ARTICLE IN PRESS

Journal of the Franklin Institute 346 (2009) 531–542

www.elsevier.com/locate/jfranklin

MEMSWear-biomonitoring system for remote vital

signs monitoring
Francis E.H. Tay, D.G. Guo, L. Xu, M.N. Nyan, K.L. Yap
National University of Singapore, Department of Mechanical Engineering, 9 Engineering Drive 1,
Block EA, 07-08, Singapore 117576, Singapore
Received 7 December 2007; accepted 20 February 2009

Abstract

This paper proposes a remote vital signs monitoring system, which integrates wireless body area
network (WBAN) and personal digital assistant (PDA) phone technology. Four different
physiological signs, e.g., ECG, SpO2, temperature and blood pressure, can be continuously acquired
or derived from two wireless sensor nodes—ECG sensor and integrated SpO2/temperature sensor.
Once sentinel events happened or the request to real-time display vital signs is confirmed, all
physiological signs and critical indices will be immediately transmitted to patient’s PDA phone
through Bluetooth and further relayed to doctor’s PDA phone through global system for mobile
communication (GSM) technology. A prototype of such system has been successfully developed and
implemented, which will offer high standard of healthcare with a major reduction in cost for our
society.
r 2009 The Franklin Institute. Published by Elsevier Ltd. All rights reserved.

1. Introduction

Healthcare will face major challenges in the near future as costs are rapidly increasing
worldwide due to aging population and widespread chronic diseases. Singapore is no
stranger to the challenges posed by an aging citizenry: it has the fastest growing elderly
population in the world. Singapore, as being unique among developed countries in
achieving high-quality healthcare, is actively advancing the application of biomedical
research in developing low-cost and cost-effective medical systems in healthcare service.

Corresponding author.
E-mail address: mpetayeh@nus.edu.sg (F.E.H. Tay).

0016-0032/$32.00 r 2009 The Franklin Institute. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jfranklin.2009.02.003
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Fifteen years down the line, the population of elderly above 65 years is estimated to double
from 10% to 20% and the country’s ratio of workers-to-elderly will shrink from 11:1 today
to 4:1 by 2025 [1]. This situation posts a problem of hospital beds not being able to meet
the number of patients to be admitted. Furthermore, chronic patients discharged from
hospitals, elderly and the disabled are desperately in need of intensive monitoring at home.
The cost of sending nurses or medical doctors to attend patients at home is very high.
Therefore, remote monitoring of vital signs for home care becomes essentially useful
especially for those patients not as critical as intensive care unit (ICU) patients but still
require monitoring of their vital signs.
Monitoring of physiological signals is not a new domain for research. Many groups are
working on similar monitoring of signals. Chen et al. [2] described monitoring of multiple
vital signs based on mobile telephony and internet. NASA Ames Astrobionics team has
developed Lifeguard that integrated commercially available vital signs detection onto a
platform and designed to be worn on the body of the wearer [3]. Amidst all these efforts on
biomonitoring, we see the potential of using low-power consumption, light weight and
integrated physiological sensors for detection of sentinel events instead of using bench-like
systems based on commercial products. Our eventual aim is to enable the wearer to have
their biovital signs detected and sentinel events promptly determined on a 24/7 basis by
simply having a low-power system located on their shirts.
Recently, the fast development of mobile technologies, including increased commu-
nication bandwidth and miniaturization of mobile terminals, has accelerated developments
in the field of mobile telemedicine [4]. Wireless patient monitoring systems not only
increase the mobility of patients and medical personnel but also improve the quality of
healthcare [5]. Several research groups have demonstrated the transmission of vital bio
signals using global system for mobile communication (GSM) technology [6]. Therefore,
the combination of new advances in sensor technology, personal digital assistants (PDAs)
and wireless communications enables the development of a remote monitoring system that
can provide patients with assistance anywhere and at any time.
In this paper, MEMSWear-biomonitoring system, which integrates personal digital
assistant phone and wireless body area network (WBAN) technology, is developed to meet
the challenges mentioned above. WBAN consists of two wireless, light weight and
miniature sensor nodes—an ECG sensor and an integrated SpO2/temperature sensor,
which can be incorporated onto a wearable shirt platform to measure various vital signs.
Each sensor node consists of a sensor probe using a low-power microprocessor and a
Bluetooth transceiver and is capable of remote data acquisition and processing and is alert
of sentinel events of a wearer.

2. Methods

2.1. Overview of the system

MEMSWear is a wearable smart shirt that can detect fall events through the use of
motions sensors, such as gyroscopes and accelerometers [7]. MEMSWear-biomonitoring
system, developed in line with the aspiration of Agency for Science, Technology and
Research (A*STAR), Singapore, further equips the smart shirt with physiological sensors
that can be used for remote monitoring of human vital signs. Four physiological signs, e.g.,
ECG, SpO2, body temperature and blood pressure can be continuously acquired or
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Integrated SpO2/
Temperature
sensor
GSM
ECG sensor

Wireless Body Area

Central Network (WBAN)
processing unit Bluetooth

Sentinel events /
Request to view
real-time vital signs
Doctor’s PDA
Wearer’s PDA phone
phone

Fig. 1. Architecture of MEMSWear-biomonitoring system.

derived from two wireless sensor node—ECG sensor and integrated SpO2/temperature
sensor as shown in Fig. 1. Each sensor node consists of a sensor probe and a Bluetooth
transceiver. The most widely used and commercially available WBAN technologies include
Bluetooth [8] and ZigBee [9]. Bluetooth is selected for its proven technological maturity
and ease of integration in many cell phones and personal digital assistant devices.
Moreover, Bluetooth allows a high communication bandwidth of up to 720 kbps, which
makes it an ideal choice for our application. The central processing unit (CPU) or the
gateway consists of a processing unit and a Bluetooth transceiver. This unit will collect all
sensors data and transmit out to global system for mobile communication network devices
through the Bluetooth interface.
PDA phones are used in MEMSWear-biomonitoring system and the main goal of the
PDA phone is threefold: firstly, at the patient’s location, the PDA-based monitor can be
used to acquire real time and continuous waveform as well as important physiological
parameters of the wearer’s vital signs; and secondly, upon detection of sentinel events, the
abnormal vital signs would be sent wirelessly through GSM to doctor/caregiver’s PDA
phone; and thirdly, the doctor/caregiver can promptly view and analyze the received
abnormal vital signs for further treatment strategy decision.
Our BAN system will utilize the sensor nodes in both active and passive mode. In
normal activity, each sensor node would be sensing its environment continuously without
forwarding its data to the CPU. Once a sentinel event is detected or a request to view the
real-time detected signals is confirmed, the CPU will immediately sends all physiological
signals to the wearer’s PDA phone, which will be further relayed to the doctor’s PDA
phone.

2.2. Physiological monitoring system

For an MEMSWear-biomonitoring system to be well-received by the wearer, light

weight and compactness of sensors together with a highly reliable and seamless system
integration are of utmost importance. The sensor nodes need to be compact, non-
obstructive and require minimal user intervention (e.g., minimal change of batteries).
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2.2.1. Integrated monitoring of blood oxygenation measurement (SpO2) and temperature

SpO2 or pulse oximetry is the measure of oxygen saturation in the blood, which is
related to the heart pulse when the blood is pumped from the heart to other parts of the
human body. When the heart pumps and relaxes, there will be a differential in absorption
of light at a thin point of a human body. Oxygenated hemoglobin absorbs more infrared
light waves and allows more red light waves to pass through. However, deoxygenated
(or reduced) hemoglobin absorbs more red light waves and allows more infrared light
waves to pass through. This unique property of hemoglobin with respect to red and
infrared light wave allows oxygen saturation to be detected non-invasively. Pulse oximetry
is a simple yet reliable method to measure oxygen saturation that otherwise would have to
be measured by invasive methods.
Temperature taken at the ear (tympanal temperature) closely matches the body core
temperature compared to that taken from other parts of the body. The tympanal
temperature gives us an indication of the state of the cognitive organ of a person—the
human brain. Extended period of high fever can damage human organs, especially the
brain, which is crucial in controlling the well-being of a person. A precise thermopile was
chosen in the application.

2.2.1.1. Prototype hardware. SpO2: Red (660 nm) and infrared (940 nm) LEDs were
chosen and populated onto a custom-made sensor board. TAOS light-to-frequency (LTF)
converters were used as the photodiodes [10]. This family of LTF optoelectronics is able to
sense lights corresponding to the red and IR wavelengths and output digitized frequency
square waves. The output of the LTF photodetector is connected to the timing port of a TI
MSP430 microcontroller. By counting the rising edges of the digitized output, the intensity
of the light can be obtained for each sample.
Temperature: An industrial infrared thermopile sensor [11] was chosen and connected to
the ADC port of the TI MSP430 microcontroller. The microcontroller will in due time
input the industrial calibration data in its algorithm. The processed raw data signals will be
correlated with the calibration data to obtain the temperature values.
The proposed integrated SpO2 and temperature sensor are fabricated as shown in Fig. 2.

Bluetooth
module
MCU board

Thermopile

SpO2 Probe

Fig. 2. Prototype of integrated SpO2/temperature sensor.

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RED IR
IR
red

Band-pass Band-pass

U3 U3
IR
U3

MAX
Segmentation
Interval
MIN

Max Min extraction

SpO2

Fig. 3. Data processing of SpO2.

2.2.1.2. Software and algorithms. The LEDs are programmed to emit light intermittently
while the LTF photodetector is ‘‘on’’ at all times to detect the amount of light incident
onto it. Fig. 3 shows the intensity of red and IR light being detected and processed. The
intensity of red and IR light that permeated through the thin part of the body such as
finger or ear lobe went through a band-pass filtering to eliminate the low-frequency noise.
The filtered signals are then passed through a moving window average method named U3
[12]. From the simple U3 method, we obtained the interval between the maximum and
minimum values. The maximum and minimum interval was correlated with the raw data to
obtain a segmentation of the raw data interval. From the raw data interval, which includes
the maximum and minimum values, we differentiated the extreme values and used these
values for computation of the required SpO2 value. SpO2 is calculated with a two-
wavelength spectrophotometric method, i.e.,
lHb
RED
 lHb
IR
ðAlRED =AlIR Þ
SpO2 ¼ (1)
lHb
RED
 lHbO
RED
2
 ðlHb
IR
 lHbO
IR
2
ÞðAlRED =AlIR Þ
where lHb
RED
and lHb
IR
are the extinction coefficients of hemoglobin for red and IR light; lHbO
RED
2
lIR
and HbO2 are the extinction coefficients of oxyhemoglobin for red and IR light [13]; and
A ¼ (MAXMIN)/(MAX+MIN).

2.2.1.3. Sentinel events. SpO2 (%O2)o85% and temperature (1C) 438.3 1C.

2.2.2. ECG monitoring

Two different types of electrocardiography machines are pervasively used today. The
first and more prevalent, the ‘‘standard ECG’’ generally involves the connection of
between 12 and 15 leads to a patient’s chest, arms and right leg via adhesive electrodes. The
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device records a short sampling (not more than 30 s) of the heart’s electrical activity
between various pairs of electrodes [14] and provides a standard ECG, which can be
interpreted by an experienced cardiologist to diagnose a wide range of possible
arrhythmias. However, such short sampling time fails to capture cardiac activities that
that are irregular or intermittent, which is typical among ICUs and the elderly. To address
this shortcoming of the ‘‘standard ECG’’, many hospitals adopt ‘‘continuous electro-
cardiogram telemetry’’ to monitor patients in intensive care. This involves the deployment
of a three-electrode ECG device to evaluate a patient’s cardiac activity for an extended
period if there is a chance that a patient has cardiac problems maybe only once or twice a
day. However, although both standard and continuous ECG devices are marketed as
‘‘portable’’, they normally obtain power from an electrical outlet. As such, they must be
mounted on a cart and wheeled from one location to another. Therefore, our objective is to
make a medical grade and battery-powered ECG sensor that can be unobtrusively worn
over a period of several days. Such a wearable sensor will be integrated into the
MEMSWear-biomonitoring system to continually log heart rate data, provide detection of
life-threatening events (e.g., arrhythmia).

2.2.2.1. Prototype hardware. A prototype of one lead ECG sensor using MSP430FG439
microcontroller unit (MCU) is fabricated to validate the feasibility of the approach as well
as detection and classification algorithm [15] as shown in Fig. 4. The ADC12 in MCU
samples the ECG signal with a sampling frequency of 512 Hz. Two linear phase
symmetrical FIR filters are implemented in MCU, where the low-pass filter is used to
remove high-power line interference and the high-pass filter is used to reduce noise induced
by electrode contact, muscle contraction and base line drift. Using symmetrical FIR filters
can reduce the demand on math multiplication operations to one-half because of the
symmetrical nature of the filter coefficients.

2.2.2.2. QRS detection and arrhythmia classification. Within the last decade, many new
approaches to QRS detection have been proposed; for example, derivative-based
algorithms, genetic algorithms, wavelet-based algorithm, filter banks as well as neural
networks [16]. However, the computational load is very important in the development of a
battery-driven long-term monitoring ECG device. In this application, a fast and reliable

Bluetooth ECG Electrodes

module

MCU board
Battery

Fig. 4. Fabricated one-lead ECG sensor prototype.

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U3 Response

ECG Signal

0 500 1000 1500 2000

Samples

Fig. 5. Measured ECG signal and corresponding U3 response during QRS peak detection.

QRS detection algorithm developed by Paoletti and Marchesi [12] is applied to real-time
analyze long term and noisy records. The algorithm is based on the fact that some
indicators of the length of the ideal curve, representing the QRS complex, are useful to
design a time domain detector with the desired features. U3 has the advantage of being
faster and having less computational load when compared with other QRS detection
algorithms. In the algorithm, the detection threshold for QRS peak is based upon the most
recent signal and noise peaks that are detected in the ongoing processed signals, thereby it
continuously adapts to the signal characteristics. Fig. 5 shows the measured ECG signal
and the corresponding U3 response during QRS peak detection. It can be clearly seen that
the U3 operator can successfully reduce the high-frequency noise and the base wander to a
large extent, thereby emphasizing the sharpness of the QRS complex.

2.2.2.3. Sentinel events. Once a beat is detected, it is characterized by a number of

features such as width, amplitude and R-to-R interval and heart beat rate (HR) can be
easily calculated by the R-to-R interval. Also, different types of ailments or arrhythmias
can be classified based on one lead ECG signal [17,18].

(a) Heart beat rate:

Tachycardia: HR 490 bpm (beats/min).
Bradycardia: HR o60 bpm.
(b) QRS width:
0.1–0.12 s indicates the Wolff–Parkinson–White syndrome or non-specific
intraventricular conduction delay or incomplete right or left bundle branch
block (RBBB or LBBB).
40.12 s indicates complete LBBB or RBBB or ventricular tachycardia.
(c) Q wave:
If Q wave’s width 40.04 s or/and Q wave’s height 425% of R wave’s height, it
indicates myocardial infarction.
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2.2.3. Blood pressure monitoring

Blood pressure measurement will consist of deriving the systolic and diastolic blood
pressures. Conventionally, blood pressure is obtained by using a cuff method utilizing
method of Korotkoff. Other cuff methods make use of pressure measurement in an
oscillometry measurement system. Both methods involve the use of cuff as the mean to
differentiate the pressures that are measured so that the systolic and diastolic pressures can
be obtained. The cuff is not the most suitable method for our wearable application as this
implies that complex electronics and mechanical components have to be employed with
pressure sensors that need to detect signals that fall in the range of millivolts.
In recent years, a new cuffless method surfaced among researchers. The pulse transit
time (PTT) is defined as the time taken for pulsed blood, which is initiated from the heart,
to travel to other parts of the human body where the plethysmogram (PPG) is taken i.e.,
finger, ear or toe. The PTT is then used to infer the systolic blood pressure, which provides
enough information for decision of hypertension and hypotension as shown in Fig. 6.

2.2.3.1. Software and algorithm. An equation based on energy conservation was used by
Fung et al. [19]. From this equation, BP is inferred from PTT using the solution,
 
1 1 d2
BP ¼ r þ rgh (2)
0:7 2 PTT2
where r ¼ 1035 kg/m3, is the density of blood, d the distance from heart to the other part
of body, PTT the pulse transit time, g the gravitational pull and h the height difference
between two sites.
Here, the most crucial parameter is the PTT value. The time between the ECG R-peak
and the maximum slope from the PPG obtained from the SpO2 board will be used to
obtain the PTT time.

2.2.3.2. Sentinel events. Hypertension: 4140/90 mmHg (systolic/diastolic).

Hypotension: o90/50 mmHg (systolic/diastolic).

(1) Heart
contraction
starts
ECG

SpO2
(2) Fresh arterial blood PTT PTT
is pushed to
fingertip

Fig. 6. Schematic view of PTT for blood pressure measurement.

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3. Implementation of MEMSWear-biomonitoring system

A prototype of the overall system has been designed and implemented as shown in
Fig. 7.
In the physiological signs acquisition module, ECG sensor and integrated SpO2/
temperature sensor continuously acquire and process real-time vital signs and wirelessly
transmit the signal as well as critical indices to the CPU. In the CPU, continuous blood
pressure signal will be derived using the PTT method. The format data packets from ECG
sensor and integrated SpO2/temperature sensor are shown in Fig. 8. ECG data packet
consists of 12 bytes starting with header ‘‘E’’ and ending with terminator ‘‘G’’. Since the
sampling rate of ECG signal is 8 times higher than the SpO2 signal, eight consecutive
digital values from ADC of ECG MCU are stored from 2nd byte to 9th byte to ensure the
synchronization with SpO2 signals for blood pressure calculation. If there is a QRS peak
within these eight ECG signals, the lower 4 bits of 10th byte store peak position.
Otherwise, the lower 4 bits will be set to 0 if no QRS peak is detected. The higher 4 bits of
10th byte indicate normal or classified arrhythmia type. Heart beat rate will be stored in
11th byte. Similarly, SpO2 data packet consists of 9 bytes starting with header ‘‘S’’ and
ending with terminator ‘‘O’’. The digital values from IR and RED are stored in 2nd to 3rd

ECG Sensor ECG data

Lead I packet
ECG Electrodes Analog front-end TI MSP430FG439
Bluetooth

Central
Light-to- Processing
SpO2 Probe frequency Unit
photodetector SpO2 &
Integrated SpO2 & Temperature (Deriving blood
Temperature Sensor data packet pressure and
IR/R LED driver TIMSP430F1611 saving all vital
and control Bluetooth signs)

Thermopile

Physiological signs acquisition module

Command for
real-time display / Bluetooth
Sentinel events

Offline data GSM Real-time

Alarm Alarm
display Display

Local storage Local storage

Doctor’s PDA phone Sentinel vital signs Patient’s PDA phone

Fig. 7. Block diagram of the implemented MEMSWear-biomonitoring system.

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Peak Heat beat

position rate

ECG data packets (bytes)

E Eight ECG signals Heart beat G

type

T O

SpO2 data packets (bytes)

IR RED Temperature
S
Peak/non-Peak

Fig. 8. Diagram of data packets from ECG sensor and integrated SpO2/temperature.

Fig. 9. Main control window and physiological signals display on PDA phone.

bytes and 4th to 5th bytes, respectively. The 6th byte indicates whether this is a peak value.
The 7th byte is a header ‘‘T’’ for temperature and the 8th byte stores the digital value from
the thermopile.
Once sentinel events happened or the request to real-time display vital signs is
confirmed, all physiological signs and critical indices will be immediately transmitted to the
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patient’s PDA phone through Bluetooth and further relayed to the doctor’s PDA phone
through GSM. A software program developed by Microsoft Embedded Visual C++ 4.0
was installed on the PDA phone to monitor both the real-time and offline vital signs. The
program can record patients’ information and continuously display ECG, IR/RED signals
from SpO2 sensor, SpO2 value, temperature, heart beat rate and systolic/diastolic blood
pressure waveforms. Also, once arrhythmia is detected, the arrhythmia type will be
immediately indicated on the screen, such as LBBB, RBBB, etc. Otherwise, NORM is used
to indicate the normal heart beat. For possible long-term store-and-forward mode, the raw
data can be stored into the extended secure digital (SD) memory (512 MB) of the PDA
phone. The waveforms are plotted in window with an area of 400  300 pixels. Fig. 9
presents the main control and display window of the program run on PDA phone.

4. Conclusions

In conclusion, MEMSWear-biomonitoring system is capable of remotely monitoring

human vital signs, which has the potential to benefit not only the elderly but also patients
who wish to stay at home for recuperation. We presented our preliminary results which we
achieved so far and we are still working on improving the overall system performance and
the information security during transmission for potential commercialization.

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