Proc. of Int. Conf.

on Advances in Computer Science, AETACS

Advanced Biotelemetry System for Primary

Healthcare Center in Rural India
1
Kamal K, 2Sabaresh Chandran G, 3Fredrick Johnson J & 4Janani Prakash
1-3
Sri Ramakrishna Engineering College/EEE, Coimbatore, India
Email: [email protected]
4
SRM Eswari Engineering college, Chennai, India
Email: {Sabaresh Chandran G,Fredrick Johnson J, JananiPrakash }@[email protected]

Abstract— Primary health care is a fundamental health care based on practical,

scientifically sensible and socially satisfactory schemes and technology made collectively
available to individuals and families at a price that the community can afford to maintain at
every stage of their development[1]. The objective of this study was to evaluate simultaneous
measurements of blood flow, pressure, ECG, glucose and temperature. The system includes
a bidirectional link that allows the communication between the nurse at the remote location
and a doctor in the city to send and receive information and to perform the various tasks
including cardiovascular and pulmonary physiology and pathology [2].

Index Terms— Advanced Biotelemetry System, Primary Health Care, Remote Health Cares

I. INTRODUCTION
Primary Health Care includes all areas that have an impact on health, such as access to health services, habits
and habitats. India has some of the best quaternary and tertiary healthcare, but secondary care is still a
considerable challenge. At all of these levels, given the large disease burden and propensity of people to
directly approach these facilities even for regular treatments is marginally less, while financial viability can
sometimes be a barrier.The number of qualified physicians in such localities is a setback and the
implementation of a biotelemetry system will not only eliminate the need of transportation of the patients, but
also provide instant assistance in the case of severe health issues[5] For higher levels of care, where proper
allopathic training would be essential, the number of such physicians may prove to be adequate. In most parts
of the country, prescribed primary care is almost non-existent. Within the urban environment, there is a
modest amount of formal primary care accessible in the form of general practitioners, ophthalmologists,
dentists, etc. as well as out-patient services. However, the care is disorganized and it comprises management
of visible symptoms instead of the overall physical condition of the individual. Hence, most rural residents
either do not seek any form of primary care or visit local doctors who offer cures, several of which cost a
great deal of money for little benefit and a few with strong potential for actual harm. The government has a
guideline for having a local health centre at a 7,000 population level, named as sub-centre but the centre does
not have a physician as such and so cannot prescribe any listed drugs, operating with very restricted hours.
The formally designated governmental Primary Healthcare Centre is at a 50,000 population level and does
have a physician as a part of the design, but is too long a distance for most people. There are a large number
of patients who visit a single physician, who oversees the health of all those who are in need of it. Chronic

© Elsevier, 2013
illnesses remain undiagnosed for long and many patients end up at urban secondary and tertiary care centers,
often at a very late stage, thus it is difficult to build financially-stable and lucid models of primary healthcare.

II. IMPLEMENTATION PLAN

The village of Oragadam is supported by the local Christian missionary, headed by the Mother, aided by a
few Sisters who aware of the healthcare systems and their necessity. One of the Sisters, having completed her
nursing degree is keen to learn more about the operation of the advanced bio-telemetry system and
commence the treatment of the patients. After the implementation of the project in real time, a two day
practical training for the sisters will be conducted for them to understand the working of the biotelemetry
system and the processes taking place. The training will cover the handling of the software interfaced with
the Advanced Biotelemetry System and operating the diagnosing equipment based on the patient's health
status, after which they will be able to access the hub and treat the patients with doctor connected through the
biotelemetry system. Reference [1],[2] cited below follows.

III. PARAMETERS TO BE MEASURED:

• ECG
• Blood Glucose
• Body Temperature
• Blood Pressure
• Heart Beat Rate
A. Temperature
In Oragadam, most of the villagers are farmers or hunters and hence toil in wild areas which are homes to
insects and snakes, and as a result, poisons bites and serious illnesses are a primary health hazard. Most of the
body disease symptoms include high body temperature which increases when the immuno mechanism of the
body attacks the foreign body or pathogen which enters the blood stream, producing antibodies(like snake
poison). The rise in temperature is the effect of the immunogens and hence by determining the temperature of
the patient the exact severity can be determined. Disorders of the immune system can result in autoimmune
diseases, inflammatory diseases and cancer[7].The circuit diagram of glucometer is shown in Figure 1

Figure 1 Circuit for digital glucometer

B. Digital Glucometer
The habitual activities of the residents of the village tend to alcoholism with an unbalanced diet for the men
and no regular exercise for the women and meager nutrition for the children. Based on our survey, most of
the aged people in the village are diabetic patients, hence if a diabetic patient approaches the primary health
centre, his blood sugar level and the blood pressure has to be determined. Therefore an instant digital

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glucometer which displays the blood glucose level of the diabetic patient to the host doctor is a necessity and
the block diagram shown in Figure 2 follows.
Natural blood glucose regulation: Glucose (C6H12O6) is a carbohydrate whose most important function is
to act as a source of energy for the human body, by being the vital precursor in the synthesis of ATP
(adenosine triphosphate). Glucose can also be used in the formation of proteins, glycogen, and lipids.
Reference [4],[5],[8] states these details.
The blood glucose regulation process includes:
1. After the glucose has been absorbed from the eaten food, it is released in the blood-stream. High blood
glucose levels causes the pancreas to produce insulin. Insulin enables the muscle cells to take glucose as
their energy source and to form a type of molecule called glycogen that works as secondary energy
storage in the case of low levels of glucose. In the liver cells, insulin instigates the conversion of glucose
into glycogen and fat. In the fat cells of the adipose tissue, insulin also promotes the conversion of
glucose into more fat and the uptake of glucose.
2. The pancreas will continue to release insulin and liver cells continue to use glucose till the drop of
concentration of glucose is below a limit; in that case, glucagon will be released instead of insulin.
3. When glucagon reaches the liver cells, it initiates the formation of glucose from glycogen, and fat into
fatty acids, which many body cells can use as energy after the glucagon enables them to. The cells will
continue to burn fat from the adipose tissue as an energy source, and follow with the protein of the
muscles, until the levels of glucose increase again by the digestion of food, and that terminates the cycle.
Diseases caused due to the variation in the glucose level in the body include Diabetes, which is a chronic
disease characterized by high or low blood glucose levels, which results from the pancreas not working
properly and not producing enough insulin or when the body cells do not respond to it in the correct way.
There are three type of Diabetes mellitus depending on the severity - Type I, Type 2 and gestational diabetes

Figure 2 Block Diagram of digital glucometer

Glucometer sensor: The sensor used has an electro-enzymatic approach, which means that it takes benefit of
glucose oxidation with a glucose oxidase enzyme. The existence of glucose oxidase catalyzes the chemical
reaction of glucose with oxygen, which causes an increase in pH, decrease in the partial pressure of oxygen,
and increase of hydrogen peroxide because of the oxidation of glucose to gluconic acid. The test strip
measures changes in one or several of this mechanisms to determine the concentration of glucose.
The stripsused have three terminals or electrodes. Figure 3 shows the test strip terminals:
• Reference electrode
• Working electrode
• Trigger electrode
A negative voltage of –0.4 V is applied at the reference electrode[12]. When blood or a glucose solution is
placed in the strip, a chemical reaction occurs, thus generating a small electrical current proportional to the
glucose concentration. This current is constantly monitored while the strip is in place, allowing the device to
monitor when blood is placed After the chemical reaction stabilizes, 5 s, the voltage is read by the ADC and
compared using a look-up table to obtain the proportional glucose value in mg/dL. This value is sent to the
host computer to inform the glucose value.
The output of the test strip shown in Figure 3 is a representation of the glucose concentration. The voltage
hence obtained is amplified and filtered. A voltage reference standard is used to compare the sample and it

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determines the level of glucose in the body.The complete block diagram of digital glucometer is shown in
figure 4.

Figure 3 Test Strip of digital glucometer

Figure 4 Digital Glucometer

C. Blood pressure
The blood pressure with systolic and diastolic abnormalities can be recorded using a digital blood pressure
monitor. This is a vital parameter in diagnosing conditions of the cardio-vascular disorders. During each
heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure. .The
blood pressure in the circulation is principally due to the pumping action of the heart. A person’s blood
pressure is regularly expressed in terms of the systolic pressure over diastolic pressure and is measured in
milli-metres of mercury (mmHg), for example 120/80.
D. Digital stethoscope
For symptoms such as cough and cold, tuberculosis, pneumonia and other pulmonary disorders, respiratory
problems, cardio vascular abnormalities, cardiological symptoms can be diagnosed only by a digital
stethoscope.
E. ECG
The ECG wave contains PQRST points that measure the rate and regularity of heartbeats, as well as the size
and position of the heart chambers, the presence of any damage to the heart like arrythmea. tachycardia and
brachycardia and the effects of drugs or devices used to regulate the heart (eg. pacemaker). From the
description of the patient approaches the hospital, found from the ECG waves, if the patient is suffering from
cardiac problems.
Electro Cardio Gram: The normal Electro Cardio Gram is composed of a P wave, a QRS complex and a T
wave (shown in Figure 5 & 6). The P wave represents atrial depolarization and the QRS represents
ventricular depolarization. The T wave reflects the phase of rapid repolarization of the ventricles.Reference
[7] details above.
P Wave: The P wave is the first wave of the electrocardiogram and represents the spread of electrical impulse
through the atrial musculature (activation or depolarization). Duration of not more than 0.10 seconds.
Amplitude of not more than 3mm in height and gently rounded, not pointed or notched are present[21].

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 The normal deflection of the P wave is upright (positive). The deflections are normally negative or biphasic,
but may be positive. [17] Sometimes, the deflection may be upright, biphasic, flat or inverted (negative)
depending upon the position of the heart in the body and the orientation of the leads.

Figure 5 ECG Waveforms

Figure 6 the individual Waves

P-R Interval:The PR interval is measured from the beginning of the P wave to the beginning of the QRS
complex. It reflects the time taken by the impulse to travel the entire distance from the SA Node to the
ventricular muscle fibers. The normal duration for this is 0.12-0.20 seconds. Normally this interval varies
with heart rate and is shorter at faster rates.
QRS Complex: Probably the most important complex in the electrocardiogram is the QRS. It represents the
spread of the electrical impulse through the ventricular muscle (depolarization) [18]. The waves which make
up this complex are labeled as follows-
- The first deflection , if it is negative (downward), is labeled the Q wave.
- The first positive (upright) delflection is labeled the R wave, whether it is predeceded by a Q
wave or not.-
- A negative deflection following an R wave is labeled an S wave.
T Wave: The T wave represents the period of recovery for the venticles (repolariztion). Generally we are
concerned with three features: 1.) direction, 2.) shape, and 3.) height. The normal shape of the T wave is
slightly rounded and slightly asymetrical. Sharply pointed or grossly notched T waves should cause
suspicion, although either feature can occur as a normal variant of the precordial leads. Notching can be an
indication of pericarditis, and sharply pointed symmetrical T waves should make one suspicious of
myocardial infarction(MI).
Instruction Commanding: This is the fundamental concept of an advanced biotelemetry system. This
involves the communication between the host doctor in urban hospitals and the hub nurse in the remote
locations. The instruction from the host doctor to the hub nurse can only be done by the following three
major means of
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 • Video conferencing
• Audio consultation
• Instant chat/messaging
Based on the morphological and anatomical injury or wound of the patient by actual appearance of the
wound, the doctor prescribes treatment by mimicking a "face to face" consultation and the real time
visualization is done through video conferencing through webcam, microphone and speakers. The doctor has
the flexibility of querying the patient with the omission of transportation. The host doctor can hence
command the hub nurse about the appropriate actions to be undertaken.
If the health ethics of a patient cannot be discussed over the microphone, certain features can be discussed
through the use of instant messaging and the conversation remains confidential between the doc and the
patient. Reference [3] follows these information.

IV. TELEMETERING COMPONENTS

A typical telemetering system consists of (Reference [6])
• An input Transducer
• Medium of transmission of data
• Equipment for receiving and processing the signal
• Recording or display equipment.

V. Sensors
There are many types of specialized sensors and transducer systems. Most heat-sensing and transmitting
elements measure temperature, pressure, and humidity. Sensors for measuring such factors as the patient’s
blood pressure, heartbeat, and breathing rate are employed.

VI. COMMUNICATIONS LINKS

Communications facilities for telemetry consist primarily of radio or wire links. Alternatives such as light
beams or sonic signals are used in a few cases, but environmental factors (e.g., atmospheric obstructions) and
local masking noises make them impractical for most applications.
Radio communication is used when it is impractical to provide wire line links. A significant consideration in
radio links is the choice of operating frequency, a choice limited to bands allocated by international
agreement. Propagation varies over a great deal over the range of frequencies involved. For aerospace
applications in which transmissions must penetrate the atmosphere, the frequency range is 100 megahertz
(100,000,000 cycles per second) to 10,00 megahertz. Line links for supervisory applications usually employ a
comparatively narrow band. They may utilize the whole or only a section of a conventional voice channel
with a bandwidth of 3 kilohertz (cycles per second). The link may be either a direct wire circuit or one of the
channels in a carrier communications system.

VII. MULTIPLEXING AND SAMPLING

A telemetry system in general must handle more than one channel of information. These data-measurement
channels are brought together by a procedure known as multiplexing, which combines the channels into one
composite signal for transmission over the communications link[30]. Multiplexing may be based on either a
time division or a frequency division. In time division, channels are joined with one after another in time
sequence; in frequency division, each channel is assigned on an individually allocated, discrete frequency
band, and these bands are then combined for simultaneous transmission. Finally, data may be handled within
the telemetry system in a continuous (analog) or discrete (digital) way. The systems are comparatively more
complex because it is necessary to translate analog signals to digital form, a procedure known as encoding.
Time-division multiplexing involves a chronological action in which samples are selected in turn from a
number of different quantity channels for transmission to the receiving point. In fixed cycle selection a
switching device connects a particular channel to the outgoing communications link in accordance with a
prearranged sequence.
With an address-reply system, information is sent only as a result of a command signal: sampling is in
concord with a predetermined scanning program, which is compliant, because it can be arranged to meet
priority requirements for information, as, for instance, when an alarming situation develops.
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VIII. TRANSMISSION
A process of modulation is used to stress the information on the carrier frequency. Of the many design
choices that must be chosen, that of the modulation method is among the most critcial. Not only does it have
a direct influence on system performance but it also tends to define areas of design in both the sender and the
receiver. The protocols and their frequency spectrum is given in the table 1.

TABLE I PROTOCOLS AND THEIR FREQUENCY SPECTRUM.

Modulation methods fall into two categories. The first includes amplitude and frequency modulation. These
related types include two pulse-based methods in which several pulses are spaced out in time, each pulse
representing one information channel. The two types are pulse-width (or pulse-duration) modulation
and pulse-position modulation. In the first, the data produces discrepancy in the width (or duration) of the
pulse; in the second, the changes is in the position of the pulse with respect to time. In the second main
class,pulse-code modulation, the information is coded digitally into groups of pulses and then sent over for
transmission.
In most telemetering systems, modulation is carried out in two stages. First, the signal modulates a sub-
carrier, which is a radio-frequency wave the frequency of which is lesser than that of the carrier, and then the
modulated subcarrier in turn modulates the carrier. Frequency modulation is used in many of these systems to
imprint the telemetry information on the subcarrier. If frequency-division multiplexing is used to combine a
group of these frequency-modulated subcarrier channels, the system is known as an FM/FM system.the
transmitter block diagram shown in Figure 7.

Figure 7 of transmitter

IX. PROCESSING THE RECEIVED SIGNAL

At the receiving end of the telemetry, two tasks must be completed to obtain the message: the fundamental
measurement data must be extracted from the received signal, and it must be presented or displayed in lucid
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form. The extraction of the data takes place in two stages and is the reverse of the steps taken in producing
the modulated composite transmitting signal. Initial demodulation produces the modulated subcarrier; this
subcarrier is then split up into its essential measurement channels by de-multiplexing. The separated signals
are fed individually to their individual points in the presentation system. Data is presented in “real time”—
that is, at the instant the variable is being measured—and in one or more recorded forms. For the regular
requirements of the latter, formal diagram displays in general are provided, together with printout of the data
by electric typewriter. They are experimental in nature, generally demonstrate a wide range of measurements.
Almost without exemption, data are recorded in a form appropriate for processing by computers. Reference
[9],[10],[11] states as follows.

X. SPECIAL APPLICATIONS AND TECHNIQUES

New purposes of telemetry are continually emerging, particularly in the fields of study and scientific
exploration. An vital area is biomedical research, in which biological information is telemetered from inside
patients by means of microminiature transmitters that are either swallowed or surgically implanted. External
monitoring of body conditions can be carried out with surface transducers.
Telemetry is often provided by television-like facilities usually employing a low-bandwidth communications
link. This type of service is beneficial when a visual warning is desired of a process inaccessible to humans.

XI. CONCLUSION
The development of an advanced biotelemetry system in Oragadam can help monitoring the patient's vital
signs remotely in real time, thus establishing a reliable communication between the healthcare facilities
driving a quality and an improved healthcare delivery to all citizens, bringing healthcare closer to the
underserved and un-served rural areas. This strengthens collaborative efforts among hospitals in facilitating
information exchange and experience sharing among medical professionals practicing in remotely located
clinics. Minimization of long distance travels of rural people to urban areas, seeking proper medical attention
while remaining in the comfort of their home-town during trauma is a major benefit.
This method will aid people with both Therapeutic and Diagnostic approach in the village and villages
around it.What started in Oragadam, Chengalpattu in the March of 2013 was an idea to create a Biotelemetry
System with advanced technologies in order to help the rural areas with broken medical dispensaries and
change the despondent face of the village clinic into a thriving Primary Health Center.

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