Development of Remote Patient Monitoring System Model Based on IOMT

Modern technological advances allow remote monitoring of all social and production-related processes. In particular, a lot of attention is being paid to remote monitoring systems in the healthcare system. In this paper, simulation and physical models of IoMT-based remote monitoring system for healthcare system are developed. Issues of application and implementation of these models are considered.


INTRODUCTION
Modern society is rapidly developing, people's needs and expectations for improving the quality of life are putting more and more pressure on industrial sectors, especially on the healthcare system.As the population grows, so does the need for medical services, especially for new and effective methods of diagnosis and treatment.Health care is one of the most important economic, social and even political problems around the world, which requires innovative, modern revolutionary solutions from modern technologies and science.In this regard, information technologies have a positive effect on all processes and procedures related to the healthcare system, increasing its treatment and diagnostic capabilities, quality and efficiency.
The integration of healthcare system and modern technologies undoubtedly provides many advantages, and one such advantage is the possibility of continuous monitoring of the patient's condition in real time [1].
The application of IoT to the healthcare system is called IoMT, i.e.Internet of medical things.The Internet of Medical Things (IoMT) is a technology that provides smart medical devices, devices, and remote healthcare services over the network, based on the basic architecture of the IoT and cloud applications that serve healthcare professionals over the network (mainly the Internet).contains many interconnected devices that can send data [2].
The importance of remote monitoring.Remote patient monitoring and care systems are a very important direction in the development of the health care system and are very often used in the context of the implementation of the concept of health care 4.0 [3].
Continuous monitoring of the patient's health is an indispensable attribute of modern health care, which allows to identify, predict and prevent many diseases and unexpected situations.In view of the above, remote monitoring is the process of repeated or continuous monitoring or measurement of the patient, his or her physiological function, and the function of life support equipment in order to make management decisions, including when to implement therapeutic interventions and to evaluate these interventions.
In the healthcare system, remote monitoring systems based on IoMT are highly valued because they allow patients to perform their daily tasks and be under continuous medical control without restricting their free movement and reduce the cost of medical services [4].Traditional remote monitoring systems cause inconvenience to patients due to the large size of the devices attached to the body and the need to frequently recharge or replace the batteries.IoMT technologies address the aforementioned challenges by developing compact, ultra-low-power sensor devices and lightweight communication protocols.The IoMT system consists of sensitive sensors worn on the body, energy-efficient personal devices that collect and process sensor data, energy-efficient transmission modules and protocols, data processing centers and service applications.

MODELS OF REMOTE PATIENT MONITORING SYSTEM
The system of remote monitoring of the patient's condition consists of a patient's personal device consisting of a data collection, processing and transmission module, a router that performs the function of retransmitting device packets, and a network that organizes, captures and processes data, stores it in a database, and blockchain.It consists of a controller device that provides a network for the doctor and the patient.During the research of the thesis, an imitation model of this remote monitoring system was developed in the Proteus software environment, as well as its physical model, i.e., the model of the system, based on the model.Patient's personal device.The patient's personal device is a module designed to be worn on the patient's body and consists of an ECG sensor (1), a zigbee transmission module (2) and a microcontroller (3).The Heart Beat sensor, Arduino Uno R3, and XBee module libraries were used in the simulation modeling process.The patient personal device model built on the basis of these elements is given in Figure 1.
The simulation model built in the Proteus software environment based on the model of the patient's personal device is presented in Figure 2. Modeling of the patient's heartbeat in the simulation model is performed using the specially developed HeartBeatSensor-Library library generator.The signal from the sensor working on the basis of this generator is received and recorded in the Arduino microcontroller.The output signal is reflected on the oscilloscope.If the information read from the sensor differs from the previously recorded information, it is sent to the XBee module through the serial ports and transmitted to the network through the module.
The physical model of the patient's personal device was built based on the above model.The ECG sensor AD8232 has the same parameters as the Arduino Uno, and the MCU microcontroller, which is more efficient in terms of size and energy consumption, and the XBee module were used.The program code developed in the process of creating an imitation model was loaded into the microcontroller.For the Xbee module, the necessary settings have been made based on the parameters presented [5].This process is carried out by XCTU software developed for Zigbee modules.This program allows you to access and configure the zigbee protocol.Active and sleep modes, routing parameters, network parameters and operating mode are configured for the XBee module in the personal device [6].
The cover for the device was printed on a 3D printer and equipped with an energy source-battery.The physical model of the Bemoq personal device is presented in Figure 3.
Router device.The router device consists of two parts, i.e. a microcontroller that runs the program code and an XBee module that performs the function of transmission and reception.The main task of the router is to expand the coverage area of the network, and the Xbee module of the router is set to the constantly active retransmission mode.Being in constant active mode means that this device consumes a lot of energy, and therefore this module is used when connected to a constant power source.
Coordinator device.The basis of the coordinator device is a powerful microcontroller and an XBee module configured in coordinator mode.The XBee module forms a network, i.e. it starts the network nodes, assigns them addresses and connects them to a single network.PAN ID (personal area network ID) for the network created by the module is entered in the settings of this module, that is, the identifier of the network created by the module.Then, when all XBee modules with this ID contact the coordinator, they will be assigned private network addresses and form the network topology.
The coordinator is the main node of the network, where all information is collected.A special software environment, i.e., an application, is needed to process the collected information.A web application was developed as part of the thesis, and data is uploaded based on the HTTP protocol.In this application, information is processed, stored in a database, formatted for storage in an external blockchain network, and presented to the patient or doctor's display on demand [7].
ZigBee/Xbee network module, virtual terminal, oscillograph and network module for transferring the received information to the web application -YUN Wi-Fi&Ethernet modules were used to Based on the developed imitation model, the physical model of the coordinator was developed.In the physical model, a Raspberry Pi 400 module was used as a microcontroller and a server running the web application.This module connects directly with the XBee network module, downloads this data through the serial port and transmits it to the web server installed in the Linux operating system installed in the module.An overview of the physical model is presented in Figure 5.
The above operations are performed on the data on the web server and displayed on the display.In addition, the coordinator acts as a gateway for the external network and connects to the external network through the built-in Wi-Fi module.This allows the transfer of information to the Blockchain network and access to the web application for other users, doctors, and patients.The

IMPLEMENTATION OF REMOTE MONITORING OF THE PATIENT'S CONDITION BASED ON IOMT
When testing the modeled remote patient condition monitoring system in Proteus software environment, the simulation process is started in all three models, i.e. patient device, router and coordinators.The patient device starts receiving sensor data and transmits them on the XBee module.The XBee module, in turn, must transmit data in the form of an electromagnetic signal with a frequency of 2.4 GHz.But the simulation environment is installed as software on a single personal computer, which does not have the ability to generate signals using electromagnetic waves.The Xbee network module in the Proteus software environment is built on the RS232 serial communication interface.In this case, data exchange between RS232 interfaces is carried out using the computer's COM ports.
In this case, it is necessary to create and attach a separate virtual COM port for each transmission module on a personal computer.In this model, this task was performed using VSPE (Virtual Serial Port Emulator), in which virtual ports Com1, COM2 and COM3 were created and attached to the XBee network modules in the Proteus software environment.As a result of the above actions, it became possible to interconnect all three modules of the system, and the transmitted data began to be received by the coordinator (Fig. 6).The received data was transmitted to the Internet using the YUN Wi-Fi&Ethernet network module.
To view the values received in the coordinator in a web browser, it is necessary to configure the local host port number of the YUN Wi-Fi&Ethernet module.In the developed model, port 8181 was attached to the network module.As a result, it is possible to contact the model web server at the address "localhost:8181" through any computer with a network connection or smartphone browser with any computer running the simulation environment.As a result, the web interface shown in Figure 7 will open.
In order to test and put into practice the physical model of the remote monitoring of the patient's condition, the patient's personal   device is worn on the patient and its outputs are worn on the patient based on the scheme presented in Figure 8.
Sensors worn on the patient's body measure the patient's heart rate and transmit it to the microcontroller.In the microcontroller, heartbeat data is stored for a specified time and sent to the transmission module based on a pre-written algorithm [8].
The transmitted information is transmitted to the coordinator through a wireless sensor network.Messages received in the coordinator are initially written to the database.Initially, when creating the database, the doctor creates a patient as shown Figure 9 by logging into the web server, entering his personal information, i.e., his name, year of birth, the patient's ID number and additional information. .The device ID number is then entered and the patient ID number and device numbers are appended.This action allows you to associate requests from a specific device with a specific patient database [9].After that, the device data is recorded in the patient's personal office and monitored by the doctor.The number of patients that can be served at the same time depends on the capacity of the Zigbee network and the power of the server.Considering that the transmission speed of the Zigbee network is 250 kbit/s, and the ECG sensor transmits information at the speed of 6 kbit/s, in the ideal case, it can serve up to 40 patients, and in the real case, it can serve up to 20 devices due to external influences and additional information.can show.Each patient will have to be created individually.
The information written in the database is diagnosed by the doctor and additional recommendations and information are entered.Based on this information, an information transaction is created and sent to the Blockchain network.
The developed system was tested on patients in a private clinic.It was worn on the patient during the daily activities of the patient and it was achieved to receive constant medical supervision without limiting his activities.During monitoring, the collected information about the patient's condition is transmitted to the monitoring center, that is, to the doctor's room, and the responsible person can make a decision operatively to prevent unpleasant situations that may arise.
The monitoring unit created and used in practice, as well as the results of remote monitoring of the patient's condition based on algorithms, are presented in Figure 10.
Through the XCTU program, it is also possible to control the network of the monitoring system and monitor the stability of connections, through which the location of each node in relation to the routers, the strength of the signal in them, and the active or inactive state of the network are controlled as shown in Figure 11.
The experimental test process was carried out for one day in each patient, and the process of changing the heart state during the daily regime of the patient was determined.There were no complaints that the location of the device on the patient's body caused discomfort.There were no interruptions or delays in the information reaching the coordinator.The operation of the web application is stable and clearly organized for the doctor.The  web application contains minimum services, and it is possible to expand the number of services.It made it possible to carry out a stable monitoring process at a distance of up to 300 m in a network consisting of one coordinator and one router.

CONCLUSION
Based on the proposed monitoring system algorithm, microcontroller control unit and wireless sensor network module in the Proteus software environment for SST, a simulation model of the remote heart rate monitoring process was developed.Modeling and research of remote monitoring elements, devices and circuits in the Proteus environment allowed defining the main functions and setting the parameters of the schematic solution for patient heartbeat monitoring.
Based on the simulation model, a physical model of the system consisting of a patient device, a router and a coordinator device was developed.The coordinator device also performs the function of a web server and launches a web application that monitors, displays information for the doctor, creates a database, and sends formats to the network for storing data in the Blockchain.This model was tested in a medical institution and provided high efficiency.

Figure 1 :
Figure 1: Patient Personal Device Model

Figure 2 :
Figure 2: Simulation model of the patient's personal device

Figure 3 :Figure 4 :
Figure 3: A physical model of the patient's personal device

Figure 5 :
Figure 5: Physical model of the coordinator device

Figure 6 :
Figure 6: Simulation model of the monitoring system

Figure 7 :
Figure 7: The web interface of the simulation model of the system of remote monitoring of the patient's condition.

Figure 8 :
Figure 8: Connection points of the patient personal device to the human body.

Figure 9 :
Figure 9: Create a new patient and attach a device window in the web application.

Figure 10 :
Figure 10: Practical application of the system of remote monitoring of the patient's condition.

Figure 11 :
Figure 11: Monitoring of the network of remote monitoring of the patient's condition.