Research Article Toward a Nationwide Mobile-Based...

Research ArticleToward a Nationwide Mobile-Based Public HealthcareService System with Wireless Sensor Networks

Chien-wen Shen1 Chin-Hsing Hsu1 Ching-chih Chou2 and Tzu-Chun Tsai3

1Department of Business Administration National Central University No 300 Zhongda Road Taoyuan 32001 Taiwan2TSL School of Business and Information Technology Quanzhou Normal University Quanzhou 362000 China3Institute of Clinical Medicine and School of Medicine National Yang-Ming University Taipei 11221 Taiwan

Correspondence should be addressed to Chien-wen Shen cwshenncuedutw

Received 26 February 2016 Accepted 19 April 2016

Academic Editor Miltiadis D Lytras

Copyright copy 2016 Chien-wen Shen et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

This paper describes the development of a nationwide public healthcare service system with the integration of cloud technologywireless sensor networks and mobile technology to provide citizens with convenient and professional healthcare services Thebasic framework of the system includes the architectures for the user end of wireless physiological examinations for the regionalhealthcare cloud and for national public healthcare service system Citizenswith chronic conditions or elderly people who are livingalone can use the wireless physiological sensing devices to keep track of their health conditions and get warning if the system detectsabnormal signals Through mobile devices citizens are able to get real-time health advice prompt warning health informationfeedback personalized support and intervention ubiquitously With the long-term tracking data for physiological sensing reliableprediction models for epidemic diseases and chronic diseases can be developed for the government to respond to and controldiseases immediately Besides such a nationwide approach enables government to have a holistic understanding of the publichealth information in real time which is helpful to establish effective policies or strategies to prevent epidemic diseases or chronicdiseases

1 Introduction

With the rapid development of mobile technology manyhealthcare applications have been widely explored to realizethe pervasive healthcare systems which have the potentialto reduce long-term costs and improve patient care andsafety [1] The concept of mobile health was defined bythe World Health Organization (WHO) as the practice ofmedicine and public health assisted by mobile technologiessuch as mobile phones patient monitoring monitors per-sonal digital assistants and other wireless technologies [2]Typical mobile health system utilizes the Internet and webservices to provide an interaction platform among doctorsand patients A doctor or a patient can easily access the samemedical record anytime and anywhere through personalcomputer tablet or smartphone [3] Healthcare costs couldbe also cut dramatically through the emerging technologiesof mobile health such as wearable wireless sensor nodes that

interface with handheld devices with cloud-based services[4] The innovations of mobile health have a huge impacton traditional healthcare monitoring and alerting systemshealthcare delivery programs clinical data collection recordmaintenance medical information awareness and detectionand prevention systems [5] The related mobile technologicalapplications can be found in fetal heart rate monitor [6]health record system for pediatric HIV [7] image trans-mission for diagnosis [8] or monitoring prevention anddetection of some medical specialties such as diabetes [9 10]overweight [11 12] asthmatic [13] and maternal care [14]

Despite the great potential of mobile applications andwireless sensor networks there is still existing a researchgap as to how to effectively integrate these technologies andapply them to healthcare service [15] Most mobile health-care applications are either funded by the public sector foronly short-term pilot programs which are usually limitedto a small number of regions [16] or merely focused on

Hindawi Publishing CorporationMobile Information SystemsVolume 2016 Article ID 1287507 11 pageshttpdxdoiorg10115520161287507

2 Mobile Information Systems

a certain medical specialty without an integrated platformWith the increasing of healthcare provided by differentorganizations cross-organizational healthcare data sharing isanother challenge in interoperable healthcare organizations[17] In order to fill the gap and extend previous work theaim of the present study is to describe the development ofa nationwide mobile-based public healthcare service systemin Taiwan that integrates cloud technology wireless sensornetworks and mobile technology to provide citizens withconvenient and professional healthcare services Regardingthe cloud framework of the system it supports the storageand management of sensor data streams as well as theprocessing of the stored data using software services hostedin the cloud Because the use of cloud computing offersa low cost access to support extensive data storage andcomputing-intensive analysis of healthcare big data [18] theplanned framework enables different databases sharing andcollaborations among users and applications in the cloudand delivers cloud services via mobile devices The servers ofthe system are implemented in the Ministry of Health andWelfare and regional health authorities in order to providedifferent mobile-related services for government officialshospital physicians and citizens Medical records lab resultsmedical images and drug information can be retrieved bymobile devices through this integrated platform The relatedadministrators could take further actions according to thedecision support services from the executive informationsystem in the cloud platform In addition the framework ofwireless physiological sensing devices is designed for home orcommunity care Patients with chronic conditions or elderlypeople who are living alone can benefit from these devicesbecause they can keep track of their health conditions andget warning if the system detects abnormal signals Becauseall of this information is kept in central or local cloudsthe government can build prediction models based on long-term tracking data for physiological sensing in order tomake assessments on the incidence ofmajor chronic diseasesMeanwhile through mobile devices citizens are able toget real-time health advice prompt warning health infor-mation feedback personalized support and interventionubiquitously Their family members or hospital physicianscan also get warnings from their mobile apps and respond toemergencies immediately Besides government officials canretrieve summarized or visual analytics information aboutpublic health at the national or regional level on their webbrowsers or mobile apps Such a nationwide approach withthe integration of cloud wireless and mobile technologiesenables government to have a holistic understanding of thepublic health information in real time which is helpful toestablish effective policies or strategies to prevent epidemicdiseases or chronic diseases

The remainder of this paper is organized as followsThe next section reviews the literature related to the devel-opment of healthcare systems and their integration withmobile technologiesThe overview of the nationwidemobile-based public healthcare service system with wireless sensornetworks is presented in Section 3 In Section 4 we describethe web apps and mobile apps for the user end hospital andinstitution end and government end The paper ends with

a conclusion implications for public health administrationand an outlook for further research

2 Literature Review

In this section we briefly review recent development ofhealthcare system and the related mobile technologicalintegrations The mobile health system can be classifiedinto three categories (1) communication from individualsto health services (call centers helpline or hotline) (2)communication from health services to individuals (appoint-ment or treatment reminders awareness and mobilizationcampaigns onhealth issues) and (3) communication betweenhealth professionals (mobile telemedicine management ofintersectoral emergencies patient monitoring patient datacollection and creation of patient records aid to diagno-sis and decision-making) [2] Many mobile health systemshave been developed to enhance public health servicesFor example a wireless handheld clinical care managementsystem was implemented and evaluated at an Aged CareFacility in Australia The trial system included the use ofhandheld computers connected to a wireless network whichlinks to an ADSL broadband connection and Oracle server[19] A wireless in-home physiological monitoring systemwhich can constantlymonitor the patientrsquos electrocardiogram(ECG) at any time or any place at home was proposed forthe elderly and chronic patients with cardiovascular diseasewho live aloneThe systemmainly consisted of three parts Amobile-care device was in charge of capturing and wirelesslysending the patientrsquos ECG data A wireless multihop relaynetwork was responsible for relaying the data sent by theformer A residential gateway (RG) was used for gatheringand uploading the received ECG data to the remote careserver through the Internet to carry out the patientrsquos healthcondition monitoring and the management of pathologicaldata An emergency alert service using short message service(SMS) based on the detection of abnormal variation of heartrate is also employed in the RG [20] A u-healthcare serviceusing Zigbee and mobile phone was developed in Korea totransfer the data of glucometer and ECG sensors to webserver for elderly patients with diabetes mellitus or heartdiseases If patients felt palpitations or chest pain they canpush a button on the top of the sensor Then the ECG wasmeasured and sent to the web server immediately [21] Amobile automated medical alert system was developed inTaiwan to provide follow-up healthcare for students andfaculty found to be overweight chronically ill or at high riskWhile the daily healthcare management service of the systemrequired the users to input personal data the system canprovide intelligent dietitian service and abnormal messageservice without human intervention [22] To improve thequality of medical care in hospital or at home a healthcaresystem based on wearable healthcare node wireless mul-timedia sensor node gateway diversified networks back-end server and pervasive devices was proposed for patientsand healthcare recipients Because the wearable healthcarenode can be bounded to patientsrsquo body and acquire vitalsigns information doctors or family members could acquireabundant information about the patients anywhere and

Mobile Information Systems 3

any time through mobile phone [23] A personal self-caresystem integrated with self-adaptive embedded intelligencemobile health record management embedded web serverand wireless communication was developed for early detec-tion and interpretation of cardiac syndromesThe systemwasdesigned for the support of ambient intelligent andpervasivecomputing services Citizens can have a ubiquitous reliableand efficient management of their own cardiac status withtheir mobile devices [24]

Meanwhile Kim et al [25] designed a real-time remotepatient monitoring system based on sensors and sensorgatewaywith embeddedGPS andWi-Fimodule for collectingtemperature information out of biological information of apatient such as weight blood sugar quantity of motion ECGbreathe temperature cholesterol and oxygen saturation BenElhadj et al [26] proposed a Priority-Based Cross LayerRouting Protocol along with a Priority Cross Layer MediumAccess Channel Protocol for healthcare applications Theprotocols were claimed to be effective for saving energy andensuring high reliability in a wireless body area networkBourouis et al [27] developed a low cost smartphone basedintelligent system to help patients in remote and isolatedareas for regular eye examinations and disease diagnosisThemobile diagnosis system was integrated with microscopiclens and adopted an artificial neural network algorithm toanalyze the retinal images captured by the microscopic lensto identify retinal disease Fortino et al [28] described aSaaS based architecture named BodyCloud that can monitoran assisted living through wearable sensors and store thecollected data in the cloud through mobile devices It enableslarge-scale data collaborations and sharing and deliverscloud services via sensor-rich mobile devices While thecloud-side of the architecture is implemented atop GoogleApp Engine the viewer-side is to provide visualizationof data analysis through advanced graphical reporting onweb browser Parekh and Saleena [29] presented a cloud-based healthcare application which integrated data miningtechniques for disease inferenceThey integrated dataminingtechniques into eclipse IDE by Java language and Weka APIWang et al [15] proposed a personalized health informa-tion service system that is based on the cloud computingenvironment integratingmobile communication technologycontext-aware technology and wireless sensor networksThesystem also provided a collaborative recommender and aphysiological indicator-based recommender recommenda-tion which includes the components of a cloud computingbased database the hybrid predictive model of PEGASIS aweb based user interface a health information querymodulea collaborative recommender and a physiological indicator-based recommender From the above literature review thereis still lack ofmobile health applications based on the nationallevel

3 System Overview

Section 3 focuses on the nationwide mobile-based publichealthcare service system that is under development in Tai-wan and explains its basic framework including the architec-ture for the user end of wireless physiological examinations

the architecture for the regional healthcare cloud and thearchitecture for national public healthcare service systemDetailed explanations are given in the following sections

31 Architecture for the User End of Wireless PhysiologicalExaminations Wireless physiological sensing devices aremainly used in patients who have been diagnosed withdiabetes mellitus or hypertension patients with mild tomoderate impairments patients with mild dementia elderlypeople who are living alone or subjects who are eligible forpriority access according to assessments made by case man-agers These devices allow patients to perform examinationsat home or provide examination services in the communityMembers who participate in the regional healthcare cloudcan be provided with an examination care box for homemeasurements as shown in Figure 1 The examination carebox contains (1) blood pressuremonitor (2)multimonitoringsystem (for total cholesterol blood glucose and uric acid)(3) earforehead thermometer (4) pulse oximeter (5) cloudtransmission box (6) pressure cuff (7) RFID reader (8) testsample and (9) heart rate variability analyzer and theseare to be used in member patients with chronic illnessesThese devices are medical equipment that are verified andregistered by the Food and Drug Administration of theDepartment of Health in Taiwan in order to verify theaccuracy and safety of the test results Relevant physiologicalexamination equipment such as blood pressure monitors areintegrated with an RFID module and a wireless module Asmart membership card with RFID technology is used for theidentification of physiological examination data and wirelessfrequency identification (with a frequency of 1356MHz)is used to complete the verification The RFID moduleincludes aCPU power supplymodules read (write)modulesmemory modules control modules display modules andtimer modules The complimentary Public Card also has aunique identification code a communication interface (withan antenna and a modulator and demodulator) and anapplication-specific integrated circuit (ASIC) which includesa communication logic circuit an encryption control logiccircuit and a data storage area When the Public Card isplaced near the card reader and enters the sensing range ofthe communication antenna (around 25 cm to 10 cm) thecard reader will provide a trace amount of electricity (up toapproximately 2V) to drive the circuit on the card The cardreading process only requires 01 seconds to be completed

Taking the blood pressure monitor or blood glucosemonitor as an example patients first need to wear thepressure cuff or insert the blood glucose test sample intothe blood glucose monitor and then place the Public Cardcontaining the RFID near the blood pressure monitor orblood glucose monitor to trigger card reading The RFIDmodule can sense and read the identification verificationon the Public Card and can immediately begin automaticblood pressure examination or blood glucose examinationAfter the measured physiological results are obtained theyare automatically uploaded using the wireless module in theblood pressure monitor or blood glucose monitor ThroughGSM gateways the data are automatically uploaded to aregional healthcare cloud using network and Internet via


3G4

G n

etw

ork Regional

healthcare cloud

RFID reader module

Gateway

Wireless module

Blood pressure monitor

Glucose meter

786 2 4

1 5 39

Figure 1 Overview of the user end

a 3G4G network Wi-Fi or Ethernet The GSM gatewayhas an ultra-low power wireless transmission module Thetransmission technology has the flowing features Firstly ituses a standard ISM (Industrial Scientific and Medical)Channel with 24GHz The wireless transmission poweris 1mW The transmission distance is less than 5 metersSecondly it has high-performance embedded firmware Itcan automatically find the base station and can performautomatic transmission Thirdly it includes 64-bit ID andcan be used as an active RFID The rage of application iswide Additionally it can be applied in measuring devicesfor physiological signals including blood pressure monitorsblood glucose meters and ear thermometer Lastly it hasstandardUART interface with easy data interface integration

In addition to examination equipment to be used at homethe public healthcare service system also provides physio-logical examination stations for communities as shown inFigure 2 This examination station includes (1) a 1010158401015840 tabletPC (2) a cloud-based smart blood pressure monitor withcylindrical cuff (3) a cloud-based smart Automatic Heightand Weight Meter (4) a cloud-based smart earforeheadthermometer (5) a cloud-based smart oxygen concentrationmeter (6) a heart rate variability analyzer (7) a cloud-based transmission box and (8) an RFID card reader Aftercommunity volunteers have completed training on usingthe equipment and devices they will assist the generalpublic to operate them and perform measurements Apartfrom measuring basic physiological data this examinationstation also has an accurate heart rate variability analyzerThis analyzer uses the sequence of time intervals betweenheartbeats as measured by the ECG or by pulse measurementand measures and analyzes changes in continuous heart rateThe heartbeat is activated by the discharge of electricity fromthe heartrsquos own rhythm and is regulated by the autonomicnervous system Regulation by the autonomic nervous systemis closely related to mortalities related to cardiovasculardiseases including psychogenic sudden death hypertensionhemorrhagic shock and septic shock As a result heart rate

variability analysis has also been found to be an index forpredicting themortality rate for postmyocardial infarction aswell as predicting the prognosis conditions for advanced livercancer patients These measurement data are automaticallyuploaded to the regional healthcare cloud through wirelesstransmission The relevant medical staff can then performmedical analysis and provide patient counseling services

32 Architecture of the Regional Healthcare Cloud Theregional architecture is developed by the regional healthauthority Each regional health authority develops theregional healthcare cloud based on the design specificationsfor a nationwide mobile-based public healthcare servicesystem as specified by the Ministry of Health and Welfarein Taiwan The healthcare cloud stores the data transmittedby the architecture for the user end of wireless physiologicalexaminations and is responsible for storing membershipdetails and physiological data for each region It acts as abridge for regional hospitals and institutions care institu-tions government agencies and other relevant authoritiesto exchange data The transfer and exchange of data usesweb service technology and if needed the transmission ofdata can be encrypted to ensure data security Data can beexchanged using XML or JSON (JavaScript Object Notation)formats The integration of heterogeneous systems in variousauthorities can also use web service or SOAP in order toperform data exchange TLS is used to encrypt the databeing transmitted The exchange technology used is a cross-platform portal The information equipment required bymedical institutions or care facilities should include firewallserver host backup host and Agent PC Externally onlyports 60 80 and 53 are open and these ports are usedfor the uploading of physiological examination informationthe website and DNS inquiries Cyber-attacks on commonlyused ports are avoided in order to ensure the security of thehost operation For all maintenance activities one must passthrough a VPN connection SSL channel encryption securityand passport verification before connecting to the internal


215 4 78

6

3

Figure 2 Physiological examination stations for communities

host to perform maintenance The client PC uses DHCP toconnect to the Internet After using private IP NAT one canconnect to the network or Internet In addition this machineis equipped with antivirus software and the Microsoft built-in firewall is activated to provide basic protection

Figure 3 shows a chart of the relationships betweenthe regional healthcare cloud home examination stationcommunity examination station regional hospitals and insti-tutions and care institutions Members of the healthcarecloud can use the data measured from the wireless physio-logical examination at home or data from the general publiccollected at community physiological examination stationsThe data are returned to the healthcare cloud database ofthe regional health authorities via wireless transmissions andthe data are synchronized to the physiological examinationdatabase of the national public healthcare service systemThe public or family members and medical staff who haveobtained consent can access the data anytime anywhereusing mobile apps or web app They can enter an accountpassport and search for physiological measurement datafrom the regional healthcare cloud including blood pressureand blood glucose so that personal health conditions canbe understood In addition the regional healthcare cloudalso incorporates relevant algorithms and smart automaticinterpretations for the returned physiological data Whenabnormal conditions occur alerts can be sent to the publicemergency contact and family doctor through SMS emailor app alert so that they can provide immediate emergencytreatment For the partnering of regional hospital institutionsand care institutions they can inquire into the long-termtracking data for the visiting patients so they can diagnosethe illness more accurately In addition the member servicecenter can provide services to members including healthadvice and health education

33 Architecture of the National Public Healthcare ServiceSystem The architecture is developed by the Ministry ofHealth andWelfare and is currently still in the planning stage

Under this architecture the public or a family member ormedical staff who have obtained consent can use the datainterface at the Ministry of Health and Welfarersquos ldquoe-counterrdquoto connect to the physiological measurement database toconduct queries on personal health information Authorizedservice institutions or medical institutions can also connectto the physiologicalmeasurement database to inquire into thepersonal health information of the patients In the future thepublic will be able to selectmore services related to healthcareand perform more comprehensive healthcare

As shown in Figure 4 the architecture of the nationalpublic healthcare service system mainly consists of the phys-iological measurement database the information platformdatabase and the executive information system databaseUnder the provisions of the Personal Information ProtectionAct the healthcare data of the users of the service are inte-gratedThemain functions of the physiological measurementdatabase include the collection of physiologicalmeasurementdata The physiological measurement data measured by thepublic at home or measured at the community examinationstations are not only uploaded to the regional healthcarecloud but are also synchronized in the physiologicalmeasure-ment database The synchronization of the data is performedthrough the web service The HTTP Client Mode is used forthe device terminal The HTTP Server Mode is used for thephysiological measurement platform For all transmissionscommunication requests are sent by the device terminal Theinformation platform database verifies the account passwordand connection security before the actual transmission ofdata The JSON format is used during transmission as itis easy to read and understand and can avoid excessiveload during data interface and handover It also significantlyimproves ease of use when interfacing between regionalhealthcare clouds In addition the main functions of theinformation platform database consist of managing useraccounts defining data format and data exchange protocoltransmission encryption auditing records and providingstatistical analysis reports In order to allow data in the


Healthcarebox

Mobile APPweb service

Healthcarecenter

Text message

Alert

Data transmission

Data query

Home

Emergency contact

Hospital

Family doctor Smart devices

Clinicarea

Community

Email

Health dataquery

Health datatransmission

Department oflocal public health

Healthcarestation

Data tra

nsmissi

onData query


AlertText

messageEmail

cloudLocal healthcare

Figure 3 Overview of the regional healthcare cloud

User

Community Home

Gateway

Devices

Medical devicequalification

Localhealthcare

cloud

Data collection(i) Data format

(iii) Encryptedcheck

(ii) Data exchange protocol

(iv) Statisticsanalysisreport

Account management(i) ID will be the key

factor

Management and report (i) KPI from health

bureau(ii) Statisticsanalysis

reportGateway

Devices

MOHWhealth data

DB

MOHWinformation platform DB

MOHWEIS DB

Figure 4 The architecture of the national public healthcare service system

regional healthcare cloud to synchronize with the registereduser data and the physiological measurement data in theinformation platform of the Ministry of Health and Welfarethe system also provides a web service so that the regionalhealthcare cloud can access and attribute registered userinformation and physiological measurement data from the

Ministry of Health and Welfare The main functions of theexecutive information system platform include performancemanagement and outputting reports It is used to managethe execution and performance indexes of various localhealth bureaus and to output relevant statistical analysisreports as well as perform OLAP analysis The indexes


Figure 5 Screenshots of the mobile app

used in the analysis include regions (counties) the numberof people age physiological measurement type number ofphysiological measurements measurements of physiologicalabnormalities physical inactivity and other dimensions ofmeasurement

At this stage the overall system still mainly focuseson member registration user content in the membershipinformation physiologicalmeasurement values uploading ofmeasurement data archiving of measurement data and syn-chronizing data with the service content Table 1 summarizesthe fields relating to physiological measurement data in thephysiological measurement database including physiologicaldata ID number simplified user identification code servicestation code physiological data typemeasurement time datatype annotation input method measured value informationannotation model of the measuring instrument and serialnumber of the measurement instrument In the future thedatabase will further integrate long-term healthcare systemdata and a large amount of data analysis and will expand thecontent and services so that it can serve as a reference forwhen the government implements policies for public health

4 Applications

41 User End The nationwide mobile-based public health-care service system provides users with services includingmember management inquiries into physiological measure-ment data and error alarms through a mobile app and acomputer-based web app Figure 5 shows an app developedfor the Android system The main functions include auto-matic upload of data manual upload of data performinglocal machine queries locating service stations configuringauthorization settings updating messages updating healthknowledge performing cloud inquiries and providing feed-back Users can use their phones or tablets to perform real-time inquiries in regards to their physiological informationand understand the trends in recorded data for the relevant

measurements in order to understand their health condi-tions For example the right-hand side of Figure 5 showsblood pressure trends measured on March 3 2015 From thefigure it can be observed that the systolic blood pressurefor the user is between 105 and 102mmHg the diastolicblood pressure is between 95 and 108mmHg and the pulseis between 73 and 77 beats per minute

Figure 6 shows the web app This program platformcontains Health Notebook Healthy Living New HealthKnowledge Network Health QampA and other related func-tions In the Health Notebook there are six physiologicalmeasurement records including the authorrsquos blood pressureblood glucose cholesterol weight body temperature anduric acid test records For example in the left side of Figure 6on April 18 2014 the blood pressure record shows that thesystolic blood pressure was 152mmHg the diastolic bloodpressure was 88mmHg and the pulse rate was 51 beats perminute The right side of Figure 6 shows inquiries into allthe measurement data for the 30 days from March 18 toApril 18 2014 There are only two days on which the bloodpressure was recorded (March 27 and April 18) Howeverthere are five recorded measurements and there are threealarms for abnormalitiesThis tracking record can allow usersto understand their health conditions with regard to bloodpressure

42 Hospital and Institution End The partnering hospital orinstitute can also develop relevant applications using the datafrom the regional healthcare cloud and provide memberswith services including physiologicalmeasurements trackingof abnormalities emergency notifications advisory servicescare referrals health reports and other services For examplethe left side of Figure 7 shows that the system in the hospitalinstitute has detected a patient with an abnormal systolicpressure of 145mmHg and a diastolic blood pressure of96mmHg on November 27 2015 at 182144 At that time theapplication would pop up a warning window and alert the


Table 1 Fields in the table of physiological measurements

Field Name Details

VitalRecordList Physiological data (i) Essential(ii) Can be one set or multiple sets of physiological data

IDNo ID number string(i) Optional but at least one of IDNo or IDENTIFIERmust have value(ii) Must comply with the ID number format

IDENTIFIER Simplified user identificationcode

(i) Optional items such as RFID card code fingerprintidentification code or other types of personallyidentifiable information

LocationID Service station code

(i) Essential(ii) The value of this field is uniformly set by the healthservice department The vendor system enters thenumber corresponding number to the service station

Type Physiological data type

(i) Essential(ii) Reference ldquoUnicode table for physiologicalmeasurement valuesrdquo(iii) For example blood pressure is ldquoBPrdquo

MTime Measurement time (i) Essential(ii) Format is yyyymmdd hhMMss

Mark Data type annotation

(i) Optional(ii) When the type is blood glucose the values of thisfield and the definitions are as follows(1) AC blood glucose before meals(2) PC blood glucose after meals(3) NM random blood glucose (not sure whetherbefore or after the meal Unclassified)

InputType Input method

(i) Optional(ii) Indicating data is automatically recorded anduploaded by the instrument or manually entered by theuser(iii) Possible values(1) device entered by the instrument defined as followsafter the user makes a measurement the instrumentautomatically records and uploads information(2) manual manual input defined as follows when theuser manually records the value in the platform orinformation transfer box supplied by the manufacturer(iv) If left blank then it is automatically regarded asldquoDevicerdquo (ie entered by the instrument)

Values Measured value

(i) Essential(ii) Reference ldquounicode table for physiologicalmeasurement valuesrdquo(iii) For example blood pressure is ldquo[110 70 72]rdquo

Remark Information annotation (i) Optional(ii) Descriptions noted by the vendor

DeviceModel Model of the measuringinstrument

(i) Optional(ii) Model number for the physiological measurementequipment is supplied by the vendor

DeviceSN Serial number of themeasurement instrument

(i) Optional(ii) Factory serial number for the physiologicalmeasurement equipment is supplied by the vendor

medical team at the service center The healthcare managerof the medical team can then examine the measured bloodpressure information for this patient receiving a total of 1392sets of data The right side of Figure 7 shows the trend inblood pressure for this patient From this figure it can be

observed that on November 26 2015 this patientrsquos systolicblood pressure reached the upper limit of the standard valuewhich is 140mmHgThis trend continues and on November27 2015 the systolic blood pressure showed abnormities andthe valuewas 145mmHgAt this time the healthcaremanager


Figure 6 Screenshots of the web app

Figure 7 Application screenshots of the hospital end

can determine if active telephone care should be providedbased on the information and the healthcare manager cantrack the abnormal events until the end of the case in orderto ensure the health and safety of the patient

When patients experience emergency conditions health-care manager can actively contact the medical institutionsemergency contacts or emergency numbers In additionthe healthcare manager can provide the patient with initialhealth education counseling care and guidance personalhealth guidance and telephone consultation and dependingon the situation secondary physician-assisted responses canbe provided If the patients are required to be transferredto another medical institute or healthcare center the systemcan also comprehensively summarize the electronic carerecords of the member for the receiving institute to viewand actively and regularly send graphs containing historicalphysiological measurements and health summary report forthe proposed health checks Additional services that meetthe requirements of the public can be provided includinghome delivery of medicines drug intake counseling chronicdisease management room service and other value-addedservices for health checks

43 Government End Theweb app on the government end isstill under construction Currently it only provides websitesof pro consulting services for the public andmanufacturer Inthe future a store of relevant data will be established in orderto perform data analysis of physiological data (the numberof people undergoing measurements gender ethnic compar-isons age physiological equipment the platform used andphysiological categories by region) data analysis on patients

(regional distributions of population ethnicities gender agegroups and the population diagnosed with hypertension ofpeople who are using the app) analysis of the uploading sta-tions (distributions of stations and the number of people whouploaded physiological data at each categories to comparehome stations and community stations classification and dis-tribution of stations within a county distribution of inactivestations) and so forth These integrated analyses can providemany additional relationships between the information andthe data The government can also develop relevant systemsso that patient data from various regions across Taiwan andfrom the national healthcare database can be compared withthe ideal values recommended by the WHO Visual anddynamic graphs can represent the public health conditionsof Taiwan Long-term tracking data for physiological sensingcan be used to build predictive models in order to makeassessments on the incidence of major chronic diseases suchas heart disease stroke high blood pressure high cholesterolhigh blood fat and diabetes as well as future trends This isbeneficial for the Ministry of Health and Welfare and localhealth authorities to respond to and control diseases as soonas possible

5 Conclusion

We present a national public healthcare project with theintegration of cloud technology wireless sensor network andmobile technology that aims to provide citizens with conve-nient and quality health services The major contributions ofthis study can be summarized as follows Firstly the proposedsystem is going to be implemented nationwide in the next


few years in Taiwan To the best of our knowledge there isstill lack of mobile-based public healthcare service systems atthe national level By enabling different databases sharing andcollaborations among users and applications in the cloud theproposed nationwide healthcare system enables governmentto have a holistic and real-time understanding of the publichealth information Secondly for the patients with chronicdiseases or elderly people this system can offer convenientservices for home or community care The system infras-tructure is capable of delivering health-related informationand interventions and improving access to health servicesvia mobile devices It can serve patients both in everydaylife and during hospitalization or rehabilitation as well ashealthcare providers during emergency or routine visitsPatients could be aware of their diagnostic disease controland monitoring via text message email and mobile appsat any place and time Thirdly with the help of the systemhospitals can provide better personalized healthcare diseasemanagement and services to patients and their relatives Themobile-based approach also provides a better and flexibleway of communicatingwith physicians patients andmedicalsuppliers Finally when the project is complete governmentofficials can understand the public health conditions ofTaiwan by visual and dynamic graphs With the long-termtracking data for physiological sensing reliable predictionmodels for epidemic diseases and chronic diseases can bedeveloped for the government to respond to and controldiseases immediately

However the most challenging tasks of this nationalproject are the cost of the infrastructure and the coordinationwith local hospital institutions It will take years to haveenough examination care boxes and community smart healthcare stations in every town and village in Taiwan Besideslocal public health bureau needs to provide enough supportsand guidelines for local hospitals because the staffs of thelocal hospitals are responsible for providing health cares andmedical services in emergency situations The system mayalso need to consider the inclusion of more wireless sensordevices such as biosensors comprise body-worn sensors(necklaces watches or rings) and environment sensors (bedstoilets or bathtubs) that measure biosignals and monitor theamount of physical activity Because semantic sensor webtechnologies enable sharing and reusing data by means ofstandardizing sensor data description [30] future system canevaluate the necessity of adopting such technologies for theinteroperability of various applications across the country

Competing Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] Z Yang A Kankanhalli B-Y Ng and J T Y Lim ldquoExaminingthe pre-adoption stages of healthcare IT a case study of vitalsigns monitoring systemsrdquo Information ampManagement vol 52no 4 pp 454ndash467 2015

[2] The World Health Organization (WHO) mHealth New hori-zons for health through mobile technologies 2011

[3] BM C Silva J J P C Rodrigues I de la Torre Dıez M Lopez-Coronado and K Saleem ldquoMobile-health a review of currentstate in 2015rdquo Journal of Biomedical Informatics vol 56 pp 265ndash272 2015

[4] S T Ali V Sivaraman and D Ostry ldquoAuthentication oflossy data in body-sensor networks for cloud-based healthcaremonitoringrdquo Future Generation Computer Systems vol 35 pp80ndash90 2014

[5] P Zuehlke J Li A Talaei-Khoei and P Ray ldquoA functionalspecification for mobile eHealth (mHealth) systemsrdquo in Pro-ceedings of the 11th IEEE International Conference on e-HealthNetworking Applications and Services (Healthcom rsquo09) pp 74ndash78 IEEE Sydney Australia December 2009

[6] C S Lee M Masek C P Lam and K T Tan ldquoAdvances infetal heart rate monitoring using smart phonesrdquo in Proceedingsof the 9th International Symposium on Communications andInformation Technology (ISCIT rsquo09) pp 735ndash740 IEEE PressIcheon Republic of Korea September 2009

[7] S Paul S Bhattacharya A Sudar et al ldquoA web-based electronichealth care system for the treatment of pediatric HIVrdquo inProceedings of the 11th International Conference on e-HealthNetworking Applications and Services (Healthcom rsquo09) pp 175ndash180 Sydney Australia December 2009

[8] L Bellina and E Missoni ldquoM-learning mobile phonesrsquo appro-priateness and potential for the training of laboratory techni-cians in limited-resource settingsrdquo Health and Technology vol1 no 2ndash4 pp 93ndash97 2011

[9] C C Quinn A L Gruber-Baldini M Shardell et alldquoMobile diabetes intervention study testing a personalizedtreatmentbehavioral communication intervention for bloodglucose controlrdquoContemporary Clinical Trials vol 30 no 4 pp334ndash346 2009

[10] M Kirwan C Vandelanotte A Fenning and M J DuncanldquoDiabetes self-management smartphone application for adultswith type 1 diabetes randomized controlled trialrdquo Journal ofMedical Internet Research vol 15 no 11 article e235 2013

[11] F Zhu M Bosch I Woo et al ldquoThe use of mobile devicesin aiding dietary assessment and evaluationrdquo IEEE Journal onSelected Topics in Signal Processing vol 4 no 4 pp 756ndash7662010

[12] H R Maamar A Boukerche and E M Petriu ldquo3-D streamingsupplying partner protocols for mobile collaborative exergam-ing for healthrdquo IEEE Transactions on Information Technology inBiomedicine vol 16 no 6 pp 1079ndash1095 2012

[13] H-C Lin L-C Chiang T-NWen K-W Yeh and J-L HuangldquoDevelopment of online diary and self-management systemon e-Healthcare for asthmatic children in Taiwanrdquo ComputerMethods and Programs in Biomedicine vol 116 no 3 pp 299ndash310 2014

[14] M Al Dahdah A Desgrees Du Lou and C Meadel ldquoMobilehealth andmaternal care a winning combination for healthcarein the developing worldrdquo Health Policy and Technology vol 4no 3 pp 225ndash231 2015

[15] S-L Wang Y L Chen A M-H Kuo H-M Chen andY S Shiu ldquoDesign and evaluation of a cloud-based mobilehealth information recommendation system on wireless sensornetworksrdquo Computers and Electrical Engineering vol 49 pp221ndash235 2016

[16] K-F Chiang H-H Wang I-K Chien et al ldquoHealthcareprovidersrsquo perceptions of barriers in implementing of home


telecare in Taiwan a qualitative studyrdquo International Journal ofMedical Informatics vol 84 no 4 pp 177ndash287 2015

[17] M Azarm-Daigle C Kuziemsky and L Peyton ldquoA review ofcross organizational healthcare data sharingrdquo Procedia Com-puter Science vol 63 pp 425ndash432 2015

[18] M Chen ldquoNDNC-BAN supporting rich media healthcareservices via named data networking in cloud-assisted wirelessbody area networksrdquo Information Sciences vol 284 pp 142ndash1562014

[19] S Chau and P Turner ldquoUtilisation of mobile handheld devicesfor care management at an Australian aged care facilityrdquoElectronic Commerce Research and Applications vol 5 no 4 pp305ndash312 2006

[20] C-C Lai R-G Lee C-C Hsiao H-S Liu and C-C Chen ldquoAH-QoS-demand personalized home physiological monitoringsystemover awirelessmulti-hop relay network formobile homehealthcare applicationsrdquo Journal of Network and ComputerApplications vol 32 no 6 pp 1229ndash1241 2009

[21] H J Lee S H Lee K-S Ha et al ldquoUbiquitous healthcareservice using Zigbee and mobile phone for elderly patientsrdquoInternational Journal of Medical Informatics vol 78 no 3 pp193ndash198 2009

[22] W-Y Jen ldquoMobile healthcare services in school-based healthcenterrdquo International Journal of Medical Informatics vol 78 no6 pp 425ndash434 2009

[23] C Sha R-C Wang H-P Huang and L-J Sun ldquoA type ofhealthcare system based on intelligent wireless sensorrdquo TheJournal of China Universities of Posts and Telecommunicationsvol 17 pp 30ndash39 2010

[24] J Fayn and P Rubel ldquoToward a personal health society incardiologyrdquo IEEE Transactions on Information Technology inBiomedicine vol 14 no 2 pp 401ndash409 2010

[25] Y-H Kim I-K Lim J-W Lee and J-K Lee ldquoSensor basedreal-time remote patient monitoring system a study on mobileDB construction of minimum network traffic in use of HTML5WebSQLrdquo Procedia Engineering vol 29 pp 2382ndash2387 2012

[26] H Ben Elhadj J Elias L Chaari and L Kamoun ldquoA prioritybased cross layer routing protocol for healthcare applicationsrdquoAd Hoc Networks vol 42 pp 1ndash18 2016

[27] A Bourouis M Feham M A Hossain and L Zhang ldquoAnintelligent mobile based decision support system for retinaldisease diagnosisrdquo Decision Support Systems vol 59 no 1 pp341ndash350 2014

[28] G Fortino D Parisi V Pirrone and G Di Fatta ldquoBodyCloudA SaaS approach for community Body sensor networksrdquo FutureGeneration Computer Systems vol 35 pp 62ndash79 2014

[29] M Parekh and B Saleena ldquoDesigning a cloud based frameworkfor healthcare system and applying clustering techniques forregion wise diagnosisrdquo Procedia Computer Science vol 50 pp537ndash542 2015

[30] J-P Calbimonte H Jeung O Corcho and K Aberer ldquoEnablingquery technologies for the semantic sensor webrdquo InternationalJournal on Semantic Web and Information Systems vol 8 no 1pp 43ndash63 2012

Submit your manuscripts athttpwwwhindawicom

Computer Games Technology

International Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


Distributed Sensor Networks


Advances in

FuzzySystems

Hindawi Publishing Corporationhttpwwwhindawicom

Volume 2014


ReconfigurableComputing

Hindawi Publishing Corporation httpwwwhindawicom Volume 2014


Applied Computational Intelligence and Soft Computing

thinspAdvancesthinspinthinsp

Artificial Intelligence

HindawithinspPublishingthinspCorporationhttpwwwhindawicom Volumethinsp2014

Advances inSoftware EngineeringHindawi Publishing Corporationhttpwwwhindawicom Volume 2014


Electrical and Computer Engineering

Journal of

Journal of

Computer Networks and Communications


Hindawi Publishing Corporation

httpwwwhindawicom Volume 2014

Advances in

Multimedia


Biomedical Imaging


ArtificialNeural Systems

Advances in


RoboticsJournal of



Computational Intelligence and Neuroscience

Industrial EngineeringJournal of


Modelling amp Simulation in EngineeringHindawi Publishing Corporation httpwwwhindawicom Volume 2014

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014


Human-ComputerInteraction

Advances in

Computer EngineeringAdvances in



a certain medical specialty without an integrated platformWith the increasing of healthcare provided by differentorganizations cross-organizational healthcare data sharing isanother challenge in interoperable healthcare organizations[17] In order to fill the gap and extend previous work theaim of the present study is to describe the development ofa nationwide mobile-based public healthcare service systemin Taiwan that integrates cloud technology wireless sensornetworks and mobile technology to provide citizens withconvenient and professional healthcare services Regardingthe cloud framework of the system it supports the storageand management of sensor data streams as well as theprocessing of the stored data using software services hostedin the cloud Because the use of cloud computing offersa low cost access to support extensive data storage andcomputing-intensive analysis of healthcare big data [18] theplanned framework enables different databases sharing andcollaborations among users and applications in the cloudand delivers cloud services via mobile devices The servers ofthe system are implemented in the Ministry of Health andWelfare and regional health authorities in order to providedifferent mobile-related services for government officialshospital physicians and citizens Medical records lab resultsmedical images and drug information can be retrieved bymobile devices through this integrated platform The relatedadministrators could take further actions according to thedecision support services from the executive informationsystem in the cloud platform In addition the framework ofwireless physiological sensing devices is designed for home orcommunity care Patients with chronic conditions or elderlypeople who are living alone can benefit from these devicesbecause they can keep track of their health conditions andget warning if the system detects abnormal signals Becauseall of this information is kept in central or local cloudsthe government can build prediction models based on long-term tracking data for physiological sensing in order tomake assessments on the incidence ofmajor chronic diseasesMeanwhile through mobile devices citizens are able toget real-time health advice prompt warning health infor-mation feedback personalized support and interventionubiquitously Their family members or hospital physicianscan also get warnings from their mobile apps and respond toemergencies immediately Besides government officials canretrieve summarized or visual analytics information aboutpublic health at the national or regional level on their webbrowsers or mobile apps Such a nationwide approach withthe integration of cloud wireless and mobile technologiesenables government to have a holistic understanding of thepublic health information in real time which is helpful toestablish effective policies or strategies to prevent epidemicdiseases or chronic diseases

The remainder of this paper is organized as followsThe next section reviews the literature related to the devel-opment of healthcare systems and their integration withmobile technologiesThe overview of the nationwidemobile-based public healthcare service system with wireless sensornetworks is presented in Section 3 In Section 4 we describethe web apps and mobile apps for the user end hospital andinstitution end and government end The paper ends with

a conclusion implications for public health administrationand an outlook for further research

2 Literature Review

In this section we briefly review recent development ofhealthcare system and the related mobile technologicalintegrations The mobile health system can be classifiedinto three categories (1) communication from individualsto health services (call centers helpline or hotline) (2)communication from health services to individuals (appoint-ment or treatment reminders awareness and mobilizationcampaigns onhealth issues) and (3) communication betweenhealth professionals (mobile telemedicine management ofintersectoral emergencies patient monitoring patient datacollection and creation of patient records aid to diagno-sis and decision-making) [2] Many mobile health systemshave been developed to enhance public health servicesFor example a wireless handheld clinical care managementsystem was implemented and evaluated at an Aged CareFacility in Australia The trial system included the use ofhandheld computers connected to a wireless network whichlinks to an ADSL broadband connection and Oracle server[19] A wireless in-home physiological monitoring systemwhich can constantlymonitor the patientrsquos electrocardiogram(ECG) at any time or any place at home was proposed forthe elderly and chronic patients with cardiovascular diseasewho live aloneThe systemmainly consisted of three parts Amobile-care device was in charge of capturing and wirelesslysending the patientrsquos ECG data A wireless multihop relaynetwork was responsible for relaying the data sent by theformer A residential gateway (RG) was used for gatheringand uploading the received ECG data to the remote careserver through the Internet to carry out the patientrsquos healthcondition monitoring and the management of pathologicaldata An emergency alert service using short message service(SMS) based on the detection of abnormal variation of heartrate is also employed in the RG [20] A u-healthcare serviceusing Zigbee and mobile phone was developed in Korea totransfer the data of glucometer and ECG sensors to webserver for elderly patients with diabetes mellitus or heartdiseases If patients felt palpitations or chest pain they canpush a button on the top of the sensor Then the ECG wasmeasured and sent to the web server immediately [21] Amobile automated medical alert system was developed inTaiwan to provide follow-up healthcare for students andfaculty found to be overweight chronically ill or at high riskWhile the daily healthcare management service of the systemrequired the users to input personal data the system canprovide intelligent dietitian service and abnormal messageservice without human intervention [22] To improve thequality of medical care in hospital or at home a healthcaresystem based on wearable healthcare node wireless mul-timedia sensor node gateway diversified networks back-end server and pervasive devices was proposed for patientsand healthcare recipients Because the wearable healthcarenode can be bounded to patientsrsquo body and acquire vitalsigns information doctors or family members could acquireabundant information about the patients anywhere and




3 System Overview






3G4

G n

etw

ork Regional

healthcare cloud

RFID reader module

Gateway

Wireless module


Glucose meter

786 2 4

1 5 39







215 4 78

6

3








Healthcarebox


Healthcarecenter

Text message

Alert

Data transmission

Data query

Home

Emergency contact

Hospital


Clinicarea

Community

Email

Health dataquery



Healthcarestation

Data tra

nsmissi

onData query


AlertText

messageEmail



User

Community Home

Gateway

Devices


Localhealthcare

cloud






factor



reportGateway

Devices

MOHWhealth data

DB


MOHWEIS DB








4 Applications







Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in






3 System Overview






3G4

G n

etw

ork Regional

healthcare cloud

RFID reader module

Gateway

Wireless module


Glucose meter

786 2 4

1 5 39







215 4 78

6

3








Healthcarebox


Healthcarecenter

Text message

Alert

Data transmission

Data query

Home

Emergency contact

Hospital


Clinicarea

Community

Email

Health dataquery



Healthcarestation

Data tra

nsmissi

onData query


AlertText

messageEmail



User

Community Home

Gateway

Devices


Localhealthcare

cloud






factor



reportGateway

Devices

MOHWhealth data

DB


MOHWEIS DB








4 Applications







Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in




3G4

G n

etw

ork Regional

healthcare cloud

RFID reader module

Gateway

Wireless module


Glucose meter

786 2 4

1 5 39







215 4 78

6

3








Healthcarebox


Healthcarecenter

Text message

Alert

Data transmission

Data query

Home

Emergency contact

Hospital


Clinicarea

Community

Email

Health dataquery



Healthcarestation

Data tra

nsmissi

onData query


AlertText

messageEmail



User

Community Home

Gateway

Devices


Localhealthcare

cloud






factor



reportGateway

Devices

MOHWhealth data

DB


MOHWEIS DB








4 Applications







Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in




215 4 78

6

3








Healthcarebox


Healthcarecenter

Text message

Alert

Data transmission

Data query

Home

Emergency contact

Hospital


Clinicarea

Community

Email

Health dataquery



Healthcarestation

Data tra

nsmissi

onData query


AlertText

messageEmail



User

Community Home

Gateway

Devices


Localhealthcare

cloud






factor



reportGateway

Devices

MOHWhealth data

DB


MOHWEIS DB








4 Applications







Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in




Healthcarebox


Healthcarecenter

Text message

Alert

Data transmission

Data query

Home

Emergency contact

Hospital


Clinicarea

Community

Email

Health dataquery



Healthcarestation

Data tra

nsmissi

onData query


AlertText

messageEmail



User

Community Home

Gateway

Devices


Localhealthcare

cloud






factor



reportGateway

Devices

MOHWhealth data

DB


MOHWEIS DB








4 Applications







Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in







4 Applications







Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in





Field Name Details






























5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in










5 Conclusion





Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in






Competing Interests


References








































Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in


























Advances in

FuzzySystems


Volume 2014












Journal of

Journal of





Advances in

Multimedia


Biomedical Imaging



Advances in


RoboticsJournal of










Advances in



Research Article Toward a Nationwide Mobile-Based...

Documents

Transcript of Research Article Toward a Nationwide Mobile-Based...