Università degli Studi di Parma

ICT for health and we-billing

Telemedicine

Prepared by Hammam Tarek Mohamed

Almehdi Fathalla
Matricola:327393

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 Abstract
Telemedicine is the art of sending medical data, which includes previous histories, prescriptions,
all types of reports like X-rays, CT scan images, pathological reports etc. through a
communication system. It is the systems with the help of which one can get medical help
whenever and wherever it is required. This process would be very fruitful to the rural society
who can remotely get opinion from the expert doctors of the city. Even in the case of urban
areas, the opinion the expert doctors in the other cities or internationally reputed doctors can be
sought. Thus, telemedicine is a boon for the ever-advancing field of medicine.
The process of telemedicine commercially started with the usage of PSTN (Public switched
telephone network) i.e., the ordinary telephone network and some data communicating
equipment. Now, in certain advanced countries, it is done through fiber optic communication and
wireless communication techniques like wireless networking (WAN), VPN (Virtual private
network), through satellite communication i.e., VSAT networks etc. The most economical
method of telemedicine is the telemedicine through Internet, as it requires minimum hardware
and a simple communicating medium as compared to the other methods. Also, nowadays due to
the advancement in the networking technology very fast and better resolution data
communication is possible using high speed networks.

INTRODUCTION TO TELEMEDICINE: -

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The institution of medicine defines telemedicine as “…the use of electronic information and
communications to provide and support health care when distance separates the participants…”

The most common applications today are in transmission of high-resolution X-rays, cardiology,
orthopedics, dermatology, and psychiatry. Often, interactive video and audio are used for patient
consultations and guidance on procedures, sometimes video briefings and records of specific
operations are kept on a network in digital form. Groups of physicians, teachers, and researchers
of ten “meet” across large distances. Telemedicine also embraces the management of electronic
patient records, access to libraries and databases on the web and on the private networks, and
excessive use of e-mail by many in the medical profession.

Telemedicine arose originally to serve rural populations, or any people who are geographically
dispersed – where time and the cost of travel make access to the best medical care difficult. Now,
it is increasingly being used in mainstream medicine, tom allow doctors of the world to share
expensive resources and valuable opinion.

Telemedicine is increasingly global in its reach, in 1997 there were 188 active programs around
the world, including Chile, India, Taiwan, Japan and the U.S.A.

The availability of telemedicine is dependent to a large degree on telecommunications, and on

high bandwidth; the field is concerned with advanced telecom equipment and standards, methods
of increasing effective bandwidth and network performance, costs of installations and operation,
security, confidentially and reliability, and the government legislation aimed at furthering the
progress in these areas.

The importance of bandwidth can be seen in an example. With a 28.8 kbps dial-up connection,
transmission of a standard X-ray takes 30 minutes, with a t1 line at 1.5 Mbps it takes 30 seconds,
with a high speed DS3 circuit, it takes 1 second. Clearly, productivity and usability of
telemedicine data depends on availability of high bandwidth.

The earliest example of telemedicine was in the physiological monitoring of the astronauts
through pioneering work done by N.A.S.A. The Gemini and Apollo astronauts in the 1960’s had
two-way video connections with space medical experts in Houston and developed a quite natural
mode of interaction from orbit that featured taking care of routine health questions and needs,
and early experiments of weightlessness. This was followed by trials at Boston’s Logan airport,
and participation by native American reservations in the STARPHAC program.

Since then, this technique of telemedicine has started and has benefited lots of people all over the
world.

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SCENARIO IN LIBYA: -

In Libya, this field is the many of people who cannot work in it for more than one reason.

 The first reason is the communication infrastructure because the first, main and
successful reason in this process (Telemedicine) is the Internet. In Libya, Internet
prices are very expensive.
 The second reason in Libya is that there is a big problem in the electricity
infrastructure, as it is never stable and interrupted for about 18 hours a day, and
this results in a fall in communication stations and coverage towers.
And I think the most important reasons if the telemedicine should be used in Libya It must be
there a good internet connection between the patient and Doctor and of course to provide an
electricity and an internet connection for 24/7

FEATURES OF INTERNET/INTRANET BASED TELEMEDICINE: -

Internet and intranet provide a very good means of achieving telemedicine. This is
basically due to a low cost involved in the installation in achieving the same.

Through our normal internet i.e., world-wide web, one requires only a computer system,
a modem and dial-up connection on both the ends. The cost of this installation is very less. One
can send messages using an e-mail or a special website can also develop.

The intranet connection is slightly costly because it requires an own network to be

developed and administered. But the speed and quality achieved through these networks is
excellent.

One can also think of innovative ways of sending the data on the internet or the intranet.
The images can be compressed using some standard software and converted into MPEG format
before sending them. Sound signals like heartbeats can sent by compressing into MP3 format.

Also, internet provides the facility of voice mail, net to phone and VoIP facilities. At
present the development of fiber-optic links would help the speed and data quality of internet-
based telemedicine.

NOTE: But the internet has it features of the telemedicine only in the first world
countries

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MEDIA OF COMMUNICATION IN TELEMEDICINE: -

1. Telephone lines
2. ISDN lines
3. Satellite communication

A telemedicine system’s basic requirement is a good and sound communication medium,

which will provide an economical and reasonably good quality of data (especially images) at
the receiver end.
The modern-day Internet system provides an excellent medium for data communication.

There can be basically two configurations that can be developed for a telemedicine through
networking: -

1. INTRANET (DEDICATED NETWORK)

2. WORLD WIDE WEB (NORMAL INTERNET)

INTRANET: -
A dedicated network for the practice of telemedicine can be established between the city hospital
and other remote areas.
A network in the form of different topologies can be designed as per the requirement.

The most common topology in which it can be connected is either a client-server type or peer-to-
peer type of networking.

CLIENT – SERVER TYPE NETWORK: -

In this type of networking, a server is placed at the main city hospital, which is connected to the
remote terminals through a telephone network, ISDN etc., a computer system and a modem.

Each terminal has a unique IP address which allows the clients to access the server. The servers
are again connected to a master or mainframe server, which will interconnect all the servers.

Thus, a server can communicate to the other servers through the mainframe servers. Hence it is
basically a concept of wide area networks connected through either a PSTN or any other link.

Whenever a remote client requires communicating to the city hospital for some information, it
will send the unique IP address of that server and logs on with that server. A mainframe or a
master server takes care of the whole network.

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In this type of topology, a client can communicate to another client also through server. Thus,
this topology requires a network system (a stable internet connection), which includes a personal
computer system on both the sides with essential network hardware and necessary software to
provide a basis of networking.

Also, a server is required at the city hospital and a mainframe type of server connecting all the
networks. The communication is through the dial-up networking through modem and TCP/IP
protocol.

HOSPITAL

SERVER

CLIENT CLIENT CLIENT MAIN

FRAME

HOSPITAL SERVER

SERVER

CLIENT CLIENT CLIENT

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PEER-TO-PEER TYPE OF NETWORKING: -

This type of networking is used to communicate directly between server and client or client to
client (directly).

This type of network consists of an interconnection between server to clients and directly
between clients.

The network can be developed using the telephone lines or ISDN etc., a computer system and a
modem. It can be designed according to the no. Of users and can be developed as a WAN. The
communication is generally through dial-up networking using modem and NETBEUI protocol.
The peer-to-peer networking topology can be shown by the following figure: -

HOSPITAL

SERVER

CLIENT CLIENT CLIENT CLIENT CLIENT

REMOTE PATIENTS

The advantage of using an intranet is the speed that can be achieved through the intranet. This is
very important in case of sending images or finer detail pictures. But the cost of developing a
maintaining an intranet is very high and in that case one can use the World Wide Web for
telemedicine.
Developing a website for a telemedicine facility: -

An innovative website can also be developed for a telemedicine programmed.

With the help of this website, one will be able to select a department and a particular expert from
a group of departments and experts.

Also, the access becomes easier than the normal e-mail as the website is prepared to accept a
particular type of data or an image attachment and it would be easier for both the remote patient
and a doctor to communicate and exchange views and other written advices etc.

This website can also provide the facility of oral communication like the voice mail and
extended techniques for transfer of sound (heart beats etc.) along with the written an image data.
All the above-described techniques require only a computer system, modem, telephone lines,
some multimedia facility like speaker and microphone, scanner etc. at both the ends.

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Thus, due to minimum hardware involved it provides an economical way for telemedicine.

FUTURE TRENDS IN TELEMEDICINE: -

Telemedicine is being widely implemented at many places in the world. it has also started
developing slowly and in the next few years many people are expected to be benefited by
telemedicine.

The only hurdle at present is the cost, which will be reduced, as commercialization of
telemedicine will take place in the fourth-coming years.

Telemedicine is also expected to be faster due to private sector intervention in the telecom area,
which will provide fiber optic links, and hence we will be having a much error free and speedier
access.

As this trend of telemedicine advances, we can also have telemedicine through satellite links or
through high-speed wireless networks as we have in certain developed countries.

Thus, we can expect a major revolution in the field of medical science through telemedicine as
this facility will reach to almost every village of the country and every individual, rich or poor,
will be able to take advantage of this facility.

ADVANTAGES OF TELEMEDICINE: -

 No transportation time of cost: -

When you see your doctor on your mobile device or computer, you can save money on gas,
parking, and public transportation. Even better, you don’t waste time traveling or risk running
into a traffic jam that makes you late for your appointment, or worse, late getting back to work.

 No need to take time off of work: -

Speaking of work, video visits largely remove the need to take time off. You can simply
schedule your visit during a break, or before or after work. You can be anywhere that
offers sufficient privacy. You can comply with your doctor’s follow-up instructions and maintain
your health without missing a day of work or wasting your precious paid time off.

 Eliminate child or elder care issues: -

Many of us have the responsibility for caring for children or older adults. Finding alternative care
so that you can see the doctor can be difficult and expensive. Bringing them along can be
stressful or impractical. Fortunately, telemedicine solves this challenge by allowing you to see
your doctor while upholding your family responsibilities.

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  On-demand options: -

More and more physician’s practices are offering telemedicine these days, so there is a good
chance that you’ll be able to see your regular doctor via video. If you cannot, but still need
remote access to care, there are a number of online-only, on-demand options on the market
today. They can’t treat every condition, but can tackle a wide variety of problems. Some
insurance companies pay for this type of care.

 Access to Specialists: -

Some patients who need the care of a specialist must drive long distances and invest a lot of time
for each visit. Telemedicine makes it possible for you and your primary care physician to
leverage the expertise of specialists who are not nearby. When it comes to serious health issues,
you want to consult with the best, not the closest.

 Less Chance of Catching a new illness: -

Where can you be sure to find a lot of sick people? At the doctor’s office of course. While
everyone does their best to prevent one patient from catching something from another, it is
always possible, especially in crowded waiting rooms. By staying home, you get the care you
need while avoiding the risk of exposure and the chance that you will pass your illness on to
someone else.

 Less Time in the Waiting Room: -

If you choose a video visit via telemedicine technology, you will eliminate all that time spent
looking at old magazines in a doctor’s office. Even if you don’t use telemedicine, choosing a
practice that offers it will reduce your wait time by letting other patients be seen from home.

 Better Health: -

When you can see your doctor as often as you need to, without the challenges of getting into the
office, you can practice better management of your medication, lifestyle, and any chronic
conditions you might have.

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DISADVANTAGES OF TELEMEDICINE: -

 Insurance coverage: -

Not all insurers cover telemedicine. there are some countries currently require insurers to cover
or reimburse the costs of telemedicine. However, these laws are constantly changing.

 Protecting medical data: - 

Hackers and other criminals may be able to access a patient’s medical data, especially if the
patient accesses telemedicine on a public network or via an unencrypted channel.

 Care delays: -

When a person needs emergency care, accessing telemedicine first may delay treatment,
particularly since a doctor cannot provide lifesaving care or laboratory tests digitally.

 Licensing issues: -

 State laws vary, and clinicians may not be able to practice medicine across state lines, depending
on the state in which they hold their license and the state in which the patient lives.

 Technological concerns: -

Finding the right digital platform to use can be challenging. Also, a weak connection can make it
difficult to offer quality care. Clinicians must also ensure that the telemedicine program they use
is secure and fully compliant with privacy laws.

 An inability to examine patients: -

Providers must rely on patient self-reports during telemedicine sessions. This may require
clinicians to ask more questions to ensure that they get a comprehensive health history. If a
patient leaves out an important symptom that might have been noticeable during in-person care,
this can compromise treatment.

 A good and stable internet connection: -

If the patient or the doctor who will be dealing with this technology (telemedicine) he must had a
good internet connection and stable because he will do a video call or just sent some information
and data, and it needs to send quickly.

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 IoT for Telemedicine

Introduction:-
IoT is becoming more and more essential in daily lives, including the management of various
health and medical needs [1]. Indeed, the concept of medical Internet of Things (mIoT), which
includes the concepts of telemedicine and telehealth, is increasingly gaining popularity thanks to
the nowadays largely used portable smart-devices, e.g., tablets and smartphones. These devices
offer advanced services combined with Internet accessibility resulting in an enhancement of the
user knowledge and experience, so that more informed choices and better and faster decisions
are taken from the medical staff [2].
Furthermore, thanks to Internet availability, data
sharing on cloud system is also desirable
allowing multiple users, geographically
separated from one another, to have access to
information and data at any time and from
anywhere [3]. Exploiting the telecommunication
infrastructure, telehealth and telemedicine
systems facilitate the exchange of electronic
information and data for remote monitoring,
diagnosis, telesurgery and other forms of
medical services [4]. This would be beneficial
Fig1: Sketch of the IoT cloud-based monitoring
especially in rural areas of Countries still under- network for anesthesia practices.
developed where there is an insufficient number of
specialists in health-care services [5]. IoT health-care
networks are beneficial in several medical environments, ranging from remote patient monitoring
[10] to management of hospitalized patients [11]. Indeed, whenever a patient is in a serious
medical condition it is of vital importance to maintain under control his/her status by
continuously monitoring some crucial compounds and parameters[12]. Therefore, critical
medical monitoring is highly requested in Intensive Care Unit (ICU) wards and in delicate
medical procedures where difficult-to-dose drugs need to be administered, as in anesthesia
practices [13]. Smart IoT solutions can effectively fulfill this need by guaranteeing an on-line
continuous connection between the patient and the medical specialist [14]. Within this context,
Table I summarizes the features of some already developed mobile Health (m-Health)
monitoring solutions. From the comparison, it is evident that majority of the IoT solutions are
provided for home monitoring of elderly people, but still no mature cloud-based system has been
proposed for hospital practices. To provide dedicated solution for hospital medical practices, we
have previously presented in [9] a first architecture for continuous monitoring of anesthesia.
Nevertheless, no cloud integration was provided in this architecture. In this work, we present the
development and the validation of a complete m-Health system as an IoT cloud-based solution
dedicated to anesthesia monitoring during surgeries. The system, sketched in Fig1. , exploits Wi-
Fi to transmit the data from the Therapeutic Drug Monitoring (TDM) platforms [15],
directly connected with the patient, to a dedicated Android

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 Table 1

app running on a tablet or smartphone, used by the anesthesiologist.

From the Android app, it is possible to share the data on the cloud by enabling teleconsulting and
remote.
visualization through a web application, from now on referred to as WebApp. Further, a
smartwatch, worn by the medical doctor, enriches the architecture by receiving alert through
notifications in case of emergency. The incoming notification includes the name of the in-danger
patient and the out-of-range
parameter.
Our architecture allows the anesthesiologist to monitor multiple patients in parallel; hence the
total process time is reduced and the practice quality is preserved [16]. Moreover, since the
efficacy of sedation depends on the action of three intravenously administered drugs, the
complete system provides the monitoring of up-to-three drugs plus temperature and ph. Thus, we
show that we are able to address two of the main challenges of anesthesia practices.
Network Architecture : -
The scenario for the developed monitoring architecture is depicted in Fig. 1. We can summarize
its main functionalities as follows. The anesthetized patient is directly monitored by a TDM
platform which continuously sends the measured data to an Android application, running on the
anesthesiologist’s smart-device, as tablet or smartphone. The smart-device enables the cloud
storage and sharing of data by exploiting the back-end solution provided by Pryv [17].
Thanks to cloud support, the patient’s data are accessible from everywhere and at anytime
(during or post-surgery) through a dedicated WebApp.
Therefore, on-line teleconsulting is possible between specialists even if geographically
separated. Further, a smartwatch, paired with the smart-device on which the Android app is
running, can be worn by the in-charged anesthesiologist so that in case a measured value is out of
safe-range, an alert can be received from the Android app.
The wearable notification is characterized by a strong vibration and a pop-up message displaying
the name of the critical patient and the out-of-range parameter. In this way, faster interventions
are ensured in case of emergencies. The main objective of our network architecture is to provide

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a safer patient monitoring by keeping the medical specialist always connected with all the
patients under his/her responsibility.
In other words, the doctor is allowed to perform in parallel different tasks without losing the
control over the anesthetized patients.
Hereafter, the main parts of the network are described in detail.

i.Android App
The doctor can keep under control multiple monitored parameters from several patients through
a dedicated app developed in Android. The app puts the doctor at the center of
the architecture by establishing a bidirectional communication from one side with the TDM on
the patient and from the other side with the cloud back-end. To guarantee an appropriate
recording of the patient’s data, all the measured values are both stored in files on the memory of
the smart-device and sent to the cloud. Main activities are:
(i) login activity that guarantees a secure access to only authorized doctors,
(ii) patient data activity where the doctor has to fill the personal data of the patient
and, if desired, the cloud sharing is enabled,
(iii) Pryv login activity to sign in the cloud environment if the sharing has been
previously selected,
(iv) device list activity to establish the communication with the TDM measuring
the patient’s parameters
(v) monitoring activity where the received data are visualized and different
actions can be taken from the doctor, as starting and stopping the
measurements or adding new patients to the network. Further, if during the
monitoring an out-of-range
value is measured from the TDM on the patient, an alert is sent to the doctor’s smartwatch to
ensure rapid intervention.
ii. Cloud Solution and WebApp
The web-based system proposes user-friendly interfaces for patients and doctors who need to
share health data while respecting the regulations. This system is based on the Pryv ehealth
middle-ware solution [17] and take benefit from its data sharing feature.
Depending on who is accessing the sharing WebApp, two different interfaces are shown to the
user. For a patient, the main window allows to share a data-stream with the doctor, while for a
doctor, the shared patients data-streams are listed.
By selecting one of the sharing, the corresponding data are plotted on multiple graphs. Thanks to
this visualization tool, the doctor can remotely monitor the patient status or access previous
measurements. These measures are received and processed by the Android app and sent to the
cloud through Pryv RESTful API (using HTTPS requests to get, update, post and delete data).

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iii. TDM System
To measure the actual concentration of the anesthetic compounds a RPi-driven system, already
presented in [15], [18], has been adopted and interfaced with the dedicated Android
app. Briefly, the TDM consists of two main blocks:
(i) the electrochemical sensing platform to detect up to three drugs plus pH and
temperature, and the RPi-based electronic system to drive the measurements and to
send, as master, the data to the Android app exploiting the TCP/IP protocol.
(ii) The data are sent following a specific protocol, as shown in Fig. 2. The protocol
consists in 6 bytes where the first byte (in green) contains the information about the
measured drug and the electrochemical technique adopted. The following four bytes
contain the data: the measured current value (in yellow) and the applied voltage (in
blue). The last byte identifies the stop of the data packet (in red).

Fig.2 . Transmitted data packet between RPi-driven

TDM system and Android app.
However, thanks to the flexibility and portability of
the here presented monitoring network, any
TDM system that wirelessly provides the measured data can be connected. Therefore, the cloud-
based monitoring architecture can be adopted for a variety of medical applications.

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Protocols and procedures :-
To set the monitoring through the network architecture, some procedures have to be followed.
Both patient and doctor have to complete some basic steps, that are summarized as work-flows in
Fig. 3.
A. Patient-side Work-flow
Since sensitive personal data are transmitted and shared on cloud, prior consent of the patient is
needed. To fulfill this requirement, we developed the WebApp, relying on Pryv shared access
feature, which allows the patient to authorize the doctor to access his/her data. Indeed, after the
creation of the Pryv account (if new registration is needed), the patient can sign in and decide to
share a subset of data with the doctor.
A consent form is presented to the patient and by clicking on a button, the patient explicitly
authorizes the doctor to access his/her data. This action results in the creation of a shared access
between the patient and the doctor.
The doctor is automatically notified about the patient decision through an email containing the
shared link. From now on, the patient sees the new sharing in a list and can revoke it at any time.
B. Doctor-side Work-flow
1) Local Monitoring Work-flow: Every time that a new patient authorizes to share a subset of
data with the in-charged anesthesiologist, the latter receives an email with the link to access the
sharing. By clicking on this link, the doctor is redirected to the WebApp where, after the login,
the incoming request from the patient can be accepted. During the surgery, the dedicated
Android app allows the doctor to continuously monitor all the patients under his/her
responsibility. To access the Android app, the doctor has to sign in through a login activity (Fig.
3a). Afterwards, a patient data activity (Fig. 3b) is reached where all the patients personal data
has to be filled and a check-box can be selected to enable the cloud sharing. If the sharing is
enabled, the doctor is asked, through the Pryv login activity (Fig.3c), to sign in also in his/her
Pryv account to link the patients information with the Pryv sharing. On the contrary, the
measured data from the sensor is just received and visualized from the Android app and saved in
files on the memory of the smart-device. The doctor can connect the Android app with the
monitoring system, by selecting from the device list activity (Fig. 3d), the hardware device
connected with the patient. At this point, it is possible to start and stop the measurements and
visualize the incoming data continuously and in an immediate way on the monitoring activity
(Fig.3e). While monitoring, the doctor can always add further patients to the network following
the same steps previously described.

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2) Remote Monitoring Work-flow: In addition to the Android app, any allowed medical
specialists can remotely access patient’s shared data through the WebApp. To do so, the doctor
has to log in the WebApp where a list of accepted patients’ sharing is available for remote
consulting. The shared links are organized accordingly to the creation date and access a

Fig. 3. Work-flow charts for patient-side and doctor side. In particular, doctor-side can be subdivided in local and remote monitoring.

visualization tool when clicked. The visualization tool is a simple web application where
patient’s data are plotted using Plotly JavaScript library.

IV. SYSTEM VALIDATION

1) Materials and Methods: The Android app was developed in Android Studio 3.0, while the
WebApp in Javascript, HTML and CSS. Pryv middle-ware solution was adopted as back-end
cloud system for data sharing. The TDM system is driven by the RPi Model B V-1.2 which is
programmed in Qt Creator 3.2 software with Qt 5.3 libraries. To simulate the scenario in Fig. 1
we have adopted a Galaxy Note pro 12.2in with Android 5.1.1 Lollipop paired with a Sony
Smartwatch 3 for the doctor and two RPi TDMs to simulate two anesthetized patients. Finally, a
laptop was used to access the WebApp on-line.
2) Validation: The system has been validated by creating a network with two RPi TDMs as
patients, one tablet and one smartwatch for the doctor and a laptop for accessing the Pryv
WebApp. Adopting this architecture, we have validated its features:
 The Android app can simultaneously communicate via Wi-Fi with the RPi and with the
cloud solution.
 The Android app can connect multiple patients at the same time, so that the
anesthesiologist can easily follow different surgeries in parallel.

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  The patient access in the WebApp and the subsequent sharing of a subset of data with the
doctor. In automatic an email with the link to the shared data is sent to the doctor. Then,
we also test the revoke of the patient sharing.
 After receiving the email from the patient, the doctor use the share link to access the
WebApp and visualize the cloud data.
 The continuous receiving and the immediate visualization of the measured data received
from the RPi on the Android app.
 We have evaluated the latency time for an event creation call on Pryv API as under
100MS, which is comparable to a standard HTTP request without any overhead. Please,
note that this parameter is influenced by the quality of internet connection, the server
location and the size of the payload (Switzerland and events with double-precision
floating-point numbers, respectively in our case).
 In case of out-of-range measured parameters from one connected patient, an alert
notification is sent to the smart-watch worn by the doctor. The notification happens as a
strong vibration and a pop-up displaying the name of the critical patient, and the out-of-
range drug.
The alert is then sent when more than n received values exceed the physiological threshold. Both
the n value and the threshold depend on the measured drug.

V. CONCLUSIONS
The report presented the design, realization and validation of a novel IoT cloud-based system to
be adopted in anesthesia practices.
The dedicated Android app running on the anesthesiologist’s tablet/smart-phone is the central
actor of the architecture. The app bidirectionally communicate, through Wi-Fi, from one side
with the RPi-based TDM system on the patient and from the other side with a cloud back-end
solution.
The cloud back-end solution is accessible by a WebApp. More in specific, the measured data by
the TDM system are sent to the Android app and, from here, to the cloud. All the data are
saved locally both on the RPi and on the tablet/smartphone to ensure a safe recording.
Through this architecture, the anesthesiologist can monitor multiple patients in parallel. In case
of any anomaly in measured data, the doctor is alerted by a notification pushed
by the Android app to the smartwatch.
This ensures a rapid and efficient medical intervention.
A variety of other medical applications requiring continuous patient monitoring, might be
addressed by the here presented monitoring network.
Indeed, it is just required a medical device able to wirelessly send the measured data for the
integration with this architecture.

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