International Journal of Engineering Trends and Technology (IJETT) - Volume4Issue5- May 2013

Innovative Approach for Wireless Health Monitoring

System Using Client-Server Architecture
Ms. Poonam Agrawal#1
Department of Computer Science and
Engineering, G. H. Raisoni Institute of
engineering and Technology for Women,
R.T.M.N.U., Nagpur.

Prof. S. P. Hingway#2

Prof. B. P. Dharaskar#3

Department of Electronics Engineering,

G. H. Raisoni Institute of engineering
and Technology for Women,
R.T.M.N.U., Nagpur

Department of Computer Science and

Engineering, Priyadarshini Indira
Gandhi College of Engineering,
R.T.M.N.U., Nagpur

Abstract Real Time Patients health monitoring system with

wireless sensor network using soft computing is an innovative
idea. It also generates predication on patients health condition
based on summation of all medical records of patient. It offers
anytime and anywhere remote monitoring of patients. In this
wireless architecture, many to many relationship between client
(patient) and server (doctor) are established and various types of
communication scheme are used between them. Apart from
monitoring patients health, wrist worn device provide few
auxiliary functions that fulfil the living demands of patients and
it uses various types of sensors to acquire continuous vital signs
of patients including blood pressure, heart rate, SpO2 and body
temperature. Transmission of this digital data over internet is
done using general packet radio service to web server where
database are stored. Generated predication will be displayed on
web application. With the help of web application authorized
medical staff and doctors can easily access patients medical
graph and generated predication. Based on this the doctor can
give advice message to patient instantly using internet service
and set new threshold for various medical parameter if needed.
A prototype system consist of data gathering, analysis, and
emergency detection phase in distributed manner and PHP
(hypertext pre-processor) based client server communication in
which main server has centralized control over all entities.
Keywords Wireless sensor network, Hypertext pre-processor
server (PHP), General packet radio service (GPRS), Prediction
logic, web server.

I. INTRODUCTION
A. Overview of wireless e-heath monitoring system
The e-health monitoring system with wireless sensor network
is used for patient tele-monitoring and tele-medicine. In old
days transmitting biomedical signal from patients to hospital
was done through telephony network. Otherwise patient was
needed to be admitted in hospital for continues observation.
Today, wireless sensor network provide mobile telemedicine
which allows patients to engage their daily routines while they
are monitored continuously anytime, anywhere. In healthcare
application wireless sensor network small, lightweight sensors
are used to be placed on the patients body. Benefits of ehealth system are used for transmission of blood pressure,
heart beat rate, level of oxygen (SpO2), body temperature
from patient to a web server using GPRS. Potential
applications of wireless e-health system are remote routine

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checkups, emergency alarm to doctor and caretakers in

emergency situation and predication on patients health
condition. So that early detection of patient health condition
can help doctor to take necessary action to handle or avoid
unusual situation in future. Doctor can continuously monitor
patients health condition from web application and give
advice message to patient on the basis of generated graph and
predication report. Doctors are also able to set new threshold
vales for patient health parameter.
Advances in wireless technology have made telemedicine and
continuous health monitoring more practical within hospital
and between hospital and mobile patients.
WRIST
WORN
DEVICE

GPRS

WEB
SERVER

Fig. 1. Gprs Communication through internet

B. Design Considerations
The aim is to introduce a new wireless e-health monitoring
system that comprise of a compact wrist worn device on
patient hand, network connected with web server and mobiles
via internet as shown in fig.1. Wrist worn device consists of
various sensors, microcontroller and GPRS kit. It allows the
transmission of any or all of the health parameters of patient
in every 15 sec to the web server. The parameters are: blood
pressure, body temperature, heat rate, and oxygen saturation.
The design of the wrist worn device is very flexible in nature,
so that future processing and memory upgrade can be
achieved simply by software changes. The hardware is
implemented with Win AVR complier that produce object
code in machine language are directly dumped into AT Mega
8 bit Microcontroller. Also multichannel analog-to-digital
(ADC) converts boost up the data signal for high bandwidth
second generation (2G) networks. The connection between
wrist worn device, web server and mobile uses the GPRS,
which allows bidirectional data transmission.
Php (Hypertext pre-processor) based Web server contain
MySql database, predication and graph generation logic.
Web application displays generated graph of all four medical
parameter of patients medical record. It also displays

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International Journal of Engineering Trends and Technology (IJETT) - Volume4Issue5- May 2013
predication on patient health condition in future. Mainly it
consists of doctor message sending module.
C. Related Work
Number of different research projects explores wireless sensor
networks for monitoring patient health 24 hours. Few projects
are concerned with developing wearable wrist worn belt,
while others have developed based for monitoring individual
patients during daily activity, at home, or in hospital. Han and
Yuo et.al proposed wireless sensor network based e-health
system based on radio-active and radio-passive positioning [1].
Authors proposed wireless sensor network application for 24
hours constant monitoring without disturbing daily activities
of elderly people and their caretakers. In this system both
fixed and mobile body sensors are used. A mixed positing
algorithm is proposed to determine the location of elderly
person. The purpose of positing is to help the system to
determine the persons activities and further to make decisions
about patient health condition.
U. Anliker, J. A. Ward et.al has developed a wearable
medical monitoring and alert system aimed at people at risk
from heart and respiratory diseases [2]. The system combines
multiparameter measurement of vital signs, online analysis
and emergency detection, activity analysis, and cellular link to
a tele medicine centre in an unobtrusive wrist-worn device.
Mobile health monitoring system for the elderly, called
iCare, which can not only dynamically monitor the elderly
anytime anywhere and automatically alarm to the emergency
centre in the emergency situation, but also play a role in
acting as a living assistant[3]. At the same time, iCare also
acts as the personal health information system which allows
doctors to view current and history condition of the elderly,
set thresholds for sensors and give advices remotely, which is
the essential part for tele-monitoring of the elderly.
Additionally, the medical guidance that includes the
communication platform and the medical knowledge database
is designed to serves as the real-time medical guidance for the
elderly.
Novel wireless, ambulatory, real-time, and auto alarm
intelligent tele cardiology system to improve healthcare for
cardiovascular disease proposed by Chin-Teng Lin et.al [4].
This expert system can identify ve types of abnormal cardiac
rhythms in real-time, including sinus tachycardia, sinus
bradycardia, wide QRS complex, atrial brillation (AF), and
cardiac asystole. Novel intelligent telecardiology system is
capable of early atrial brillation detection, and represents a
successful rst step toward improving efficiency and quality
of care in cardiovascular disease.
Alexandros Pantelopoulos [5]et.al also present novel model
based on a fuzzy regular formal language to describe the
current state of health of the wireless health monitoring
system user, which considers symptom ambiguity and causal
relationships between various disorders and symptoms to
derive a thorough estimation with a certain degree of
condence .
Researcher at Taiwan have implemented and tested home
telecare system for combine biomedical data, including threechannel electrocardiogram (ECG) and blood pressure (BP),

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video, and audio into a National Television Standard

Committee (NTSC) channel for communication between the
patient and healthcare provider [6].
Shihab A. Hameed, Vladimir Miho et.al have built a
prototype system using open source technologies for
centralized medical patient records that can be viewed and
updated by physicians using any web browser[7]. This
research project focuses on developing a novel model for an
integrated Medical, Healthcare, and Emergency using Internet,
wireless, multimedia, and real time technologies. Authors
focus on developing a mobile web to enhance patients
facilities. It is based on W3C web standards which, allows
patients to access their account from any mobile phone with
capabilities of connecting to the Internet.
A complete real time ECG acquisition, transmission,
storage, and visualization system for nonclinical applications
proposed by A. I. Heernande and F. Mora, G. Vollegas [8].
The purpose of the system is the provision of extended
monitoring for patients under drug therapy after infarction,
data collection in some particular cases, remote consultation,
and low cost ECG monitoring for elderly.
M.F.A Rasid, and B. Woodward et.al [9] focus on the
design of a processor, which samples signals from sensors on
the patient. It then transmits digital data over a Bluetooth link
to a mobile telephone that uses the General Packet Radio
Service.
A mobile patient monitoring system was designed,
developed, and tested by Yuan-Hasiang Lin, I.-Chien Jan et.al
[10].Authors integrate current personal digital assistant and
wireless local area network technology. At the patients
location, a wireless PDA-based monitor is used to acquire
continuously the patients vital signs including heart beat, 3
lead ECG, and SpO2. Through the WLAN, the patients
biosignals can be transmitted in real time to a remote centre
management unit, and authorized medical staffs can access the
data and the case history of patient by the wireless devices.
D. Uniqueness of Wireless E-Heath Monitoring system
Wireless e-heath monitoring system has following unique
features as compare to above mention projects.
Uniqueness of Wireless E-Heath Monitoring system

Multi-parameter
Monitoring

Real time
communications

Mobile health
monitoring

Predication
generation

All-in-one Wrist
worn system

Emergency
detection

Large medical
database

Living Assistant &

Medical guidance

Remote analysis

Fig. 2. Unique features of wireless e-heath monitoring system

1) Multi-parameter Monitoring: The E-health monitoring

system measure heart rate, SpO2 , body temperature and blood
pressure at same time.

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International Journal of Engineering Trends and Technology (IJETT) - Volume4Issue5- May 2013
2) Real time communications: The gprs connection to the tele
medicine centre at web application features very flexible
communication channel that can use short message system
(SMS).
3) Mobile health monitoring: E-heath monitoring system
monitors patients in real time and if any collected values
exceed the predefined threshold then it send alert message to
doctor and family members.
4) Predication generation: If there is possibility of any unlike
situation in patient near future, this module gives predication
message to the doctor terminal. So that early detection will
helps the patients to avoid uncertainty in future.
5) All-in-one wrist worn system: This system combines all
sensors, microcontroller, communication, and processing
devices in a single wrist worn enclosure. Overhead of
mounting sensors over different location of human body is
totally reduced. So that sensor data are more accurate.
6) Emergency Detection: For emergency detection, the
analysis can incorporate patient profile and database to reduce
number of false alarms.
7) Large medical database and graph generation: All medical
history of patients is stored in database on web server and
displayed in the form of graph on doctor terminal. It helps
doctor in giving medical advice to patients.
8) Living Assistant and Medical guidance: Wrist worn device
have some auxiliary functions like displaying real time date
and time to assist patients in their daily life activities. This
system can offer online medical guidance.
9) Remote Analysis: The wrist worn device can perform an
analysis of all sensors collected data online and presenting
them in the form of graph to doctor terminal.
Main Contribution: The main contributions in this paper can
be summarized as follows:
System supporting wireless sensor network and Gprs
communication between patients wrist worn devices
and web server are implemented and tested.
Proposed
predication
generation
algorithm
automatically generates predication on patients
health in next 24hous. So that early precaution can be
taken to avoid any unusual situation in future.
Web based telemedicine and tele-monitoring system
is implemented which support many to one clientserver relationship between many patients and
centralized web server.
II. SYSTEM ARCHITECTURE
The aim of this study is to design and implement a wireless ehealth monitoring system for continuous monitoring vital
signs of patients and to facilitate telemedicine system to
mobile patients. The main aim of system is to generate
predication on patients health condition, so that early caution
can be taken to avoid dangers situation in future. Figure 3
shows the architecture of proposed system.
The system can be divided into 3 main parts:1) Tele-monitoring and Emergency detection system

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2) Remote Analysis System

3) Telemedicine system
Tele monitoring system consists of wrist worn devices
coupled with Gprs kit. While remote analysis system consists
of web server and telemedicine system are called web
application.

T:112 BP:92/140 HB:60rpm SpO2: 92

SMS: - Take Crocin 1-1 AD

Azithromiciane 1-1 BD
1-1-2013

WEB SERVER
GPRS

PREDICATION
GENERATOR

11:11:00am

(SOFT COMPUTING)

PATIENT-1

PATIENTS
DATABASE
T:92 BP:80/120 HB:70rpm SpO2:98
GPRS

SMS: - Hello
1-1-2013

11:11:00am
PATIENT-N

WEB APPLICATION

G
P
R
S

G
P
R
S

SMS
PROVIDER

GENERATED PREDICATION
GENERATED GRAPH
SMS SENDING MODULE

EMERGENCY SMS
FAMILY / DOCTOR

Fig. 3. Block diagram of the wireless e-heath monitoring system

A. Wrist Worn device and Gprs Kit

Wrist worn device are designed with low power consumption
in mind. This device is highly portable in nature. It consists of
six functional blocks: power supply, sensors, analog to digital
convertor, display unit, processing unit and communication
subsystem. As shown in figure 3 wrist worn device contains
sensors are continuously sense different vital signs of patients
which are measured in every 15sec and send it to the main
server using Gprs. At the same time, Emergency Detection
module continuously analysis the data, if any value found to
be out of range of predefined set of threshold then wrist worn
system send alert message to doctor and caretakers mobiles.
So that real time help can be provided to the patients.
Power Supply: Several modules run at different voltages
levels like microcontroller required 1.8-3.0V. So that we used
9 V rechargeable battery for providing continues and
uninterrupted power supply.
Sensors: For mobile patients, the main parameters that are
need to be monitored are blood pressure, pulse rate, body
temperature and oxygen saturation (SpO2). The main
challenge handled by the design at this stage was the method

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International Journal of Engineering Trends and Technology (IJETT) - Volume4Issue5- May 2013
used to derive all the above information from wrist worn
sensors and need to maintain the power consumption to a
minimum level.
a) Blood Pressure Sensor:
To perform a measurement, we use a method called
oscillometric. The air will be pumped into the cuff to be
around 20 mmHg above average systolic pressure. After that
the air will be slowly released from the cuff causing the
pressure in the cuff to decrease. As the cuff is slowly deflated,
we will be measuring the tiny oscillation in the air pressure of
the arm cuff. The systolic pressure will be the pressure at
which the pulsation starts to occur. We will use the MCU to
detect the point at which this oscillation happens and then
record the pressure in the cuff. Then the pressure in the cuff
will decrease further. The diastolic pressure will be taken at
the point in which the oscillation starts to disappear.
b) Heart beat rate and SpO2 Sensor:
Heart rate is the number of heartbeats per unit of time and is
usually expressed in beats per minute (bpm). Normal heart
beats about 60 to 100 times a minute. This sensor Count the
number of pulses within a certain interval (say 15 sec), and
easily determine the heart rate in bpm as
bpm= (No. of Heart Beat /15s ) * 4
The measurement of oxygen level in blood is based on heart
beat rate of patient by the following formula.
SpO2 = (heart_beat * 11) / 10;
Working principal of heart beat rate sensor is:
This technique measure the heart rate by sensing the
change in blood volume in a finger artery while the
heart is pumping the blood.
It consists of an infrared LED that transmits an IR
signal through the fingertip, a part of which is
reflected by the blood cells.
The reflected signal is detected by a photo diode
sensor.
The changing blood volume with heartbeat results in
a train of pulses at the output of the photo diode, the
magnitude of which is too small to be detected
directly by a microcontroller.
Amplifiers are used to filter and amplify the signal to
appropriate voltage level so that the pulses can be
counted by a microcontroller.

The heart rate is displayed on a 3 digit seven

segment display.

Fig.4. Working principal of IR sensor

c) Temperature Sensor:
Analog temperature sensor provides an output voltage
proportional to the temperature. Output can be directly fed to
the input of an analog to digital convertor for digital

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processing. Examples of such sensors are LM34, LM35. We

are measuring the temperature as
Ex: T (f) = 18*T(c) + 3200 = (18*314) + 3200 =8852= 88.52
Display unit: - This unit display the doctor advice in 16
character on 7 segment led. It also show current date and time
which are power by 3 V battery.
Processing unit: - It consists of 8 bit microcontroller, real time
operating system and EEPROM.
8 bit AVR microcontroller with 32kBytes: The 8 bit AVR is
a low-power CMOS 8-bit microcontroller based on the AVR
enhanced RISC architecture. By executing powerful
instructions in a single clock cycle, the ATmega32 achieves
throughputs approaching 1 MIPS per MHz allowing the
system designed to optimize power consumption versus
processing speed. Microcontroller runs the predefined medical
algorithm.
a) Real time operating system: - Wrist worn device
continuously monitor the patient in real time, and
send this data to main server. If real time operating
system found any emergency satiation then send
quick alarm to doctor and caretakers.
b) EEPROM:- For storing emergency detection and
analysis module. Also it stored the current date and
time.
Communication subsystem: Wireless communication
capability is integrated with wrist worn device in the form of
an on-board global system. The General packet radio service
of internet enables data exchange with the web server,
caretakers and doctor mobiles as shown in figure 1. The
prototype uses a 2G airtel sim with internet pack to support
high speed and low cost internet connection.
a) Communication Scheme: Six schemes are
implemented as
1. W to WS: Wrist (W) worn devices can send
patients medical data to web server (WS).
2. WS to WA: Graph and predication are
displayed on web application (WA) from
web server.
3. WA to WS: While doctor send advice
message to patient, to retrieve patient
mobile number from database stored on web
server, web application send the query to
web server.
4. WA to W: When doctor send message to be
displayed on patient wrist worn unit.
5. W to WS/Ms: In emergency situation, alert
message from wrist worn unit to doctor and
caretaker mobiles.
6. WS to DM: Web server sends predication
message to doctor mobile (DM), only when
it find any predication contain abnormal
parameters.
b) Cases: Communication are takes place using Gprs in
two cases:Case 1: Wrist worn and web server are communicate
with each other in normal situation as well as in
emergency situation.

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International Journal of Engineering Trends and Technology (IJETT) - Volume4Issue5- May 2013
Case 2: Wrist worn system can support one way
communication in emergency situation between wrist
worn and doctor, caretakers mobiles.
Algorithm: The initial analysis starts with a comparison of
the blood pressure, SpO2, body temperature and Hear beat
rate with predefine values.
Based on the results of this analysis, four different scenarios
are possible.
Normal: It indicates that all medical parameters of
patient are fine.
Error: A re-measurement is performed.
Emergency Situation: If any one or all values are
diverted from predefined range, then wrist worn
device send alert message to doctor and caretakers
mobile.
The doctors then perform a detailed analysis of all data
further steps are taken.
B. Web Server: Php Server
Web server can stored all medical data of patients in MySql
database called Patients log. Php server runs predefined
medical algorithm called CHECK MEDICAL-PARAMETER
algorithm:ALGORITHM: CHECK MEDICAL-PARAMETER
Step 1: Receive patients parameters from the wrist worn
device.
Step2: Compare received patient medical values to predefined
Value, and assigns a risk factor accordingly.
Step 3: Prepare graph to reflect the patient health parameter.
Step 4: Auto generate the predication for patient health
condition in next 24 hours based on the average values
derived from the all values stored in patient database.
Step 5: If generated predication show high risk in future, then
only it send alert message to doctor to avoid any unusual
situation in future trough web Sms provider.
Step 6: At the same time, it display graph and predication
values on web application.
As shown in diagram this procedure is carried out
continuously for accurate results.

Fig. 5. Web Server Operations

Predication module execute median filter algorithm to

generate predication values.
C. Web Application: Tele Medicine Centre
At the TMC, doctor careful read displayed predication
values and study graph for various medical parameters of
patients. This software will allow only authorized doctors to
securely access medical records and details of a patient, which
enables doctor to reply quickly and appropriately. This makes
the TMC to offer the emergency treatment and waiting and
travelling time of patient can be saved. Also doctor can set the
new threshold values for parameter to handled current medical
health condition of patients.

Fig. 6. Snap shot of working of Web Application

When doctor enter the patient number, message, set new

threshold values and press Send Message to Patient button ,
set of action was performed as shown in figure 7.

PATIENT WRIST
WEB SEVER
Database

Graph

Predication
Values

Abnormal Predication
Values

SMS
Display
Web SMS provider
WEB APPLICATION
Doctor message sending
window

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Doctor Mobile

Fig. 7.working of Doctor Message Sending Module

III. CLIENT SERVER APPLICATION

The wireless client server architecture is defined as follows:
the client application resides in wrist worn device provides
continues remote monitoring, visualization, transmission and
receiving of messages to the server and mobile. The server is
centralized web server, take care of remote analysis of
incoming medical data of patients and if receiving values
exceed the predefined threshold then automatically the
message will be forwarded to doctor, family friends which

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International Journal of Engineering Trends and Technology (IJETT) - Volume4Issue5- May 2013
indicate emergency situation. Web server is also responsible
for displaying graph, predication logic on web application.
Client application is develop using C# and the server is
designed using Php language. Database is designed using
MySql. General packet radio services are used for wireless
connection between client and server.
The relationship between clients and server are described as
follows:a. Many to One (M: 1):
The wireless e-health
monitoring system connects more than one patients
wrist worn devices to the single php server at the
same time. Client application can send collected
patient medical data to the server.
Php Server
Database

Client
Patient-1
Patient-2

1: M

Tele Medicine
Centre
Doctor and
Caretakers

Patient-N
Fig. 8. Client Server Architecture for e-heath monitoring system

b.

c.

One to One (1:1): This type of relationship exists

between web server and web client. Centralized
server has complete control over all system. Server
can send data to display on web client. On the other
hand, when doctor need to send the message to client
side, doctor can enter only patient number and the
message. Web client application then send this
patient number to the web server for searching of
mobile number for particular patient in database
index by patient number. Then server returns the
mobile number of that patients if records find
otherwise error will displayed on web client side.
One to Many (1: M): At the time of emergency
situation, wrist worn device can send the alert
message to doctor, family members and whose
mobile numbers are stored in database.

IV. SYSTEM TEST RESULTS

Measurement of wrist worn device is erroneous in two
situations: the wave form could not be detected, e.g. too much
noisy in the environment and when patient cannot properly
placed sensor on body. In calculating predication results, such
erroneous results were excluded from consideration.
a) Measurement Results: An investigation of the
blood pressure data showed 70 % accurate. Due to
noise some results showed deflections and were
appeared many times. This may result in some
cases that they are insufficient for this system to
be used with confidence in a clinical environment

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V. CONCLUSION
A wireless health monitoring system is designed, developed
and tested and is found efficient and user friendly in all
aspects. We have developed a wearable patients monitoring
and alert system. The system combines measurement of vital
signs, online analysis and emergency detection, predication
and graph generation, sending of doctor message, sending of
web based predication messages and gprs connectivity
between wrist worn, web server, web application and mobiles.
A prototype of wrist worn device, web server, and
telemedicine centre has been implemented successfully.
REFERENCES

Web Client
1:1

M: 1

for measuring blood pressure. Further work is

going on to overcome this system.
b) Feedback from questionnaire: This system was
found 80% comfortable.

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