M-Health can be defined as “mobile computing, medical sensor, and communications technologies for health-care.” This emerging concept represents the evolution of e-health systems from traditional desktop “telemedicine” platforms to wireless and mobile configurations. Current and emerging developments in wireless communications integrated with developments in pervasive and wearable technologies will have a radical impact on future health-care delivery systems. This editorial paper presents a snapshot of recent developments in these areas and addresses some of the challenges and future implementation issues from the m-Health perspective. The contributions presented in this special section represent some of these recent developments and illustrate the multidisciplinary nature of this important and emerging concept.

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Guest Editorial Introduction to the Special Section on M-Health: Beyond Seamless Mobility and Global Wireless Health-Care Connectivity

With an increasingly mobile society and the worldwide deployment of mobile and wireless networks, the wireless infrastructure can support many current and emerging healthcare applications. This could fulfill the vision of "Pervasive Healthcare" or healthcare to anyone, anytime, and anywhere by removing locational, time and other restraints while increasing both the coverage and the quality. In this paper, we present applications and requirements of pervasive healthcare, wireless networking solutions and several important research problems. The pervasive healthcare applications include pervasive health monitoring, intelligent emergency management system, pervasive health-care data access, and ubiquitous mobile telemedicine. One major application in pervasive healthcare, termed comprehensive health monitoring is presented in significant details using wireless networking solutions of wireless LANs, ad hoc wireless networks, and, cellular/GSM/3G infrastructure-oriented networks. Many interesting challenges of comprehensive wireless health monitoring, including context-awareness, reliability, and, autonomous and adaptable operation are also presented along with several high-level solutions. Several interesting research problems have been identified and presented for future research.

Pervasive healthcare and wireless health monitoring

Wireless telemedicine using GSM and GPRS technologies can only provide low bandwidth connections, which makes it difficult to transmit images and video. Satellite or 3G wireless transmission provides greater bandwidth, but the running costs are high. Wireless networks (WLANs) appear promising, since they can supply high bandwidth at low cost. However, the WLAN technology has limitations, such as coverage. A new wireless networking technology named the wireless mesh network (WMN) overcomes some of the limitations of the WLAN. A WMN combines the characteristics of both a WLAN and ad hoc networks, thus forming an intelligent, large scale and broadband wireless network. These features are attractive for telemedicine and telecare because of the ability to provide data, voice and video communications over a large area. One successful wireless telemedicine project which uses wireless mesh technology is the Emergency Room Link (ER-LINK) in Tucson, Arizona, USA. There are three key characteristics of a WMN: self-organization, including self-management and self-healing; dynamic changes in network topology; and scalability. What we may now see is a shift from mobile communication and satellite systems for wireless telemedicine to the use of wireless networks based on mesh technology, since the latter are very attractive in terms of cost, reliability and speed.

Wireless Mesh Networks

Advances in semiconductor technology have resulted in the creation of miniature medical embedded systems that can wirelessly monitor the vital signs of patients. These lightweight medical systems can aid providers in large disasters who become overwhelmed with the large number of patients, limited resources, and insufficient information. In a mass casualty incident, small embedded medical systems facilitate patient care, resource allocation, and real-time communication in the advanced health and disaster aid network (AID-N). We present the design of electronic triage tags on lightweight, embedded systems with limited memory and computational power. These electronic triage tags use noninvasive, biomedical sensors (pulse oximeter, electrocardiogram, and blood pressure cuff) to continuously monitor the vital signs of a patient and deliver pertinent information to first responders. This electronic triage system facilitates the seamless collection and dissemination of data from the incident site to key members of the distributed emergency response community. The real-time collection of data through a mesh network in a mass casualty drill was shown to approximately triple the number of times patients that were triaged compared with the traditional paper triage system.

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The Advanced Health and Disaster Aid Network: A Light-Weight Wireless Medical System for Triage

This paper presents the design, deployment, and empirical study of a wireless clinical monitoring system that collects pulse and oxygen saturation readings from patients. The primary contribution of this paper is an in-depth clinical trial that assesses the feasibility of wireless sensor networks for patient monitoring in general hospital units. We present a detailed analysis of the system reliability from a long term hospital deployment over seven months involving 41 patients in a step-down cardiology unit. The network achieved high reliability (median 99.68%, range 95.21% -- 100%). The overall reliability of the system was dominated by sensing reliability of the pulse oximeters (median 80.85%, range 0.46% -- 97.69%). Sensing failures usually occurred in short bursts, although longer periods were also present due to sensor disconnections. We show that the sensing reliability could be significantly improved through oversampling and by implementing a disconnection alarm system that incurs minimal intervention cost. A retrospective data analysis indicated that the system provided sufficient temporal resolution to support the detection of clinical deterioration in three patients who suffered from significant clinical events including transfer to Intensive Care Units. These results indicate the feasibility and promise of using wireless sensor networks for continuous patient monitoring and clinical deterioration detection in general hospital units.

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Reliable clinical monitoring using wireless sensor networks: experiences in a step-down hospital unit

This paper proposes a mobile patient monitoring system, which integrates current personal digital assistant (PDA) technology and wireless local area network (WLAN) technology. At the patient's location, a wireless PDA-based monitor is used to acquire continuously the patient's vital signs, including heart rate, three-lead electrocardiography, and SpO/sub 2/. Through the WLAN, the patient's biosignals can be transmitted in real-time to a remote central management unit, and authorized medical staffs can access the data and the case history of the patient, either by the central management unit or the wireless devices. A prototype of this system has been developed and implemented. The system has been evaluated by technical verification, clinical test, and user survey. The evaluation of performance yields a high degree of satisfaction (mean=4.64, standard deviation-SD=0.53 in a five-point Likert scale) of users who used the PDA-based system for intrahospital transport. The results also show that the wireless PDA model is superior to the currently used monitors both in mobility and in usability, and is, therefore, better suited to patient transport.

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A wireless PDA-based physiological monitoring system for patient transport

Purpose
The microcirculatory system of the human body is closely related to its physiological conditions. The laser Doppler flowmeter can detect symptoms through variations in the microcirculation; however, the present commercial Doppler flowmeter is very expensive, heavy, and inconvenient to carry. Therefore, an inexpensive, small, and portable laser Doppler flowmeter is proposed.

Portable laser Doppler flowmeter for microcirculation detection

Atomistic simulations of nanoindentations with spherical and Berkovich indenters were carried out to study the effects of size on nanohardness. For spherical indenters with the radii ranging from 10 A to 50 A, it was found that nanohardness was inversely proportional to the indenter radius. For Berkovich indenters, it was found that nanohardness roughly followed a trend that was inversely proportional to the indentation depth. It was concluded that the indentation size effect at the atomistic scale might follow a trend similar to that observed at the micron and sub-micron scales.

Atomistic studies of nanohardness size effects

The laser Doppler flowmeter has become an effective tool for the clinical study of microcirculation with non-invasive measurements and excellent velocity resolution. Microcirculation flow measurements cannot be used as reference criteria for circulation function. Thus, the relative change in fingertip microcirculation was measured through inflation and deflation of an automatic sphygmomanometer wrapped around the arm, and the blood pressure and functional parameters of circulation, such as biological zero (BZ), peak flow (PF) and time to peak flow (tp), were determined. For 50 healthy participants, the correlation coefficients for the laser Doppler flowmeter and oscillometric results were 0.950 and 0.838 for systolic and diastolic pressure, respectively. The mean and standard errors for both methods fell within the range specified in the Association for the Advancement of Medical Instrumentation standards. The BZ of an edema patient was about 5 times higher than normal. For patients with peripheral arterial occlusive disease (PAOD), the PF could not be determined, and the tp was about twice the normal value. The accuracy of blood pressure measurements using the laser Doppler flowmeter was comparable to that of the commonly used oscillometric sphygmomanometer, and the physiological circulation functional parameters were useful in identifying signs of edema and PAOD.

Yen-Yu Chen

Papers

A wireless PDA-based physiological monitoring system for patient transport

Portable laser Doppler flowmeter for microcirculation detection

Atomistic studies of nanohardness size effects

Application of the laser Doppler flowmeter for measurement of blood pressure and functional parameters of microcirculation.

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