Low Cost, Portable ECG Device By ‘Muhammad Sarmad Rashid’ MEM-Major Telecommunications Engineering- ID: 12717575 Abstract Electrocardiogram device is one of the most widely thought of devices when it comes to hospital care. The aim of this review is to look into various technologies employed into constructing an ECG device that is capable of monitoring the heart state and displaying effectively to either the doctor or the patient at hand, the current state of the heart and its function. ECG devices are mostly subject to hospital care due to the fact that they deliver all the data via a serial port to the displaying machine, which makes these devices rather hospital bound if you will. In recent times, attempts have been made to mobilize the device by using microcontrollers and Bluetooth devices in order for the device to transmit data wirelessly so that it is no longer bound to hospital walls and that patient care can be extended beyond that. The major concern that remains however is the cost and communication between the hospital and patient employing the use of this mobile device. It is yet to be improved upon which is the primary research gap that needs focus and in the long run improving on such research can ultimately see an ECG device in every household and aid in preventing many fatalities. 1. Introduction Cardiovascular diseases have significantly increased over the years, which include heart abnormalities, heart attacks, strokes and blood vessel diseases. The high number of such diseases is alarming on its own. In Australia, each year around 54,000 Australians suffer a heart attack. This means one attack in every 10 minutes! By website (“The Heart Disease in Australia”). The number is even higher when you take into account the hospitalizations that are carried out each year for patients with heart attacks, let alone cardiovascular diseases. Although preventing such diseases entirely falls in the medical dimension, however aiding doctors with the tools to provide extra care in terms of such demanding situations is definitely what engineers can achieve. ECG devices have long been used in hospitals to monitor heart functions be it so during intensive care, or simply under post op observation. It is imperative that devices that allow mobility, are cheap and easy to interact with be produced for the populace to make sure unpredictable diseases such as heart attacks can either be monitored earlier via an abnormality in heart function or in case something should happen, then be able to communicate quickly and effectively with the doctors and emergency helplines to salvage precious time that may save a potential patients life. In the subsequent review, various methodologies used to produce these wireless ECG devices will be discussed keeping in mind the general health monitoring systems that are being aimed at. These designs will be looked at and an analogy will be drawn as to what gaps are present between the attempts made so far and what further improvement needs to be brought to make these systems more viable for future use. 2. Literature Review ECG machines are required to be mobile and the device parameters need to be flexible in order for the new smart devices to make any impact into the medical world. ECG smart shirts have been researched into and are one of the methodologies that adopt a creative way to wear the electrodes to monitor heart state continuously for medical purposes. Clinically standard 12-lead ECG is recorded from this “smart shirt.” The data is encrypted and wirelessly transmitted via an on-chip ISM band radio and flexible antenna allowing secure, continuous cardiac monitoring on a smartphone while dissipating less than 1mW (Morrison, T, Silver, J & Otis, B 2014). This design is very innovative in it that it allows the patient to wear the device and check the outcome on a smart phone. The communication is wireless. What can be taken from this is the single chip method that allows for all the device functions at low power, which is safe for patient. So low power attributes and integration of processing power into a single unit can be used. The draw back however is the whole shirt to wear for monitoring the heart is viable for a continuous monitoring case, if the patient wants to keep the device for limited hours of check than wearing the shirt seems a bit more hectic than handy. Another design that is worked on is an electronic smart sensor that works alongside a HHD (hand held device) to monitor constantly the heart function and searches for any abnormalities (Fensli, R, Gunnarson, E & Hejlesen, O 2005). This device is used primarily for those patients that suffered from a cardiac arrest and survived. They are living at home and are under risk be it so they are careful about their health since the incident. This device allows for their vitals to be recorded and in case of an emergency the date to transmitted to a clinical alarm service center for immediate assistant. A good strategy has been taken into account for people who need constant monitoring, with further addressing as to what can be done in terms of safety should an unfortunate situation arise. The communication is wireless. The drawbacks however are that the system is not built with an electric ground, and the device needs to be replaced after several days have passed in its use. This causes issues for the every day household since affording such electrodes would become more costly given the disposable nature of the device. It is therefore important to come up with a device similar to mobility of this device, but something of a long-term use. Another design that has been implement although not directly to measure ECG, but requires ECG as a part of its calculation to figure out blood pressure for hypertension is the E-Chair for BP and ECG monitoring. The chair employs the use of e-textile materials and electrodes on the armrests of the chair to monitor the ECG and BP of the person sitting on it (Wu, K, Chan, C & Zhang, Y 2006). The benefit of this creative design is that it’s more interactive with the patient. Many of these designs are also implemented on treadmills and are currently being used in gyms for monitoring heart rates while exercising effectively. The drawbacks however are that the design is implemented for keeping track records of the patient and reduces the mobility of the patient at hand therefore is not acceptable as a continuous monitoring mechanism. A lot can be improved keeping in mind the fact that a lot of these devices face issues of delay, buffering connections, faulty alarm systems that might go off due to interference (Baig, Mirza Mansoor, Hamid Gholamhosseini, and Martin J. Connolly). Keeping in mind the fact that the ECG device is being designed with the intent of it being integrated into households as a general machine that can be used both as a basic measurement device and for safety precautions a number of research gaps seem to unravel themselves. More research needs to be made to ensure the device is of low cost, allows an acceptable degree of mobility, the signal interference is taken into account and the device allows flexibility between continuous use and basic measurement use. 3. Evaluation It is evident from the literature reviewed earlier, that many problems persist in the design of such a device. The analysis of these articles suggests that one must look into not just the medical side of the device, but also look at it from a consumer level in order to better understand the constraints that device faces when it comes to public use. The hospitals have been equipped with advanced devices, which the doctors are able to translate, but for the common user, there are sudden factors that need to be made more interactive. The previous literature looked at many ways the research was carried out to make the device more user friendly by employing textile materials, some making the electrodes wireless and smart where as some monitoring systems were made for temporary use, while others were made for a longer continuous use. The research led towards each device, allowed me to identify the main issues that were yet a part of the devices lagging behind one another. The major issues perhaps recognized were how to make sure the device is portable enough for the user to be able to use it for ‘both’ continuous or long-term use. The cost of building such device needed to be low, since affordability is a major issue in the medical industry. A subtle hint towards the background connections of these devices to an online platform that would allow for safety alarming systems to be installed for a quick response team to be in action should the need be detected by such a device. This back ground data base however is an additional problem that needs to be looked into further since creating a common network would allow for fast analysis by doctors, and emergency staff of the situation without creating much delays as that could be fatal for the individual at hand. I propose to hand pick the smart electrode approach, but allow for a substitute that would not need to be replaced after certain days of use. Also employing a wireless device hub that could be placed near for a more reliable processing capability using a suitable wireless connection that reduces interference. This hub could be made mobile too and this is again part of the research gap that needs further research. 4. Conclusions In light of the work presented above, it is evident that many research gaps are present within the design methodologies adopted to produce a reliable, smart ECG device that can employ the use of cheap resources at disposal and come up with a reliable fairly accurate information to the user that can then be further processed for any type of precautions or decisions to be made based upon need. Wireless technology is essential in making the devices mobile, but interference needs to be adhered to. Creative designs such as smart shirts and e-chairs make the device more interactive with the populace however the continuous and one time basic measurement needs are to be taken into account. The smart electrode technology no doubt is very mobile, incorporating a safety measure tool as well, but the disposability of the device leads to more cost due to constant purchase of something that cannot last for a long period of time. It is therefore a requirement to produce a low cost portable device that can adhere to these needs and the research states that more work needs to be done in order make this device good enough for a large population to be able to interact with it, afford it and gain benefit from it. In the long run, this research can help commercialize the device, that can help assist many doctors, patients and create jobs for the society. 5. References Ali, Zulfiqar, Ghulam Muhammad, and Mohammed F. Alhamid. "An Automatic Health Monitoring System For Patients Suffering From Voice Complications In Smart Cities". IEEE Access (2017): 1-1. Web. Aminian, Media. "A Hospital Healthcare Monitoring System Using Wireless Sensor Networks". Journal of Health & Medical Informatics 04.02 (2013): 1-5. Web. Baig, Mirza Mansoor, Hamid Gholamhosseini, and Martin J. Connolly. "A Comprehensive Survey Of Wearable And Wireless ECG Monitoring Systems For Older Adults". Medical & Biological Engineering & Computing 51.5 (2013): 485-495. Web. Fensli, R, Gunnarson, E & Hejlesen, O 2005, ‘A wireless ECG system for continuous event recording and communication to a clinical alarm station’, Engineering in Medicine and Biology Society, 2004. IEMBS '04. 26th Annual International Conference of the IEEE, pp. 1024-1056, accessed 9 May 2017, 10.1109/IEMBS.2004.1403644, IEEE. Foundation, The. "Heart Disease In Australia". The Heart Foundation. N.p., 2017. Web. 9 May 2017. Gruetzmann, Anna, Stefan Hansen, and Jörg Müller. "Novel Dry Electrodes For ECG Monitoring". Physiological Measurement 28.11 (2007): 1375-1390. Web. Lin, J.M., and C.H. Lin. "RFID-Based Wireless Health Monitoring System Design". Procedia Engineering 67 (2013): 117-127. Web. Morrison, T, Silver, J & Otis, B 2014, A Single-chip Encrypted Wireless 12-Lead ECG Smart Shirt for Continuous Health Monitoring, Pdf, accessed 9 May 2017, Milenković, Aleksandar, Chris Otto, and Emil Jovanov. "Wireless Sensor Networks For Personal Health Monitoring: Issues And An Implementation". Computer Communications 29.13-14 (2006): 2521-2533. Web. Noro, Mutsumi, Daisuke Anzai, and Jianqing Wang. "Common-Mode Noise Cancellation Circuit For Wearable ECG". Healthcare Technology Letters 4.2 (2017): 64-67. Web. Po, Samuel Ng Choon et al. "Memswear - Biomonitoring - Incorporating Sensors Into Smart Shirt For Wireless Sentinel Medical Detection And Alarm". Journal of Physics: Conference Series 34 (2006): 1068-1072. Web. Shelar, Manisha, Jaykaran Singh, and Mukesh Tiwari. "Wireless Patient Health Monitoring System". International Journal of Computer Applications 62.6 (2013): 1-5. Web. Smarsly, Kay, and Kincho H. Law. "Decentralized Fault Detection And Isolation In Wireless Structural Health Monitoring Systems Using Analytical Redundancy". Advances in Engineering Software 73 (2014): 1-10. Web. Wu, K, Chan, C & Zhang, Y 2006, ‘Contactless and Cuffless Monitoring of Blood Pressure on a Chair Using E-Textile Materials’, Medical Devices and Biosensors, 2006. 3rd IEEE/EMBS International Summer School on, pp. 98-100, accessed 9 May 2017, BS International Summer School on, IEEE.