An Interactive Telecare System Enhanced with IoT Technology
Many researchers have proposed health-monitoring systems that adopt existing equipment and technology. The most popular wireless technologies are Bluetooth and WLAN.1,2 Chi-Huang Hung and his colleagues have suggested using RFID and WLAN to transmit data to mobile phones and record data.3 These techniques, however, have inherent drawbacks due to restrictive factors, such as device pairing, connection distance, and location. In the last few years, researchers and developers have incorporated Internet of Things (IoT) technology into various system solutions. However, these systems only apply IoT technology to access server databases; they can’t directly access and control mobile devices. For instance, Antonio Jara and his colleagues proposed a diabetes therapy management device for use in insulin therapy dosage calculation.7 But this device only collects physiological parameters to upload to a server to assist physicians in determination of treatment regimes.7 Liviu Constantinescu and his colleagues
proposed a SparkMed Framework under 3G/4G and Long- Term Evolution (LTE) using HTTP, TCP/IP, and User Datagram Protocol (UDP) wireless technologies.8 They suggested that practitioners, paramedics, and patients use the handheld devices to access multimedia data in hospital information systems. These system architectures are, however, still based on accessing server database communication mechanisms, and they can’t directly access and control mobile devices to receive status updates.
Our ITCS exploits medical devices and smartphone applications to promote effective self-care. Figure 1 outlines the tasks involved in creating interactive models between patients and family caregivers. The ITCS uses medical devices to collect and upload a patient’s physiological parameters, such as blood glucose values, measurement scenarios (before and after meals or activities, at night, and so on), and measurement times. According to this data, the system will judge whether the patient’s status is abnormal. If the status is abnormal, the ITCS will immediately notify the family caregiver and patient so that the caregiver can express concern to the patient and track the patient’s status. If the patient does not measure his or her blood glucose level on schedule, the ITCS will send a reminder. If the patient does not respond, the ITCS will notify the family caregiver. This mechanism can effectively promote behavioral change in patients and help them avoid medical incidents. In particular, letting caregivers immediately follow up with patients in the event of missed-measurement events reinforces positive health behavior in the patient. At the very least, patients will be less likely to skip blood measurements simply to avoid being nagged by caregivers. The ITCS could confirm whether the system received patient measurements on time. If the system didn’t receive measurements on schedule, the ITCS would notify family caregivers to confirm patient safety.
We showed our ITCS to medical institutions in Israel, Malaysia, Indonesia, and China, and the health professionals in these institutions expressed an interest in the function that lets caregivers receive status updates of patients in real time. They felt the ITCS could improve the quality of care for chronically ill patients, effectively reducing healthcare costs. In the future, we hope to improve the ITCS so that it can provide caregivers with information after confirming a patient has received medical treatment. In addition, we’ll address how to handle a scenario in which there is no network signal. Currently, we use smartphones to achieve GPS positioning. If medical devices had GPS, our positioning functions could also be implemented in the medical devices. The range of activity of chronic patients is usually fixed and periodical, so we will look to combine other mobile positioning technologies and virtual fence functionality to solve the issue of no network coverage. We will also look to use the general packet radio service modules of 2.5G medical devices to execute a less accurate positioning method, such as mobile radio cellular positioning. We also plan to design a questionnaire to evaluate system practicality of our solution for patients and family caregivers.