Pulse Oximeter 20 2.1.3. Blood Pressure Sensor 23 2.1.4. Various Sensor Brands 24 2.1.5. Advanced Research 27 2.1.6. Home Care Monitoring Systems 31 2.2. Medical Information Standards and Organizations 35 2.2.1. ASTM 39 2.2.2. CEN/TC251 Health Informatics 39 2.2.3. CEN ISSS eHealth Standardization Focus Group 42 2.2.4. DICOM (Digital Imaging and Communicaitons in Medicine) 43 2.2.5. HL7 (Health Level Seven) 44 2.2.6. IEEE 1073 46 2.2.7. Security and Privacy in Health Care Services 46 3. TECHNOLOGIES 48 3.1. GSM/GPRS 48 3.2. Database Types 58 iv 3.2.1. MySQL 58 3.2.2. MsSQL 59 3.3. Web Servers and Programming 59 3.3.1. Web Server Models 59 3.3.1.1. Internet Information Services 59 3.3.1.2. Apache HTTP Server Project 60 3.3.2. Programming Languages 60 3.3.2.1. PHP 60 3.3.2.2. Active Server Pages and ASP.Net 62 3.4. Web Services 63 3.4.1. Web Services Architecture 64 3.4.2. Advantages of Web Services in Health Care 65 3.5. Symbian OS Smartphones 67 3.5.1. The Development Process and Development Tools 69 3.5.1.1. Metrowerks CodeWarrior 70 3.5.1.2. Software Developers Kit (SDK) 71 3.5.1.3. Compiling a HelloWorld 72 3.5.1.4. Debugging 72 3.5.2. Python for Series 60 Platform 75 3.6. Windows CE, Pocket PC and Windows Mobile 5.0 76 3.7. Sensors 77 3.7.1. General Sensor Architecture 77 3.7.2. The MSP430 Microcontroller 78 3.7.3. Bluetooth-enabled Sensors 78 3.7.3.1. Bluetooth Applications on Devices Supporting Symbian OS 81 4. IMPLEMENTATION: THE DOLPHIN PROJECT 82 4.1. Used Technologies 82 4.1.1. Nokia S60 Platform 82 4.1.2. Global Positioning System (GPS) 83 4.1.3. Python for Series 60 Platform 84 4.1.4. Cell ID 84 4.1.5. Database Side 85 4.2. The Phone Application, Installation and Setup 85 4.3. Application Setup on Database Side 88 4.4. Results 89 5. CONCLUSIONS 90 REFERENCES 93 BIOGRAPHY 94 v ACRONYMS 3GPP : 3G Partnership Project ADS : ARM Developer Suite API : Application Programming Interface APN : Access Point Network ARM : Advanced RISC Machines ASP : Active Server Pages BAN : Body Area Network BSC : Base Station Controller BSS : Base Station Subsystem BTS : Base Transceiver Station CCOW : Clinical Context Management Specification CDMA : Code Division Multiple Access CEN : European Committee for Standardization CEPT : Conference of European Posts and Telegraphs CHS : Citizen Health System CID : Cell ID CLR : Common Language Runtime CS : Coding Scheme DICOM : Digital Imaging and Communications in Medicine DSL : Digital Subscribers Line ECG : Electrocardiogram EDGE : Enhanced Data rates for GSM Evolution EHR : Electronic Health Record ETSI : European Telecommunication Standards Institute FDA : Food&Drug Administration GCC : GNU C Compiler GDB : GNU Debugger GGSN : GPRS support nodes GNU : GNU's Not Unix GPRMC : Global Positioning Minimum Required Sentence GPRS : General Packet Radio Service GPS : Global Positioning System GSA : Global Mobile Suppliers Association GSM : Global System for Mobile Communication GSMA : GSM Association GSN : GPRS Support Node GTP : GPRS Tunneling Protocol GUI : Graphical User Interface HCU : Home Care Unit HL7 : Health Level Seven HLR : Home Location register HSDPA : High Speed Downlink Packet Access vi HTTP : Hypertext Transfer Protocol ICT : Information and Communications Technology IDE : Integrated Development Environment IEEE : Institute of Electrical and Electronics Engineers IIS : Internet Information Services ISDN : Integrated Serviced Digital Network ISO : International Standards Organization ISPM : Intelligent Signal Processing Modules JTAG : Join Test Action Group LAC : Location Area Code MBU : Mobile Base Unit MCC : Mobile Country Code MMS : Multimedia Messaging Service MNC : Mobile Network Code MS : Mobile Station MSC/VLR : Mobile switching center/visitor location register NASA : National Aeronautics and Space Administration NMEA : National Marine Electronics Association NSS : Network and Switching Subsystem ODBC : Open Database Connectivity PCU : Packet Control Unit PDA : Personal Digital Assistant PDP : Packet Data Network PHM : Personal Health Monitoring PHP : Hypertext Processor PLMN : Public Land Mobile Network PSTN : Public Switched Telephone Network PTP : Point-to-point RA : Routing Area RR : Radio Resource SDK : Software Developers Kit SGSN : Serving GPRS support nodes SIG : Special Interest Group TDMA : Time Division Multiple Access TDS : Tabular Data Stream TEID : Tunnel Endpoint Identifier UART : Universal Asynchronous Receiver/Transmitter UI : User Interface UMTS : Universal Mobile Telecommunications System URL : Uniform Resource Locator WAP : Wireless Application Protocol WG : Workgroup XML : Extensible Markup Language vii LIST OF TABLES Page Nr Table 2.1 : Message format for glucose measurement……........................... 38 Table 3.1 : GPRS Coding Schemes…………………………………........... 57 Table 4.1 : Description of a NMEA line………............................................ 87 viii LIST OF FIGURES Page Nr Figure 1.1 : Spread of Wireless Communications .......................................... 3 Figure 1.2 : Technology of Today-Telecommunications Complexity ........... 4 Figure 1.3 : Turkey Telecommunications Sector............................................ 11 Figure 2.1 : ECG sensor by Alive Technologies............................................. 19 Figure 2.2 : Alive Technologies ECG Sensor Characteristics........................ 20 Figure 2.3 : 12 Lead ECG, QRS Diagnostics……………….......................... 20 Figure 2.4 : AIRES project……………………………………….................. 21 Figure 2.5 : Piconet…………………………………………………...............21 Figure 2.6 : A Bluetooth oximeter with ear probe…………………................22 Figure 2.7 : A Bluetooth oximeter with finger probe……………….............. 22 Figure 2.8 : A&D Blood Pressure Monitor Characteristics………................ 23 Figure 2.9 : Biopatch developed by Telzuit……………………………….... 24 Figure 2.10 : IBM Mobile Health Toolkit......... 25 Figure 2.11 : Graphical User Interface-IBM Mobile Health Toolkit……........ 25 Figure 2.12 : e-San Diabetes Monitoring Solution…………………................ 27 Figure 2.13 : VitaSens…………………………………………………........... 28 Figure 2.14 : Intelligent Signal Processing Modules for Wearable Sensors..... 29 Figure 2.15 : Mobihealth, feasibility of GPRS and UMTS……………........... 29 Figure 2.16 : ECG and oximeter data on an IPAQ type PDA………............... 30 Figure 2.17 : J2EE-based architecture of e-Vital server…………................... 31 Figure 2.18 : Oppurtunities and challenges in Home Networking.................... 32 Figure 2.19 : Standardization based on glucose measurement-Issues............. 37 Figure 2.20 : Standardization based on glucose measurement-Standard Mode 37 Figure 2.21 : Effects of Standardization…………………………………….... 38 Figure 3.1 : General architecture of a GSM network……………….............. 49 Figure 3.2 : Client Server relation in GPRS………………………………… 51 Figure 3.3 : GSM Technologies Evolution………………………………..... 52 Figure 3.4 : GPRS network architecture......................................................... 55 Figure 3.5 : Architecture of GPRS backbone network……………................ 55 Figure 3.6 : Tunneling mechanism for IP packet sending toward MS............ 56 Figure 3.7 : Web services integrated in remote patient monitoring................ 66 Figure 3.8 : Symbian User Interfaces……………………………….............. 69 Figure 3.9 : General Sensor Architecture……………………………............ 77 Figure 3.10 : Bluetooth RFCOMM Protocol………………………………..... 80 Figure 4.1 : Nokia 6600………………………………………………........... 83 Figure 4.2 : Holux GPSlim 236 GPS Receiver…………………................... 83 Figure 4.3 : The Python Phone Application………………………................ 86 Figure 4.4 : Class from reading information from a GPS receiver……......... 87 Figure 4.5 : NMEA 0183 Line........................................................................ 87 Figure 4.6 : The GSM Information Solution……………………................... 88 ix Figure 4.7 : A Python script for HTTP post….……………………............... 88 Figure 4.8 : Dolphin Project Control Panel…………………………............ 89 x MOBILE TELEMEDICINE AND WIRELESS REMOTE MONITORING APPLICATIONS SUMMARY In this study, a mobile sample application is implemented by defining the related global standards formed for Telemedicine. The work is focused on recommendations of technology associated with a feasibility study. The project does not strictly