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Real-time artificial intelligence based health monitoring, diagnosing and

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Article in Mathematical Biosciences & Engineering · May 2022

DOI: 10.3934/mbe.2022357

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 MBE, 19(8): 7586–7605.
DOI: 10.3934/mbe.2022357
Received: 22 February 2022
Revised: 04 April 2022
Accepted: 09 May 2022
Published: 23 May 2022
http://www.aimspress.com/journal/MBE

Research article

Real-time artificial intelligence based health monitoring, diagnosing and

environmental control system for COVID-19 patients

Muhammad Zia Ur Rahman1,*, Ali Hassan Raza1, Abeer Abdulaziz AlSanad2,*, Muhammad
Azeem Akbar3, Rabia Liaquat4, Muhammad Tanveer Riaz1, Lulwah AlSuwaidan5, Halah
Abdulaziz Al-Alshaikh2 and Hatoon S Alsagri2

1
Department of Mechanical, Mechatronics and Manufacturing Engineering, University of
Engineering and Technology Lahore, Faisalabad Campus, Faisalabad 38000, Pakistan
2
Imam Mohammad Ibn Saud Islamic University, Information Systems Department, Riyadh 11432,
Saudi Arabia
3
Lappeenranta University of Technology, Department of Information Technology, Lappeenranta
53851, Finland
4
U.S.-Pakistan Centre for Advanced Studies in Energy (USPCAS-E), National University of
Sciences & Technology (NUST), Sector H-12, Islamabad 44000, Pakistan
5
College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University,
Riyadh 11432, Saudi Arabia

* Correspondence: Email: [email protected], [email protected].

Abstract: By upgrading medical facilities with internet of things (IoT), early researchers have
produced positive results. Isolated COVID-19 patients in remote areas, where patients are not able to
approach a doctor for the detection of routine parameters, are now getting feasible. The doctors and
families will be able to track the patient's health outside of the hospital utilizing sensors, cloud storage,
data transmission, and IoT mobile applications. The main purpose of the proposed research-based
project is to develop a remote health surveillance system utilizing local sensors. The proposed system
also provides GSM messages, live location, and send email to the doctor during emergency conditions.
Based on artificial intelligence (AI), a feedback action is taken in case of the absence of a doctor, where
an automatic injection system injects the dose into the patient's body during an emergency. The
significant parameters catering to our project are limited to ECG monitoring, SpO2 level detection,
body temperature, and pulse rate measurement. Some parameters will be remotely shown to the doctor
via the Blynk application in case of any abrupt change in the parameters. If the doctor is not available,
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the IoT system will send the location to the emergency team and relatives. In severe conditions, an AI-
based system will analyze the parameters and injects the dose.

Keywords: artificial intelligence; Blynk IoT platform; electrocardiogram (ECG); emergency

condition; internet of things (IoT); SpO2

1. Introduction

Chronic disease (for example, cardiovascular disease, diabetes, Alzheimer’s) has increased, with
mortality associated with a rise in coronial health disease to 66% by 2030. Telehealth, which includes
virtual healthcare, makes use of technology to improve communication between doctors, clinics, and
patients. Clinics, doctors, and patients can share information, monitor, and follow up on care plans
using electronic communication technology, which allows for maximum virtual participation
throughout medical treatment. We now live in a globe where technology can execute procedures,
perform pre-operative planning, and monitor results from afar [1], in accordance with the World Health
Organization (WHO). It is necessary to monitor patients continuously with chronic illnesses to avert
life-threatening scenarios.
This decade, the Internet of Things has been hailed as the beginning of a new era of
interconnectedness for everyday devices everywhere. Remote health monitoring mechanisms [2,3],
parking management [4], smart houses [5], smart cities [6], smart environment [7], industrial sites [8],
and agricultural lands [9]. Health and environmental conditions can be tracked using IoT in healthcare
management. The importance of IoT systems has been increased in real-time applications because of
their simple structure. IoT connects computers to the internet through sensors and networks in order to
process data in real-time [10,11]. Figure 1 shows the IoT applications in real-time systems.

Figure 1. IoT applications in daily life.

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In this article, a system for remote health surveillance is developed by utilizing locally available
sensors. This system will provide the live location, GSM messages, and an email to the doctors during
emergency conditions. The remainder of the paper is laid out as follows: Section 2 contains the
literature survey of previously existing techniques and problem statements. Section 3 contains the
materials and methodology of the proposed system. Section 4 gives the general description of
intelligent neural networks and defines the training of the proposed intelligent system. Section 5
contains the real-time implementation results of the proposed system and provides a discussion of
obtained results. Section 5 also gives a comparison among proposed and different existing IoT-based
health monitoring systems. The conclusions and future works are described in the last.

2. Literature review

A health monitoring gadget might make use of interconnected pieces of equipment. It is then sent
to M2M, which are machines for people, machines for computers, portable devices, or cellphones [12].
Health care tracking and optimization may be done in a far more efficient, intelligently scalable, and
interoperable manner with this method. Modern systems now include a flexible user interface [13],
helper devices [14], and mental health management [15] to help people live smarter lives. The IoT is
essential for monitoring health because it allows us to link equipment for medication to gather health
data from patients and work on it to avoid catastrophic occurrences [16]. It is also possible to connect
medical sensors and process them. In every expansion sign of progress of humanity in technology, the
critical issue in life is achieving good health. A sensing device may be considered “smart” if it is
combined with a network-capable application processor (NCAP) that provides local control, and
feedback and connects each sensing device to the high-level network. [17]. The situation in the
hospitals is getting worst by the viral infections of COVID-19, which create space shortage for new
patients. Numerous hospitals have already initiated to invest in technology acceptance. For example,
to reduce administrative burdens while improving healthcare outcomes. Saratoga Hospital purchased
IoT-enabled patient monitoring devices [18].
In healthcare hardware and software, the medical IoT is keenly integrated to back clinicians and
patients. Continuous patient surveillance provisions are in place. When they come home, no
arrangement is made to verify the parameters. And thus, there’s a risk that the illness might come back.
Therefore, the Internet of Things health surveillance system is the answer. Data from a patient is often
measured and uploaded to the server (temperature, heart rate, SpO2, ECG). The physician might even
have not to live with the patient to check the patient’s status. The doctor can look at the health state of
his patient using his android mobile application or the smartphone of the patient. If any parameter
exceeds the threshold value, the doctor receives a message of an emergency alert. The optimal control
of humidity and temperature of the room also keeps a safe environment in the patient room [19].
According to the WHO, COVID-19 has harmed more than 10 million individuals in the world. And
there is also a high overall death rate. During COVID-19, many doctors who met patients to secure
COVID-19 patients were also affected [20]. In various monitoring applications, wireless sensor networks
(WSNs) have been widely employed because of the advantages of low cost and easy deployment,
including battlefield surveillance, environmental monitoring, and bio identification [21,22], etc.
The key function of IoT in an emergency is to monitor and notify the patient. Wearable gadgets,
medical tracking systems, supply chains, remote patient monitoring, and more are examples of IoT in
the medical and healthcare sectors. IoT can help improve diagnostic accuracy by continuously

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monitoring health changes. Users can stay in touch with doctors or nurses via IoT healthcare apps.
They assist healthcare workforces to work more efficiently with the patients in working place [23]. An
IoT platform will help the doctor and the patient. The doctor examines the health indicators of patients
through the IoT platform (Blynk). It is necessary to constantly monitor patients with chronic illnesses
in order to avert life-threatening scenarios. The IoT is essential for monitoring health because it allows
linking health parameter measuring instruments to gather patient health data and proceed with it to
avoid catastrophic occurrences. It is also possible to connect medical sensors and process them. The
design of the wireless sensor network consists of nodes that are used to monitor environments such as
temperature. This may be assessed through the physicalizing of the Internet. This technology is
exciting for an extensive range of applications such as medical, environmental, transit, military,
entertainment, home defense, crisis management, and smart spaces [24,25].
Normally, many researchers have considered the machine learning techniques as efficient
diagnostic tool health monitoring of patients [26–28]. For the best solution of real-time problems, the
most suitable AI techniques is the neural network [29].

3. Materials and methodology

In this section, we provided the materials and methodology of the proposed system. The complete
description of the system using a flowchart is also presented.

3.1. General context

There are three primary problems with existing IoT-based health surveillance systems. First, the
communication lines such as 3G/4G are used commonly under relatively high-cost conditions.
Secondly, in general, data privacy problems are not addressed. And at last, most of them are not
analyzed or monitored. Our main work is to make a low-cost and more robust system via ESP32 board.
One of the key elements of this project is Blynk, a development platform for e-health monitoring that
works along with Arduino Uno. Up to 15 sensors can be connected and measured using Blynk. The
Blynk platform is utilized for biomedical sensors such as ECG sensor, body temperature sensor and
oxygen saturation and pulse rate sensor. LoRa communication technology, a novel, private and
broadcast modulation approach, enables the transmission of data at extremely low data rates to very
long ranges are utilized for the wireless transfer of measured health data to the cloud.
When patients have to take a medicine at a certain point during the day, the patient will be notified
of the medication and the condition. Blynk IoT platform is the best solution for monitoring parameters
from remote location. A complete flow chart of the proposed real-time health monitoring system is
shown in Figure 2.

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Figure 2. Flow chart for real time monitoring.

3.2. CAD model design and hardware implementation

The CAD modal of an auto-injector device that injects the dose automatically is developed and
implemented as shown in Figures 3–5. There are three slots in this device, and two prefilled syringes
are placed at the 1st and 3rd slot, and the 2nd or central space is empty. The first syringe belongs to
emergency treatment for the heart disease patients, and the other needle is for the treatment of patients
with breathing disorder. When the parameter is gone critical, it gets a notification to take-action. When
the heart disease is detected, the first servo SG90 starts to take the heart’s string from 1st slot and take
it to the space. When the syringe is placed, the stepper motors begin to rotate the shaft, and then the
slider moves on the post to push the barrel, and then the needle injects into the patient’s muscle. A
spring mechanism is present there to take out the injection. Below Figures represent the CAD design
and hardware implementation.

Figure 3. 1st CAD model.

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Figure 4. 2nd CAD model.

Figure 5: Hardware implementation of slected CAD model design.

3.3. General description of proposed methodology

An innovative health management system has been created that is intelligent enough to monitor
IoT and Cloud patients’ vital health metrics automatically and link their doctor through live contact
with the patient. This collects the patient’s heart rate, heart rate, level SpO2, ECG, and temperature
using sensors connected to the patient’s body and communicates the current state of the emergency
condition if the threshold of the parameter is reported and comprehensive medical data to the patient’s
doctor. The doctor will continue to follow the patient and urge the patient to observe and interact
directly with their state of health without going to the hospital. All the sensors are connected to the
patient’s body to measure the real-time data and then the observed values are sent to the microcontroller.
The working principle of NodeMCU microcontroller, in the proposed methodology, is shown in
Figure 6. The NodeMCU microcontroller is attached to the internet module ESP32. An IoT platform
(Blynk) collects all the data from this controller and displays it to the doctor.
If any of the parameter values changed from the threshold, the doctor would receive an emergency
email. A doctor can communicate with their patient via live calling. Figure 7 represents the step-by-
step working principle of the proposed methodology.

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Figure 6. Working principle of IoT-based NodeMCU in the proposed methodology.

Figure 7. Steps involved in working of proposed methodology.

4. The intelligent neural networks

In this section, we provided the intelligent neural networks, their selection accuracy improvement
trainings and testing.

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4.1. General context

Many classifiers and machine learning techniques were created to categorize data sets for
classification issues. Linear classificatory are employed when input data is linearly separable.
Relatively raw electrical networks of neurons based on the neural construction of the brain are artificial
neural networks (ANC). The process records one by one and learns by comparing their record
categorization with the actual record classification known. The mistakes from the original
categorization of the first record are reproduced in the network and are utilized for subsequent
iterations to change the network algorithm. A neuron is a collection of input values (xi) and associated
weights in an artificial neural network (wi). Function (g), which accumulates the consequences and
maps the output results (y).

4.2. Selection of neural network

The neural network of three fundamental kinds of artificial neural network (ANN), deep neural
network (DNN), and convolutional (CNN). ANN for pattern recognition issues, CNN for HD, and
DNN for multiple hidden layers are frequently applied. DNN is used for several hidden layers in this
paper. At its most straightforward, the deep network (DNN) or the deep network for the shortest is the
neural network with a certain complexity, generally two layers. Deep networks use advanced
mathematical models to handle data in complicated ways.

Figure 8. The evolution to deep neural networks (DNN).

First, it was necessary to create machine learning. ML is a framework for automating statistical
models (via algorithms), such as a linear regression model, to improve predictions. A single model is
a model that predicts something. These forecasts are accurately produced. The learning model –
machine learning takes all its poor predictions and changes the weight of the model in order to build a
more miniature error model. The learning part of the model building has created artificial neural
networks. The essence of neural network training is back-propagation. It is the way weight in a neural
network may be adjusted based on the error rate achieved during the previous epoch. Proper adjustment
of weights helps you to minimize error rates and make the model more generalized and dependable.
Neural network background propagation is a brief “backward error propagation” form. It is an artificial
neural networking standard technique. In this technique, the loss function gradient for all weights in
the network may be calculated.

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Figure 9. Visual representation of ANN with backpropagation.

ANNs use the hidden layer as a storage location and assess the importance of one of the inputs to
the output. The hidden layer contains information about the relevance of input and links the importance
of input combinations.

4.2.1. Improving accuracy

Deep networks allow the performance of a model to improve precision. You can take a collection
of inputs and produce output for a model. The usage of a deep network is so simple as to copy and
paste a code line for each layer. The ML platform you use does not matter; it is as easy to type in the
letters 2 or 2000 to guide the model to two or 2000 nodes in each layer.

4.2.2. Training and testing

Dataset from the EMG body data, utilized as input for classification using ANN feedforward with
backpropagation technology. 80:20 ratios are used to train and evaluate the neural network as shown
in Figure 10. For neural network training, 80% of data set values are utilized. It’s more accurate to
train a neural network several times [30]. An epoch is called the number of times the entire training
data set is passed on. The optimum scenario is that the training and validation error continues to
decrease in a number of periods. When the model ends at 1 stage, the model parameters are modified
according to the results.

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Figure 10. Training progress.

A part of date set is considered as validation data set. For the validation data set, the fitted model
is used to predict reactions to these observations. For the testing of the neural network, the remaining
20% are employed. Usually, it is a holdout dataset that has not been utilized for training or cross-
validation. The test analyses the final model fit the data set of training while adjusting the
hyperparameters of the model. Classification results are acquired through training and testing.

5. Results and discussion

In this section, we report the results of the real-time implementation of the proposed system,
discuss the obtained results, and compare the proposed and different existing methods.

5.1. Implementation of IOT

The Blynk application is designed to monitor the heart rate, SpO2 level, and body temperature
and control the room’s environment by maintaining the temperature and humidity. The Blynk
application is also capable of showing the live location of the patient in case of emergency. This
location will be shared with doctors and family members. The ESP32 sends an email to the doctor The
ESP32 is also able to call and send messages using the SIM900A module. The design gets the data
from the ESP32 and sends it to the laptop which is viewed on a serial monitor.

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Figure 11. Hardware implementation.

Figure 12. Blynk IoT system.

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IOT enables the data transfer to Blynk application using ESP8266. The heart rate, SpO2 level and
temperature data sends to first screen of Blynk interface. The room’s temperature and humidity
transferred to the second page of Blynk interface. The application is also able to set the predefined
levels for heart rate, SpO2 level, and body temperature, once the parameters meet the current level the
doctor receives an email alert about the critical parameter of patient health. The live location of the
patient is also available on the interface.
For the second interface, one can set the humidity and temperature levels to the desired value for
the patient’s room. That helps to maintain the environment around the patient. Once we set a level
using the slider, Blynk sends the data to the Blynk cloud using API and ESP8266 gets that data from
Blynk cloud and sets in the hardware to compare it with current values around the patient. Figure 12
shows the interface first and second for vital features and room environmental control.

5.2. Circuit design

Fans, relays, and humidifiers are the major components in this circuit schematic which are shown
in Figure 13. With the aid of two relays stated above, the fan and the humidifier are regulated. For
humidity and temperature in °F, the real data or input is obtained from the DHT11 sensor in mmHg.
These criteria are specified using sliders, Blynk’s GUI feature. Both parameters’ thresholds have
previously been specified and sliders match and react to these values. Examples,
if(sliderhumidity<h){ digitalWrite(relayhumid,LOW };
The fan had to hold a temperature of 20°F and the sensor transfers that information’s to the fan
quicker in order to retain the necessary temperature when it surpasses the set threshold.

Figure 13. The schematic diagram of fans, relays and humidifiers circuit.

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5.3. Implementation of neural network

A technique of identifying QRS complex (R-Peaks) ECG signal is presented using an undecimated
discrete wavelet transform (DWT) [31]. It is shown how DWT is used to filter an ECG signal through
the bandpass to maintain the R-peaks, which is best for selected BPF frequencies. The heart ratio is
also calculated (in beats per minute) using the calculation of total R peaks. The proposed robustness
of the Scheme is further proven using different types of ECG signals from MIT-BIH and ECG-ID
databases.
The QRS complex consists of the conjunction of three deflections (Q, R and S) (ECG). It referred
to the depolarization of the ventricles right and left of the heart and the contraction of the big ventricular
muscles. Average QRS amplitude is 5 to 30 mm and duration between 0.06 and 0.12 seconds,
respectively [32]. QRS complex width, amplitude, or form is essential for the diagnosis of coronary
rhythm, aberrant behavior, VHH, myocardial infarction, electrolyte disorder, and other illness
conditions. An ECG signal from the MIT-BIH database is shown below in Figure 14.

R
300
MIT BIH data base ECG signal
250

200
Amplitude of the ECG signal

150

100

50

-50

-100 Q
Q
S
-150
0 50 100 150 200 250 300
S
Sample Index (X)

Figure 14. ECG signal output.

The form of an aberrant QRS complex varies from near-normal to strange and/or slurred and
nodules. The enlargement of one or both ventricles, or the faulty pacemaker or aberrantly performed
beat, is often responsible for large QRS complexes. In obese, hyperthyroid and pleural effusion
individuals, low voltage or unusually tiny QRS complexes might be detected.
Now, we describe the symlet4 wavelet for an ECG signal. Note that the rationale for choosing
symlet4 is that the “sym4” wavelet is like the QRS complex and is a suitable option for QRS detection.
Symlet4 of an ECG signal is shown in Figure 15.

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Figure 15. Symlet4 wavelet for an ECG signal.

As a technique of identifying QRS complex (R-Peaks) ECG signal is presented using a decimated
discrete wavelet transform (DWT). It is shown how DWT is used to filter an ECG signal through the
bandpass to maintain the R-peaks, which is best for selected BPF frequencies. The heart ratio is also
calculated (in beats per minute) using the calculation of total R peaks. The proposed robustness of the
Scheme is further proven using different types of ECG signals from MIT-BIH and ECG-ID databases.

Figure 16. Loss and accuracy of training and test datasets.

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Figure 16 demonstrates the loss of training and validation and precision. Our objective was to
obtain as low a validation loss as feasible. The loss of assurance in Figure 16 is higher than the loss of
training, which is also shown in the confusion matrix of Figure 17. It is referred to as oversize. If the
data set comprises any scenario, the overfit may be advantageous for the neural network’s performance.

Figure 17. Confusion matrix.

Comparison
12
Number of Features

10
8
6
4
2
0

Research Work

Figure 18. Comparison of proposed research with existing research having no of features.

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5.4. Comparison

A brief comparison between different techniques in terms of sensors and features used for
different health monitoring research is given in above Figure 18. Below there is Table 1 has a brief
comparison between eight different research.

Table 1. Comparison of proposed and the existing techniques.

Ref. NET System Heart App ECG GSM LCD Email Room Injector GPS
rate + alert control
SpO2
Proposed WIFI AI         
[33] IP Based      
[34] WIFI Fuzzy    
[35] LoraWAN     
[36] BT + Wifi     
[37] BT + Wifi   
[38] Wifi   
[39] LoRa AI   
[40] Wifi AI  

6. Summary

6.1. Conclusions

By applying the deep neural network, the training data is processed in MATLAB, and the output
class is generated that shows the probabilities of the output class with respect to the target class. The
confusion matrix is made up of marginal and joint probabilities. This matrix shows the loss and
validation of the training data. The overall result from DNN is generated, and our system becomes
intelligent by training the system. Our designed IOT-based system can automatically send data to the
doctor via the web page. Also, an AI-based medicine prescription system can give a dose to the patient
in the absence of a doctor during a severe emergency. This system can also be used as a product for
patients living in rural areas as helping them to avoid hospital expenses; they can use the device and
check their vital signs and get the correct medicine for them via doctor or the AI-based system [41].

6.2. Limitations

Our AI-Based Patient Monitoring System has been designed to help doctors observe the vital
signs of patients remotely via a webpage and to help people who are in need of a hospital and living
in rural areas but cannot reach the hospital and also in case of the absence of a doctor, to prescribe
medicines to the patients accordingly. The fully developed proposed system has many applications.
There is no need for the doctor to visit the patient, again and again, the doctor can monitor the patient's
vital signs via a webpage from anywhere in the world. This system can be used in hospitals so that
doctors can simply observe the patient while sitting in their office. This system can also be used as a
product for patients living in rural areas as helping them to avoid hospital expenses, they can simply

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use the device and check their vital signs and can get the right medicine for them via doctor or the AI-
based system [42].

6.3. Future work and suggestions

In future research, the real-time health monitoring system will be installed in the isolated sections
of the local hospitals. In this way, the monitoring of patients without medical staff will be quite easy.
Also, the health monitoring data of the whole remote areas population will be interlinked to the server
cloud, and it can be observed by using the mobile application of this system.

Conflict of interest

The authors declare that there is no conflict of interest.

Acknowledgement

The authors extend their appreciation to the Deanship of Scientific Research at Imam Mohammad Ibn
Saud Islamic University for funding this work through Research Group no. RG-21-07-03.

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