International Conference on Complex, Intelligent and Software Intensive Systems

Development of a Vital Sign Data Mining System for Chronic Patient

Monitoring

Vincent S. Tseng1 Lee-Cheng Chen1 Chao-Hui Lee1 Jin-Shang Wu2 Yu-Chia, Hsu3
1
Dept. of Computer Science and Information Engineering, National Cheng Kung University, Taiwan, R.O.C.
2
Dept. of Family Medicine, National Cheng Kung University Hospital, Taiwan, R.O.C.
3
Southern Innovation Center, Institute for Information Industry, Taiwan, R.O.C.
Email: tsengsm@mail.ncku.edu.tw

Moreover, we proposed a chronic illness predicting

Abstract mechanism to explore the relation between bio-signals
In recent years, the structure of global population and illness changes. Therefore, prediction model
keeps going towards highly-aged continuously. The building could be applied to various chronic illnesses
development of chronic patient medical care system corresponding to patients bio-signals. For a period of
becomes important and meaningful since people paid a ECG, we allocate P wave, QRS complex and T wave
lot attention to medical prevention. The medical care with medical knowledge. The period of each waveform
system has to provide alerts in time before the severe has a static rhythm, as shown in Figure 2.
chronic illness occurs, such as stroke, diabetics, heart
disease. Thus, necessary procedures can be taken in
short time to save one precious life. In this paper, we Patient
Bio-monitoring System
presented a data mining system for chronic patient
Receive Equipment
monitoring with applications on caring of Signal
Data Setting
cardiovascular patients. By mining vital signs like ECG,
the system can predict with a classification tree and Lab Sample
Patient

Diagnosis Doctor
inform doctors to take actions if any anomaly could
happen. A series of experiments on PAF data showed that Nurse
Treatment
our system can stably predict the anomaly from patients
ECG data without coding of medical rules as done in
other existing approaches. Life Support Lab Result
Equipment
Keyword: Data mining, Electrocardiogram analysis,
Pharmacy
Patient monitoring system, Vital sign analysis
Figure 1. Workflow for patient vital sign monitoring.
1. Introduction
The structure of this paper is organized as follows: We
With the development of global civilization and discuss related works in Section 2, and section 3 gives a
industry, the structure of global population keeps going detail description of the vital sign monitoring system we
towards highly-aged continuously. It makes the old-aged proposed. Section 4 describes the experiments and
medical care more important. If we can take notice on performance evaluation. Finally, we make a conclusion
patients vital signs like electrocardiogram (ECG), blood and future work in section 5.
pressure, heart beat and body temperature, it is very R
likely that we can make appropriate care procedure on
the patients in time. Therefore, it is valuable to develop
medical care and monitoring techniques.
The main function of a medical monitoring system is
to receive the vital signs of patients to monitor their T
status. Under the procedure of monitoring, it can provide P
alerts and proper medical decisions to paramedics based
on the collected data. Figure 1 shows the workflow for
patient vital sign monitoring.
Our goal is focused on developing a data mining Q
system for analyzing the vital signs of chronic patients.
For applications, we treated illness related to ECG as
application since ECG has been proved effective in S
clinical medicine for years. We sought for doctors Figure 2. A rhythm map of ECG waveform.
professional opinions since the signatures and diagnoses
already had explicit directions.

0-7695-3109-1/08 $25.00 2008 IEEE 649

DOI 10.1109/CISIS.2008.140
2. Related Work
The traditional patient monitoring system was
proposed by Puers [8] in 1989. Its structure contains data
receiving, transmission, paramedics and functional
components. The main part of this structure is to process
patients vital signs by equipments and send to
paramedics and expert system to make diagnoses. Alonso
et al. [1] [8] proposed a leading system as shown in
Figure 3. Bio-signal time series were transformed by
Fourier Transform and indexed by R* Tree. It could
introduce a general model and rule set to treatment unit.
DataBase Step
DataBase Step11 Step
Step22 Step
Step33
Using the discrete Creating R* tree Creating reference
Fourier transform classification model for popular
groups
Figure 3. Structure of patient monitoring as proposed
by Alonso et al.
There are some related studies to bio-signal analysis,
such as ECG analysis and parsing. For instance, Wolff el
al. [4] used a non-supervised to diagnose via
bio-information, or detect apnea by ECG [6] [7]. Even
more, the complete hardware equipment [5] applied to
daily life care. The above methods were traditional
statistics basically. They could achieve certain results,
yet in tremendous data the precision and time cost
performed relatively lower.
W. Zong [11] pointed out that Paroxysmal Atrial
Fibrillation (PAF) is related to the occurrence of Atrial
Premature Contraction (APC) and the closer to the point
of PAF, the more impact of APC. For this kind of
approach, some medical rules have to be set in advance.
This might not be feasible in some applications, e.g.,
analysis of new diseases. Therefore, we presented a
general data mining system for patient monitoring in this
paper without requirements of coding medical rules in
advance.
3. Patient Monitoring System
3.1 Problem Definition
We assumed that patients illnesses are often related to
some kinds of their bio-signals. By observing those
bio-signals and adopting corresponding medical
attributes identified by professional doctors, we are able
to build a classification tree based on target illness with
data mining methods. Thus doctors could take
suggestions of the system into account and diagnose
more properly.
3.2 System Flow
Figure 4 shows the flow of patient monitoring system
proposed in this study. The flow could be separated into
several parts as described in the following. Firstly, the
system caught patients raw bio-signals. For training data,
a diagnosis would be given, such as normal or abnormal.
We then derive some bio-indicators through the
doctors domain knowledge based on the illness. With
the stage, the rules reliability and precision could be
enhanced. With these indicators, we transformed raw
bio-signals into an attribute table and performed data
mining skills to generate a classification tree. Finally,
this tree could be applied to clinical diagnoses. The next
Support
Action
paragraph will describe the realization of the system.
Treatment
Raw bio-signal (i.e. ECG) Diagnosis will be given in train set
Step
Step44
RuleBase
RuleBase
Suggestions Experts identified key indicators i.e.heart ratecount of APC
Extract value from raw bio-signal
Perform data mining on all attribute
Generate classification rule Output
Figure 4. Flow of patient monitoring system.
3.3 The realization of patient monitoring system
Since raw bio-signal data are usually consecutive time
series sequences, we identified some medical reference
points by tools provided from WFDB [12]. Then, we
preprocessed signals for easier reading thereafter through
bio-indicators recommended by doctors.
Because patients bio-signals have individual
differences, we proposed a mechanism to numerate and
emphasize the attributes which doctors recommended in
order to simplify the construction of classification model.
Figure 5 shows the idea of the extreme pattern
statistics we proposed. This method normalized raw
bio-signals first and then treated each attribute as a
distribution. We divided this distribution into 100 parts
between the maximum and minimum and set a threshold
parameter . Then we extracted percent data of both
side endpoints and calculated their origin average and
standard deviation to fully record the characteristic of
this attribute. We did the above procedure for every
attribute that doctors recommended and recorded the
distribution of characteristic such as the number of
anomaly and average.
We set a parameter for processing simplicity. The
parameter is for dividing the whole bio-signal as
segments to perform easier on time series. It contains the
same attributes in each segment. A weight of a segment
would be given then after considering the importance of
medical theory, doctors recommendation and the time
impact of attributes. For example, the doctors
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recommended attributes as {a1 ,a2, a3 ,, ak} for an we divided ECG into 3 segments, that is, =3.
illness and we divided a bio-signal into segments of {S1
,S2, S3 ,, S}. Thus, every segment Sn contains Classifier 1 Model 1

attributes {an1, an2, an3, , ank}. We assume the weight of Classifier 2 Model 2
Sn is Wn, and we calculated extended attributes aj, as Data Table Classification
shown below. Rule

a 'j = ai , j Wi , 1 j k Classifier N Model N

i =1

By applying the above procedure, we could have a set

of attributes as {axy|1x, 1yk} {aj|1jk}. Figure 6. Multi-classifiers evaluation.
Thus the above data could serve as training data in
Table 1. Example data after preprocessing.
building the classification model. Table 1 shows the table
Attribute A Attribute B Attribute X Diagnosis
for numerical attributes after preprocessing.
In order to focus on various data and illness more Case 1 Value A1 Value A1 Value X1 Normal
preciously, we adopted a multi-classifiers method to
build classification model. F-measure was used to Case m Normal
evaluate all classifiers in this kernel as shown below: Case m+1 Abnormal
2 recall precision 2 TP
F measure = =
recall + precision 2 TP + FP + FN
Case n Abnormal
The evaluation of F-measure takes recall and precision
into consideration to prevent a high recall and high false
positive situation. Based on known data, we can choose A classification result is shown in Table 3. The
the classifier with the highest F-measure value in indicators for evaluating the system are mainly precision
multi-classifiers for further anomaly detection and and recall and aided with false positive (FP), as follows:
X +W W
diagnosis kernel, as shown in Figure 6. With the previous precision = , recall =
X +Y + Z +W Z +W
built classification model, we could give the Y
preprocessed raw bio-signals into this model and decide FP =
Y +W
whether this case is normal or at risk.
Occurrence Table 2. PAF dataset.
The whole value
Train sets Test sets
Abnormal: % Normal Patients 50 44
Non-Immediate Risk
(No PAF 45minutes later 25 28
PAF
or former)
Patients
Patient with PAF in 30
25 28
minutes later

Value Table 3. Diagram of a classification result.

Normal part: 100-2%
Prediction
Normal Abnormal
Class
Normal X Y
Minima Maxima Abnormal Z W

Figure 5. Diagram of extreme pattern statistics. 4.2 Experimental Evaluation

4. Experimental Evaluation
4.1 Experiment Dataset
The bio-signals used in the following experiments
were obtained from PhysioNet [15]. From this source,
we chose the PAF Database [13] for our experiment
samples which are ECG signals in 30 minute long.
The dataset includes 100 training instances, which
have 50 normal patients and 100 test instances, as shown
in Table 2. This study mainly targeted on the patients
with PAF. Based on suggestions from a medical expert,
4.2.1 Extreme Pattern Statistics
We tested different settings of in extreme pattern
statistics for classification. The training sets were taken
to do the inner test. Figure 7 shows the experimental
results. When =95 or 90, the precision outperformed
others. Besides, the recall under =90 is better than that
under =95. Thus, we set =90 for our further
experiments.
4.2.2 Evaluation of Multi-classifiers

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 We used different kinds of classifiers provided by square weight <1,5,25>
WEKA [3], and the evaluation results are shown in Table We chose 5-Fold validation method to repeatedly test
4. Obviously NaiveBayes could achieve 68% of recall. upon the above weight policies, shown in Table 6. In
Besides this, we chose J48 classifier for the following aspect of recall, linear weight <1,2,3> was less than
experiments since it generates a rule-based classifier square weight <1,2,4> and <1,3,9>, yet square weight
rapidly. Based on the above, we adopted NaiveBayes and <1,3,9> and <1,5,25> were similar to square weight
J48 to build multi-classifiers of the system. <1,2,4>. In another aspect of precision, all weight skills
performed the same.
100% Briefly speaking, square weight <1, 2, 4> was better
80%
since we emphasized on the outcome of recall.
60% Precision
40% Recall
Table 4. Multi-classifiers experiment.
20% recall false positive
0% NaiveBayesSimple 68% 67%
40% 50% 60% 70% 80% 90% 95%
NaiveBayes 68% 69%
%
libSVM 61% 76%
Figure 7. Extreme pattern statistics.
Radial Basis Function 57% 56%
4.2.3 Effects of number of Attributes Random-ForestTree 39% 21%

According to medical experts recommendations, we J48 32% 26%

experimented two sets of attributes, shown as follows 1-NN Classification 29% 26%
(avg abbreviates for average and stdev for standard
deviation): NaiveBayes-Multi 29% 36%
LogitRegression Tree 25% 36%
Set A
avg, stdev of P-wave lengths difference Classification Tree 21% 19%
avg, stdev of P-wave amplitudes difference Probit-Regression Tree 21% 35%
avg, stdev of R-wave lengths difference
avg, stdev of T-wave lengths difference ADTree 18% 25%
avg, stdev of T-wave amplitudes difference RandomForest 7% 4%
count, avg, stdev of time lag between T and P-wave
count ,avg ,stdev of time lag between P and Q-wave
weighted attributes of the above Table 5. Comparison of number of attributes.
Set B NaiveBayes NaiveBayes J48
count of P-wave length difference
recall false positive recall
count of P-wave amplitude difference
count of R-wave length difference Set A 67% 69% 32%
count of T-wave length difference
count of T-wave amplitude difference Set B 75% 55% 28%
weighted attributes of the above
Set B enhanced the attributes of Set A and included Table 6. Comparison of weight experiment.
weighted attributes as well. The result is shown in Table precision recall
5. We compared those two combinations of attribute sets <1,2,3> 56.32% 63.14%
mainly in the NaiveBayes classifier. Set B had better
<1,2,4> 54.64% 68.97%
recall than Set A and reduced false positive as well.
<1,3,9> 56.32% 69.00%
<1,5,25> 57.76% 57.42%
4.2.4 Effects of Weighting

In previous experiments, we introduced a weight 4.2.5 Effects of the Length of Bio-signals

mechanism on 3 segments. According to the studies of
references and the doctors recommendation, we gave
more weight for the segment near the endpoints of data.
We tested certain kinds of weight methods and their
value:
linear weight <1,2,3>
square weight <1,2,4>
square weight <1,3,9>
Currently we experimented with 30 minutes ECG and
we discuss on different lengths of bio-signals in this
paragraph. We extracted the beginning 5 minutes, 15
minutes, and the whole 30 minutes in the ECG data and
made an experiment shown in Table 7.In the aspect of
recall, 30 minutes ECG data performed more stable than
any other time sample. However, the sample of 5

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minutes ECG could achieve 61.48% of precision and
relatively low 46% of recall. We inferred that the normal
patterns are more obvious in short time and the abnormal
patterns need a long observation. The length of
bio-signals had not much impact on precision in this
experiment, but longer bio-signals definitely are good for
the diagnoses of illnesses.
Table 7. Effects of bio-signals length.
precision recall
5 minutes 61.48% 46%
15 minutes 54.52% 59.71%
30 minutes 54.64% 68.97%
4.3 General Experimental Result
We showed the adjustment on parameters and data
types through the above experiments. For PAF, the whole
setting and experiment results are described as follows:
1. We got 30 minutes ECG in PAF and set =3 to
divide data into 3 segments.
2. By medical experts recommendation in section
4.2.3, we extracted each attribute with respect to
every segment.
3. We transformed data by using extreme pattern
statistics and set =90 to get the attribute table such
as Table 1.
4. We extended the attributes with a weight <1,2,4> in
the attribute table
5. Finally the multi-classifiers read the preprocessed
attribute table to build PAF classification model. We
evaluated J48 and NaiveBayes classifier via
F-measure and chose better one for the classification
kernel.
6. We tested performance by 5-Fold validation.
The experiment showed that this system could achieve
54% of precision and 68.97% of recall. In the PhysioNet
2001 Challenge Event 2 (PAF Prediction) [14], the recall
was ranged between 54% and 79%. The system of this
research can achieve stable 68.97% of recall.
5. Conclusion and Future Work
We have presented a data mining system for chronic
patient monitoring with applications on caring of
cardiovascular patients. By the operation of this system,
we could aid general and chronic illnesses diagnoses.
Based on the designed architecture, we completed an
analysis and prediction system on chronic illnesses via
ECG. This system could do analysis and prediction to
assist the care and diagnoses in clinical medical related
to ECG. The followings are the main characteristics of
the system:
1. A foundation based on light medical knowledge:
This system was not a fully independent auto system. We
still required experts to list the features of bio-signals.
This mechanism could avoid irrelevant information to
affect the system and ensure the medical basis of the
results. However, only light medical knowledge instead
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of precise medical rules is needed in our system.
2. Feature extraction in periodic data: This system
adopted segmentation skill and extreme pattern statistics.
Segmentation skill could avoid the missing impact of
relatively infrequent patterns to data mining and
emphasize the signal signature in the period of time.
Extreme pattern statistics could calculate the changes of
attributes in each segment and make a great contribution
to illness data analysis and mining.
3. Adaptive structure to data signatures: Our structure
has considered medical factors with various bio-signals.
Therefore, the operation of this system did not adapt to a
kind of signal only. The embedded multi-classifiers could
improve the flexibility of data requirements.
4. Stable analysis results: Based on real data
experiments, we observed that system could have a
certain precision and recall to illness prediction. For
public test data PAF, the system could maintain stable
sensitivity and the result was not far from the
achievement of medical approval. This shows that the
system had stable results in bio-signal analysis and
illness prediction.
Our research had completed a system design and
requirement for chronic patient bio-signal data mining
techniques and validated the possibility by real data.
Currently we applied the system to illness related to ECG
only. For the future work, we pointed out some possible
aspects here:
1. The reduction of parameters: Besides the doctors
recommendation, this system still had to set three
parameters. We would like to reduce the number of
parameters or provide a parameter-free system.
2. The application of bio-signals: This system took
ECG into consideration for now. We would hope to
combine time series, such as blood pressure and breathe,
to enhance the analysis and the feasibility with kinds of
illness.
3. The choice of multi-classifiers: This system adopted
a measuring indicator to use a better classifier only. We
would like to combine the results of multi- classifiers to
achieve a higher performance.
Acknowledgement
This research was supported by the Applied
Information Services Development & Integration project
of Institute for Information Industry and sponsored by
MOEA, Taiwan, R.O.C. under grant no
IA95H01311D01.
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