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IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006                                                             1655




             A Wrist-Worn Integrated Health Monitoring
              Instrument with a Tele-Reporting Device
                    for Telemedicine and Telecare
                   Jae Min Kang, Student Member, IEEE, Taiwoo Yoo, and Hee Chan Kim, Member, IEEE



   Abstract—In this paper, the prototype development of a                       people consume a high proportion of healthcare services, and
wrist-worn integrated health monitoring device (WIHMD) with                     in the future, this proportion is likely to rise considerably [2].
tele-reporting function for emergency telemedicine and home                     In addition, emergency occurrence frequency related to the
telecare for the elderly is reported. The WIHMD consists of
six vital biosignal measuring modules, which include a fall                     elderly or patients at risk of potentially critical events is also
detector, a single-channel electrocardiogram, noninvasive blood                 increasing. In emergency situations, it has always been recog-
pressure, pulse oximetry (SpO2 ), respiration rate, and body                    nized that promptness and the appropriateness of treatment are
surface temperature measuring units. The size of the WIHMD                      the most critical factors. Recent studies have shown that early
is 60 × 50 × 20 mm, except the wrist cuff, and the total sys-                   and specialized prehospital management contributes to emer-
tem weighs 200 g, including two 1.5-V AAA-sized batteries. The
functional objective of the WIHMD is to provide information con-                gency case survival. The prehospital phase of management—in
cerning current condition, such as vital biosignals and locational              particular, accurate triage to direct the patient to the closest
information, with compromised fidelity to experts at a distance                  most appropriate facility—is of critical importance [3].
through the commercial cellular phone network. The developed                       One possible solution to the problem of delivering efficient
system will provide the facility for rapid and appropriate direc-               care to an aging population and patients in potential emergency
tions to be given by experts in emergency situations and will enable
the user or caregiver to manage changes in health condition with                environments is to introduce telemedicine and telecare by com-
helpful treatment.                                                              bining health state monitoring devices with tele-reporting func-
                                                                                tionality. To provide an effective care service, it is necessary to
  Index Terms—Biosignal measurement, cellular phone network,
emergency telemedicine, health monitoring device, home telecare,                develop a mobile patient monitor with a tele-reporting function.
ubiquitous healthcare.                                                             Existing patient monitoring devices have been used exten-
                                                                                sively in many areas of healthcare, from the hospital intensive
                                                                                care unit (ICU) to care at home [4]. Although commercialized
                          I. I NTRODUCTION
                                                                                patient monitors provide high fidelity data, and many facilities

T     HE PROVISION of healthcare in most countries is fac-
      ing common problems, namely an aging population, the
burden of chronic conditions, the increase of emergency occur-
                                                                                are using them, they are limited from the user’s perspective.
                                                                                1) They are inconvenient, that is, they are bulky and need to
                                                                                be connected to several electrodes to measure various vital
rence frequencies, an increase in the associated medical costs,                 biosignals. 2) They have poor mobility and restrict usage in
and the lack of efficient health models to provide a satisfactory                hospitals or indoors. 3) They are relatively expensive to be used
solution [1]. Of these, the main topic requiring solution is the                all the time and by people who cannot afford them. Due to these
provision of an effective medical service to the elderly and                    limitations, existing patient monitoring systems are unsuitable
emergency patients.                                                             when monitoring has to be accomplished over periods of several
   Due to the aging population in the present era, the require-                 weeks or months, as is the case for the elderly and patients at
ments for efficient healthcare for the elderly and the associated                risk of potentially critical events.
healthcare cost burden are increasing. In fact, the cost of care                   An integrated portable telemedicine system would benefit the
for those aged over 65 at present is more than ten times that for               elderly and patients in critical life conditions by providing a
individuals aged between 16 and 64 years. Moreover, elderly                     periodic health condition monitoring and a rapid response ca-
                                                                                pability in emergency situations based on information exchange
                                                                                between a patient and a professional. This type of system
   Manuscript received October 6, 2004; revised May 5, 2006. This work was      will undoubtedly result in reduced mortality and dramatically
supported in part by the Korea Science and Engineering Foundation through
the Bioelectronics Program of the Specified R&D Grants from the Ministry of      improve patient outcomes. It will benefit not only individual
Science and Technology. This paper was presented in part at the 26th Annual     users but also eventually the whole community by reducing
International Conference of the IEEE Engineering in Medicine and Biology        total healthcare costs.
Society, San Francisco, CA, September 1–4, 2004.
   J. M. Kang and H. C. Kim are with the Department of Biomedical Engi-            In this paper, we describe a wrist-worn integrated health
neering, College of Medicine, Seoul National University, Seoul 110-744, Korea   monitoring device (WIHMD) with tele-reporting function for
(e-mail: hckim@snu.ac.kr).                                                      emergency telemedicine and home telecare. Our strategy is that
   T. Yoo is with the Department of Family Medicine, College of Medicine,
Seoul National University, Seoul 110-744, Korea.                                every possible vital biosignal instrument is built into a wrist-
   Digital Object Identifier 10.1109/TIM.2006.881035                             worn unit, and a central processor supervises the operation of

                                                              0018-9456/$20.00 © 2006 IEEE
1656                                                    IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006




Fig. 1. Functional block diagram of the WIHMD system.




                                                                         Fig. 3.   Photograph of the developed WIHMD worn on the wrist.


                                                                         attached to the inner surfaces of the cuff, and a finger clip-
                                                                         type SpO2 sensor is connected to the main unit. Fig. 3 shows
                                                                         a picture of the developed system worn on the wrist. It also
Fig. 2. Schematic drawing of the prototype WIHMD.
                                                                         contains two printed circuit boards, which include analog and
                                                                         digital circuitry and other onboard sensors. The size of the
each component, analyzes the measured data, and then rapidly
                                                                         WIHMD is 60 × 50 × 20 mm, excepting the wrist cuff, and
communicates with the patient’s caregivers, such as doctors
                                                                         the total system weighs 200 g, including two 1.5-V AAA-sized
or relatives, through a connected telecommunication device.
                                                                         batteries. The total power consumption is about 150 mA with
Thus, it is possible to get rapid and appropriate directions
                                                                         3-V supply voltage in active mode, where all measuring mod-
made to handle emergency situations and to enable the user or
                                                                         ules are in operation and about 5 mA in idle mode with only the
caregiver to detect and manage changes in the user’s health.
                                                                         fall detector in operation.
The technical challenge in the development of such a device is
                                                                            The software of WIHMD was developed for operational
not only to integrate several health monitoring devices into a
                                                                         simplicity and efficiency. Considering the fact that the possible
small wrist-wearable unit but also to make the system practical
                                                                         users are relatively old and infirm, any complicated user inter-
for healthcare service that is reliable under various operating
                                                                         face would be counterproductive in daily life or in emergency
conditions, easy to operate and manage, and affordable for
                                                                         situations. The WIHMD provides relatively large graphic icons
most possible users. Ultimately, the WIHMD will enhance the
                                                                         on a 128 × 64 pixel graphic LCD and three input buttons as user
quality of life for the elderly and patients in potential emergency
                                                                         interface and connects with public telecommunication devices,
environments.
                                                                         like cellular phones, in a wireless manner. When it is ordered to
                                                                         do so, the microcontroller wakes up from a power-saving mode
                II. M ATERIALS AND M ETHODS                              and digitizes the analog output of each measurement module
                                                                         through its imbedded A/D converter with 10-bit resolution and
A. System Description                                                    100-Hz sampling rate. In emergency telemedicine mode, the
   The WIHMD consists of six vital biosignal measuring                   WIHMD starts to operate either if it automatically detects the
modules, which include a fall detector, single-channel electro-          emergency occurrence, mainly based on the fall detector output,
cardiogram (ECG), noninvasive blood pressure (NIBP), pulse               or if the wearer presses any button for longer than 5 s when
oximetry (SpO2 ), respiration rate, and body surface tempera-            he/she feels something is wrong. In this mode, the WIHMD
ture (BST) measuring units. As shown in Fig. 1, the central              performs all measurements and sends the measured data to pre-
unit of a microcontroller (ATmega103L, Atmel, USA) with                  assigned caregivers as quickly as possible. The characteristics
128 KB of in-system programmable flash, 4 KB SRAM,                        of each measurement module and telecommunication device
and programmable serial universal asynchronous receiver                  are given below.
transmitter (UART) manages the operation of each measure-
ment module and evaluates the patient state by collecting and
                                                                         B. Measurement Module and Telecommunication
analyzing the measured data. As shown in Fig. 2, the hardware
                                                                         Device Description
of the actual device is made of a wrist cuff for the NIBP
measurement and a main unit mounted on the cuff. Two textile               1) Fall Detector: Falls are one of the greatest obstacles to
electrodes for ECG and a semiconductor temperature sensor are            independent living for frail and elderly people. People of all
KANG et al.: WIHMD WITH A TELE-REPORTING DEVICE FOR TELEMEDICINE AND TELECARE                                                      1657



ages fall, but these accidents rarely cause injury for the younger   The NIBP module was constructed using a motor, pump,
members of society; however, among the elderly population,           solenoid valve, and wrist cuff from a commercialized product
they are often much more serious. Perhaps half of all falls in       (SE-309, Sein Inc., Korea) and a small semiconductor pressure
older people result in minor soft-tissue damage, but 10%–15%         sensor (MPXM2053, Motorola, USA). All electronic circuitry
cause serious physical injury [5]. So, early detection is an         and the program for oscillometric pressure measurement were
important step in providing elderly people with the reassurance      developed in this laboratory [8].
and confidence necessary to maintain an active lifestyle.                4) SpO2 : Pulse oximetry is a noninvasive method of moni-
   It is known that a combination of an accelerometer and            toring the arterial oxygen saturation level based on Beer’s law
a gyroscope must be used to accurately detect the different          for the absorption of light by hemoglobin and oxyhemoglobin.
kinds of falls [6]. We developed a simple fall detector using        The pulse oximeter makes use of the pulsatile components of
a two-axis accelerometer (MMA3201, Motorola, USA) and a              arterial blood’s absorbance values at two different wavelengths.
in-house-made posture sensor that is basically composed of a         We used red (660 nm) and infrared (940 nm) light emitting
photo-interrupter with a pendulum. As a result of a pendulum         diode (LED) as the incident light source. The reflected light is
swing, a photo-interrupter acts as an ON–OFF switch to indicate      recorded by a photodetector, and variations in light intensity
the wearer’s wrist orientation with respect to gravity. The fall     are caused by changes in flow and pressure pulsations in
detection scheme is as follows. First, the system is in idle mode    blood. Then, the SpO2 value is calculated from the level of
to minimize power consumption. If peak acceleration exceeds          variations in light intensity in each channel (Red, IR). For this
a predetermined threshold, the comparator output wakes up the        system, a SpO2 module was developed using a commercial
system into active mode. Then, after 1 s, the central processor      finger clip sensor (8000H, NONIN, USA) connected to the
unit turns on the posture sensor and reads its output for the        main unit, which includes the required electronic circuitry
next 1 s. If the output of the posture sensor indicates that the     and program.
subject’s lower arm is laid on the ground, the central processor        5) Respiration Rate: In patients with chronic obstructive
unit determines an occurrence of fall; otherwise, it just returns    pulmonary diseases and sleep apnea, it is important to evaluate
to idle mode. Using this relatively simple operational scheme,       the extent of obstruction of the respiratory system; regular
we achieved a remarkable reduction in the number of false            testing is often useful in this regard [9]. Long-term ambula-
positive alarms caused by vehicle (elevator, car, etc.) riding or    tory recording of respiration can provide more extensive and
brisk motions of arm and so on.                                      specific information about the occurrence of abnormal patterns
   Since almost all emergency situations are accompanied by          of breathing.
a fall, the fall detector remains active all the time and is            In this study, respiration rate was estimated from the R–R
crucially used to detect emergency onset. When the WIHMD             interval variation curve, which is the only possible way under
detects a fall event, it confirms whether the wearer is con-          the limitation that the measuring position is restricted to the
scious or not by raising a sound alarm. Then, if there is no         wrist. First, we calculate the R–R interval between each beat
response from the wearer in a given time (10 s), the WIHMD           from the ECG waveform using the QRS detection algorithm.
starts the vital biosignal measurements and provides the emer-       After rejecting false detection of the QRS peak using the mean
gency occurrence to preassigned caregivers with the appropriate      time interval threshold, we acquire the R–R interval variation
information.                                                         curve. Then, the respiration rate is calculated using the baseline
   2) Single-Channel ECG: ECG is widely used as one of               crossing algorithm [10].
the most simple and effective methods of continuously mon-              6) BST: Central body temperature is one of the basic factors
itoring the heart for tele-healthcare and conventional med-          that reflect homeostasis, and it can indirectly tell whether a pa-
ical care. For ECG measurement on the wrist, we used only            tient’s condition has worsened or whether the temperature of the
two textile electrodes for a single channel (Lead I), which          patient’s environment has changed. BST, as determined from
record the ECG between each arm. The textile electrodes are          wrist skin, is quite different from the central body temperature
made of a conductive sheet, which has a surface resistance of        but can be used to detect changes in a patient’s environmental
0.05–0.1 Ω/cm2 . One textile ECG electrode for the left arm          or physiological state.
is attached to the inner surface of the wrist cuff, and the right       In the developed system, the BST module was fabricated
hand must touch the other electrode at the outer layer of the        using an IC-type temperature sensor (TC1047, Microchips,
cuff. The analog circuitry of the ECG module consists of an          USA). It is small in size, low cost, consumes little power, and
instrumentation amplifier, a notch filter, and a noninverting          is highly accurate. The sensor is attached to the inner surface of
amplifier with a total gain and bandwidth of 80 dB and 40 Hz,         the wrist cuff with its sensing surface contacting the skin.
respectively. The ECG signal is converted into a digital signal         7) Tele-Reporting Device: The tele-reporting device is an
with sampling rate of 100 Hz for heart rate (HR) estimations.        essential part of telemedicine or tele-healthcare systems like
   3) NIBP: Abnormal blood pressure is the most powerful             WIHMD. In the case of emergency telemedicine, it must
cardiovascular risk factor. Regular blood pressure monitoring at     rapidly transfer the information acquired by the instrument
home in free living conditions is helpful in the management of       to caregivers. In home telecare for the elderly, such a rapid
cardiovascular diseases [7]. The accumulated NIBP data over          transfer is not necessary, but transferring the measured data to
an extended period can be used to evaluate a patient’s health        a centralized server or doctor’s personal computer is still re-
and indicate the time for medical treatment. In this study, a        quired for later examination by healthcare services. Nowadays,
conventional digital wrist sphygmomanometer was developed.           many kinds of wireless communication devices are available,
1658                                              IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006



                                                           TABLE I
                                           SUMMARY OF PERFORMANCE EVALUATION RESULTS




e.g., Bluetooth, wireless local area network (LAN), radio fre-
quency (RF) transceiver, and a cellular phone.
   In our previous research, we compared the telecommuni-
cation methods to be used with a chest strap type of patient
monitoring device for emergency telemedicine system (ETS)
[11]. Based on the results of the previous study and considering
the system complexity, power consumption, and reliability, we
chose an RF transceiver and a cellular phone for short- and
long-range telecommunications, respectively. In the developed
system, tele-reporting was accomplished in two separate ways.
The first involved an RF link between the WIHMD and a cellu-
lar phone for short-range transmission. The second involved the
transmission of information to remote caregivers and/or a server
computer through the commercial cellular phone network. We
used TXM-LC and RXM-LC (433 MHz, 10 mW, FM, LINX
tech, USA) as RF transmission and reception modules, respec-
tively; the latter is connected to a cellular phone (IM-3000, SK
Teletech, Korea) via an RS-232 connection with 38400-Bd rate.
                                                                    Fig. 4. Screen display of the data acquisition program for the performance
                                                                    evaluation test.
                         III. R ESULTS
A. Performance Evaluation
   Prior to practical application, we evaluated the performance
of each measurement module using commercialized simulators
and a test setup and by human trial as summarized in Table I.
Except the human trial cases, the transducers or electrodes of
the WIHMD were directly connected to the simulators or the
test setup. Fig. 4 shows a screen display of the data acquisition
program used for the performance evaluation test and system
debugging. This program consists of one data block in which
the measured parameters and patient information are shown
and three waveform blocks for SpO2 , ECG, and oscillatory cuff
pressure of NIBP measurement.
   Performance evaluation of the developed ECG module was
accomplished using a commercial ECG simulator (Patient-
Simulator 214B, DNI Nevada Inc., USA) [12]. For various
simulated ECG outputs with range of 40–240 bpm, the devel-
oped ECG module produced HR outputs for normal waveforms
within a mean error of ±1%. The performance of the devel-
                                                                    Fig. 5. Respiration rate detection using R–R interval variability. (Above)
oped NIBP module was verified using a commercial simulator           Real respiration waveform using a spirometer. (Below) Extracted respiration
(BPPump2M, BIO_TEK, USA) [13]. For all simulator outputs            waveform from R–R interval variability.
KANG et al.: WIHMD WITH A TELE-REPORTING DEVICE FOR TELEMEDICINE AND TELECARE                                                        1659



                                                         TABLE II
         USER NEEDS ANALYSIS OF THE HEALTH MONITORING DEVICE FOR EMERGENCY TELEMEDICINE AT FOUR DIFFERENT SITUATIONS




for wrist measurement, the developed NIBP module provided              activates the device by pressing the emergency button. Once
outputs within an error range of ±5 mmHg. In the case of the           an emergency has been detected, the main control unit sends an
SpO2 module, we used a commercial SpO2 simulator (Oxitest              emergency alarm and the patient’s health information through
plus7, DNI Nevada Inc., USA) for evaluation [14]. Over various         the connected cellular phone using the short messaging service
ranges of SpO2 levels, the output showed an accuracy within            (SMS), which is basically a text transmission service provided
an error range of ±2%. In a performance evaluation study, the          by the cellular phone company. In this study, we transferred
respiration rate was simultaneously measured using a commer-           six parameters, i.e., HR, respiration rate, blood pressure, SpO2 ,
cial spirometer (WebDoc Spiro, Elbio Company, Korea) as a              BST, and the location of the user as represented by the mobile
reference. In Fig. 5, the upper plot shows the respiratory signal      phone service base station ID. The advantages of the peer-
of the spirometer, while the bottom plot shows the extracted           to-peer SMS model are the rapid and safe transmission of
respiratory signal as the R–R interval variability from the ECG.       text messages without having to establish a centralized large-
Extensive comparative tests showed that the respiratory signal         scale service system. Furthermore, it is possible to assign
by R–R interval variability was highly correlated with the real        multiple receivers, including doctors or family members, so
respiration rate. However, the R–R interval variation is affected      that interested parties may receive the message simultaneously.
by many physiologic or emotional factors other than respira-           In addition, recently, mobile phones are being equipped with a
tion. In addition, since the respiratory signal is sampled by each     global positioning system (GPS), which can directly guide the
heartbeat, the extracted respiratory signal showed a low corre-        rescue team to the precise emergency location [11].
lation with the actual over the range of 8–18 breaths/min [10].           Due to the difficulty in applying the developed WIHMD to
   For the evaluation of the BST module, the developed module          real emergency situations, we attempted to simulate emergency
was tested inside a heated chamber at temperatures that were           situations and evaluated the performance of the system. Three
incremented over the range of 25 ◦ C to 40 ◦ C in 1 ◦ C steps. The     volunteer subjects were asked to wear the WIHMD for 16 h
results showed good linearity and an accuracy within a mean            a day during waking hours and were asked to make three
error of ±1.5%.                                                        manual emergency alarms and three simulated falls per day.
   For the evaluation of the fall detector, a total of 150 simulated   Fig. 6 shows the test result of the emergency telemedicine
cases were tested. Five human subjects were asked to try three         application. Fig. 6(a) shows typical accelerometer and posture
different types of movements, namely 1) fall while walking,            sensor waveforms with parameters and events used in the fall
2) fall while standing, and 3) sit from standing with ten times        detection algorithm, while Fig. 6(b) shows a screen display of
repetition of each. Our fall detection algorithm based on two-         the emergency event-logging program during this testing. This
stage checking of the posture after the falling acceleration           program shows the logged emergency events with records of the
signals provided a good detection rate of over 90%. Table I            patient information (ID, name, and age), the measured phys-
summarizes the results of the performance evaluation.                  iological values, event type, and position/location ID. In real
                                                                       applications, a cellular phone was wirelessly connected to the
B. Application to Emergency Telemedicine                               WIHMD and sent emergency messages and health information
                                                                       to other designated cellular phones shown on the right-hand
   The functional objective of the WIHMD with respect to
                                                                       side in Fig. 7. All subjects felt comfortable wearing the device
emergency telemedicine is to provide patient health informa-
                                                                       for 16 h. All manually activated and simulated events were
tion, such as vital biosignals and locational information, to the
                                                                       successfully detected, and the preassigned recipient cellular
nearest emergency service center in a form that allows rapid
                                                                       phone received messages correctly.
and appropriate expert response. We analyzed four possible
emergency scenarios in which the device would be useful;
                                                                                              IV. C ONCLUSION
Table II summarizes the results.
   In the emergency telemedicine mode, the WIHMD starts                   We have developed a WIHMD for use in emergency
to operate as soon as it automatically detects an emergency            telemedicine and home telecare for the elderly. The unit was de-
occurrence using its built-in fall detector or when the user           signed to provide tele-healthcare services for high-risk patients
1660                                                        IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006




Fig. 6. Test results for the emergency telemedicine application. (a) Typical waveforms of the accelerometer and the posture sensor for the simulated fall.
(b) Screen display of the emergency event-logging program.


                                                                                 rate, and 6) BST. The tele-reporting function of the WIHMD
                                                                                 was realized by wireless connection to a cellular phone. All
                                                                                 test results confirm the applicability of the WIHMD to both
                                                                                 emergency telemedicine and home telecare.
                                                                                    A shortcoming of the WIHMD is the limited fidelity of the
                                                                                 measured biosignals due to the limited body contact with an
                                                                                 area of the wrist. If we could measure biosignals at other sites,
                                                                                 such as the chest, waist, and ankle, and connect such distributed
                                                                                 measurement modules using a so-called personal area network
                                                                                 (PAN), then more and higher fidelity biosignals would be ac-
Fig. 7. Photograph of the cellular phone connected to the developed WIHMD        quired. Bluetooth will be a more promising and stable solution
and SMS display on the receiver’s cellular phone in the emergency telemedicine   in this case because it has encryption, security, low power
application.
                                                                                 consumption, ad hoc networking, and works at short range [11].
                                                                                 Furthermore, a Bluetooth mobile phone is now available, which
and the solitary elderly at “any time/any place” in an uncon-                    will be a practical solution for the central unit of a PAN.
strained fashion, in other words, ubiquitous healthcare services.                   In this preliminary study, we demonstrate that the developed
The transmitted vital information comprises six physiological                    WIHMD provides convenient and comfortable multiparameter
parameters and variables, namely 1) fall detection, 2) single-                   health monitoring for a period of weeks or months or even
channel ECG, 3) arterial blood pressure, 4) SpO2 , 5) respiration                continuous monitoring in a very cost-effective manner with
KANG et al.: WIHMD WITH A TELE-REPORTING DEVICE FOR TELEMEDICINE AND TELECARE                                                                                   1661



acceptable fidelity and reliability. With some modification and                                                   Taiwoo Yoo received the M.D. and Ph.D. degrees
a better fitting for individual applications, the WIHMD will                                                     from Seoul National University, Seoul, Korea, in
                                                                                                                1980 and 1989, respectively.
ultimately enhance the quality of life for the elderly and those                                                   From 1980 to 1984, he completed family practice
patients at risk of requiring emergency treatment.                                                              residency and fellowship with the Department of
                                                                                                                Family Medicine, Seoul National University Hospi-
                                                                                                                tal. From 1984 to 1989, he again finished residency
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     Available: http://us.fluke.com/usen/products/specifications.htm?cs_id=
     34927(FlukeProducts)&category=FB-SIMS(FlukeProducts)
[14] Specification of Oxitest Plus7. last checked 22 April 2006.
     [Online]. Available: http://www.demaco-ben.nl/01c2c9944712bfa04/
     spo2simulator/specifications/index.html


                           Jae Min Kang (S’01) received the M.S. degree in
                           biomedical engineering from Seoul National Univer-
                           sity, Seoul, Korea, in 2000. He is currently working
                           toward the Ph.D. degree at the Medical Electronics
                           Laboratory (MELab), Seoul National University.
                              Since 2001, he has been with the MELab, Seoul
                           National University. He participated in various
                           national fund projects including “Development of
                           a Ubiquitous Biotelemetry System for Emergency
                           Care,” “Development of a Intelligent Robot for
                           Supporting the Human Life,” and “Development of
a Core Technology of Silver Medical Instrument for the Elderly.” His interests
include patient monitoring technology, emergency telemedicine, and the wire-
less portable healthcare system.
   Mr. Kang is a Student Member of the Korea Society of Medical and
Biological Engineering and IEEE/EMBS.

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2006 a wrist-worn_integrated_health_monitoring_instrument_with_a_tele-reporting_device_for_telemedicine_and_telecare

  • 1. IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006 1655 A Wrist-Worn Integrated Health Monitoring Instrument with a Tele-Reporting Device for Telemedicine and Telecare Jae Min Kang, Student Member, IEEE, Taiwoo Yoo, and Hee Chan Kim, Member, IEEE Abstract—In this paper, the prototype development of a people consume a high proportion of healthcare services, and wrist-worn integrated health monitoring device (WIHMD) with in the future, this proportion is likely to rise considerably [2]. tele-reporting function for emergency telemedicine and home In addition, emergency occurrence frequency related to the telecare for the elderly is reported. The WIHMD consists of six vital biosignal measuring modules, which include a fall elderly or patients at risk of potentially critical events is also detector, a single-channel electrocardiogram, noninvasive blood increasing. In emergency situations, it has always been recog- pressure, pulse oximetry (SpO2 ), respiration rate, and body nized that promptness and the appropriateness of treatment are surface temperature measuring units. The size of the WIHMD the most critical factors. Recent studies have shown that early is 60 × 50 × 20 mm, except the wrist cuff, and the total sys- and specialized prehospital management contributes to emer- tem weighs 200 g, including two 1.5-V AAA-sized batteries. The functional objective of the WIHMD is to provide information con- gency case survival. The prehospital phase of management—in cerning current condition, such as vital biosignals and locational particular, accurate triage to direct the patient to the closest information, with compromised fidelity to experts at a distance most appropriate facility—is of critical importance [3]. through the commercial cellular phone network. The developed One possible solution to the problem of delivering efficient system will provide the facility for rapid and appropriate direc- care to an aging population and patients in potential emergency tions to be given by experts in emergency situations and will enable the user or caregiver to manage changes in health condition with environments is to introduce telemedicine and telecare by com- helpful treatment. bining health state monitoring devices with tele-reporting func- tionality. To provide an effective care service, it is necessary to Index Terms—Biosignal measurement, cellular phone network, emergency telemedicine, health monitoring device, home telecare, develop a mobile patient monitor with a tele-reporting function. ubiquitous healthcare. Existing patient monitoring devices have been used exten- sively in many areas of healthcare, from the hospital intensive care unit (ICU) to care at home [4]. Although commercialized I. I NTRODUCTION patient monitors provide high fidelity data, and many facilities T HE PROVISION of healthcare in most countries is fac- ing common problems, namely an aging population, the burden of chronic conditions, the increase of emergency occur- are using them, they are limited from the user’s perspective. 1) They are inconvenient, that is, they are bulky and need to be connected to several electrodes to measure various vital rence frequencies, an increase in the associated medical costs, biosignals. 2) They have poor mobility and restrict usage in and the lack of efficient health models to provide a satisfactory hospitals or indoors. 3) They are relatively expensive to be used solution [1]. Of these, the main topic requiring solution is the all the time and by people who cannot afford them. Due to these provision of an effective medical service to the elderly and limitations, existing patient monitoring systems are unsuitable emergency patients. when monitoring has to be accomplished over periods of several Due to the aging population in the present era, the require- weeks or months, as is the case for the elderly and patients at ments for efficient healthcare for the elderly and the associated risk of potentially critical events. healthcare cost burden are increasing. In fact, the cost of care An integrated portable telemedicine system would benefit the for those aged over 65 at present is more than ten times that for elderly and patients in critical life conditions by providing a individuals aged between 16 and 64 years. Moreover, elderly periodic health condition monitoring and a rapid response ca- pability in emergency situations based on information exchange between a patient and a professional. This type of system Manuscript received October 6, 2004; revised May 5, 2006. This work was will undoubtedly result in reduced mortality and dramatically supported in part by the Korea Science and Engineering Foundation through the Bioelectronics Program of the Specified R&D Grants from the Ministry of improve patient outcomes. It will benefit not only individual Science and Technology. This paper was presented in part at the 26th Annual users but also eventually the whole community by reducing International Conference of the IEEE Engineering in Medicine and Biology total healthcare costs. Society, San Francisco, CA, September 1–4, 2004. J. M. Kang and H. C. Kim are with the Department of Biomedical Engi- In this paper, we describe a wrist-worn integrated health neering, College of Medicine, Seoul National University, Seoul 110-744, Korea monitoring device (WIHMD) with tele-reporting function for (e-mail: hckim@snu.ac.kr). emergency telemedicine and home telecare. Our strategy is that T. Yoo is with the Department of Family Medicine, College of Medicine, Seoul National University, Seoul 110-744, Korea. every possible vital biosignal instrument is built into a wrist- Digital Object Identifier 10.1109/TIM.2006.881035 worn unit, and a central processor supervises the operation of 0018-9456/$20.00 © 2006 IEEE
  • 2. 1656 IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006 Fig. 1. Functional block diagram of the WIHMD system. Fig. 3. Photograph of the developed WIHMD worn on the wrist. attached to the inner surfaces of the cuff, and a finger clip- type SpO2 sensor is connected to the main unit. Fig. 3 shows a picture of the developed system worn on the wrist. It also Fig. 2. Schematic drawing of the prototype WIHMD. contains two printed circuit boards, which include analog and digital circuitry and other onboard sensors. The size of the each component, analyzes the measured data, and then rapidly WIHMD is 60 × 50 × 20 mm, excepting the wrist cuff, and communicates with the patient’s caregivers, such as doctors the total system weighs 200 g, including two 1.5-V AAA-sized or relatives, through a connected telecommunication device. batteries. The total power consumption is about 150 mA with Thus, it is possible to get rapid and appropriate directions 3-V supply voltage in active mode, where all measuring mod- made to handle emergency situations and to enable the user or ules are in operation and about 5 mA in idle mode with only the caregiver to detect and manage changes in the user’s health. fall detector in operation. The technical challenge in the development of such a device is The software of WIHMD was developed for operational not only to integrate several health monitoring devices into a simplicity and efficiency. Considering the fact that the possible small wrist-wearable unit but also to make the system practical users are relatively old and infirm, any complicated user inter- for healthcare service that is reliable under various operating face would be counterproductive in daily life or in emergency conditions, easy to operate and manage, and affordable for situations. The WIHMD provides relatively large graphic icons most possible users. Ultimately, the WIHMD will enhance the on a 128 × 64 pixel graphic LCD and three input buttons as user quality of life for the elderly and patients in potential emergency interface and connects with public telecommunication devices, environments. like cellular phones, in a wireless manner. When it is ordered to do so, the microcontroller wakes up from a power-saving mode II. M ATERIALS AND M ETHODS and digitizes the analog output of each measurement module through its imbedded A/D converter with 10-bit resolution and A. System Description 100-Hz sampling rate. In emergency telemedicine mode, the The WIHMD consists of six vital biosignal measuring WIHMD starts to operate either if it automatically detects the modules, which include a fall detector, single-channel electro- emergency occurrence, mainly based on the fall detector output, cardiogram (ECG), noninvasive blood pressure (NIBP), pulse or if the wearer presses any button for longer than 5 s when oximetry (SpO2 ), respiration rate, and body surface tempera- he/she feels something is wrong. In this mode, the WIHMD ture (BST) measuring units. As shown in Fig. 1, the central performs all measurements and sends the measured data to pre- unit of a microcontroller (ATmega103L, Atmel, USA) with assigned caregivers as quickly as possible. The characteristics 128 KB of in-system programmable flash, 4 KB SRAM, of each measurement module and telecommunication device and programmable serial universal asynchronous receiver are given below. transmitter (UART) manages the operation of each measure- ment module and evaluates the patient state by collecting and B. Measurement Module and Telecommunication analyzing the measured data. As shown in Fig. 2, the hardware Device Description of the actual device is made of a wrist cuff for the NIBP measurement and a main unit mounted on the cuff. Two textile 1) Fall Detector: Falls are one of the greatest obstacles to electrodes for ECG and a semiconductor temperature sensor are independent living for frail and elderly people. People of all
  • 3. KANG et al.: WIHMD WITH A TELE-REPORTING DEVICE FOR TELEMEDICINE AND TELECARE 1657 ages fall, but these accidents rarely cause injury for the younger The NIBP module was constructed using a motor, pump, members of society; however, among the elderly population, solenoid valve, and wrist cuff from a commercialized product they are often much more serious. Perhaps half of all falls in (SE-309, Sein Inc., Korea) and a small semiconductor pressure older people result in minor soft-tissue damage, but 10%–15% sensor (MPXM2053, Motorola, USA). All electronic circuitry cause serious physical injury [5]. So, early detection is an and the program for oscillometric pressure measurement were important step in providing elderly people with the reassurance developed in this laboratory [8]. and confidence necessary to maintain an active lifestyle. 4) SpO2 : Pulse oximetry is a noninvasive method of moni- It is known that a combination of an accelerometer and toring the arterial oxygen saturation level based on Beer’s law a gyroscope must be used to accurately detect the different for the absorption of light by hemoglobin and oxyhemoglobin. kinds of falls [6]. We developed a simple fall detector using The pulse oximeter makes use of the pulsatile components of a two-axis accelerometer (MMA3201, Motorola, USA) and a arterial blood’s absorbance values at two different wavelengths. in-house-made posture sensor that is basically composed of a We used red (660 nm) and infrared (940 nm) light emitting photo-interrupter with a pendulum. As a result of a pendulum diode (LED) as the incident light source. The reflected light is swing, a photo-interrupter acts as an ON–OFF switch to indicate recorded by a photodetector, and variations in light intensity the wearer’s wrist orientation with respect to gravity. The fall are caused by changes in flow and pressure pulsations in detection scheme is as follows. First, the system is in idle mode blood. Then, the SpO2 value is calculated from the level of to minimize power consumption. If peak acceleration exceeds variations in light intensity in each channel (Red, IR). For this a predetermined threshold, the comparator output wakes up the system, a SpO2 module was developed using a commercial system into active mode. Then, after 1 s, the central processor finger clip sensor (8000H, NONIN, USA) connected to the unit turns on the posture sensor and reads its output for the main unit, which includes the required electronic circuitry next 1 s. If the output of the posture sensor indicates that the and program. subject’s lower arm is laid on the ground, the central processor 5) Respiration Rate: In patients with chronic obstructive unit determines an occurrence of fall; otherwise, it just returns pulmonary diseases and sleep apnea, it is important to evaluate to idle mode. Using this relatively simple operational scheme, the extent of obstruction of the respiratory system; regular we achieved a remarkable reduction in the number of false testing is often useful in this regard [9]. Long-term ambula- positive alarms caused by vehicle (elevator, car, etc.) riding or tory recording of respiration can provide more extensive and brisk motions of arm and so on. specific information about the occurrence of abnormal patterns Since almost all emergency situations are accompanied by of breathing. a fall, the fall detector remains active all the time and is In this study, respiration rate was estimated from the R–R crucially used to detect emergency onset. When the WIHMD interval variation curve, which is the only possible way under detects a fall event, it confirms whether the wearer is con- the limitation that the measuring position is restricted to the scious or not by raising a sound alarm. Then, if there is no wrist. First, we calculate the R–R interval between each beat response from the wearer in a given time (10 s), the WIHMD from the ECG waveform using the QRS detection algorithm. starts the vital biosignal measurements and provides the emer- After rejecting false detection of the QRS peak using the mean gency occurrence to preassigned caregivers with the appropriate time interval threshold, we acquire the R–R interval variation information. curve. Then, the respiration rate is calculated using the baseline 2) Single-Channel ECG: ECG is widely used as one of crossing algorithm [10]. the most simple and effective methods of continuously mon- 6) BST: Central body temperature is one of the basic factors itoring the heart for tele-healthcare and conventional med- that reflect homeostasis, and it can indirectly tell whether a pa- ical care. For ECG measurement on the wrist, we used only tient’s condition has worsened or whether the temperature of the two textile electrodes for a single channel (Lead I), which patient’s environment has changed. BST, as determined from record the ECG between each arm. The textile electrodes are wrist skin, is quite different from the central body temperature made of a conductive sheet, which has a surface resistance of but can be used to detect changes in a patient’s environmental 0.05–0.1 Ω/cm2 . One textile ECG electrode for the left arm or physiological state. is attached to the inner surface of the wrist cuff, and the right In the developed system, the BST module was fabricated hand must touch the other electrode at the outer layer of the using an IC-type temperature sensor (TC1047, Microchips, cuff. The analog circuitry of the ECG module consists of an USA). It is small in size, low cost, consumes little power, and instrumentation amplifier, a notch filter, and a noninverting is highly accurate. The sensor is attached to the inner surface of amplifier with a total gain and bandwidth of 80 dB and 40 Hz, the wrist cuff with its sensing surface contacting the skin. respectively. The ECG signal is converted into a digital signal 7) Tele-Reporting Device: The tele-reporting device is an with sampling rate of 100 Hz for heart rate (HR) estimations. essential part of telemedicine or tele-healthcare systems like 3) NIBP: Abnormal blood pressure is the most powerful WIHMD. In the case of emergency telemedicine, it must cardiovascular risk factor. Regular blood pressure monitoring at rapidly transfer the information acquired by the instrument home in free living conditions is helpful in the management of to caregivers. In home telecare for the elderly, such a rapid cardiovascular diseases [7]. The accumulated NIBP data over transfer is not necessary, but transferring the measured data to an extended period can be used to evaluate a patient’s health a centralized server or doctor’s personal computer is still re- and indicate the time for medical treatment. In this study, a quired for later examination by healthcare services. Nowadays, conventional digital wrist sphygmomanometer was developed. many kinds of wireless communication devices are available,
  • 4. 1658 IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006 TABLE I SUMMARY OF PERFORMANCE EVALUATION RESULTS e.g., Bluetooth, wireless local area network (LAN), radio fre- quency (RF) transceiver, and a cellular phone. In our previous research, we compared the telecommuni- cation methods to be used with a chest strap type of patient monitoring device for emergency telemedicine system (ETS) [11]. Based on the results of the previous study and considering the system complexity, power consumption, and reliability, we chose an RF transceiver and a cellular phone for short- and long-range telecommunications, respectively. In the developed system, tele-reporting was accomplished in two separate ways. The first involved an RF link between the WIHMD and a cellu- lar phone for short-range transmission. The second involved the transmission of information to remote caregivers and/or a server computer through the commercial cellular phone network. We used TXM-LC and RXM-LC (433 MHz, 10 mW, FM, LINX tech, USA) as RF transmission and reception modules, respec- tively; the latter is connected to a cellular phone (IM-3000, SK Teletech, Korea) via an RS-232 connection with 38400-Bd rate. Fig. 4. Screen display of the data acquisition program for the performance evaluation test. III. R ESULTS A. Performance Evaluation Prior to practical application, we evaluated the performance of each measurement module using commercialized simulators and a test setup and by human trial as summarized in Table I. Except the human trial cases, the transducers or electrodes of the WIHMD were directly connected to the simulators or the test setup. Fig. 4 shows a screen display of the data acquisition program used for the performance evaluation test and system debugging. This program consists of one data block in which the measured parameters and patient information are shown and three waveform blocks for SpO2 , ECG, and oscillatory cuff pressure of NIBP measurement. Performance evaluation of the developed ECG module was accomplished using a commercial ECG simulator (Patient- Simulator 214B, DNI Nevada Inc., USA) [12]. For various simulated ECG outputs with range of 40–240 bpm, the devel- oped ECG module produced HR outputs for normal waveforms within a mean error of ±1%. The performance of the devel- Fig. 5. Respiration rate detection using R–R interval variability. (Above) oped NIBP module was verified using a commercial simulator Real respiration waveform using a spirometer. (Below) Extracted respiration (BPPump2M, BIO_TEK, USA) [13]. For all simulator outputs waveform from R–R interval variability.
  • 5. KANG et al.: WIHMD WITH A TELE-REPORTING DEVICE FOR TELEMEDICINE AND TELECARE 1659 TABLE II USER NEEDS ANALYSIS OF THE HEALTH MONITORING DEVICE FOR EMERGENCY TELEMEDICINE AT FOUR DIFFERENT SITUATIONS for wrist measurement, the developed NIBP module provided activates the device by pressing the emergency button. Once outputs within an error range of ±5 mmHg. In the case of the an emergency has been detected, the main control unit sends an SpO2 module, we used a commercial SpO2 simulator (Oxitest emergency alarm and the patient’s health information through plus7, DNI Nevada Inc., USA) for evaluation [14]. Over various the connected cellular phone using the short messaging service ranges of SpO2 levels, the output showed an accuracy within (SMS), which is basically a text transmission service provided an error range of ±2%. In a performance evaluation study, the by the cellular phone company. In this study, we transferred respiration rate was simultaneously measured using a commer- six parameters, i.e., HR, respiration rate, blood pressure, SpO2 , cial spirometer (WebDoc Spiro, Elbio Company, Korea) as a BST, and the location of the user as represented by the mobile reference. In Fig. 5, the upper plot shows the respiratory signal phone service base station ID. The advantages of the peer- of the spirometer, while the bottom plot shows the extracted to-peer SMS model are the rapid and safe transmission of respiratory signal as the R–R interval variability from the ECG. text messages without having to establish a centralized large- Extensive comparative tests showed that the respiratory signal scale service system. Furthermore, it is possible to assign by R–R interval variability was highly correlated with the real multiple receivers, including doctors or family members, so respiration rate. However, the R–R interval variation is affected that interested parties may receive the message simultaneously. by many physiologic or emotional factors other than respira- In addition, recently, mobile phones are being equipped with a tion. In addition, since the respiratory signal is sampled by each global positioning system (GPS), which can directly guide the heartbeat, the extracted respiratory signal showed a low corre- rescue team to the precise emergency location [11]. lation with the actual over the range of 8–18 breaths/min [10]. Due to the difficulty in applying the developed WIHMD to For the evaluation of the BST module, the developed module real emergency situations, we attempted to simulate emergency was tested inside a heated chamber at temperatures that were situations and evaluated the performance of the system. Three incremented over the range of 25 ◦ C to 40 ◦ C in 1 ◦ C steps. The volunteer subjects were asked to wear the WIHMD for 16 h results showed good linearity and an accuracy within a mean a day during waking hours and were asked to make three error of ±1.5%. manual emergency alarms and three simulated falls per day. For the evaluation of the fall detector, a total of 150 simulated Fig. 6 shows the test result of the emergency telemedicine cases were tested. Five human subjects were asked to try three application. Fig. 6(a) shows typical accelerometer and posture different types of movements, namely 1) fall while walking, sensor waveforms with parameters and events used in the fall 2) fall while standing, and 3) sit from standing with ten times detection algorithm, while Fig. 6(b) shows a screen display of repetition of each. Our fall detection algorithm based on two- the emergency event-logging program during this testing. This stage checking of the posture after the falling acceleration program shows the logged emergency events with records of the signals provided a good detection rate of over 90%. Table I patient information (ID, name, and age), the measured phys- summarizes the results of the performance evaluation. iological values, event type, and position/location ID. In real applications, a cellular phone was wirelessly connected to the B. Application to Emergency Telemedicine WIHMD and sent emergency messages and health information to other designated cellular phones shown on the right-hand The functional objective of the WIHMD with respect to side in Fig. 7. All subjects felt comfortable wearing the device emergency telemedicine is to provide patient health informa- for 16 h. All manually activated and simulated events were tion, such as vital biosignals and locational information, to the successfully detected, and the preassigned recipient cellular nearest emergency service center in a form that allows rapid phone received messages correctly. and appropriate expert response. We analyzed four possible emergency scenarios in which the device would be useful; IV. C ONCLUSION Table II summarizes the results. In the emergency telemedicine mode, the WIHMD starts We have developed a WIHMD for use in emergency to operate as soon as it automatically detects an emergency telemedicine and home telecare for the elderly. The unit was de- occurrence using its built-in fall detector or when the user signed to provide tele-healthcare services for high-risk patients
  • 6. 1660 IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT, VOL. 55, NO. 5, OCTOBER 2006 Fig. 6. Test results for the emergency telemedicine application. (a) Typical waveforms of the accelerometer and the posture sensor for the simulated fall. (b) Screen display of the emergency event-logging program. rate, and 6) BST. The tele-reporting function of the WIHMD was realized by wireless connection to a cellular phone. All test results confirm the applicability of the WIHMD to both emergency telemedicine and home telecare. A shortcoming of the WIHMD is the limited fidelity of the measured biosignals due to the limited body contact with an area of the wrist. If we could measure biosignals at other sites, such as the chest, waist, and ankle, and connect such distributed measurement modules using a so-called personal area network (PAN), then more and higher fidelity biosignals would be ac- Fig. 7. Photograph of the cellular phone connected to the developed WIHMD quired. Bluetooth will be a more promising and stable solution and SMS display on the receiver’s cellular phone in the emergency telemedicine in this case because it has encryption, security, low power application. consumption, ad hoc networking, and works at short range [11]. Furthermore, a Bluetooth mobile phone is now available, which and the solitary elderly at “any time/any place” in an uncon- will be a practical solution for the central unit of a PAN. strained fashion, in other words, ubiquitous healthcare services. In this preliminary study, we demonstrate that the developed The transmitted vital information comprises six physiological WIHMD provides convenient and comfortable multiparameter parameters and variables, namely 1) fall detection, 2) single- health monitoring for a period of weeks or months or even channel ECG, 3) arterial blood pressure, 4) SpO2 , 5) respiration continuous monitoring in a very cost-effective manner with
  • 7. KANG et al.: WIHMD WITH A TELE-REPORTING DEVICE FOR TELEMEDICINE AND TELECARE 1661 acceptable fidelity and reliability. With some modification and Taiwoo Yoo received the M.D. and Ph.D. degrees a better fitting for individual applications, the WIHMD will from Seoul National University, Seoul, Korea, in 1980 and 1989, respectively. ultimately enhance the quality of life for the elderly and those From 1980 to 1984, he completed family practice patients at risk of requiring emergency treatment. residency and fellowship with the Department of Family Medicine, Seoul National University Hospi- tal. From 1984 to 1989, he again finished residency R EFERENCES and fellowship with the Department of Family Medi- [1] F. Castanie, C. Maihes, and M. Ferhaoui, “The U-R-Safe project: A cine, Case Western Reserve University, Cleveland, multidisciplinary approach for a fully ‘nomad’ care of patients,” in “IST OH, and Bowman Gray School of Medicine. Since Project Report,” IST-2001-33352, 2002. 1990, he has been a faculty member with the De- [2] K. Doughty, K. Cameron, and P. Garner, “Three generations of telecare partment of Family Medicine, Seoul National University Hospital, where he is of the elderly,” J. Telemed. Telecare, vol. 2, no. 2, pp. 71–80, Jun. 1996. currently a Professor and Chairman. His research interest is mobile telecare and [3] B. Meade, “Emergency care in a remote area using interactive video e-health. He has granted with major telemedicine projects from the government technology: A study in prehospital telemedicine,” J. Telemed. Telecare, several times. vol. 8, no. 2, pp. 115–117, Apr. 2002. [4] W. G. Scanlon, N. E. Evans, G. C. Crumley, and Z. M. McCreesh, “Low- power radio telemetry: The potential for remote patient monitoring,” Hee Chan Kim (M’95) received the Ph.D. degree in J. Telemed. Telecare, vol. 2, no. 4, pp. 185–191, Dec. 1996. control and instrumentation engineering (biomedical [5] K. Doughty, R. Lewis, and A. McIntosh, “The design of a practical and engineering major) from Seoul National University, reliable fall detector for community and institutional telecare,” J. Telemed. Seoul, Korea, in 1989. Telecare, vol. 6, suppl. 1, pp. 150–154, Feb. 2000. From 1982 to 1989, he was a Research Member [6] B. Najafi and K. Aminian, “Measurement of stand-sit and sit-stand transi- with the Department of Biomedical Engineering, tions using a miniature gyroscope and its application in fall risk evaluation Seoul National University Hospital. From 1989 to in the elderly,” IEEE Trans. Biomed. Eng., vol. 49, no. 8, pp. 843–851, 1991, he was a Staff Engineer with the Artificial Aug. 2002. Heart Research Laboratory, University of Utah, Salt [7] I. B. Aris, A. A. E. Wagie, and N. B. Mariun, “An Internet-based blood Lake City, working on a National Institute of Health- pressure monitoring system for patients,” J. Telemed. Telecare, vol. 7, funded electrohydraulic total artificial heart project. no. 1, pp. 51–53, Feb. 2001. In 1991, he joined the faculty of the Department of Biomedical Engineering, [8] J. H. Park, J. M. Kang, and H. C. Kim, “Development of a digital College of Medicine, Seoul National University, where he is currently a wrist sphygmomanometer for emergency use,” in Proc. ICBME, 2002, Professor. From 1993 to 1994, he was a Visiting Professor with the Department pp. 181–183. of Pharmaceutics and the Artificial Heart Research Laboratory, University [9] C. Ruggiero, R. Sacile, and M. Giacomini, “Home telecare,” J. Telemed. of Utah. He is currently leading the Medical Electronics Laboratory, Seoul Telecare, vol. 5, no. 1, pp. 11–17, Mar. 1999. National University, where his major research activities are the development [10] P. Z. Zhang, W. N. Tapp, S. S. Reisman, and B. H. Natelson, “Respiration of biomedical systems with special interests in electronic instrumentations, response curve analysis of heart rate variability,” IEEE Trans. Biomed. biosensors, and microsystems for the ubiquitous healthcare system. In these Eng., vol. 44, no. 4, pp. 321–325, Apr. 1997. areas, he has published over 73 peer-reviewed scientific papers in international [11] D. G. Park and H. C. Kim, “Comparative study of telecommunication journals. methods for emergency telemedicine,” J. Telemed. Telecare, vol. 9, no. 5, Dr. Kim is a member of the Korea Society of Medical and Biological pp. 300–303, Sep. 2003. Engineering, IEEE/EMBS, and the American Society of Artificial Internal [12] Specification of PS214B. last checked 22 April 2006. [Online]. Avail- Organs. able: http://www.mtk-biomed.com/03_produkt/_PDF/englisch/214_e.pdf [13] Specification of BPPUMP2M. last checked 22 April 2006. [Online]. Available: http://us.fluke.com/usen/products/specifications.htm?cs_id= 34927(FlukeProducts)&category=FB-SIMS(FlukeProducts) [14] Specification of Oxitest Plus7. last checked 22 April 2006. [Online]. Available: http://www.demaco-ben.nl/01c2c9944712bfa04/ spo2simulator/specifications/index.html Jae Min Kang (S’01) received the M.S. degree in biomedical engineering from Seoul National Univer- sity, Seoul, Korea, in 2000. He is currently working toward the Ph.D. degree at the Medical Electronics Laboratory (MELab), Seoul National University. Since 2001, he has been with the MELab, Seoul National University. He participated in various national fund projects including “Development of a Ubiquitous Biotelemetry System for Emergency Care,” “Development of a Intelligent Robot for Supporting the Human Life,” and “Development of a Core Technology of Silver Medical Instrument for the Elderly.” His interests include patient monitoring technology, emergency telemedicine, and the wire- less portable healthcare system. Mr. Kang is a Student Member of the Korea Society of Medical and Biological Engineering and IEEE/EMBS.