Wireless Monitoring Systems for Enhancing National

Health Services in Developing Regions

Adelina Basholli

, Thomas Lagkas

, George Eleftherakis

and Peter Bath

South-East European Research Centre, University of Sheffield, Thessaloniki, Greece

CITY College- International Faculty of the University of Sheffield, Thessaloniki, Greece

Information School, University of Sheffield, Sheffield, U.K.

Keywords: Wireless Sensor Networks, Wireless Health Monitoring System, e-Healthcare.

Abstract: Sensor based applications and Wireless Technologies introduce sophisticated health methods, especially for

patients who need continuous monitoring. Wireless Body Area Networks (WBAN) applied in medical

systems provide wireless wearable sensor’s structured architecture, which uses elements of remotely

observance and monitoring of home-based patient rehabilitation. The possibility of transmitting and

receiving remotely and continuously signals leads to constant monitoring of patient’s vital parameters and

real-time exchange of information. Considering Republic of Kosovo as a developing country, this

application is considered to provide many benefits. As thought, the system will offer constant monitoring,

early detection and prevention of abnormal conditions which are caused from last war or even natural

conditions. Current research will present thoroughly examined and observed WBAN related factors which

are used for enhancing e-healthcare. Moreover, during our future research we plan to analyze all existing

architectures in order to conclude on and propose a unique schema that can be applied on developing

regions, like Kosovo, and be beneficial.

1 INTRODUCTION

Unlimited wireless network connectivity of devices

within a geographic area nowadays is considered an

essential need. The radio frequency signals are

transmitted and received using antennas, which

cover a limited geographic range and should

consider various impairments and difficulties.

Wireless Area Networks usually use mobile

telecommunication technologies, like: Fourth

generation standards: LTE, WiMAX; Third

generation standards: UMTS, CDMA 2000; or even

Second generation standards: GSM. These

technologies are provided by a wireless service

provider regionally, nationally or even globally.

The Institute of Electrical and Electronics

Engineers (IEEE) 802 constitutes a body which

specifies the computer networking standards. It

includes several groups, including IEEE 802.15

Task Group 6: Body Area Networks. This standard

includes low complexity, low power consumption

and short-range networks which are designed

(Chartier 2008, Kwak et al., 2011, Isikman et al.,

2011) to operate in devices located around the

human body. Body Area Networks represent

emerging technologies with potential human care

impact derived from continuous monitoring

applications (Jovanov, 2005). This includes usage of

small devices that can be part of human’s everyday

activities. Hence, Wireless Body Area Networks

together with intelligent sensors, introduce modern

health care technologies which can solve (Bults et

al., 2004) many medical encountered problems

while monitoring patient’s everyday activities. This

fact is apparent also considering the wide

availability of wireless networks and their increased

bandwidth in one hand; and the advancing

miniaturization of sensor’s dimensions in another

hand. Consequently, remote medical advices, based

on received parameters through wireless connection

from a sensor activity, will make easier the medical

care. Moreover, the application of Wireless Sensor

Network in developing regions is followed by the

lack of having medical specialists (Joshi et al.,

2013). However, there exist a number of issues

which should be considered, such as: limitation of

sensor’s weight and size, wireless connectivity,

reliability of transmission, security or

511

Basholli A., Lagkas T., Eleftherakis G. and Bath P..

Wireless Monitoring Systems for Enhancing National Health Services in Developing Regions.

DOI: 10.5220/0004913905110516

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2014), pages 511-516

ISBN: 978-989-758-010-9

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

interoperability of platforms.

Application of Wireless Sensor Networks

(WSN) in developing regions can provide many

facilities for patients in general and healthcare

centres, in particular. More specifically, considering

Republic of Kosovo as a newly created and a

developing country, this application will offer many

benefits. Furthermore the number of people who

need continuous monitoring and those who need

constant remote observation is increasing,

considering also that Kosovo is a country which

recently has experienced war, though it has a high

number of elderly people who live alone. Medical

centers provide environments with limited space

considering the country’s population; and they use

traditional health care mechanisms. Wireless Body

Area Networks together with intelligent sensors, will

help lower the number of hospitalized people, and

provide new healthcare tools.

The generic aim of our research is the evaluation

and critical analysis of currently used WBAN

system architectures, and proposal of a general

schema which will fulfil developing regions needs.

While analysing proposed schemas of wireless body

area networks, we will try to define a new system

architecture which can be implemented in

developing areas, like Republic of Kosovo, and suit

their conditions and needs. Focus here is to present a

new system architecture which can help people and

facilitate their life by applying applications based on

wireless sensor technology.

We intend to focus on the following objectives:

 Review in detail state-of-the-art WSN

technologies.

 Analyze proposed health monitoring systems.

 Examine the telecommunications

infrastructure in Republic of Kosovo.

 Research the health system policies and

structure in Republic of Kosovo.

 Reveal opportunities for deploying country-

wide health monitoring systems.

 Exhibit the benefits and perform a feasibility

study.

 Develop architectures that adopt efficient

approaches for the case of Republic of

Kosovo.

 Evaluate proposed schemas.

Through this position paper we present a brief

background about Wireless communication and

Body Area Networks in section two. Related

information about sensors and types of sensors, are

summarized in section three. Section four, describes

WBAN system architecture. Wireless Body Area

Network challenges and important considerations

are thoroughly analyzed in section five. In section

six we present our approach to propose a WSN

schema which can be applied in developing regions

like Republic of Kosovo. The last section includes

some conclusions based on the research done until

this stage.

2 WIRELESS

COMMUNICATIONS AND

BODY AREA NETWORKS

Wireless communications enable data exchange

between several parties connected in the same

network. Most common devices which use wireless

data exchange are: cordless telephones, fixed,

mobile or portable applications, cellular phones,

radios, personal digital assistants (PDA), global

positioning systems (GPS), garage door openers,

wireless computer mice or keyboard, headphones,

satellite television and broadcast television.

The main idea of Body Area Networks in health

applications is the collection of patient vital data in

order to provide diagnosis, help in early detection of

abnormal conditions, or prevent its consequences

(Jovanov et al., 2005). With the usage of wireless

communication the e-healthcare services are enabled

(Li and Lou, 2010). This term includes the assembly

of vital parameters from small wearable or

implantable sensors through short-range wireless

connection technologies. Some of the advantages of

using WBAN include (Chen et al., 2010):

 Effectiveness and efficiency

 Flexibility

 Cost-effective

Wearable health-monitoring devices which use

Wireless Body Area Networks can be integrated into

human’s clothes. In this way, they can monitor

continuously a diagnostic procedure; supervise a

chronic patient condition or different surgical

procedures.

Current technologies provide unsuitable

applications (Jovanov et al., 2005) for lengthy and

continuous monitoring due to complex, power

demanding and interference from other devices

operating in the same frequency range (for example

Bluetooth). Therefore, there is seen the need for a

future wireless based technology, which will

overcome mentioned issues.

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3 SENSOR’S APPLICATION

Healthcare applications nowadays are seen as an

emerging need especially when considering the

aging population, chronic diseases, acute care, or the

means of early diagnosis (Balakrishna et al., 2013).

Consequently, taking into account the proportion of

elderly people, which is closely doubling from 10%

to 20% over next 50 years (Yang, 2007); and the

increased number of people who live alone, the

provision of e-health services constitutes a rising

need.

Sensors detect physical phenomena, in this case

patient movements, activities, blood flow, heart

beats, or related measures, which are then converted

into electrical signals. These signals are amplified,

encoded, and transmitted using wireless connection.

Advantages of sensor’s usage are summarized in

(Yang, 2007), as below:

 Continuous surveillance 24/7

 Timely diagnosis

 Preventing sequences

 Home care

 Improved quality of life

Taking into consideration the sensor’s

applications and the benefits they offer, the industry

has managed to develop different types of sensors

with various functionalities, respectively different

sensing parameters. Existence of various types of

sensors is based on sensor’s function and working

methodology. Below, are summarized some of the

most used sensors based on (Chen et al., 2010).

 Accelerometer/ Gyroscope

Is used to observe body posture and maintain

orientation. Examples of activities include:

sitting, laying, kneeling, walking, or running.

 Blood Glucose (blood sugar) and pressure

sensor

Represent the amount of glucose circulating in

the blood. This includes the non-invasive

glucose monitoring through infrared

technologies and optical sensing. This sensor

measures human blood pressure while using

oscillometric technique.

 CO2 Gas Sensor

It senses the concentration of gaseous carbon

dioxide and oxygen levels and monitors their

changes during human respiration process.

 ECG Sensor

This sensor constitutes a graphic recorder of

human heart electrical activity by using several

electrodes attached at specific parts of body

(usually arms or chest).

Figure 1: Applied sensor’s in humans everyday lives (Li

and Lou, 2010).

 EEG Sensor

The brain electrical activity is observed while

using small electrodes. These electrodes

forward the received signals, amplify and then

transmit them.

 EMG Sensor

The electrical activity that muscles generate is

recorded through EMG sensors.

In Figure 1 are presented some of the mentioned

sensors that are applied in industry. Depending on

each sensor’s functionality and its sensing abilities

some of them are wearable sensors, and the others

implantable.

4 SYSTEM ARCHITECTURE

Seen the relevance of wireless sensor based

applications in medical environments, one should

consider the wearable and implantable sensor nodes.

These nodes should sense biological information

(Kwak et al., 2011), such as heart rate, ECG, blood

pressure, or important environmental parameters like

temperature or humidity.

Gathered information from human body are

transmitted over a short-range distance using

wireless connection to a device which may be a

microcontroller.

Sensors have the ability to monitor readings,

gather patient’s related data and patient profile.

These data are transmitted to one or more gateways.

Respective gateways, which may be also local

servers, should perform data processing (Li and Lou

2010).

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After data processing, the patient related data

from all wireless body area networks are sent to a

centralized database for recording purposes.

In Figure 2, is presented a possible three layer

system architecture of a wireless sensor based

application. Hence, starting with the lowest level, we

have the physiological sensors; the second layer is

composed of personal servers (personal data

collecting devices), such as cell phones, PDAs,

home computers, laptops; while the third level

encompasses the architecture of remote healthcare

servers including the access of the user (in our case

the doctor or nurse) in the collected data which are

stored in the corresponding database.

Figure 2: Possible system architecture of a wireless sensor

based application.

The servers initialize, monitor, configure, and

synchronize all WBAN nodes and process sensors’

collected information. Personal data collecting

devices should provide secure communication

(Jovanov et al., 2005) with remote servers in the

upper level while using wireless connection. The

wireless links, including the access points, are used

to transmit accumulated data from several nodes to

the central storage equipments.

5 WIRELESS BODY AREA

NETWORK CHALLENGES

Despite the benefits that Wireless Body Area

Networks provide, there are also challenges and

problems that need consideration. In the following

subsections are presented separately some of the

issues that a system designer should take care of.

5.1 User’s Point of View

Based on continuous research in the field of

Wireless Body Area Networks, its structure,

components and application, there are also some

limitations which are related to user’s view of the

system.

While applied in medical areas there is

evident that sensors should adapt user’s state.

Furthermore, the sensor’s size needs consideration

when used as wearable device on human’s body.

Here are included for example the design and

operating functionalities of a WBAN, in the sense

that they should not affect the user’s everyday life

and activities.

5.2 Data Security

The transmission of data through several nodes

should be carefully analyzed and considered. In this

way, the data privacy and integrity need to be

ensured, either when stored inside the wireless body

area networks or during their transmission. Failure

to receive correct, non-modified, or other patient

data, may result in non-effective or even wrong

treatments (Li and Loum 2010; Milenković et al.,

2006). The error coding techniques, encryption and

cryptographically data, can prevent these drawbacks.

In this way data are securely stored and transmitted,

and at the same time accessed by authorized people.

Moreover, the main challenges still remain the

seamless connectivity, and secure and reliable

communication (Jovanov, 2005).

5.3 Sensor’s Considerations

Depending on the system application, a system

designer should first decide the type of sensor the

system needs. While choosing the sensor, its size

and weight may be factors for sensor’s application

and whole system architecture. These factors

determine sensor’s placement.

Besides sensor’s considerations, the power

source is another system component which will play

an important role for functioning of the whole

application. Therefore, system designers should

think carefully about power sources and power

consumption, and their rechargeable capabilities.

Usually this attribute is dominated by the operation

of wireless chips and radio transmissions. This

means that application engineers should choose a

wireless platform which can provide low power

consumption and has a minimum transmitting

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power, meanwhile still operating in short-range

frequency bands.

In general, low power consumption and small

dimensions of sensors; provide two essential

physical requirements that determine the lifetime

and suitability to be wearable by patients (Yuce,

2010). However, these requirements are closely

related with wireless communication’s operating

range, and transmission characteristics of used

sensors.

6 OUR APPROACH TO PROPOSE

A WBAN SCHEMA

FOR DEVELOPING REGIONS

Referring to Wireless Body Area Networks

operating logic, many applications are enabled,

including health monitoring systems, emergency

response systems, computer-assisted rehabilitation,

or similar systems trying to facilitate people’s lives.

An example of WBAN in medical area is presented

in (Bults et al., 2004). With the aim of analyzing and

monitoring vital signals based on a Body Area

Network, and UMTS and GPRS platforms, The

MobiHealth project was presented. This system

continuously transmits audio, images and

positioning information of patients to health service

providers. However, the observed biosignals are

transmitted to the remote healthcare location using

wireless telephony services; this fact may not be

convenient considering WBAN challenges.

Another proceeding work is also the

“MedVision” project (Lagkas and Eleftherakis,

2013). This project involves the development of a

complete, automated, and flexible distributed system

for monitoring health status, human activity, and/or

environmental variables in different remote

locations. This presents an ongoing project which is

thought to provide a framework that involves

different types of independent sensors, which would

be able to provide autonomous services to any

requesting entity. The main goal here is the

integration of various smart sensors capable of

supporting different applications without the

limitations imposed by a centralized architecture.

Among the latest WSN research issues that are taken

into consideration in this project are ad hoc

connectivity, network self-configuration, energy

efficiency, resource requirements optimization,

distributed service provision, and software agents’

interaction-behaviour.

Aimed to analyze all existing WBAN

architectures, we will try to conclude on and propose

schemes that can be applied in developing regions.

While critically evaluating existing applications and

their system design, we will try to suggest an

applicative architecture which may be beneficial for

developing regions, respectively in our case,

Republic of Kosovo.

While analyzing the mechanisms and

infrastructure how this schema can be applied in

developing regions, we came to some technical parts

which are found in Kosovo market. For example, a

simple system-architecture for efficient collection

and dissemination of monitored health data using

WBAN may consist of small scale components, such

as: health field sensor, microcontroller, GPS-

SIM900 chip, GPRS component, sensor’s battery,

and an electronic board where these components are

assembled. This mainly includes the first layer

presented in Figure 2. The corresponding sensor

nodes may be connected wirelessly with a

‘temporary’ storage system, for example a PDA or a

mobile phone. This device will forward the collected

information to the permanent data storages where

the users will have easier to receive data.

In any case, wireless connection obstacles should

be thoroughly analyzed. The best solution to

overcome wireless connection challenges would be

the usage of fourth generation standards, which

provide higher data rates, more reliable services, and

a totally digital (all IP) platform which enables

application of more sophisticated coding techniques

for data security. These components, equipments

and technologies present an existing infrastructure

and opportunities to propose a WSN schema.

7 CONCLUSIONS

Taking into account advantages of wireless sensor

networks while applied in practice and absence of

these applications in Kosovo region, we believe in

many benefits and facilitations for patients in this

region. Medical centres will have easier to monitor

patients in distance, provide better diagnosis, lower

the number of hospitalized people, and prevent

abnormal conditions. Moreover, as a developing

country, Kosovo wireless infrastructure is improving

day by day by implementation of new state of art

antennas and fibre optic connections.

With provision of new technologies, people’s

interest to use them would be higher especially

considering its advantages and market absence. This

leads to conclusions that WSN applications will

have positive impact in Kosovo people's lives.

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ACKNOWLEDGEMENTS

This work was supported by the ICT-KOSEU

project and partially contributes to the MedVision

project.

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