Real-Time patient monitoring using TCP/IP model, Web publishing, powerline communication, Gsm Technology in LabVIEW

1. International Journal of Applied Engineering Research
ISSN 0973-4562 Volume 9, Number 24 (2014) pp. 26517-26533
© Research India Publications
http://www.ripublication.com
Paper code: 07_30202 - IJAER--URGENT MOST
A Real-time remote ICU patient monitoring system
using TCP protocol, power line protocol, GSM
technology, web publishing and E-mail generation
D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
Senior Development Engineer, TIFAC CORE, VIT University
shaluece@gmail.com
B.Tech, ECE, Student,VIT University
rdante.dhar@gmail.com
B.Tech, ECE, Student,VIT University
kaushikb8@gmail.com
Abstract
The proposed system aims at non-invasively measure vital parameters of the
ICU patient and make available the real-time data to the physician using the
above mentioned protocols. The system is designed in such a way that if due to
non-availability of resources if one of the data transfer protocols fails the
parameters (ECG, Heart rate, blood Pressure and body temperature) are sent
through the next protocol and hence the data reaches the physician and the
patient is serviced accordingly The sole purpose of the system is to ease the
monitoring system and to ensure proper treatment of the patient in the right
time.
Another area where the system focuses is that in rural areas very few resources
are available which includes non-availability of internet, so real-time data is
transferred using power lines from one room to other. Also using GSM
technology data can be sent to phone using text message if doctor is not present
in the hospital premises.
Keywords— Wireless, Remote patient monitoring, TCP protocol, GSM, power
line, SMTP protocol, web publishing, heart rate, blood pressure, ECG, ICU.
I. INTRODUCTION
In this era of 22ND
century, technology has entered the daily life of common man and is

2. 26518 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
changing the way we think, we eat, and in more broader sense our day-to-day life. It is
continuously improving the life of common man by offering the best possible solutions
to the problems faced by a common man everyday. One such field where technology
has vast impact is the biomedical branch. The advancement of technology in this field
has led to various improvements and discoveries to cure various simple as well as
chronic diseases.
On the similar note, one such area where the advantages of technology can be felt
is the intensive care unit (ICU) in a hospital. Here through technology various non-
invasive way of measuring various parameters has been developed. In this paper we
measure few of these parameters like blood pressure using a technique called
photoelectric-plethysmography(PPG), ECG and parameters associated with it, heart
rate(through ECG waveform) and body temperature non-invasively. In hospitals, for an
ICU patient continuous monitoring of various parameters is required and since monitors
are located in one room, the physician has to visit the room multiple times and estimate
patient’s blood pressure, heart rate, body temperature, etc. In case of emergencies the
physician has to depend on others to get the information. To solve the above mentioned
problem, a mechanism must be present so that the physician can themselves get these
values. This paper aims at devising a mechanism to sort out this problem.
Firstly it is important to get all these parameters at one place so we build a
graphical user interface using NI LabVIEW. Here the various parameters like ECG,
blood pressure heart rate and other parameters are available. Next comes the data
transfer part which aims at providing the data to physician at normal situations as well
as at the time of emergency. So we have proposed five ways to send the data to the
physician keeping in mind that the physician themselves can check the parameters and
advise medications. Thus this can considerably reduce errors and patient can get the
best possible treatment.
Firstly we propose data transfer using TCP/IP protocol to send real-time data
from patient computer to any other inter-connected computer in hospital so that many
patients can be monitored at a same place and doctor present anywhere inside hospital
premises can respond to the patient.
Another factor that must be considered in medical treatment is the non-availability
of proper instruments and infrastructure in rural areas and hence TCP/IP protocol is
difficult to implement. So to design a robust ICU monitoring system, we propose the
transmission of important data through power line. With the help of this mode of data
transfer, there is no need for complex and costly network of computers. Through the
power lines present inside a room, for short distance we can transmit the data from one
computer to other. But there are limitations associated with this method. Firstly through
this method it is not possible to transmit graphical data to another computer or a
network. Secondly, it gives accurate results only if used for a short range.
Thirdly, there might be situations at times of emergency needed physician is not
present at premises. So to make monitoring possible, we have published all the
parameters associated with the patient over the internet using NI LabVIEW. So if
doctor is at home or busy in some other task and have internet connectivity, at the time
of emergency he can still view all the live data of the patient on a specific website. Also

3. A Real-time remote ICU patient monitoring system using TCP protocol 26519
an email can be generated to the e-mail id of the doctor where the real time data can be
viewed.
Another feature that has been added to provide information during emergency is
the GSM support. If doctor is outside hospital and don’t have internet connectivity, he
can still get all the information sent on his phone as a text message.
Thus, in this paper we propose a complete monitoring of intensive care unit in a
hospital using the above mentioned data transfer protocols.
II. DESIGN OF THE SYSTEM
A. Block Diagram of the proposed system
In this block diagram we are showing the hardware setup of our system. In the
proposed setup we have used and also developed sensors to calculate various
parameters related with the patient. These sensors are interfaced with a microcontroller
and finally the collected data is given to a computer using serial communication. On
computer using LabVIEW’s Virtual instrument we have made a complete setup needed
to monitor these parameters (client side). For taking data from PPG sensor unit, ECG
sensor and RTD PT100 and sending the data to the computer having LabVIEW, we
have used NDAQ 9215 and for thermocouple we have used NDAQ 9211. The block
diagram is shown in Fig. 1(a).
Fig. 1(a) Block diagram showing the input system
In Fig. 1(b), the block diagram shows how data can be transferred from client side
to server side using either the TCP/IP protocol or through power line. In case of
emergency data can be transferred from server computer to the phone or e-mail id of the
doctor using GSM technology and SMTP protocol respectively.

4. 26520 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
Fig. 1(b) Block diagram showing data transfer from server to client
Obtaining ECG signal
To obtain ECG waveform (and from it we have calculated heart rate, QRS interval, Q-T
interval and R-R interval), we have used AD8232 sensor. Fig.2 shows the block
diagram to get the ECG signal.
Fig. 2 Block diagram to get ECG Signal and hence estimate other parameters
Through DAQ Assistant function, we designed a VI and displayed the raw signal
that is acquired in the graph by setting proper sampling frequency. We used DSP toolkit
in LabVIEW to calculative R-R interval, QRS, QT interval. Since we did not use any
filter, so we got quite alternating values for QRS complex and QT interval. But R-R
interval was found to be quite accurate. Using this, later pulse rate is calculated.
B. Calculating blood pressure
To calculate heart rate we will be using the technique called Volume Oscillometry
(VO). This method employs photoelectric plethysmography (PPG) to detect the
volume of blood changes in the artery. The VO method is similar to the oscillometric
method except that it is based on arterial blood volume oscillations instead of cuff
pressure oscillations. The disadvantage of cuff based system is that it can provided one
reading in let’s say 10 minutes. So it is not suitable for continuous monitoring.
In our designed system, a high intensity LED is placed at one side of a finger and
a LDR (Light Dependent Resistor) is placed at another side. In our method we have
used visible light source to obtain PPG instead of using IR light sources as prolonged

5. A Real-time remote ICU patient monitoring system using TCP protocol 26521
exposure to IR light can create problems for patients.
The light is absorbed by the blood, mussels, skin and bones of the finger. With the
change of blood pressure the volume of blood vessels are varied while the volume of
other parts of the finger remains constant. So the light absorption is varied only by the
change of volume of blood. We know the resistance of the LDR is high in dark and
becomes low when light falls on it. Its resistance is inversely proportional with light
intensity. Thus with the change of light intensity being absorbed by LDR, the voltage
also changes and hence we get a PPG waveform. During systolic pressure the light
absorbed is less and hence resistance is more. Hence we get higher voltage during
systolic pressure. Similarly during diastolic pressure absorbed light is more and hence
we get lower voltage reading. The resistance change of LDR is very less and hence as
output we get a low frequency and very low amplitude AC signal with a high amplitude
DC signal. To remove this DC bias we have formed a signal conditioning circuit
Fig.2 shows the block diagram of the system.
Fig.2 Block diagram for calculating blood pressure and other parameters
As said above the output signal of LDR contains large DC bias. So in signal
conditioning circuit we have used subtractor circuit to nullify the DC bias. But the
frequency of AC signal is less than 1.5 Hz, so we can’t use filters. So we make use of
LM358 op-amp for the subtractor circuit which acts as automatic reference selector to
nullify the dc bias. The signal conditioning circuit can be seen in Fig. 2.

6. 26522 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
Fig.3: Shows the design of the double stage amplifier
This circuit can be analysed in two parts or two stages:
In the first stage,
Where,
Since, R8= 820KΩ and R9= 10KΩ, A01= 82.
Therefore,
In second stage,
Where, R7= 820KΩ and R6= 1KΩ, Ao2 =820.
Therefore,
Aot = Ao1*Ao2 = 67240
Where R7= 820KΩ and R6= 1KΩ
Vo2 = 67240(Vin - Vref)
The output of the amplifier is then taken by the DAQ assistant and further
parameters like systolic and diastolic pressure are calculated in LabVIEW. To calculate
the pressure the input signal is passed through analog to digital counter and the resultant
digital signal is quantized. In the quantized signal the one which is greater gives systolic
pressure while the one which is least gives the diastolic pressure values. The results are

7. A Real-time remote ICU patient monitoring system using TCP protocol 26523
continuously displayed on the designed VI of LabVIEW. For continuous monitoring of
blood pressure our developed system is to be calibrated with a standard system before
measurement. The accuracy of this system depends mainly on this calibration. The
amplifier calibration is done using sphygmomanometer for different patients. This is
done because our developed system is based on volume oscillometric method and
different patients have different blood volume in their fingers. So every time proper
calibration is required before recording accurate readings of different patients. But once
the calibration is done for a subject, it can continuously display SP, DP of the subject
without any faulty results.
The formulae for other derived parameters are given below.
Pulse Pressure (mm Hg) = Systolic Pressure – Diastolic pressure.
Mean Arterial Pressure (MAP) (mm Hg) = 1/3(pulse pressure) + diastolic
pressure
C. Body temperature
In the system RTD PT 100 is used to measure body temperature. The advantage of
using PT100 is that it gives 100ohms resistance at zero degrees Celsius. The output of
PT100 is approx 10mV at 37 ᵒC. LM 358 is used as current mirror which gives
current output of 1mA. RTD output is taken by the DAQ assistant and the temperature
is derived by further analysis in NI LabVIEW
D. Room Temperature
We have also included in our system a sensor to show us the room temperature. This
offers a great advantage in places (like hospitals rural areas) where system for
monitoring room temperature is not available.
To calculate we have used a thermocouple whose output is given to cDAQ. The
output is taken by the DAQ assistant and room temperature displayed on designed VI in
LabVIEW.
E. TCP/UDP Protocol
To broadcast data from the patient’s room to the monitoring room, we used TCP/UDP
protocol. It is an wired protocol, so the computers must be connected to a network. The
computer connected directly to the patient will act as server and the computer in the
Monitoring room will be a client. Now in LabVIEW, we use UDP write function to
create a VI that will send the data continuously through the Ethernet cable on the Client
side. We will design another VI using a UDP read function and other necessary tools
for the output visualization (graph indicators etc.) On the client side to receive the data
from the cable .The IP address of the Computer that will be used in the monitoring
room is fed in the server side. After that both the VI’s are run simultaneously and the
corresponding changes can be noticed in the client side (monitoring room).
TCP/UDP enables us to form a stable live broadcasting from the server side to the
client side. But the whole setup is limited to a room since it is a wired protocol. To
initiate broadcasting of the patient’s data to the doctor on far side (say his room), we go
for Web publishing.

8. 26524 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
F. Web publishing
To take the monitoring to the far side, we went for web publishing. Through web
publishing we are publishing our whole VI in the internet in a webpage .Using web
publishing toolkit in LabVIEW; we can publish our data (in fact the complete VI) in the
Internet. It asks for remote control of the VI, by enabling it we can control our VI from
a web browser. We can set the Title, Header and Footer of our webpage. After that an
html link gets generated. We need to download some necessary plug-ins to view the
content of the webpage. The plug-in is free to download from The National Instrument
website. Using the same link on any other computer (connected to Internet), we can
view the entire VI from the patient side.
Web publishing solves the limitation of TCP/UDP protocol, now a doctor sitting
anywhere in the world can view the exact Dynamic results of his patient provided he
has connectivity over the internet.
G. SMTP protocol
It is just an extension of the monitoring system. There is a SMTP function palette
already available in LabVIEW. We used SMTP Email Send message to send a mail
from the monitoring room to doctor in case of an emergency by specifying the mail
address of the recipient. The sender needs to feed his/her Log-in details along with
Mail server. After the VI is run, the LabVIEW will send a mail from the sender’s email
ID to the recipient’s ID.
H. GSM text alerts
We also used GSM to ensure that if all the above protocols fail, the doctor must at least
get a report if there is a sudden emergency situation.
Here we have used a Serial enabled GSM modem. We connected the modem to
the pc using a Serial RS232 interface. Then we have designed a Serial communication
VI in the LabVIEW using VISA Write function and passed the AT commands serially
to the modem and accordingly a text containing the various parameters is sent.
The AT commands used in the implemented are as follows:-
AT+CMGS:-Used to send message to a phone no.
AT+CMGF:-Used to set SMS format. Here text format is used.
AT+CMGW:-Used to store message in the SIM.
In virtual assistant designed in LabVIEW we have mentioned a normal range for
the measured parameters. Also in the VI an external button is provided to send data as
text. Hence in GSM part, the working can be seen as two cases.
The first case will be the normal mode of operation. In this mode the measured
parameters for the patient are in normal range. Also the GSM module sends text to a
particular phone number only when a person monitoring the VI enables the respective
command button in VI. The text will be sent to the phone of respective doctor.
The second case is when the patients measured parameters deviates from the
normal range. At this point in VI graphically the concerned parameters are shown in red

9. A Real-time remote ICU patient monitoring system using TCP protocol 26525
color. Along with this text message is automatically sent from the respective GSM
connected SIM to the phone number of a doctor as well as a sub-ordinate doctor.
Thus GSM technology can be used to send the patients report even if all other
medium fails.
I. Power Line
We used a power line modem PLC 1187 from Sunrom Technologies to establish a
power line communication. The phase and neutral from the distribution box is
connected to the positive and negative of the modem respectively. The modem is
interfaced to the computers via a Serial RS232 interface. So accordingly a serial
communication VI is designed in the LabVIEW .Using VISA write function from the
client side (Patient), all the parameters are passed to the server side (monitoring) via
power cables. On the receiver side, the parameters are taken serially from the modem to
the LabVIEW using VISA Read function. Fig.4(a) shows the block diagram and
Fig.4(b) shows the IC used for power line communication.
In power line communication broadcasting is not possible for dynamic values, we
need to store the static values and then draw a curve to denote dynamic signals like
ECG, which will cause a slight delay between the transmitter and the receiver, which is
forbidden because delay is not an option in medical Science. Moreover, it is very much
prone to noises and it suffers signal attenuation which can prove quite fatal. So it must
be avoided as much as possible. TCP /IP are better alternatives. We included power line
as the least priority. It should be used only when every other option fail.
Fig. 4(a): Showing block diagram for power line communication

10. 26526 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
Fig. 4(b): Showing the IC used for power line communication
III. WORKING OF THE SYSTEM
In the starting the biomedical parameters like ECG, PPG, body temperature and room
temperature are measured and fed to client computer. On the client computer all the
parameters proposed are calculated and displayed on the VI. After calculation of
biomedical parameters the values are sent to server computer using either TCP/IP
protocol or through power lines. After that it is checked whether the few parameters
namely heart rate, body temperature and blood pressure are in normal range. If they
exceed the normal range, the parameters are shown in red color in VI to alert the person
monitoring the server computer. Also a text message containing information regarding
the measured parameters is sent to the phone number of the doctor. Now if doctor is
busy and does not acknowledge the message then buzzer will be ringed. If doctor
acknowledges the message he can request the data to be sent as e-mail to his e-mail id.
If the measured parameters are in normal range then simply the data is shown in VI in
normal manner. Also doctor can request information regarding the measured
parameters sent to him as text message or e-mail id or both. The message or e-mail are
sent manually by the person monitoring the server computer using respective command
buttons.
The working of the proposed system can be illustrated using the flowchart as
shown in Fig.5.

11. A Real-time remote ICU patient monitoring system using TCP protocol 26527
Fig.5: Shows the flowchart explaining the working of the system
IV. RESULT AND CONCLUSION
Remote monitoring of patient was discussed in this paper. The proposed system offer
many advantages in the hospitals because of its advanced technology and step by step
structure where if one method fails, other method is used for data transfer. Also for
measuring parameters like heart rate, blood pressure, ECG graph we have used
embedded systems in contrast to DSP processors. The work of DSP processing is
achieved in LabVIEW. Thus it makes it a low cost alternative for hospitals where
computers are readily available.
In the proposed system the TCP protocol (our first priority in data transfer
protocol) allows for efficient and accurate monitoring of patient in the whole hospital

12. 26528 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
premises. Also with the usage of web publishing and GSM technology, it makes it an
efficient system for long distance monitoring. Also in absence of viability of resources
like internet or resources for TCP protocol in rural areas, we have proposed data
transmission through power lines from server to client. Thus the step by step structure
of the proposed system where other method is used if one system fails allows for
efficient remote monitoring of the patient.
A. Result:
The proposed remote monitoring of ICU patients was tested rigorously. The first part
which is taking input of various parameters of the patient was tested under a certified
physician over various patients as well as normal people and the achieved results were
same as the ones measured by the physician except for the PP and MAP. According to
American National Standard for electronics or automated sphygmomanometers, the
mean difference should be ±5 mm Hg or less with a standard deviation (SD) of ±8 mm
Hg or less. So from the above table the difference in PP and MAP of our system with
sphygmomanometer is under standard rule. Therefore, the proposed results are quite
reliable and according to international standards.
The second part which is our main concerned area, the data transmission part was
also properly verified. The proposed system as it is a hardware project, the parameters
values are shown in the VI (virtual assistant) of LabVIEW. A few test results are shown
below which show successful implementation of proposed system. Figure 6(a) shows
the hardware setup to obtain PPG waveform. Figure 6(b) and (c) shows the obtained
PPG waveform. In figure 6(b), the amplitude of the peak is used to calculate the systolic
pressure while the amplitude of the peak in figure 6(c) is used to calculate the diastolic
pressure. The results were obtained and were verified with the readings obtained by
physician using normal cuff system assembly. Figure 7(a) shows the AD8232 sensor
used by us to obtain ECG signal and (b) part shows the obtained raw ECG signal. Now
using the obtained parameters we further calculate other parameters of importance and
show the required parameters at one place by designing a VI(virtual instrument) on
LabVIEW. Fig.8 shows the designed VI. Now the data are transferred from client
computer to server computer for monitoring. Fig. 9(a) shows the implemented TCP/IP
protocol. The first computer is the client (patient side) and the second computer is the
server computer (monitoring side). Fig. 9(b) shows the VI obtained on client side.
Fig.10(a) shows the web publishing of the VI on internet whereas the (b) part clearly
shows the address where the VI is published. Lastly Fig. 11(a) part shows the
implementation of GSM where the information regarding the measured parameters are
sent as text and received on the phone of the doctor. Fig. 11(b) shows the data received.

13. A Real-time remote ICU patient monitoring system using TCP protocol 26529
Fig. 6(a): Shows the circuit to obtain PPG waveform
Fig. 6(b): Shows the PPG waveform obtained. The measured amplitude is used to
calculate systolic pressure
Fig. 6(c): Shows the amplitude of other peak used to calculate diastolic pressure

14. 26530 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
Fig. 7(a): Shows the AD8232 sensor which was used to obtain ECG signal
Fig. 7(b): Shows the obtained raw ECG signal
Fig. 8: Shows the designed VI on NI LabView

15. A Real-time remote ICU patient monitoring system using TCP protocol 26531
Fig. 9(a): Shows the implementation of TCP protocol. Left computer is the server
and the right one is the client computer.
Fig. 9(b): Shows the obtained VI on client’s computer.
Fig. 10(a): Showing the web publishing of VI on a specific website

16. 26532 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya
Fig. 10(b): Showing the web address of published VI in internet explorer
Fig. 11(a): Shows the implementation of GSM part
Fig. 11(b): Shows the text message received on client’s phone with patients
report.

17. A Real-time remote ICU patient monitoring system using TCP protocol 26533
Acknowledgement
We are very thankful to Dr. Thanikaiselvan, VIT UNIVERSITY for guiding us through
the entire process. We are also thankful to Dr.Purushothaman Surendran,VIT
UNIVERSITY for motivating us throughout the process.We are very grateful to the
Entire TIFAC team for giving us components and the necessary platform to test our
Idea.
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18. 26534 D. Shalini, Rajarshee Dhar and Kaushik Bhattacharya