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Annex 1-"Description of Work"
Project acronym: CARDIOSMART
Project full title: Intelligent Cardiology Monitoring
System using GPS/GPRS Networks
Proposal/Contract no.: IST-2001-35073
Related to other Contract no.:
1. Project Summary
1.1 Objectives
The main design and realisation of a novel intelligent
and portable electrocardiograph device with a GPRS
link for monitoring the heart activity of patients and the
automatic detection and transmission of fundamental
heart failures. This general objective will be achieved by
means of the following detailed objectives: A) Design of
the portable electrocardiograph prototype. This design
will be done according to the concept defined by a
patent owned by CARDIOTEST. It must maximise its
autonomy, real-time processing power capability and
robustness. It must be also user-friendly, as a patient
maybe in critical situation will use it. B) Selection of
algorithms for cardiac disease detection, compression
and cryptography to optimise the amount of data
transmission. C) Integration of the device in an already
existent Cardiac Monitoring System (CAMS). D)
Industrial version of the terminal will be commercialised
by CARDIOTEST. E) Technology transfer from AICIA to
CARDIOTEST.
1.2. Description of the work
The project is organised in several tasks as follows:
1)Portable Electrocardiograph Design. This task
includes the design of the system architecture and its
partitioning in several subsystems:
- Signal Conditioning Module, which will adapt cardiac
signals.
- Signal Processing Module, which includes cardiac
signal preprocessing, pattern recognition, compression
and cryptography.
- Communication Module, including
transmission and GSM Voice links.
GPRS
data
- GPS Module, to determine the exact location of the
patient.
- Power Module, to maximise power savings to provide
maximum autonomy.
Special care must be taken in the interaction of the
subsystems and Hardware&Software integration
2)System Prototyping. Physical realisation of the
previous subsystems.
3)System Integration. Interconnection of previous
subsystems. Special care must be taken with the power
consumption and electromagnetic interference between
the Signal Conditioning and Communication Modules.
4)System testing and validation. Local centre test will be
used to validate design performance according to
already proven routines and tests. It will include fieldtesting, where the prototypes will be evaluated in
Cardiotest medical centre, and performance checked.
5) Dissemination of the results. The experiment
expertise gained will be disseminated by contributions in
relevant international congresses and journals and
generation of media material.
All this work will be based on previous research carried
out by CARDIOTEST and AICIA, which have already
generated a first version of an on-line portable
electrocardiograph using GSM.
2. Project Objectives
Introduction:
Traditional cardiology monitoring systems are based on
massive storage of electrocardiograph signals. The
patient is attached to a holter device during an enough
amount of time, usually 24h or 48h, and then the cardiac
stored signals is studied off line using appropriate
software. This software includes signal-processing
algorithms, as heart rate detector and pattern
recognition, that allows detecting a high number of heart
failures. Cardiotest has gained experience in this field
during last few years of medical activity.
But nowadays, there is an increasing demand for
continuous monitoring systems with a high autonomy
and a small size. That means we need a continuous link
with a medical centre. The state of technology points to
GSM mobile communications as the obvious link
between patient and specialist to support the
transmission. The problem is that a continuous
transmission requires a huge amount of information and
time. From the economical point of view, GSM does not
represent a valid option for this kind of application. All
these conclusions have been derived from the
experiments carried out by Cardiotest and AICIA over
their prototype using GSM network.
Besides, patients require an intelligent system capable
of detect heart pathologies, that is to say, a system in
which they must not be worried about the moment in
which they should transmit the electrocardiogram (ECG)
to the specialist. They claim for an automatic detection
of the heart dysfunction
transmission to the doctor.
and
the
subsequent
All these considerations are taken into account in the
CardioSmart project proposed. GPRS network is the
most suitable communication channel to solve the
problem of the continuous transmission of data. With
GPRS, the user of CardioSmart is going to pay only for
the amount of data transmitted, and not proportional to
the connection time. In GSM, only 9600bps bandwidth is
available while GPRS provides a minimum of 64Kbytes.
Besides, automatic pathology detection is included
before the transmission. The idea of this ECG preprocessor is to reduce the amount of data transmitted.
Instead of a continuous link with the specialist in which
the majority of the information is useless, only the
problematic ECG is transmitted.
CardioSmart project is then based on a portable
terminal for the acquisition, pre-processing and
transmission of cardiac signals and the GPRS network
(PAC) used to send the ECG signal to a host computer
in the medical centre or a specialist consulting room.
Figure 1. PAC terminal block diagram
A block diagram of the PAC terminal is showed in
figure 1. It is a pocket size device with the following
subsystems:
a) An ECG Conditioning Module that consists of three
or ten electrodes attached to standard patches,
amplification and filtering stages. The ten-electrode
version allows for complete heart diagnoses, while the
three electrodes is a simplification for syncope
arrhythmias. Special instrumentation amplifiers are
chosen from previous designs.
b) A Signal Processing Module is going to implement
the whole digital processing stage that includes data
conversion, heart rate detection, pattern recognition,
compression algorithm and signal cryptography. The
previous GSM prototype integrates an 8-bit
microcontroller. In this proposal the use of a 32-bit
microcontroller (MMC2107) from the MCORE Motorola
family is suggested. This microcontroller includes all
necessary hardware (RAM and Flash memories,
coprocessor, Digital and Analog I/O signals, low-power
modes...) to fulfil all electronic requirements in this
applications.
c)
A GPRS Module from XACOM includes a data and
a voice channel for the direct communication between
the patient and the cardiology specialist.
d)
A GPS Module will provide the exact location of
the patient. This module will be optional in the final
application, as it can be substituted by the information
provided by the telephony network.
e)
Finally, a Power Module is devoted to supply the
power to all modules with minimum energy
consumption.
The main goal of the project is to integrate the critical
subsystems in a portable device: an electrocardiograph,
an efficient digital processing block and a GPRS
modem. The main technical problems to be solved
are:
a)
To guarantee the reliability of the components
and communication channel. Special care in the
selection of components will be needed.
b)
To achieve electromagnetic compatibility
between the Signal Conditioning Module and the
Communication Module (cardiac input signal in the
order of mV and 2Watts of RF signal). This will be done
employing a suitable switching scheme
c)
To obtain maximum autonomy minimising power
consumption. To find a good balance between optimal
signal
processing
and
power
consumption.
Communication will be established only when a cardiac
disease is detected.
d)
To reduce the manufacturing and functioning
cost at a minimum, to make this new technology
accessible to any social level.
e)
To achieve a minimum size and weight to
guarantee user's acceptability. Notice that the device
will be suspended from the user's belt.
A host centre will held a medical team to provide 24hour emergency attendance, a database and an Internet
site, so the ECG data can be shared between
specialists or consulted from hospitals. Figure 2 is a
basic scheme of the cardiology network based on the
PAC terminal, the host centre and Internet access. A
base station allows GPRS communication using only
the telephony network to prevent uncontrollable Internet
delays. This base station uses another GPRS modem.
As we said before, the automatic recognition
of heart failure is a demand of the patients for
improving their quality of life. As a consequence, the
digital processor must implement several ECG preprocessing steps. They are illustrated in Figure 3.
·
First of all, a QRS (the three parts Q-R-S that
composes a cardiac pulse shape) detector must be
implemented
for
the
heart
rate
calculation.
Supraventricular tachycardia, bradycardia and syncope
diagnoses are based on this algorithm. Several of them
are described in the literature. It must be taken into
account the noise interference due to the electronics
and the GPRS modem. The final algorithm will be tested
using international biomedical databases.
·
Some arrhythmias will be detected using pattern
recognition techniques. By comparison with the normal
ECG, neural networks [1] will classify the different kind
of heart diseases: blocks, flutter, atrial and ventricular
fibrillation and supraventricular and ventricular scape.
Again, the final algorithm will be tested using
international biomedical databases [2].
·
Once the processor has detected an abnormal
heart activity, it automatically connects with the medical
centre to transmit the information. As GPRS cost is
related with the amount of data, a compression
algorithm based on wavelets is going to be
implemented. They have been demonstrated [3] to be
very efficient to reduce the number of packages
transmitted (mean compression ratios up to 8:1 in GSM
network).
·
The last task of the processor consists in the
encryption of the ECG signal, because national and
international regulations force the privacy of this
personal information.
Figure 2. Basic scheme of the cardiology network
Figure 3. Flow diagram of processor tasks.
Objectives:
1.
The design and realisation of a novel intelligent
and portable electrocardiograph device with a GPRS
link (PAC) for monitoring the heart activity of patients
and the automatic detection and transmission of
fundamental heart failures. This design will comprise
several subsystems: microcontroller system for data
signal analysis, communication subsystem including
GPRS/GSM standard links and power subsystem.
2.
Improving the quality of life of cardiology
patients, as they have not to be confined in hospitals.
They will feel free of walking or even travelling but
keeping contact with their cardiology specialist or
hospital. A direct and almost instant medical support is
provided, as a voice channel is included in the GPRS
connection. The adjustments of the system to other
countries in Europe will allow to extend the initiative to
the rest of the European Community and setting up a
novel collaborative environment to share data for
continuity of care.
Basically, this general objective will be achieved by
means of the following detailed measurable objectives:
1.
Design of the PAC terminal prototype. This design
will be done according to concept defined by a patent
owned by Cardiotest and AICIA plus the additional
requirements for the GPRS link and the digital
processing stage. The main objective will be to achieve
the maximum autonomy, at least 24 hours.
Target: PAC prototype design.
2.
Selection of algorithms for QRS detection and
pattern recognition, according to the standards defined
in biomedical signal databases. The result must be to
detect the maximum number of pathologies. Selection of
algorithms for compression and cryptography. The result
must be to optimise the amount of data transmission.
Target: Selection and implementation of digital
algorithms for heart failures detection, digital
compression and cryptography.
3.
Fabrication of prototype version of the PAC
terminal.
Target: An industrial PAC terminal according to technical specifications and previous design. 4.
Technology
transfer
from
AICIA
to
TELEASISTENCIA CARDIOTEST addressing the final
features of the PAC terminal.
Target: Technology transfer to TELEASISTENCIA
CARDIOTEST.
5.
Industrial version of the terminal will be
commercialised by TELEASISTENCIA CARDIOTEST.
The objective will be setting a Spanish GPRS network
during the first year, with the collaboration of some
hospitals and specialist. The experience will be
extended to other European countries during the second
year
Target:
a)
A Spanish GPRS network for transmission and
storage of ECG signals.
b)
Trials to some European countries.
The main risk of the project is to achieve a good
balance between signal processing capabilities and
power consumption, as, to our knowledge, there no
exists any intelligent cardiology portable device as the
one proposed in this project in the market.
[1] B.G. Celler and P. Chazal. "Low Computational cost
classifiers for ECG diagnosis using Neural Networks",
Proceeding of the 20th Annual International Conference
of the IEEE Engineering in Medicine and Biology, vol.
3, Nov 1998, pp. 1337-1340.
[2] T. Penzel, B. Kemp, G. Klösch, A. Schlögl, J. Hasan,
A. Värri and I. Korhonen, “Acquisition of Biomedicals
Signals Databases”, IEEE Engineering in Medicine and
Biology Mag., vol. 20, no. 3, May/june 2001, pp. 25-32.
[3] R.S.H. Istepanian and A.A. Petrosian. "Optimal Zonal
Wavelet-Based ECG Data Compression for a Mobile
Telecardiology System". IEEE Engineering in Medicine
and Biology Mag., vol. 4, no. 3, Sept 2000, pp. 200-211.
3. Participant List
Date Date
Parti Parti
Participant
Participant
Enter Exit
c.
Short
c.
Country Proje Proje
Name
Role No.
Name
ct
ct
Start
End of
Teleasisten
CARDIOTE Españ of
C
1
cia
Projec
ST
a Projec
Cardiotest
t
t
Asociación
para la
Start
Investigació
End of
Españ of
ny
AICIA
MB
2
Projec
a Projec
Cooperació
t
t
n Industrial
de
Andalucía
4. Contribution To Programme/Key Action Objectives
This contribution of this project to the IST
Subsystems objectives, described in the 2001
Workprogramme, can be summarised as follows:
1.
The proposed device is composed by several
subsystems (electrocardiograph, signal processing
system, communication system, positioning system,
power stage...). These subsystems must be designed
and validated separately and then integrated taking into
account their interactions.
2.
Hardware/software
important role in this design.
integration
plays
an
3.
Advanced signal processing stages, including
pattern recognition, data compression and cryptography
are crucial in this project.
4.
Manufacturing processes must be carefully
analysed, because the realisation of medical
instrumentation that manages very weak signals is very
critical.
5.
Design, manufacturing and validation of this
medical device must comply with medical
specifications. The final device must obtain EU
certification.
6.
The device must be portable and include
wireless communications.
7.
The weight and size of the device must be
minimised, as it will be applied to patients that suffer
from heart diseases. This device must be fully accepted
by the user.
8.
The total power consumption of the device is
also critical because the autonomy of the system should
be as large as possible. It is foreseen that two blocks
will be high power consuming: the Signal Processing
Module that is in charge of the detection of
electrocardiograph anomalies, and the Communication
Module. At least, 24-hour of autonomy is necessary.
Notice that the batteries used in this device must not be
charged while it is being connected to the patient, and
will have to be substituted for their charge.
9.
Not only the cost of the device is critical, but also
the performance of the compression algorithm, because
it will drastically decrease the volume of data and
therefore the communication cost in GPRS.
10. This device must be user-friendly, because in a
potential case of a heart attack, the patient must be
capable to manage it, answer a call, maintain its
connectivity, etc.
11.
There are other topics included in the 2001
Workprogramme under the subsystems action line that
will also be consider in this project, as it is the use
intelligent
signal
processing,
RF
design
interactions...
This proposal also satisfies all conditions to be
considered as a trial, as a sufficiently deployed
technology, as it is the case of the proposed system, is
transferred to a company to improve their products. It is
clear that AICIA, the supplier, will transfer the
technology to TELEASISTENCIA CARDIOTEST, the
user.
The proposal also indirectly relates with several
objectives within the IST 2001 Workprogramme, as it is
the case of the following action lines:
·
KEY ACTION I - SYSTEMS AND SERVICES FOR
THE CITIZEN
I.1 Health
I.1.1 Intelligent environment for citizen
centred health management
·
KEY ACTION II - NEW METHODS OF WORK
AND ELECTRONIC COMMERCE
II.4 Information and network security and other
confidence building technologies
II.4.2 Enhancing security in electronic transactions
5. Needs and Benefits
Actual cardiology monitoring systems are improved in
terms of storage capacity or autonomy. But new mobile
communications technology is opening new horizons for
new ideas that will improve the quality of life of patients.
Portability and autonomy are concepts very close to
actual mobile communications. So the junction of this
concepts led to new applications that could not be
exploited some months ago. Is the first time to our
knowledge that a portable electrocardiograph (PAC)
allows the continuous detection and on-line GPRS
data transmission is put in place in the cardiology
market.
The
collaboration
between
AICIA
and
TELEASISTENCIA CARDIOTEST has been oriented
following this perspective during last few years. The first
system product developed was a pocketsize personal
portable electrocardiograph equipment (see Figure 4)
with a frequency modulated transmission using the
basic
telephony
network
(transtelephonic
electrocardiograph system). The system only allowed
the patients to transmit their ECG whenever they feel
bad to a 24-hour duty medical centre. This system also
includes a QRS detection algorithm for automatic
syncope detection. That was an important feature over
the first system. The syncope was detected without the
participation
of
the
patient.
This
portable
electrocardiograph is commercially available since
1999.
The next step consisted of using the new technology
possibilities, that was, GSM transmission. A prototype
including a GSM data modem (see Figure 5) has been
developed and it has been proved that concept was
technically feasible. Nevertheless, despite of the
technological evolution, communication infrastructure
and advanced hardware needed for complex highquality telemedicine services, they remain very
expensive. GSM transmission cost is related with time of
connection, leading to a very expensive continuous
monitoring system. Also the power consumption of a
continuous GSM data transmission led to a very
reduced autonomy. The main conclusion of these
experiences is the necessity of joining together portable
equipment, continuous monitoring system, power
consumption, cost of transmission and optimisation of
the amount of data to be transmitted.
One solution to this problem is the use of the GPRS
network. This novel communication protocol is going to
allow a non expensive transmission and a cost related
with the amount of data transmitted. A GPRS modem
will be soon available to solve the link between the
patient and specialist. An additional solution consists of
reducing the amount of data to transmit. It must be
taken into account that in a continuous monitoring
system, the majority of the information is a normal ECG
signal. But the fact is that the information of interest for
the specialist is just the abnormal ECG signal. Instead
of doing the signal processing after the transmission, as
holter equipment in hospitals, the signal processing will
be done before the transmission. The result is that only
the important information is transmitted so the amount
of data and the cost for the patient is reduced. If we
combine an intelligent detection system with data
compression of information, the amount of data is not
only reduced but also optimised.
In this proposal the development of a new terminal
(PAC) with portability, autonomy, signal acquisition
and digital processing, data compression and
encryption, and a GPRS link is suggested. GPRS
modem provides a data channel and also a GSM voice
channel for the direct communication between patient
and specialist. ECG information is transmitted to a host
computer with a database, so the specialist will
diagnose and propose actions to the patient. It also
allows a continuity of care, even if the patient is
geographically far from the cardiologist.
Additionally, the host computer could implement an
Internet site, so the information will be consulted from
hospitals or other specialists, even if they are far from
the host computer. The system including the portable
terminal plus a host computer with external access may
become a complete cardiology network that will improve
the quality of life of people.
To summarise, the main innovation of the proposal is
the integration of a set of subsystems using new
technologies, such us GPRS data transmission and
GSM voice link, to solve the problems of cost and
continuous monitoring of the current cardiology
devices.
Figure 4. Actual portable electrocardiograph device
commercialised .
Figure 5. Photograph of the prototype including GSM
data transmission