UNIT III WIRELESS HEALTH SYSTEMS 9

Need for wireless monitoring, Definition of Body area network, BAN and Healthcare,
Technical Challenges- System security and reliability, BAN Architecture – Introduction,
Wireless communication Techniques.

3.1 Need for wireless monitoring

Wireless monitoring through wearable devices could be useful for hospitalized patients,
particularly those who are unstable or at higher risk for serious complications such as critically
ill patients. This review aims at summarizing current evidence regarding the use of wireless
monitoring in the ICU setting.
Wireless sensor network (WSN) technologies have the potential to change our lifestyle with
different applications in fields such as healthcare, entertainment, travel, retail, industry,
dependent care and emergency management, in addition to many other areas. The combination
of wireless sensors and sensor networks with computing and artificial intelligence research
have built a cross-disciplinary concept of ambient intelligence in order to overcome the
challenges we face in everyday life.

3.2 Definition of Body area network

Body Area Network (BAN) technology uses small, low power wireless devices that can be
carried or embedded inside or on the body. Applications include but are not limited to:
 Health and wellness monitoring
 Sports training (e.g., to measure performance)
 Personalized medicine (e.g., heart monitors)
 Personal safety (e.g., fall detection)

A number of wireless BAN communication technologies have been implemented based on the
existing radio technologies. However, if BAN technology is to achieve its full potential, it
needs a more specific and dedicated technology, which is optimized for BAN. For example,
solutions for monitoring people during exercise one or two hours a day, or a few days a week,
may not be suitable for 24/7 monitoring as a part of the Internet of Things (IoT) concept.
3.3 BAN and Healthcare
Body Area Network (BAN) is a technology that allows communication between ultra-small
and ultra low-power intelligent sensors/devices that are located on the body surface or
implanted inside the body. In addition, the wearable/implantable nodes can communicate to a
controller device that is located in the vicinity of the body. These radio-enabled sensors can be
used to continuously gather a variety of important health and/or physiological data. Radio-
enabled implantable medical devices offer a revolutionary set of applications among which we
can point to smart pills for precision drug delivery, intelligent endoscope capsules, glucose
monitors and eye pressure sensing systems. Similarly, wearable sensors allow for various
medical/physiological monitoring (e.g. electrocardiogram, temperature, respiration, heart rate,
and blood pressure), disability assistance, human performance management, etc.
Wearable devices that work outside the confines of the hospital without expert medical
assistance must fulfill a number of characteristics:
 Usability: The device has to be worn on a continuous basis and must therefore be small
and lightweight. The challenge is to compress the device size down.
 Power consumption: The device should have low power consumption, reducing the
need for frequent re-charging and disruptions in monitoring.
 Design: The device must be elegant without the need to attach long wires and electrodes
from the device to the patient and from the device to the mobile gateway that transmits
data (to the remote medical care unit).
 Cost: If a patient is required to purchase the unit, it should cost sub US$200 to be
affordable or for the hospital to give it away free as part of medical care.
Devices that fulfill these conditions can expect to become popular. Manufacturers will find that
users are able to easily integrate such devices into their daily lives for maximum benefit.
The typical set of parameters that the device must monitor include heart activity, fetal heart
rate, skin resistance, skin temperature, refractive index of blood etc. Based on what the device
is required to measure and monitor, its components would include:
 Bio sensors: Application specific bio sensors that emit signals indicating measured
parameters
 Analog-to-digital converters: Application specific analog front end to digitize the
sensor signals. The device may also be equipped with signal conditioning circuitry.
  General purpose micro controller: To process signals for the device to function. Signals
could indicate battery levels, failure, etc. or signals received from accelerometer,
displays and switches, memory and connectivity solutions.
 Wireless interface: In most instances, the device will connect to a mobile gateway over
a Body Area Network (BAN) or the newer Bluetooth LE (low energy) suitable for
continuous transfer of medical data.
 Memory: In modern wearable devices, the data is sent in real-time to a mobile gateway
(smart phone or a tablet) and then to the patient’s remote health care provider. These
devices can also store data in off line mode, synchronizing the data when the device
goes online.
 Power management: The device design must ensure that energy consumption is
minimized for longer uninterrupted device deployment and stand by time.

3.4 Technical Challenges

Effectiveness of the WBAN is important from both patients and healthcare perspective.
As the time passes, challenges to the emerging technologies increases along with the
advancements. There is variety of challenges faced by WBAN as explain below. These
challenges are classified in six major classes such as energy, mobility, security and
communications (i.e., networking, QoS and cooperation).

A. Energy Requirements: Since, most of the devices in WBAN are using the wireless
medium, therefore they are portable. Such devices are small in size and carry power
source too. Hence, the power is always limited. Wireless natures made them roam
free, meaning the devices are free to move. The power to the device of the network
is provided with the help of batteries. Things are not simplified by allowing the
power from battery but is encompasses some more challenges of power
management of the battery supplies especially in case of implants. Since the sensors
that are implanted in the body are so small that the battery cannot sustain more than
a month. Removing the implants and re-installation require even more management
of the complications generated. Different parameters that alter the power
consumption include communication bandwidth and processing power. There is
 need to have better scheduling algorithm along with better power management
schemes.

B. WBAN Security: In any network, communication data is of worth importance. In

case of WBAN, it becomes more critical as it has been connected to the Physical
system. These communication channels are very much visible to the attacker and if
not securely implemented it could any of the attack including eavesdropping on
traffic between the nodes, message injection, message replay, spoofing and off
course compromise the integrity of physical devices. Upon successful attack, such
actions not only invade privacy but may lead to catastrophic situation.

C. Mobility Support: WBAN provides two major advantages, i.e., portable

monitoring and location independence. Regardless of the application, these are the
key factors due to which WBAN is potential candidate in many venues. But these
two advantages put some special limitations i.e., mobility. Mobility can pose
serious problem in some application like E-Health care even posture do effect the
communication. The mobility is defined between the user and the WBAN as a
seamless link. One of the major issues is to reach to sink, which may be single or
multi hop. Message is flooded to all nodes to reach sink node and the path with
minimum delay is selected. Reliable multipath routing is another solution proposed.
A path list is maintained depending upon different factors of the routing and the
link is established accordingly.

D. Quality of Service: Quality of Service (QoS) is the requirements fulfilled by

system as requested by the users. For more life critical system, timeliness may be
the parameter for the quality. System, that cannot fulfill the said requirement, falls
short of providing the QoS. Same is true for other factors like bandwidth, latency,
jitter, robustness, trustworthiness, adaptability. Similarly, seamless roaming and
end to end wireless connection between the body nodes and the sink nodes is
another QoS factor.

E. Cooperation between Nodes: When the intermediate nodes help source

destination pair in communication, the cooperation occurs. The intermediate nodes
may refer as helper or relay as shown in Fig. Cooperation offers a good solution for
many of the limitations in WBAN such as distance, mobility, coverage and channel
impairments.
3.5 System security and reliability

Sensor nodes/actuators represent essentially the wireless sensor network, and the sensor
node senses acoustic factors including temperature, pressure, sound, pulse rate, ECG, blood
pressure, and heart rate of the human body. In healthcare, this form of sensor network is known
as a wireless body area network (WBAN)
Wireless body area networks consist of sensors, biological parameters, body control
unit, personal device assistant, transmission factor, and user access. Figure shows that the
wireless body area network along with the sensor senses the biological factors continuously in
order to obtain the human health information from the body control unit. The electrocardiogram
(ECG) sensor records the patient's electric impulse as it passes through the heart muscle. This
assists in monitoring the patient's heartbeat, which is used to track various movements such as
resting and moving. The temperature of the human body's ears, skin, and forehead are detected
by the body temperature sensor.
The pressure of blood as it travels through the arteries is measured by blood pressure
and the pulse wave is measured by the heart rate sensor as it pumps blood through the patient's
body. The saturation level of oxygen in the blood is measured with a pulse oximeter. The
airflow sensor can be positioned near the human body's nasal to assess the body's respiration.
The collected information will be transferred and stored in the personal device assistants (PDA)
and later transmitted to the base station. From the base station, the data will be transferred to
the respective user applications such as cloud databases, ambulances, family members, and
doctors via the Internet.
A cloud database's purpose is to store the patient's data on a server so that the doctor
can access it and then send the patient's information to the user via the internet. Star topology
is used in the body area network. The body control unit acts as a central node and then each
sensor will sense and communicate to the center node. The center node interfaces the human
body by using Bluetooth or ZigBee or Personal Device Assistants (PDA), and then the patient’s
information can be accessed by the doctors using the Internet.

Security Issues in WBAN

The purpose of network security is to protect data from threats during data transmission.
There are two forms of attacks in network security: active and passive attacks, both of which
contribute to the detection of malicious data. An active attack is primarily focused on data and
has a significant impact on the system's operation. A passive attack damages or modifies data
but does not degrade information resources. The security flaws are applied at various levels.
Each layer of the TCP/IP layered architecture generates attacks. IP attacks are introduced in
the second layer (logic link control), resulting in address spoofing for incorrect communication.
Internet Control Message Protocol (ICMP) attacks is generated in the media access control
layer, which results in sniffing and man-in-the-middle attacks. In the third network layer,
routing attacks such as blackhole and eavesdropping attacks are created. TCP attacks are
originated in the transport layer, resulting in high synchronization flooding in data
communication. Application layer attacks are generated in the OSI model's application layer,
resulting in authentication issues such as accessing the user's username and password
A denial of service (DoS) attack will restrict data from authorized users and prevent
them from accessing their resources. Because of the week password, distributed denial of
service (DDoS) attacks is generated. The main difference between a DOS and a DDOS attack
is that a DOS attack targets a single host at a time, but a DDoS attack targets numerous hosts
simultaneously. These types of attacks will degrade network performance.

The term “reliability” refers to the fact that health-care practitioners receive monitoring
data in a timely and accurate manner. WBAN sensors must be capable of viewing and detecting
essential active signs of human health; therefore, reliability is critical. WBAN sensors must be
capable of viewing and detecting essential active signs of human health; therefore, reliability
is critical
3.6 BAN Architecture

WBAN is designed with special purpose sensor which can autonomously connect with
various sensors and appliances, located inside and outside of a human body.
Below Figure demonstrates a simple WBAN architecture where the architecture is
divided into several sections. Here we have classified the network architecture into four
sections. The first section is the WBAN part which consists of several numbers of sensor nodes.
These nodes are cheap and low-power nodes with inertial and physiological sensors,
strategically placed on the human body. All the sensors can be used for continuous monitoring
of movement, vital parameters like heart rate, ECG, Blood pressure etc. and the surrounding
environment. There are vast monitoring systems are being used already based on wired
connections. Any wired connection in a monitoring system can be problematic and awkward
worn by a person and could restrict his mobility. So, WBAN can be a very effective solution
in this area especially in a healthcare system where a patient needs to be monitored
continuously and requires mobility.
The next section is the coordination node where the entire sensor nodes will directly
connected with a coordination node known as Central Control Unit (CCU). CCU takes the
responsibility to collect information from the sensor nodes and to deliver to the next section.
For monitoring human body activities

there is no such wireless technology is fixed for targeting WBAN. Most popular
wireless technologies used for medical monitoring system are WLAN, WiFi, GSM, 3G,
4G,WPAN (Bluetooth, ZigBee) etc. . Except Cellular network standard all of these
technologies are commonly available for short distance communication. WMTS (Wireless
Medical Telemetry Service) and Ultra-Wide Band are another technology that could be used
for body monitoring system as they operate in low transmission power.
The third section is the WBAN communication which will act as a gateway to transfer
the information to the destination. A mobile node can be a gateway to a remote station to send
Mobile Message to a cellular network using GSM/3G/4G. A router or a PC can be a remote
node to communicate via email or other service using Ethernet which is shown in Figure.
The last section will be a control center consists of end node devices such as Mobile
phone for message, PC for monitoring and email and server for storing the information in the
database.
WBAN Requirements and Workflow
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Requirements for Wireless Medical Sensors in WBAN
Wireless medical sensors should satisfy the following main requirements such as

Figure . A Typical WBAN communication.

wearability, reliability, security, and interoperability :
Wearibility: To achieve non-invasive and unobtrusive continuous monitoring
Wearibility is a very important issue. These sensors must be lightweight and small. Size and
weight of sensors are mainly determined by the size and weight of batteries . But, a battery’s
capacity is directly proportional to its size.
Reliability: Reliable communication in WBANs is of paramount importance for any
WBAN application. So the designer should target a reliable communication technique which
will ensure uninterrupted communication and optimal throughput. A careful trade-off between
communication and computation is very crucial for a reliable system design.
Security: Another important issue is the security of the network. All the wireless
medical sensors must meet the requirements of privacy and should ensure data integrity and
authentication.
Interoperability: Wireless medical sensors should allow users to easily build a robust
WBAN. Standards governing that interaction of wireless medical sensors will help vendor
competition and eventually lead to more accessible systems .
Monitoring Sensors
Wireless body area network is a system which can continuously monitor a person’s
activities. Based on the operating environments the monitoring sensors can be classified into
two types.
v Wearable sensor devices worked on the human body surface.
v Implantable devices operated inside human body
Wearable sensor devices allow the individual to follow closely the changes in her or his
functions and in the surrounding environment and provide feedback for maintaining optimal
and instant status. For example ECG, EEG, Blood pressure sensor can be used to monitor a
critical patient, GPS sensor can be used to locate an area and different types of sensor that can
be used to measure the distance, temperature, movement etc.
To measure heath parameters, implantable sensors are planted in close contact with the
skin, and sometimes even inside the human body. Implantable biosensors are an important class
of biosensors based on their ability to continuously measure metabolite levels, without the need
for person interference and regardless of the person’s physiological state (sleep, rest, etc.) . the
implantable biosensors have great impact to diabetes and trauma care patients, as well as
soldiers in action (military). Figure focuses on the sensor nodes with wireless capabilities.
Traffic Types
In a WBAN traffic can be divided into three categories such as:
v Normal traffic
v Emergency traffic
v On-demand traffic
 Figure . Sensor nodes in WBAN.
Normal traffic is the data traffic which is used to monitor the normal condition of a
person without any criticality and on demand events. Emergency traffic is initiated by nodes
when they exceed a predefined threshold or in any emergency situation. Such type of traffic is
totally unpredictable.
On-demand traffic is initiated by the authorized personnel like doctor or consultant to
acquire certain information for diagnostic purpose .
Work Flow
Figure shows the work flow chart of WBAN. In the flowchart workflow is divided into
two sections. First section is the WBAN where all the sensors devices will collect data and
process them to the control center. While processing if any error occurs then it will read data
again from the sensor and will forward for processing.
The control center will send the data to the desired location. If any problem occurs then
it will generate an error where resend option should be needed again.
WBAN Standards and Technologies
As WBAN is a short range wireless networks so different types of wireless short range
technologies can be involved in different stages. In this segment we will describe most common
technologies such as Bluetooth, ZigBee, WiFi, IEEE 802.15.6 etc. that can be used to deploy
WBAN.
Bluetooth
Bluetooth is an IEEE 802.15.1 standard commonly known as WPAN (Wireless
Personal Area Network). Bluetooth technology was designed as a short range wireless
communication standard, anticipated to form a network with security and low power
consumption. A typical Bluetooth network forms a Piconet where a Bluetooth device works as
a master and another seven Bluetooth devices

Figure Working flowchart of WBAN.

work as slaves which gives each device to communicate with each other
simultaneously. Another type of Bluetooth network can be formed with more than one Piconet
known as Scatternet. In Scatternet a node of a Piconet (can be a master or a slave) joins as a
slave in another Piconet. Figure shows how a Piconet and Scatternet are formed using
Bluetooth nodes. Though, the basic Bluetooth protocol does not support relaying but it is
possible to join together numerous Piconet into a large Scatternet, and to expand the physical
size of the network beyond Bluetooth's limited range using this method.
Bluetooth devices operate in the 2.4 GHz ISM band (Industrial, Scientific and Medical
band), utilizing frequency hopping among 79 1 MHz channels at a nominal rate of 1600
hops/sec to avoid interference. It is classified with three classes of devices with coverage
ranging from 1 to 100 m and different transmission powers ranging from 1 mW to 100 mW
with 3 Mbps data rate. A very key feature of Bluetooth is that all the Bluetooth devices can
communication with each other in NLOS condition. Bluetooth is suitable for short distance
data transmission applications such as between servers of WBANs or between a WBAN and a
personal computer.
ZigBee

ZigBee is an IEEE 802.15.4 standardized solutions for wireless telecommunications

designed for sensors and controls, and suitable for use in harsh or isolated conditions. One of
the biggest advantages of ZigBee network is its low power consumption. Figure shows a
typical ZigBee network topology which consist of three kinds of devices or nodes such as
coordinator, router and end device. One coordinator exists in every ZigBee network. It starts
the network and handles management functions as well as data routing functions. End devices
are devices that are battery-powered due to their low-power consumption. They are in standby
mode most of the time and become active to collect and transmit data.

Bluetooth network.

Figure ZigBee network.

Devices such as sensors are configured as end devices. They are connected to the
network through the routers. Routers help to carry data across multi-hop ZigBee networks. In
some cases ZigBee network topology are formed without routers when the network is point to
point and point to multipoint.
ZigBee is aimed at RF applications that require low data rate, long battery lifespan and
secure networking. Through the standby mode, ZigBee enabled devices can be operational for
several years. ZigBee-based wireless devices operate in three different frequency bands such
as 868 MHz, 915 MHz, and 2.4 GHz. Therefore, one substantial drawback of using ZigBee
network for WBAN applications is due to interference with wireless local area network
(WLAN) transmission, especially at 2.4 GHz. As ZigBee devices operate at low data rate so it
can be unsuitable for large-scale and real time WBAN applications. But, it can be very much
suitable for personal use like assisted living, health monitoring, sports, environment etc. within
a modest range between 50 - 70 meters
WiFi
WiFi is an IEEE 802.11 standard for wireless local area network (WLAN). Generally
WiFi technology comes with four standards (802.11 a/b/g/n) that runs in ISM band 2.4 and 5
GHz with a modest coverage of 100 meter. Wi-Fi permits users to transfer data at broadband
speed when connected to an access point (AP) or in ad hoc mode. Fig shows a WiFi network
where WiFi sensor nodes and users can transfer data using internet by standard WiFi router. In
some modified version, WiFi devices can be used in data acquisition applications that allow a
direct communications between the sensors and the smart phones/ PC even without an
intermediate router.
WiFi is preferably suitable for large amount of data transfers with high-speed wireless
connectivity that allows videoconferencing, voice calls and video streaming. An important
advantage is that all smart phones, tablets and laptops have Wi-Fi integrated; however the main
disadvantage of this technology is high energy consumption.
IEEE 802.15.6 WBAN
IEEE 802.15.6 is the latest addition in WPAN which is known as WBAN standard that
provides various medical and non medical applications and supports communications inside
and around the human body. This standard supports communication inside and outside of
human body which can be used for different medical and non medical applications such as e-
Healthcare monitoring, sports, environment etc.
IEEE 802.15.6 standard is classified by three physical layer standards. Each standard
uses different frequency bands for data transmission with data rate 10 Mbps maximum. First
one is Narrowband (NB) which operates within the range of 400, 800, 900 MHz and 2.3, 2.4
GHz bands. The Human Body Communication (HBC) is another standard which operates at
range of 50 MHz. The Ultra Wideband (UWB) technology operates between 3.1 GHz to 10.6
GHz which supports high bandwidth in short range communication.
3.7 Introduction Wireless communication Techniques
In today’s world, wireless communication has a major application in sharing of
information anywhere and at anytime. We can use wireless networks in the form of WLAN or
Wi-Fi in various fields such as education, healthcare, and industrial sector. As the technology
is growing, the demands of users as well as the demand of ubiquitous networking is increasing.
WBAN(Wireless Body Area Network) allows the user to move another without having the
restriction of a cable for sharing information.
The communication in body sensor networks is of 2 types:
1. In-body communication
2. On-body communication
In-body communication is the communication between sensor nodes that are implanted
inside human body. The MICS (Medical Implant Communication System) communication can
be used only for in-body communication. On-body communication occurs between wearable
devices which consist of sensor nodes. The ISM (Industrial Scientific and Medical) band
and UWB (Ultra-wideband) communication can be used only for on-body communication.
A body area network (BAN), also referred to as a wireless body area network (WBAN)
or a body sensor network (BSN) or a medical body area network (MBAN), is a wireless
network of wearable computing devices. BAN devices may be embedded inside the body,
implants, may be surface-mounted on the body in a fixed position Wearable technology or may
be accompanied devices which humans can carry in different positions, in clothes pockets, by
hand or in various bags. A WBAN system can use WPAN wireless technologies as gateways
to reach longer ranges. Through gateway devices, it is possible to connect the wearable devices
on the human body to the internet. This way, medical professionals can access patient data
online using the internet independent of the patient location. In modern technology wireless
communication provides a lot of possibilities to be able to share its information to each other
at anytime and anywhere. Intelligent mobile communication network and WLAN, Wi-Fi are
applied to various sectors such as education; health care service and industry in order to provide
people a convenient way to communicate with each other. As the demand of ubiquitous
network is increased, the devices for home, office and other information devices that can
communicate wireless in short range have been getting more attention. The standard and
technique development of ubiquitous network has rapidly put itself into the world market.
Wireless Body Area Network (WBAN) is becoming a special application of such technique.
WBAN differs with other wireless sensor networks (WSN) with some significant points. First
difference between a WBAN and WSN is mobility. In WBAN user can move with sensor nodes
with same mobility pattern whereas WSN is generally used to be stationary. Energy
consumption is much less in WBAN than other WSNs arrangement. In addition, WBAN sensor
devices are found cheaper than WSNs. For reliability, node complexity and density, WBAN
nodes are however traditional. WSNs do not tackle specific requirements associated with the
interaction between the network and the human body . The WBAN performs like Virtual
Doctor Server, by keeping the different responsibilities like- maintain the history of the patient,
giving advices to the patient in general/emergency (first aid help from second person) case etc.
To understand the communication approach of this emerging WBAN technology, we first need
to know the conceptual structure of WBAN so that, one can easily know the flow of
communication within the system and to the outside world, this has been achieved by the
demonstration of a simple WBAN communication architecture. Where this architecture is
mainly comprised with three different layers namely: Tier 1, Tier 2 and Tier3 and these are
further described better in the given figure