UNIT IV.

WIRELESS HEALTH SYSTEMS :

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

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.

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.

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
 Power management: The device design must ensure that energy
consumption is
minimized for longer uninterrupted device deployment and stand by
time.goes online.

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,bjitter, 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.
 Fig.1

System security and reliability:

Fig.2

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 black hole
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.

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
 Fig. monitoring Human Body

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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you. Requirements for Wireless Medical Sensors in WBAN Wireless medical
sensors should satisfy the following main requirements such as
 Fig. 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.

 Wearable sensor devices worked on the human body surface.

 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:

 Normal traffic
 Emergency traffic
 On-demand traffic
 Fig. 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 Pico net where a
Bluetooth device works as a master and another seven Bluetooth devices

Fig. 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 Pico net known as Scatter net. In Scatter net a node of a Pico net (can be a
master or a slave) joins as a slave in another Pico net. Figure shows how a Pico net
and Scatter net are formed using Bluetooth nodes. Though, the basic Bluetooth
protocol does not support relaying but it is possible to join together numerous Pico
net into a large Scatter net, 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 tele-

communications 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.

Fig.Bluetooth network.

Fig. 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.

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.