Development of Remote Monitoring Cardiac Patients
System Based on GPRS
Cai Ken
Information College
Zhongkai University of Agriculture and Engineering
Guangzhou, China
caiken218@gmail.com
Abstract—Nowadays, the electrocardiograph (ECG) is certainly
the most effective tool to identity anomalies in the cardiac
activity. In this paper, we propose a remote medical monitoring
system for ECG data. The system is composed of two parts,
which are portable remote medical monitoring unit and the
monitoring center. The portable remote medical monitoring unit
consists of Advanced RISC Machines (ARM) with the embedded
operating system, a custom ECG board, and a GPRS module
capable of transmitting information to processing centers. The
monitoring center is composed of the monitoring station and the
information processing system which realizes information
management, real-time analysis, wireless transmission, a warning
mechanism for emergency and ECG diagnosis. The aim of this
project is to provide an ECG medical monitoring for the user
(patient or potential patient) at any time and any place, if there is
any abnormal change of ECG data.
Keywords- GPRS; ECG monitoring system; ARM; uclinux
I. INTRODUCTION
The incidence of heart and vascular diseases nowadays are
much higher than before. Moreover, because of the ageing of
the population and high pressure on life or job, the number of
cardiac deaths is steadily increasing. It is very important to
quickly identify a heart attack and immediately contact to the
medical specialists. Heart disease is the world's greatest killer,
thus any improvement in diagnosis and treatment tools are
welcomed by the medical community. In modern medicine,
there are sorts of method to diagnose heart disease, such as
electrocardiogram (ECG), ultrasound, MRI, CT and so on.
Among these methods, ECG diagnosis has the advantages of
convenience and low cost so that it can be used in a wide area.
However, in a traditional ECG monitoring system, a quite
bulky and cumbersome instrument with multiple cables and
electrodes is used, where patients are required to lie down and
remain still or restricted to move within a limited area. This
bulkiness is due to electronics involved in obtaining high
quality signals from the confounding effects of patient
movement and electrode attachment artifacts. New wireless
technologies make possible the implementation of high level
integration wireless devices which allow the replacement of
traditional large wired monitoring devices. The entire process
of obtaining ECG signals from patients can be greatly eased
978-1-4244-5316-0/10/$26.00 ©2010 IEEE
Liang Xiaoying
Guangdong Women's Polytechnic College
Guangzhou, China
devfpga@126.com
with the use of portable system that allows remote monitoring.
With the help of these portable ECG devices, patients are free
to move without cables connecting to a stationary instrument.
In recent years, some works focus on optimization of ECG
sensing methods, such as many portable ECG devices have
been invented in terms of size, weight, performance and
privacy [1-2], many of which are based on low-power digital
signal processor [3]. Some works tend to use emerging wireless
transmission solutions like Bluetooth [4-5] and ZigBee
technology [6-7] to improve mobility and minimize power
consumption of the wearable part. These inventions carries out
some advantages: the patients often are released from the
hospital to give the priority to other heart patients on the
waiting list, whom need to be hospitalized immediately. It does
not only have an important positive economic impact, but it
also produces an increment of the social wellbeing.
Furthermore, it makes possible the continuous supervision
during patients’ quotidian life, for instance, some of heart
medicaments are effective only when the patients have
minimum activity, namely, when they are hospitalized, but
these medicaments are not so effective at home, where the
patients have normal or higher activity level. In this case,
monitor some heart patients in longer period of time to provide
more certain documentation for the treatment's correctness is
an added advantage.
The main objective of this project is to develop a system
that can be supplemented with real-time wireless monitoring
systems which are designed and implemented through GPRS
network and are able to record and transmit biosignals of
patients. This study attempts to track patient cardiac data.
However, similar techniques could be used to monitor other
bodily variables like temperature, blood-sugar content,
breathing patterns, weights and lipid levels. The reminder of
this paper is organized as follows: The system level design is
described in Section II. The implementation of each module is
detailed in Section III. Section IV covers the plans for future
development and optimization.
II. SYSTEM ARCHITECTURE
We develop a wireless sensor network system using GPRS
network, which focus on sensor network, control and health-
care related applications. The system is composed of two parts, known as the atrial complex; the QRS complex corresponds to
which are portable remote medical monitoring unit and the the current that causes contraction of the left and right
monitoring center as shown in Fig. 1. First, ECG data is ventricles; the T wave represents the repolarization of the
acquired by using electrodes attached to body skin, and then ventricles; and the U wave, although not always visible, is
transferred through first amplifier, high-pass (HP) filter, low- considered to be a representation of the papillary muscles or
pass (LP) filter, second amplifier and A/D converter Purkinje fibers [9]. Any deviation from the norm in a particular
successively; then, the data, after being digitalized by the electrocardiogram is indicative of a possible heart disorder.
embedded A/D and processed in LPC2478, is connected onto
the GPRS communication module in the serial mode(RS232)
in the form of data stream, and transmitted through the
communication with the GPRS base station; after this, the base
station SGSN(Serving GPRS Support Node) carries on the
correspondence with GGSN(Gateway of GPRS Supporting
Node), while GGSN does some processing to the grouped
information, which is then transmitted to Internet through
GSN(GPRS service node); finally, GSN finds the monitoring
center server on the Internet according to an assigned IP
address, and saves the information into the monitoring center
server. The doctors judge the patient health state by their
experiment and the analyzed results of the ECG analysis
software which is developed by NI LabVIEW programming
language, and provide the doctor's advice in real time. For the
Figure 2. Example of a normal ECG trace
patient who suffers a heart shock will get first-time treatment
and the efficiencies of rescuing are increasing.
B. Amplifier and Filters
A normal ECG signal falls in the range of 1–5mV.
Amplifier is required to increase this weak signal into an
acceptable level for practical purposes. However, due to the
existing noises that have a much stronger voltage level than
ECG signal, the gain of the amplifier should not be too big
otherwise the useful signal would be lost in noises. Considering
these, the amplification system consists of two-stage
amplification where the first stage is the instrumentation
amplifier and the second stage is the operational amplifier. We
choose AD620 as the preliminary difference mode amplifier to
obtain high CMRR in appropriate magnification. The
magnification time is 11. The second stage amplifier was
designed having a changeable gain via a rheostat from 1 to 100.
Thus the overall gain of the system can reach 1100.
Figure 1. Topology for wireless ECG sensor network

III. MATERIALS AND METHODS

A. ECG signal
ECG is abbreviated from the word electrocardiogram, or
alternatively called EKG, which is the abbreviation of the
German word elektrokardiogramm. An ECG is a graphical
display produced by an electrocardiograph, which records the
electrical activity of the heart over time. Electrocardiograms
are made by applying electrodes to various parts of the body to
lead off the tiny heart current to the recording instrument. The Figure 3. Analog acquisition stage block diagram
normal electrocardiogram shows typical upward and
downward deflections that reflect the alternate contraction of On the other hand, the ECG signal has the frequency range
the atria (the two upper chambers) and of the ventricles (the 0.05-100Hz. It is quite sensitive to environmental and
two lower chambers) of the heart [8]. Fig.2 shows an example biological noise and artifacts. After amplification, this type of
of a normal ECG trace, which consists of a P wave, a QRS signal distortion can be removed with a passive high-pass filter
complex and a T wave. A small U wave may also be with a cut-off frequency of 0.5 Hz. And a 5th order
sometimes visible, but is neglected in this work for its Butterworth low pass switch capacitors filter with cutoff
inconsistency. The P wave is due to atrial contraction and is frequency of 100 Hz was also utilized to attenuate high
frequency components. Besides, in order to remove the 50Hz
power line interference, a right-leg driver is employed to inject
common-mode signals back into the body to cancel them out
and further attenuate the noise. The analog stage's block
diagram is shown in Fig. 3.
C. The Main Control Module
There were lots of microcontrollers that were used in ECG
monitor, from 8-bit to 32-bit microcontroller, as well as
DSPs[10]. In this design, we chose an ARM7TDMI-S core
based microcontroller called LPC2478, which is the production
of NXP Semiconductors. The LPC2478 microcontroller has
512 kB of on-chip high-speed flash memory. This flash
memory includes a special 128-bit wide memory interface and
accelerator architecture that enables the CPU to execute
sequential instructions from flash memory at the maximum 72
MHz system clock rate. The LPC2478, with real-time debug
interfaces that include both JTAG and embedded trace, can
execute both 32-bit ARM and 16-bit Thumb instructions. The
LPC2478 microcontroller incorporates an LCD controller, a
10/100 Ethernet Media Access Controller (MAC), a USB full-
speed Device/Host/OTG Controller with 4 kB of endpoint
RAM, four UARTs, two Controller Area Network (CAN)
channels, an SPI interface, two Synchronous Serial Ports
(SSP), three I2C interfaces, and an I2S interface [11].These
features make this device optimally suited for portable
electronics and Point-of-Sale (POS) applications. In addtion,
LPC2478 includes a 10-bit ADC with external eight-channel.
With this, there is no need for an addition of AD conversion
device in external system. The main controller is to accomplish
the conversion from analog amplification ECG signal collected
by acquisition module to A\D signal, encode the signal and
enable LCD to display electrocardiogram, send to the GPRS
module through Universal Asynchronous Receiver/Transmitter
(UART) port.
D. Introduction of GPRS and Transmission Module
The General Packet Radio Service (GPRS) is a connectivity
solution based on Internet Protocols supporting a wide range of
enterprise and consumer applications available now with
almost every GSM network. GPRS is a method of enhancing
2G phones to enable them to send and receive data more
rapidly. It promises data rates from 56 up to 114 Kbps and
continuous connection to the Internet for mobile phone and
computer users. GPRS supports a number of data services such
as Short Message Service (SMS), Multimedia Messaging
Service (MMS), Wireless Application Protocol (WAP) access,
as well as Internet communications services (Email and World
Wide Web access). Additionally GPRS customers enjoy a
number of advanced, feature-rich data services such as color
Internet browsing, e-mail on the move, video streaming,
multimedia messages and location-based services. GPRS data
transfer is typically charged per megabyte of traffic transferred,
while data communication via traditional circuit switching is
billed per minute of connection time, independent of whether
the user actually is using the capacity or is in an idle state.
GPRS is a best-effort packet switched service, as opposed to
circuit switching, where a certain quality of service (QoS) is
guaranteed during the connection for non-mobile users.2G
cellular systems combined with GPRS are often described as
"2.5G", that is, a technology between the second (2G) and third
(3G) generations of mobile telephony. It provides moderate
speed data transfer, by using unused Time division multiple
access (TDMA) channels in, for example, the GSM system.
For many operators, the adoption of GPRS has been a fast and
cost-effective strategy that supported the real first wave of
mobile Internet services [9].
Prioritizing easy operation, a GPRS module SIM300
provided by Simcom is chosen to be the transmitter/receiver so
that the user could send his/her ECG signals at anytime
wherever GSM coverage is present.SIM300 is a Tri-band
GSM/GPRS engine that works on frequencies EGSM 900
MHz, DCS 1800 MHz and PCS1900 MHz. SIM300 provides
GPRS multi-slot class 10 capability and support the GPRS
coding schemes CS-1, CS-2, CS-3 and CS-4.With a tiny
configuration of 40mm x 33mm x 2.85 mm, SIM300 can fit
almost all the space requirement in your industrial application,
such as M2M, Telematics and other mobile data
communication systems. SIM300 provides all hardware
interfaces between the module and customers’ boards except
the RF antenna interface. The two serial ports can help you
easily develop your applications. It is designed with power
saving technique, the current consumption to as low as 2.5mA
in SLEEP mode. Also the SIM300 is integrated with the
TCP/IP protocol, Extended TCP/IP AT commands are
developed for customers to use the TCP/IP protocol easily,
which is very useful for those data transfer applications [12].
Communication between the microcontroller and the
SIM300 is made through an UART interface. It has been set to
57600bps, 8-bit data, 1 stop bit and non parity. The module
transmits the data grouped in logical frames. And it can be used
as a modem in a computer system to connect to Internet; even
there is no TCP/IP protocol stack in the software. These ensure
the security of data transmission. GPRS facilitates instant
connections whereby information can be sent or received
immediately as the need arises.
E. Implementation of Personal Monitoring Terminals
In order to develop the ECG related software just like
developing application software in Personal Computer (PC),
the system uses an Operating System (OS) named uClinux.
uClinux is a Linux derivative intended for microcontrollers
without Memory Management Unit (MMU). It's free and open
source software under GNU Public License. The original
uClinux is a derivative of Linux 2.0 kernel intended for
microcontrollers without Memory Management Units (MMUs).
However, the Linux/Microcontroller Project has grown both in
brand recognition and coverage of processor architectures.
Today's uClinux as an operating system includes Linux kernel
releases for 2.0 2.4 and 2.6 as well as a collection of user
applications, libraries and tool chains. The uClinux is much,
much smaller than Linux kernel while retaining the main
advantages of Linux OS: stability, superior network capability
and excellent file system support. We ported uClinux operating
system on the NXP LPC2478 platform and the Embedded
Operating System (EOS) supports a lot of kernel functions to
handles interrupt, timer, task schedule and resources
management of hardware. First of all, the firmware system will
do initialization of UART, A/D conversions, LCD controller,
and then create ECG data acquisition task, data transmission
task, timer task, ISR task and so on. Finally, start these tasks.
The structure of software can be seen in Fig.4.
Bootloader
Start uClinux
Creat Task
Scheduler
ECG acquisition
task
Data transmission
task
Timer task ... ISR task
Figure 4. Firmware architecture based on uClinux multi-tasking operating
system
F. The Design of the Monitoring Center
The monitoring center consists of monitoring and control
platform and information processing system. The information
processing system which has been designed using NI
LabVIEW owns various function such as electronic medical
records, alarm systems, real-time display of ECG waves,
analysis of heart rate, etc.. And its core function is to do real-
time display against ECG waves and analysis of heart rate. The
main function of the monitoring station is to receive and
process the physiological data from the portable terminal
through the GPRS module and then store the data to certain
databases in the information processing system and form a
electronic medical record. The electronic medical record
includes the whole information of paper medical record and the
data are displayed of words, table, chart, curve and so on.
According to the individual's special situation and the
characteristics of medical records, we can setup the user's
health alarm in the system, and send voice warning message to
the user timely when the system discovers an emergency
occurs.
IV. CONCLUSION AND FUTURE WORKS
In this paper, we have demonstrated the design of an
uClinux wireless ECG monitor. The system tries to build a
continuous ECG monitoring for patient who has cardiac
disease. Based on the rapidly development of wireless
communication technique, the system consists of a portable
terminal with ECG sensors, GPRS, microcontroller and can be
transmitted to the Remote Service Center via wireless network.
It will be an important part of wireless remote monitoring
system in the future when healthcare is done anywhere at
anytime. We believe that our proposed system can have great
impact on the development of new health care monitoring
system for patients and others who may have benefit from such
a system. In future, the system CPU will use TI ultra low-
power 16-bit RISC MSP430FG439 instead of NXP LPC2478.
MSP430FG439 is mainly characterized by its ultra-low power
consumption, external high integration of CPU and portable
devices suited for low power. And TinyOS is used as an
operating system instead of uClinux for our ECG monitor. The
TinyOS is designed specifically to provide support for
embedded systems with minimal amount of physical hardware
(e.g. The TinyOS core consumes only 396 byte of
memory).Also, we can apply relative location estimation
technology by GPS in our system in order to get position of
patient indoor. The doctor will get more information about
patient for health-care.
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