Monitoring Human Blood Pressure for U-Healthcare Using ISO/IEEE PHD Standard

Gi Hyun Bang, Do Kyeong Lee and Deok Jai Choi Electronics Computer Engineering, Chonnam National University 77 Yongbong-dong, Buk-gu, Gwangju 500-757, South Korea badmanner@naver.com ldk7175@nate.com dchoi@jnu.ac.kr

ABSTRACT
In the world, our society is faced up to aging populations. Thus, the demands of health care services, the increase of medical costs, along with problems caused by the lack of medical professionals have become critical issues in society. Thus, U-Health services have been introduced to resolve this kind of issues by proposing real-time health care services in a ubiquitous environment which could operate at anytime and anywhere. Blood pressure monitor is the most important pervasive personal health equipment due to regular supervising blood pressure could significantly help the people preventing complication of critical diseases. Therefore in this paper, we introduce standardization of U-Health for blood pressure measurement. Additionally, we develop a management application on Android-based mobile phone to retrieve personal health information measured from blood pressure device. The results achieved from our experiment show that our system could be utilized as an effective service which could be deployed directly in the ubiquitous environment.

KEYWORDS
U-health, IEEE 11073, Health Device Profile(HDP), Blood pressure monitor, Healthcare

1 INTRODUCTION Our society is faced with aging and increasing number of populations. These situations cause many issues in health. Blood pressure is a major indicator of many diseases, wherein high blood pressure could lead to a sudden death. Although blood pressure frequently changes under a variety of circumstances and measurement methods, sustained high blood pressure leads to the risk of critical diseases such as heart failure, stroke, atherosclerosis, cerebral infection, peripheral ISBN: 978-0-9891305-4-7 2014 SDIWC

vascular abnormality and kidney failure [1]. Recently, high blood pressure patients are rapidly increasing. Once blood pressure has been over the safe value, it is difficult to reduce it. Therefore, best method for blood pressure treatment is frequent checking to prevent high blood pressure. If we could early detect the existence high blood pressure, the treatment will be more straightforward. Ubiquitous Healthcare (u-Health) indicates health care and medical services that can be used anytime and anywhere with device and network technology. It is convergence of IT technology and medical services to solve problems of the lack of medical specialists and medical cost. By using U-Health, the users could receive medical services at anytime and anywhere because their vital sign is always monitored and checked by medical specialists. This is in fact useful especially for patients having chronic diseases [2]. Lately, a new U-Health service for high blood pressure patients has been introduced. Much investment and research are being applied to produce devices and solutions. However, these technologies are not deployed ubiquitously because of the prohibition caused by the law of remote medical service. However, United State of America (USA) has already permitted this kind of medical service recently. Additionally, many countries are revising their laws to permit remote medical service. Above of all, U-Health is the best service to solve many problems such as increasing medical costs and a lack of medical specialists. Therefore, in this paper, we introduce a u-Health service that supports the existence of a trend for blood pressure measurement that only communicates with Personal Health Device (PHD) and manager device. Additionally, an androidbased management application which is used to

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gather a users measured blood pressure value is also implemented. The rest of the paper is organized as follows. In section 2, we introduce U-Health standards. Section 3, we introduce commercial blood pressure monitor for U-Health. Section 4, we introduce Android-based application for U-Health. Our implementation is described in Section 5. Finally, Section 6 draws our conclusion. 2 U-HEALTH STANDARDIZATION There is IEEE 11073 PHD Working Group (WG) for investigating on u-Health standardization due to the fact that most health devices utilize their own protocols to communicate with a manager, which belong to the same manufacturer. The protocols are heterogeneous because they fully depend on their manufacturers. To solve this problem, compatibility and scalability is guaranteed in the ISO/IEEE 11073 PHD standards by defining the structure of the data and the protocol for information delivery between individual medical devices and the manager. The manager is responsible for collecting and managing information captured from the individual medical devices. Therefore, a U-Health system was designed and developed based on the ISO/IEEE 11073 PHD standards in order to guarantee scalability and compatibility among different PHDs from various companies [7]. In South Korea, Telecommunications Technology Association (TTA) established PG 419 WG which is responsible for U-Health standardization. Additionally, the Ministry of Food and Drug Safety (MFDS) is responsible for qualifying the quality of U-Health products, such as performance, safety criterion, etc. 2.1 ISO/IEEE 11073 PHD Standards The ISO/IEEE 11073 PHD standards consist of an 11073-20601 Optimized Exchange Protocol and 11073-104xx specializations for devices such as glucose meter, Pulse oximeter, etc (Figure 2). Currently, there are 10 devices specializations with more devices coming out all the time by the ISO/IEEE 11073 PHD WG [8] (Table 1).

Table 1. ISO/IEEE 11073 Device specialization.

IEEE 1107310404 10406 10407 10408 10415 10417 10441 10442 10471 10472

Device Pulse oximeter Basic ECG Blood pressure Thermometer Weighing scale Glucose meter Cardiovascular Strength Activity hub Medication monitor

The ISO/IEEE 11073 standards define the structure of the protocol and functions between individual medical device and manager. It consists of a Domain Information Model (DIM), a Service Model (SM), and a Communication Model (CM). DIM is a model focused on objects, and it defines individual medical devices and objects. Each object consists of attribute, and each attribute indicates the measured data of function of individual medical devices. Figure 1 illustrates a DIM for blood pressure monitoring. SM defines procedural access to data between individual medical devices and the manager. When accessing data, it is accessed by the way that is defined in DIM. There are Event-Report, GET, SET, and ACTION. CM defines the correspondence of the network in a one-to-one connection between an individual medical service and a manager. The CM manages the connection between devices by defining the Finite State Machine (FSM). Thus, it can describe the action in accordance with the current situation [7].

Figure 1. DIM for blood pressure monitoring

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agent or manager does not have any more messages to be transferred, this phase is initiated to release the established session. During this phase, association release request and response messages are exchanged, with a disassociation reason [9]. 2.2 South Korea U-Health standardization In South Korea, Telecommunications Technology Association(TTA) also have an interest in UHealth standardization since 2007. TTA established TTA PG 419 which is responsible for enacting U-Health standards. So far, standards by PG 419 is TTAK.KO-09.0063 service communication protocol based on U-Health, TTA.KO-10.0305 1-channel ECG transmission protocol, TTAK.KO-10.0304 technical requirements for the protection of personal health information, TTAK.KO-10.0464 U-Health service information security reference model and TTAK.KO-10.0463 U-Health service reference model. Ministry of Food and Drug Safety (MFDS) also recognizes the importance of U-Health and enacts assessment and approval guidelines for U-Health system. MFDS defined that U-Health medical device system must be qualified the requirements including safety, system security, personal information privacy, diagnosis support system and the communication quality.
Association request
Association response

Figure 2. IEEE 11073 PHD protocol stack.

The communication procedures can be divided into four phases (Figure 3). 1. 2. 3. 4. Association Phase Configuration Phase Operation Phase Disassociation phase

In Association Phase, an agent sends an association request message including association information to a manager to establish a session. The manager analyzes the message and checks the configuration of the agent. If the manager can recognize the configuration, the manager responds with an accepted message and operation phase initiated. If the manager does not recognize the configuration, the manager responds with an accepted-unknown-config message and the next configuration phase is initiated. In Configuration Phase, the agent sends its configuration to the manager. The manager stores the configuration. After that, the agent attempts to communicate with the manager, the manager responds with an accepted message and the operation phase initiated. In Operation Phase, the manager will send a Get method to retrieve the device information. The agent will transmit device information to the manager as soon as it receives the GET request from the manager. After that, the personal health data are transmitted to the manager periodically or whenever the agent obtains health data from a PHD. In Disassociation Phase, the agent and the manager release the established session. If the ISBN: 978-0-9891305-4-7 2014 SDIWC

A G E N T

Configuration send

Configuration accepted
Agent information request Agent information send Health data send Health data accepted Association release request Association release response

M A N A G E R

Figure 3. Communication procedure in ISO/IEEE 1107320601 protocol

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3 BLOOD PRESSURE MONITOR FOR UHEALTH SERVICE There are not many blood pressure monitor systems available for U-health because the expense to integrate communication components into these devices is exponentially increased. For example, to integrate Bluetooth communication functionality into the agent, the production expense will be increased 4 times 1 . POLAR, OMRON, A&D is representative of the companies that produce PHD. Their PHD is based on IEEE 11073 standards. 4 U-HEALTH ANDROID-BASED APPLICATION Mainly, smartphone is utilized as a manager . The common communication protocol is Bluetooth. Samsung Electronics announced S-health application that connect OMRON company blood pressure monitor HEM-7081-IT and A&D blood pressure monitor UA-767PBT-C. This application shares the captured data using Social Networking Service (SNS) and e-mail. OPENIT company announced HealthUP application which connects blood pressure monitor UA-767PBT-C and UA-851-PBT-C in A&D, HEM-708-IT in OMRON, For a D40b in Forecare. In addition, OPENIT announced HealthUP NFC that connects A&D UA-767NFC using not Bluetooth but NFC [13]. Figure 4 illustrate the Graphic User Interface (GUI) of S-health and HealthUP applications. 5 IMPLEMENTATION PRESSURE MANAGER OF BLOOD

blood pressure device of UA-767PBT-C of A&D manufacturer is used for this experiment. To communicate with PHD using Bluetooth, we adopt the Bluetooth HDP which is described as follows

Figure 4. Graphic User Interface (GUI) of S-health and HealthUP Android-based application.

5.1 Bluetooth HDP (Health Device Profile) Bluetooth Health Device Profile defines the underlying wireless connection and protocol. It operates in conjunction with the ISO/IEEE 1107320601 Personal Health Data Exchange Protocol and associated 11073-104xx device specialization specifications to provide application level interoperability for a wide variety of personal health devices. Since Android 4.0(API level 14) support for the Bluetooth Health Device Profile (HDP), it lets us create applications using Bluetooth to communicate with health devices, such as heartrate monitors, blood meters, thermometers, and scales [11]. 5.2 Implementation based on Android Platform based HDP The conventional Android Platform HDP sample published by Google Inc. provide us only a function for receiving raw data captured from a Bluetooth-supported HDP devices. We develop our application based on this sample to work with the blood pressure monitor. This includes the communication between smartphone and UA142

We utilize smartphone as a manager to receive health information data from PHD. The reason is the smartphone has both Bluetooth protocol to communicate with PHD and 3G, LTE technologies to communicate with medical institutions. A management application on Android phone is developed to receive the values measured by our blood pressure devices. The
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http://www.boryungand.co.kr/

ISBN: 978-0-9891305-4-7 2014 SDIWC

767PBT-C, receiving the health data captured from UA-767PBT-C. A GUI of our developed application is illustrated as in Figure 5.

Figure 6. Openhealth project android application.

6 CONCLUSION In this paper, we introduce standardization of UHealth supported for blood pressure monitor and a management application on android mobile phone. In order to transmit personal health information measured from the devices, standards are designed to ensure the portability, extensibility and interoperability of the U-Health system. Furthermore, we develop our application based on open sources to make it operate with blood pressure monitors. However based on the results achieved from our experiment, we found out that the value of human blood pressure is incorrect if we only measure it irregularly. So, such device is miniaturized for suitable attaching directly on human body to monitor the blood pressure in realtime. Nonetheless, this kind of device has not supported U-Health service yet. So, our further work will focus on the development of U-Health framework on this device Acknowledgement This research was financially supported by the Ministry of Education(MOE) and National Research Foundation of Korea(NRF) through the Human Resource Training Project for Regional Innovation. 7 REFERENCES
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Figure 5. The GUI of our application based on Android HDP sample for communicating with blood pressure device

5.3 Implementation based on OpenHealth project OpenHealth is an early research project published by Libresoft for development of free software tools and applications for healthcare. They have developed a management application for biomedical devices. Their ISO/IEEE 11073-20601 standard implementation has been successfully tested and it has already supported for several health and biomedical devices. Moreover, it have already implemented main components of this standard including Domain Information Model, Service Model and Communication Model. Additionally, this manager supports the Medical Device Encoding Rules (MDER). The new coder and decoder library for MDER is implemented by an OpenHealth team [12]. However, the Openhealth Project has been suspended in 2011. We attempt to modify the Bluetooth communication part of this project in order to make it operate on modern smartphones, such as Samsung Galaxy S3/S4, etc. Figure 6 shows the results of our implementation based on the suspended Openhealth application.

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Biospace, http://www.biospace.co.kr/. A&D, http://www.andonline.com/. Omron, http://www.omron.com/. Allmedicus http://www.allmedicus.co.kr/. Jae-Choong Nam, Won-Kyeong Seo, Jae-Seoung Bae and You-Ze Cho, Design and Development of a uHealth System Based on the ISO/IEEE 11073 PHD Standards, 2011 17th Asia-Pacific Conference on Communications (APCC), 2nd 5th October 2011, Sutera Harbour Resort, Kota Kinabalu, Sabah, Malaysia. Joon-Ho Lim, Chanyong Park and Soo-Jun Park, Home Healthcare Settop-box for Senior Chronic Care using ISO/IEEE 11073 PHD Standard, 32nd in Proc. Of IEEE EMBS, Aug. 31, 2010. Ju Geon Pak and Kee Hyun Park, Advanced Pulse Oximetry System for Remote Monitoring and Management, Journal of Biomedicine and Biotechnology, Volume 2012, Article ID 930582, 8 pages, doi:10.1155/2012/930582 KOREA Ministry of Food and Drug Safety, "assessment and approval guidelines for u-Health system as a medical device", 2010. 09. Android Developer, http://developer.android.com OpenHealth Project, http://openhealth.libresoft.es OPENIT, https://www.openit.co.kr

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