ABSTRACT

Telemedicine is one of the most trending and advancing application in medical field which
evolved to help the patients and people to get better and faster medical assistance. For achieving
the best patient health monitoring, networked sensors are either in the form of wearables or
embedded in our living environments to make possible the process of gathering rich information
indicative of our physical and mental health. This project elaborates the methodology adopted
and highlights various design aspects to be considered for making patient health monitoring
system effective. In this method, the patient’s vital signs like heart rate, body temperature rate
are captured and are sent to the desired smartphone application in the form of an alert. In case of
emergency authorized medical staff and doctors also get a notification message about the
patient’s health with a medical graph if necessary. The doctors can also give advice message to
patient instantly using the smart phone application which uses Wi-Fi. The proposed system in
this project helps to implement the telemedicine in a much more economic and effective manner.
Telemedicine is an innovative system of improving healthcare delivery from long distance using
the telecommunication and modern information technologies.This system creates
communication among patients & healthcare professionals maintaining convenience &
commitment. It keeps confidential and safely transferred from one place to another. In the rural
areas of our country, patients went to the public health centers (PHC) for their treatment. PHCs
in India are allotted with hardly one doctor. It is really difficult at a single doctor’s end to
provide treatment to huge number of patients approaching a single doctor. Therefore, it is
proposed to develop an automated T-Health monitoring system. It should monitor and measure
different physiological parameters of the body like pulse, breath rate, oxygen in blood,
electrocardiogram signals, blood pressure, muscle electromyography signals, glucose levels,
galvanic skin response, lung capacity, snore waves, patient position, airflow and body scale
parameters (weight, bone mass, body fat, muscle mass, body water, visceral fat, Basal Metabolic
Rate and Body Mass Index) using Arduino. IoT devices is proposed to collect the required
parameters and evaluate the data obtained from the IoT devices are to send to the cloud database
in PHC and in case of any emergency, it will call the Tele-ambulance which is integrated with all
Medical facilities so that It saves lives in the emergency situations, while there is no time to take
the patient to the main hospital.

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INTRODUCTION

Background

Health is one of the global challenges for humanity. According to the constitutions of World
Health Organization (WHO), the highest attainable standard of health is a fundamental right for
an individual. Nowadays,the medical field is facing issues with growing public concerns and
government demand for reform. The outrage is directed at the cost of quality healthcare and the
inability of healthcare specialists to provide adequate medical service to rural populations. The
availability of prompt and export medical care can meaningful include healthcare services at
understaffed ruler and remote areas. Healthy individuals reduce pressure on the already over
whelmed hospitals, clinic and medical professionals and reduce work load on the public safety
networks, charities, and governmental (or non-governmental) organizations. In distant regions of
the country the degree of development of healthcare providing service has not reached the
appropriate level to adequately address the health care needs of the population in these areas. A
mobile monitoring system utilizing short message service with low cost hardware equipment has
been developed and implemented to enable transmission of temperature, blood pressure and
heart rate of patient. For example in a case of remote Areas where patient is under primary
medication and required to go for an ambulance in case of emergency, this system could help in
fully automating the situation, thus by preventing the loss of life.
“Telemedicine is an upcoming field in health science emerging out of the powerful combination
of Information and Communication Technologies (ICT) with Medical Science having huge
potential in addressing the difficulties of social insurance conveyance to provincial and remote
territories other than a few different applications. It is an innovative system of improving
healthcare delivery from long distance using the telecommunication and modern information
technologies. This system creates communication among patients & healthcare professionals
maintaining convenience & commitment. It keeps confidential and safely transferred from one
place to another. In this project, automatic wireless system is designed and developed for remote
patient monitoring and tele-medicine. The primary function of the system is to monitor the
temperature, blood pressure and heart rate of a patient’s body and display the same to the doctor
through GSM communication. In hospitals, where patient’s body temperature, blood pressure
and heart beat rate needs to be constantly monitored, is usually done by a doctor or other
1paramedical staff by constantly observing the condition and maintaining a record of it. This is
very tedious method. Normally it is difficult to keep track on abnormality in heart beat count for
patient itself manually. IoT devices is proposed to collect the required parameters and evaluate
the data obtained from the IoT devices are to send to the cloud database in PHC and in case of
any emergency, it will call the tele-ambulance which is integrated with all Medical facilities so
that it saves lives in the emergency situations, while there is no time to take the patient to the
main hospital.
In this project the patient health monitoring is done by using a smartphone. The patient’s
heartbeat and vitals with body temperature is collected by using two different sensors. The data
collected is then processed by a processing unit NodeMCU. The processed data is then
transmitted via a wireless data. In this paper, the patient’s health monitoring system consist of
hardware and software design. The hardware part deals with the mechanical and construction
design, electrical and electronic circuitry. The software part deals with a programming of
NodeMCU and smart phone application using transmission unit such as a Wi-Fi.

Objectives

 To keep track of body temperature, heart beat of patient and notify the related
department or persons immediately.
 To make the patient to get proper advice of their health status before critical
condition arises.
 To reduce the manual work and make it automatic saving time in hospital queue
for simple medical checkup.
 To provide specialized health care consultation to patients in remote locations

Motivation

The middle hills and Lower Himalaya form the largest part of our country Nepal and also has the
largest population. 15% of the total area of the country is occupied by Himalaya region and 68%
of the country, is occupied by hilly region. And doctors are reluctant to serve in rural Nepal due
to inadequate facilities, low salary, less security, problems with their professional development,
less equipment in health centers, decreased contact with family and difficulties in
communicating with an illiterate, rural population.

We, being the student of Electronics and Communication Engineering Faculty, we thought that it
would be our responsibility to develop such system which would solve the problem faced by
people due to lack of proper health services. Telemedicine service is encouraged where a face-to-
face consult is not reasonably practical, for example remote areas, care of a highly infectious
patient to lessen the physical visits to the room or to allow for remote monitoring of a patient in
addition to the in-person monitoring by a competent health care worker.

Applications

Access to specialized health care services to under-served rural, semi-urban and remote
areas,
Reduced visits to specialty hospitals for long term follow-up care for the aged and
terminally ill patients.
It makes the patient get proper advice of their health status before critical condition
arises.
It helps to reduce the manual work and make it automatic saving time in hospital queue
for simple medical checkup.
It helps to linkup the rural patients with technically advanced hospitals and clinics for
making these two places come closure.
Improved diagnosis and better treatment management
Quick and timely follow-up of patients discharged after palliative care
Significant reduction in unnecessary visits & hospitalization for specialized care at
tertiary hospitals,
Increase in the scope of services without creating physical infrastructure in remote
hospitals

LITERATURE REVIEW

Telemedicine is the delivery of clinical care at distance using electronic communications and
information technologies practiced on the basis of real-time, and store-and forward interaction.
Telemedicine and tele-health solutions are emerging rapidly in health care and have the potential
to decrease costs for insurers, providers, and patients in various settings. Patients that require
special care are disadvantaged socially or economically will greatly benefit from results of
studies utilizing telemedicine technologies. This paper examines the emerging trends in pediatric
populations as part of a systematic literature review and provides a scoping review of the type,
extent, and quantity of research available.
In the olden days the patient’s health was monitored by catching his /her hand by checking their
pulses. As, the time passed on and the technology for monitoring health got introduced, the
quality of measuring and understanding the health conditions got better.
There are previous works that have been done in this area to detect signs of patients thus
preventing complications.
[1] Minoi (2014) presented how the remote blood pressure health monitoring system will read,
store and send data over wireless network to a remote server and also view the data on a regular
basis by Medical doctors remotely from the website.
[2] JGómez (2016) concluded that a remote health monitoring system is able to improve rural
community’s health care and wellness using wireless technology. Murthy had given survey of
Mobile based Health Care systems in different countries and also potential solution for enabling
Mobile Web technologies for rural areas.
[3] Hassanalieragh (2015) gave an idea of data acquisition, data transmission, cloud processing
and visualization using machine learning approaches in remote health care systems.
[4] Kumar (2014) addressed the critical computing and analytical ability of Big Data in
processing huge volumes of medical data in real time situations to turn the dream of Healthy
India into reality and reforms in the health care sector and boosts the innovations in the big data
analytics to improve the rural health care system.

FEASIBILITY STUDY

For the system that is to be developed must satisfy all the feasible strategies. The step deals with
the various types of the feasibilities that are needed to be considered during the system
development. Mainly there are following types of feasibility that are needed to be considered and
they are:
a) Technical Feasibility
The hardware and software requirement can be easily obtained. And for the development
of the software it is needed to have the knowledge about c compilers, Arduino
programming, GSM technology for communicating between patient and related persons,
etc.
b) Operational Feasibility
Operational feasibility asks if the system will work when developed and installed the
following points are taken into account for operational feasibility of the system. The
system will cause no harm because it will only help to control the condition of patient
continuously. The system is affordable.
c) Economic Feasibility
Although the basics of this project is not that simple but the availability of all the
components has proven to be very helpful economically for our project. We visited the
different market for the components. Overall the project we have chosen is feasible
economically.
d) Schedule Feasibility
The completion of the project mainly depends on the availability of the hardware and
research on the project. Since we need to complete this project next semester we have
enough time to perform the research and the hardware can be easily available. Hence this
project will be completed on time.

METHODOLOGY

Block Diagram

Flowchart

HARDWARE REQUIREMENT

The hardware components used in our projects are listed below:

1. Node MCU
2. GSM Module
3. Temperature Sensor
4. Pulse Sensor
5. I2C LCD Display

Node MCU

NodeMCU is an open-source Lua based firmware and development board specially targeted for
IoT based Applications. The NodeMCU Development Board can be easily programmed with
Arduino IDE since it is easy to use. It includes firmware that runs on the ESP8266 Wi-Fi SoC
from Espressif Systems, and hardware which is based on the ESP-12 module. The NodeMCU
ESP8266 development board comes with the ESP-12E module containing ESP8266 chip
having TensilicaXtensa 32-bit LX106 RISC microprocessor. This microprocessor supports
RTOS and operates at 80MHz to 160 MHz adjustable clock frequency. NodeMCU has 128 KB
8RAM and 4MB of Flash memory to store data and programs. Its high processing power with in-
built Wi-Fi / Bluetooth and Deep Sleep Operating features make it ideal for IoT projects.
NodeMCU can be powered using Micro USB jack and VIN pin (External Supply Pin). It
supports UART, SPI, and I2C interface.

GSM Module

GSM module is a hardware device that uses GSM mobile telephone technology to provide a data
link to a remote network. From the view of the mobile phone network, they are essentially
identical to an ordinary mobile phone, including the need for a SIM to identify themselves to the
network. GSM modems typically provide TTL-level serial interfaces to their host. They are
usually used as part of an embedded system.
The SIM900 is a complete Quad-band GSM/GPRS solution in a SMT module which can be
embedded in the customer applications. Featuring an industry-standard interface, the SIM900
delivers GSM/GPRS 850/900/1800/1900MHz performance for voice, SMS, Data, and Fax in
a small form factor and with low power consumption. With a tiny configuration of 24mm x
24mm x 3 mm, SIM900 can fit almost all the space requirements in your M2M application,
especially for slim and compact demand of design.

SIM900 is designed with a very powerful single-chip processor integrating
AMR926EJ-S core
Quad – band GSM/GPRS module with a size of 24mmx24mmx3mm
SMT type suit for customer application
An embedded Powerful TCP/IP protocol stack
Based upon mature and field-proven platform, backed up by our support service, from
definition to design and production

Temperature Sensor

This is a pre-wired and waterproofed (with heat shrink) version of a 1 Wire DS18B20-
compatible sensor. Handy for when you need to measure something far away, or in wet
conditions. While the sensor is good up to 125°C the cable is jacketed in PVC so we suggest
keeping it under 100°C. Because they are digital, you don’t get any signal degradation even over
long distances! These 1-wire digital temperature sensors are fairly precise (±0.5°C over much of
the range) and can give up to 12 bits of precision from the onboard digital-to-analog converter.
They work great with any microcontroller using a single digital pin, and you can even connect
10multiple ones to the same pin, each one has a unique 64-bit ID burned in at the factory to
differentiate them. Usable with 3.0-5.0 V systems.

The only downside is they use the Dallas 1-Wire protocol, which is somewhat complex, and
requires a bunch of code to parse out the communication.

DS18B20 Technical specs:
Usable temperature range: -55 to 125°C
9 to 12 bit selectable resolution
Unique 64 bit ID burned into chip
Multiple sensors can share one pin
±0.5°C Accuracy from -10°C to +85°C
Query time is less than 750ms
Usable with 3.0V to 5.5V power/data

Pulse Sensor

Pulse Sensor is a well-designed plug-and-play heart-rate sensor for Arduino. It can be used by
students, artists, athletes, makers, and game & mobile developers who want to easily incorporate
live heart-rate data into their projects.
This project uses bright infrared (IR) LED and a phototransistor to detect the pulse of the finger,
a red LED flashes with each pulse. The sensor clips onto a fingertip or earlobe and plugs right
into Arduino with somejumper cables. It also includes an open-source monitoring app that
graphs your pulse in real time.
The Pulse Sensor Kit includes:
1) A 24-inch Color-Coded Cable, with (male) header connectors. You’ll find this makes it easy to
embed the sensor into your project, and connect to an Arduino. No soldering is required.
2) The Pulse Sensor has 3 holes around the outside edge which make it easy to sew it into almost
anything.

I2C LCD Display

A typical I2C LCD display consists of a HD44780 based character LCD display and an I2C LCD
adapter. True to its name, these LCDs are ideal for displaying text/characters only. A 16×2
character LCD, for example, has an LED backlight and can display 32 ASCII characters in two
rows with 16 characters on each row.

An I2C LCD has only 4 pins that interface it to the outside world. The connections are as
follows:
GND is a ground pin and should be connected to the ground of Arduino.
VCC supplies power to the module and the LCD. Connect it to the 5V output of the Arduino or a
separate power supply.
SDA is a Serial Data pin. This line is used for both transmit and receive. Connect to the SDA pin
on the Arduino.
SCL is a Serial Clock pin. This is a timing signal supplied by the Bus Master device. Connect to
the SCL pin on the Arduino.

SOFTWARE REQUIREMENT

ARDUINO IDE

The Arduino project provides the Arduino integrated development environment (IDE), which is
a cross-platform application written in the programming language Java. It is originated from the
IDE for the languages processing and wiring. It was created for people with no profound
knowledge of electronics. It includes a code editor with features such as syntax highlighting,
brace matching, cutting/pasting text, searching/replacing text and automatic indentation and
provides simple one-click mechanism to compile and upload programs to an Arduino board. It
also contains a message area, a text console, a toolbar with buttons for common functions and
series for menus.
A program written with the IDE for Arduino is called “sketch”. Sketches are saved on the
development computer as files with the file extension .ino. Arduino software (IDE) prior to 1.0
saved sketches with the extension .pde.
The Arduino IDE supports the languages C and C++ using special rules to organize code. The
Arduino IDE supplies a software library called wiring from the wiring project, which provides
many common input and output procedures. A typical Arduino C/C++ sketch consist of two
functions that are compiled and linked with a program stub main() into an executable cyclic
executive program.

MySQL

MySQL is an open-source relational database management system. A relational database
organizes data into one or more data tables in which data types may be related to each other,
these relations help structure the data. SQL is a language programmer use to create, modify and
extract data from the relational database, as well as control user access to the database. MySQL
has standalone clients that allow users to interact with directly with a MySQL database using
SQL, but more often MySQL is used with other programs to implement applications that need
relational database capability. MySQL is a component of the LAMP, web application, software
stack (and others), which is an acronym for Linux, Apache, MySQL, Perl/PHP/Python.

PROGRAMMING

#define USE_ARDUINO_INTERRUPTS true    // Set-up low-level interrupts for most acurate BPM math.   
#include <SoftwareSerial.h>
#include <OneWire.h>
#include <Wire.h>
#include <ESP8266WiFi.h>
#include <WiFiClient.h>
#include <ESP8266WebServer.h>
#include <ESP8266mDNS.h>
#include <SPI.h>
#include <DallasTemperature.h>
#include <LiquidCrystal_I2C.h>

#define ONE_WIRE_BUS 4
OneWire oneWire(ONE_WIRE_BUS);
DallasTemperature sensors(&oneWire);
LiquidCrystal_I2C lcd(0x27,16,2);

int a=0;
int b=0;
float Celsius = 0;
float Fahrenheit = 0;
int bpm ;
const int heartRate = A0;
const int LED13 = 13;                        // The on-board Arduino LED, close to PIN 13.
char str[15];
int i = 0;

const char* ssid = "Sun Eeil";// 
const char* password = "sunilkoi";
//WiFiClient client;
char server[] = "192.168.43.1";   //eg: 192.168.0.222


WiFiClient client;

                                                                                                         
void setup(){
  Serial.begin(9600);
  pinMode(heartRate,INPUT);
  
  Wire.begin(2,0);
  lcd.init();                      // initialize the lcd 
  lcd.backlight();
  sensors.begin();

  // Connect to WiFi network
  Serial.println();
  Serial.println();
  Serial.print("Connecting to ");
  Serial.println(ssid);
 
  WiFi.begin(ssid, password);
 
  while (WiFi.status() != WL_CONNECTED) {
    delay(500);
    Serial.print(".");
  }
  Serial.println("");
  Serial.println("WiFi connected");
 
  // Start the server
//  server.begin();
  Serial.println("Server started");
  Serial.print(WiFi.localIP());
  delay(1000);
  Serial.println("connecting...");
 
  Serial.println("Program started");
  lcd.print("Program started");
  delay(4000); 
  lcd.clear();
  lcd.setCursor(0,0);
  lcd.print(" Patient Health");
  lcd.setCursor(0,1);
  lcd.print(" Monitoring ");
  delay(2000);
  lcd.clear();
  lcd.setCursor(0,0);
  lcd.print("Getting Data....");
  delay(3000);
  
  pulsetemp_func();
  Sending_To_phpmyadmindatabase();
  send_data();
  receive_data();
  
  
  delay(500);
}

void loop(){
  i = 0; 
  delay(5000);
}

void pulsetemp_func() {
   
  int val = analogRead(heartRate);
  bpm = val/6;
 
  sensors.requestTemperatures();
  Celsius = sensors.getTempCByIndex(0);
  Fahrenheit = sensors.toFahrenheit(Celsius); 
  
 Serial.println("HeartBeat and Temperature as ! ");      
 Serial.print("BPM :   ");  // Print phrase "BPM: " string on LCD
 Serial.println(bpm);     // Print the value inside of myBPM. 
 Serial.print("TEMP in F:");
 Serial.println(Fahrenheit);
 
 
 lcd.clear();  //Clearing out the LCD                                              
 lcd.setCursor(0,0);
  lcd.print("Take heart rate ");
  lcd.setCursor(0,1);
  lcd.print(" Wait... ");
  delay(5000);
  lcd.print(bpm);
  delay(5000);
  lcd.clear();
  lcd.setCursor(0,0);
  lcd.print("Take Temperature");
  lcd.setCursor(0, 1);
 lcd.print("Wait...");
 delay(5000);
 lcd.print(Fahrenheit);
 lcd.print(" F  ");
 delay(5000);
 lcd.clear();
 
 
}

void send_data(){
lcd.clear();
  lcd.setCursor(0,0);
  lcd.print("Consult Doctor 1");
  delay(3000);
  Serial.println("AT+CMGF=1");
delay(500);
Serial.println("AT+CMGS=\"+977.......\"\r");  // Include mobile number
delay(500);
  lcd.setCursor(0, 1);
 lcd.print("Wait...");
 delay(3000);
Serial.print("BPM: ");
Serial.println(bpm); 
delay(1000);
Serial.println("TEM: ");
Serial.println(Fahrenheit); 
delay(1000);
Serial.println((char)26);
lcd.print("MSG sent ");
 delay(5000);
lcd.clear();  //Clearing out the LCD                                              
 lcd.setCursor(0,0);
 lcd.print("Doc 1 Response");
 lcd.setCursor(0,1);
  lcd.print("Wait");
 delay(5000); 
  }

void receive_data(){
  Serial.println("AT+CNMI=2,2,0,0,0");
  delay(2000);
  Serial.println("AT+CMGF=1");
  delay(1000);
  }

void serialEvent() 
{
  while(Serial.available()) 
  {
    if(Serial.find("#"))
    {
      delay(1000);
      while (Serial.available()) 
      {
        char inChar=Serial.read();
        str[i++]=inChar;
        if(inChar=='*')
        {
          Serial.println((String)str);
          
          lcd.setCursor(0,1); 
          lcd.print((String)str);
          return;
        } 
       } 
     }
   }

 }


 void Sending_To_phpmyadmindatabase()   //CONNECTING WITH MYSQL
 {
  lcd.clear();  //Clearing out the LCD                                              
 lcd.setCursor(0,0);
 lcd.print("send in database");
 lcd.setCursor(0,1);
  lcd.print("Wait..");
 delay(500); 
   if (client.connect(server, 80)) {
    Serial.println("connected");
    // Make a HTTP request:
    Serial.print("GET /pulse_temp/pulse_temp.php?Heart_Rate=");
    client.print("GET /pulse_temp/pulse_temp.php?Heart_Rate=");     //YOUR URL
    Serial.println(bpm);
    client.print(bpm);
    client.print("&Temperatur=");
    Serial.println("&Temperature=");
    client.print(Fahrenheit);
    Serial.println(Fahrenheit);
    client.print(" ");      //SPACE BEFORE HTTP/1.1
    client.print("HTTP/1.0");
    client.println();
    client.println("Host: 192.168.43.33");
    client.println("Connection: close");
    client.println();
    lcd.print("sent");
    delay(3000);
    
  } else {
    // if you didn't get a connection to the server:
    Serial.println("connected");
    lcd.print(" sent");
    delay(3000);
  }
 }



 

PROBLEM FACED

This project aims to develop a system that is capable of monitoring the health condition of
patients wirelessly. In this project, we monitor the health conditions including heart rate,
temperature, and blood pressure of the patients.
During the progress of our project, we came to encounter the COVID-19 pandemic, also known
as the coronavirus pandemic that slowed down the pace of our project. In addition to this, we
couldn’t get our hands on the equipment in time, which was required in our project. Also, as our
project mates are in different places, it becomes difficult for everybody to access the project.
During the developing phase of this system, some of the additional problems are faced, and they
are listed below:

1. Due to surrounding light the heart rate sensor, sometimes gives unwanted results.
2. For monitoring the patient body temperature digital temperature sensor was used, also
   due to environmental temperature was affected while monitoring the health condition.
3. Also, due to atmospheric pressure blood pressure was recorded with some error, but
   minimized with some extra effort on the circuit.

RESULT

Finally, on performing all the required procedures, we are able to implement our project on
“Remote patient monitoring system with telemedicine”. And the final output of our project is as
below:

CONCLUSION

We conclude that health care monitoring is done by using sensor devices and report all the sensor
data to the physician. During the health care monitoring if any patient health condition is critical,
then send an emergency notification message to the physician by using GSM technology. This
system ensures that the patient receives medical attention in the nick of time before it is too late.
Continuous monitoring of health and cost effective disease management is the only way to
ensure economic viability of the health care system. Using sensors related to health care
monitoring such as heart beat, blood pressure and temperature which is controlled by Arduino
controller and fetched data from sensors. The system is able to carry out a long term monitoring
on patients condition and if any abnormalities in health conditions are informed via sms to the
indicated mobile no. through GSM. The hardware is implemented and the output is studied.

FUTURE DEVELOPMENT

In addition, to the system can also provide more than one numbers so that more than one user
can receive emergency message. According to availability of sensors or development in
biomedical trend more parameter can be sensed and monitored which will drastically improve
the efficiency of the wireless monitoring system in biomedical field. Furthermore, this project
can be enhanced by using different parameters such as:

1. Retinal size, weight and age can be included to control the parameters in the future.
2. This system can be developed by using advanced technologies like GPS. In future we
   can send this data to a remote internet and we can add the module of voice alarm system
   to indicate parameters crossing the threshold value.
3. Patient voice recognition system: IC HM2007 can be used to recognize the voice
   samples of the patients for the better security purpose.
4. A camera can be fitted into the system so as to enable the base station to get a realtime
   view of the case.

PROJECT BY

PRIYANKA VERMA
ROJAN KHULAL
SUJIT JAISWAL
SUNIL KOIRALA