Mobile phone-enabled control of medical care and handicapped

Transcription

Review
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Mobile phone-enabled control
of medical care and
handicapped assistance
Expert Rev. Med. Devices 8(6), 757–768 (2011)
Lin Liu1 and Jing Liu†1,2
Department of Biomedical
Engineering, School of Medicine,
Tsinghua University, Beijing 100084,
China
2
Technical Institute of Physics and
Chemistry, Chinese Academy of
Sciences, Beijing 100190, China
†
Author for correspondence:
Tel.: +86 106 279 4896
Fax: +86 108 254 3767
jliubme@tsinghua.edu.cn
1
Mobile phones are now playing an ever more crucial role in people’s daily lives. They are serving
not only as a way of talking and delivering messages, but also for exchanging various information.
Nevertheless, the functional limit of the phone is still far from being reached. Among the many
promising applications, using mobile phones as an actuating element to control data or devices
is useful in quite a few emerging medical care and handicapped assistance settings owing to
its wireless communication feature. In this article, selected progresses of mobile phone-enabled
controlling have been summarized, with more focus on evaluating its emerging roles in medical
care. Several typical applications in the area are illustrated and some potential technical challenges
and key issues worthy of pursuit are outlined. The intent of the article is to provide an elementary
knowledge for people with different backgrounds, such as electrical or biomedical engineers,
as well as people who are working on interdisciplinary areas. It is expected that medical care at
any time and anywhere will be possible via the actuation platform provided by the mobile phone
and mobile medicine will be pushed forward to a new height in the coming years.
Keywords : actuation • control • healthcare • mobile medicine • mobile phone • pervasive medicine • telemedicine
Today, mobile phones are widely used in daily
life and are playing an increasingly important
role in the field of information and communication technology. In addition to its conventional
talking function, the current mobile phone can
already support many additional services and
accessory functions, such as short message service (SMS) for text messaging, multimedia message service for sending and receiving photos and
video, email, packet switching for access to the
internet, gaming, MP3 player, camera with video
recorder, Bluetooth®, infrared, radio and global
positioning system (GPS) among others [101] .
Now an emerging trend of using mobile phones
to control systems is being witnessed. Mobile
phones can easily communicate with many different existing machines over cellular networks
and most of them have built-in short-range communication capabilities. This allows the phone to
communicate well with, and control, appliances
within either short- or long-distance regions [1] .
When it comes to mobile phone-enabled control, we mean that the mobile phone works as
the control element in a system. It is a central
unit to control data and commands transmission
between different devices or networks. Owing
www.expert-reviews.com
10.1586/ERD.11.32
to its unique convenience, the mobile phone has
been used to control a series of home and office
appliances (e.g., televisions, cameras, refrigerators, lights and photocopiers) and more practical equipment that significantly facilitates users,
especially handicapped people’s, daily life. Such
controlling mechanisms are usually implemented
via wireless application protocol (WAP) and SMS
commands [2,3] . Text messaging is one of the most
commonly utilized forms of electronic communication and even very cheap phones support SMS.
As is well known, SMS is a globally accepted
wireless service that enables the transmission
of control messages between mobile phone subscribers and electrical appliances. This provides
a rather low-cost and easy-to-use solution for
wireless connectivity. Naturally, advanced control needs complicated systems and people are
carrying smart phones with better input/output
so as to improve control capabilities.
With Bluetooth and third generation (3G)
service, mobile phone-enabled control is being
further extended. So far, people can already
remotely control their personal computer (PC)
by a mobile phone [102] . Furthermore, longdistance monitoring and telemedicine has also
© 2010 Expert Reviews Ltd
ISSN 1743-4440
757
Review
Liu & Liu
become a reality [4,5] . The growing power and sophistication in
a cellular phone has made it an increasingly feasible platform for
mobile health (m-health) applications, such as ��
collecting community and clinical health data, delivering healthcare information
to practitioners, researchers and patients, real-time monitoring of
a patient’s vital signs, and directly providing care through actuation. These mobile solutions can offer remote services to fatigued
patients, increasing their independence with potentially better
outcomes. Remote medical service systems generally consist of
three tiers: one or more sensors that capture information about
the patient; a data hub (such as a personal digital assistant, laptop or cell phone) for local data processing and display, and a
medical network that records and analyzes information to detect
anomalies [6] . Since monitoring in-hospital is financially more
challenging than that at home, more people are getting interested
in receiving telemonitoring service. This may give them freedom
of staying at home and living with their family, while receiving
low-cost medical care as well as having a relatively high quality
of life. By means of 3G service, the increasing medical data traffic and demand from different clinical applications and mobile
medical sensors will be more compatible with the growing data
rate of current 3G systems in the near future [7] . Specifically,
in a society penetrated by remote medical monitoring and telemedicine systems, home medical care and remote diagnosis, and
even guided or automated treatment will become common in the
future as a convenient service.
As an actuator element, the controlling role of mobile phones
in healthcare is receiving an increasing amount of attention.
Therefore, there is an urgent need to better understand the basic
technologies enabled from such controlling mechanisms. To
push forward the innovations along this important direction,
this article is dedicated to presenting a comprehensive overview
on the mobile phone-enabled controlling issues in personal and
medical care. Typical examples already in practice will be selected
for illustration. Technical possibilities and challenges will be outlined. Finally, a brief outlook on future mobile controlling in
healthcare will be given.
Mobile phone control in disabled people’s
daily assistance
Mobile phones have penetrated nearly all aspects of people’s everyday life. As is noticed, many researchers are trying to develop
smart card functions in mobile phones. In order to take full
advantage of the portable, flexible and smart properties, as well
as wireless communication functions, mobile phones are being
used in many different control systems. In this section, a discussion will be made on the controller in people’s daily life, which is
especially useful for persons with physical disabilities.
Home or office appliances controlled by mobile phones
Using mobile phones to remotely control home or office appliances
is becoming an important function of mobile phones in the daily
assistance of disabled people. Typical applications include remote
mobile programming of televisions, lights, heating thermostats,
security cameras and so on. This will significantly improve the life
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quality and health recovery of a person with physical disabilities
and thus help maintain good health. The architecture of controlling home or office appliances with smart phones can be depicted
in Figure 1. The system, called personal universal controller (PUC)
system, was designed to control appliances in their environment
through a remote user interface. There are four parts in the system: a specification language (enabling automatic generation of
user interfaces); a communication protocol; appliance adaptors
(translation layers that bridge the gap between the PUC protocol
and the appliances’ proprietary protocols); and interface generators.
When the user decides to control an appliance, the controller device
downloads a corresponding abstract functional description from
the appliance and uses the description to automatically generate
an interface. The communication channel between the controller
and the appliance is two-way, through which the user sends their
commands to the appliance and the appliance provides feedback
for the user. The system can connect between multiple interface
generators and an appliance, or between an interface generator
and multiple appliances, using a peer-to-peer connection model [1] .
The specific approach for interconnecting appliances and
mobile networks to control electronic devices, as well as remote
mobile devices, may not be the same among different systems.
One common approach is to enable mobile access to home or
office appliances via WAP and SMS commands. Another way
has been demonstrated by a prototype implementation, in which
Home Audio Video Interoperability (HAVi) and WAP are used
as two of the emerging communication network technologies [3] .
With regards to computers, one can use the software ‘Maxthon2
Plugin’ (M2P) to realize simple control using a mobile phone. On
the other hand, people may employ a Bluetooth module to help
control the PC through mobile phones [8,102,103] . With a Bluetooth
module and relevant software, users can further control PCs to send
mail, save files and start or stop services from anywhere in the world
using the portable mobile phones. Mobile phones could also control
robots via the internet, SMS or voice mechanisms [9–11,104,105] . They
can also be used as a remote control, on/off switches in the car,
remote monitoring or activating alarms [106,107,201] . Phones could
acquire data and transmit them in time in the so-called ‘field of
digitization’, which enhanced the speed and flexibility, and reduced
the expense for the new data collection and transmission [12] .
Controlling of mobile phones in environment monitoring
for health maintenance
Mobile phones equipped with certain sensors have been employed
to help monitor and actively control the environment. People, especially those physically disabled, can use it to detect toxic or harmful gases, learn the state of surroundings with a wireless sensing
network and even take appropriate action. This will help improve
the living environment and thus better serve health maintenance.
The system, as shown in Figure 2, is to detect toxic gases (toluene,
ammonia, hydrogen sulfide gases) with a mobile phone taking pictures and sending them to a host computer [13] . Similarly, a remote
actuation and monitoring system for the indoor environment
could be set up with more environmental sensors [14] . The mobile
phone connects with sensors and microcontrollers, receiving data
Expert Rev. Med. Devices 8(6), (2011)
Mobile phone-enabled control of medical care & handicapped assistance
acquired from sensors and sending control
message via a user interface. When abnormal data appears, corresponding measures
are carried out through the network.
There are certainly many other fields that
are controlled by mobile phones and people
are generally prone to control more things in
their environment using their phones [108] .
Mobile phone control in
medical fields
Review
Communication
protocol
Home or office
appliances
Appliance adaptor
Microcontroller
and software
Feedback
Control
Mobile phone
with user interface
The aforementioned examples enabled by
Figure 1. The architecture of personal universal controller system.
the mobile phone’s control functions are
mainly for assisting people’s daily life and
public health. In fact, many more applications can be found in
As mobile phones can now feasibly be used in many situations,
medical fields. Remote monitoring and telemedicine are among they could also play an important role in future telemedicine. In
the most important aspects.
the system of mobile phone-based telemedicine (Figure 3) , mobile
Today, there are more senior citizens and chronic diseases than phones mainly serve as a message transmitter or information
ever before. The number of people who need constant assistance controller. This system has the three-tier design, and each has its
in medical care has increased a lot. Also, patients discharged from own functionality and works together for the whole system [6] .
hospitals may often require additional healthcare services and The first tier is the set of sensors or monitors that discern signals
monitoring of their health status, while these services are always of interest, and then relay the information to the mobile phone
expensive and troublesome. Technical advances on wireless con- through wireless networks or devices like Bluetooth. The mobile
nectivity and mobile devices will give practitioners, medical cen- phone receives the raw data and then displays it in charts or
ters and hospitals new tools for managing patient care, electronic curves and analyzes or stores the data based on different requirerecords and medical billing to ultimately enable patients to have ments of systems. In the future, mobile phones could receive and
more independence of their own well being.
process the data in real-time and automatically send messages
In this section, focus will be put on mobile phone-enabled con- to the service centre when abnormal data appears. The mobile
trolling in medical fields. The concept and examples of application phone then transmits the data to an outside medical network via
around the theme of telemedicine will be discussed.
the internet, global system for mobile communication (GSM),
Wi-Fi™ or some other means [7] . The third tier, the medical
The concept of mobile phone-based telemedicine
network, is often operated by a healthcare provider, such as a
Telemedicine is a rapidly developing area where medical infor- hospital or telemedicine center where the staff are able to perform
mation is transferred through interactive audiovisual media for medical procedures. Feedback will be sent to the person under
the purpose of consulting or monitoring. It may be as simple as care through the mobile phone or some action will be taken to
two health professionals discussing a case over the telephone, help people deal with health problems.
or as complex as using satellite technology and videoconference
Mobile telemedicine solutions take full use of the extensive and
equipment to conduct a real-time consultation between medi- fairly reliable wireless mobile communication networks already
cal specialists from different countries. There are generally three available all over the world. Moreover, it is convenient and relatypes of telemedicine: store-and-forward; remote monitoring; and tively cheap for the patient. Since mobile phones can be managed
interactive services. Telemedicine could also refer to the use of
communications and information technologies for the delivery of
Mobile phone
clinical care, which provides day-to-day monitoring and preventive and emergency care to patients with chronic conditions and
diseases and to people living in isolated communities and remote
regions [6,109] .
Gas
However, many of the currently available telemedicine systems
are not so convenient. As effective as those solutions might be,
they do not provide people with a satisfactory quality of life.
Although many devices used in telemedicine, such as the Holter
monitor (��
a portable device for continuously monitoring variDetector
Microcomputer
ous electrical activity of the central nervous system for at least
24 h [110]) or bedside monitor, are powerful, they are often too
expensive, complicated or unwieldy, which prevents them from
Figure 2. Measurement system with mobile phone.
being widely accepted.
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Third party medical
applications
Bluetooth®
Monitoring
center
3G/GPRS/Wi-Fi
Smartphone
Server
can easily exchange messages with professionals as well as get feedback through the
phone (Figure 4) , and they would receive
directions from the server or learn something more from a well established database. To realize all of these functions, better
user interfaces are needed.
According to the results of a questionnaire, more and more patients are likely to
use the mobile phone in medical care [16] .
The mobile phone-enabled interactive telemedicine system may assist patients and
give doctors fast information or preliminary
results, which would enable early detection
of diseases, which is useful in early diagnosis
and patients’ distance monitoring.
Mobile phone-based telemedicine
Nowadays, more and more people suffer
from chronic diseases, such as heart disease, diabetes mellitus or asthma, and they
Pateint
web
viewer
Remote physician
Home/office/travel
need to be cared out of hospital. Remote
environment
service, also known as self-monitoring/testFigure 3. The concept of mobile phone-enabled telemedicine.
ing, is an important part of telemedicine,
which enables medical professionals to
individually, the controlling modules that are developed will evaluate and treat a patient remotely using various technological
almost certainly cost less than the traditional devices commonly devices. Mobile phone-based telemedicine can provide compaused in hospitals [6,7] .
rable healthcare to traditional in-person encounters, supply greater
satisfaction to patients and are usually more cost effective.
Mobile phone-enabled interactive services
In this section, we selectively illustrate several typical examples
Using a mobile phone, telemedicine may be as simple as a of mobile phone-based telemedicine for people suffering from
reminder of medical care by messages or calls, since making a different diseases.
call and sending messages are two basic functions of the mobile
phone. Here, interactive telemedicine service means real-time Mobile phone-based electrocardiogram
interaction between the patient and healthcare provider, includ- remote monitoring
ing phone counseling message transmission, online communica- Cardiovascular diseases, including coronary artery disease, heart
tion, electronic medical records, remote actuation and so on, with attack, myocardial infarction, angina, congestive heart failure,
the mobile phone as a major control tool. Many activities, such as hardening of the arteries, stroke and peripheral vascular disease,
pathological history review, physical examination and psychiatric are now the leading cause of mortality in the developed world.
evaluations, can be conducted comparably to those performed in People suffering from these diseases need constant service regardtraditional face-to-face visits. In addition, ‘clinician-interactive’ ing their health status after being discharged from hospitals.
telemedicine services will be much less costly and time consuming Traditional heart monitoring solutions have existed for many
than in-person clinical visits [109] . There are medical firms and years, such as the Holter monitor to record the patient’s ECG for
organizations providing mobile phone medical services, which 24–48 h and provide data to be analyzed afterwards by the carcan benefit from automated telephone answering functions. Such diologist [110] . However, Holter monitors record but do not detect
phones can help answer some medical questions in a professional arrhythmias when patients are out of hospital. Moreover, they
and consistent manner, 24 h a day [111] .
are unable to automatically transmit information at the moment
With advanced communication technologies being used to when an abnormal cardio-activity occurs and appropriately actureduce healthcare barriers, doctor–patient interactions through ate in saving a patient’s life during the monitoring phase. Most
periodical monitoring of health status and physical symptoms critical of all, they are too expensive for daily use.
bring encouraging results. New methods, such as questionnaire
As a unique telemonitoring platform, the system based on
management system and messaging system, will be developed and mobile phone controlling provides a new and feasible solution,
gradually improved [15] . They would transmit patients’ reported which can be easily adopted in ECG telemonitoring. Many people
outcomes using mobile phones or the internet, and allow people have studied mobile phone-based ECG monitoring, proposed
access to certain medical database through their phones. Patients new ideas and methods, and also conducted some experiments or
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demonstrated some practical applications
[17–26,112–116,202] . There are many mobile
Conversation
phone-based controlling systems for ECG
Message
monitoring, while the design of each is
more or less the same, such as one shown
Database
in Figure 5.
This mobile phone-based ECG service
Multimedia
could be simply divided into four parts:
system on the patient; doctor’s unit; web
Patients
Mobile phone
Server
Others
server or database; and network operator.
In the system on the patient, there is a wireless biomedical sensor to acquire the ECG
Figure 4. Structure of phone interaction telemedicine.
signal of the patient and then send the data
to the mobile phone through Bluetooth or
some other wireless unit. The mobile phone receives the data can arrange therapy as early as possible. Actuation mechanisms
and has the task of processing raw data and detecting an abnor- can even be designed in the phone to help save the user’s life if a
mality at this stage before transmission. The user interface of heart attack occurs unexpectedly. People have made attempts in
the mobile phone displays the ECG curves or controls the data clinical trials to study these systems [20] . In the near future, the
stream, which means that users can give orders to complete the feasibility of mobile phone-based ECG monitoring system will
executive function as offered. The mobile phone processes and gradually improve to provide better telemedicine service.
stores the data in a memory chip, or sends data to the monitoring
centre if necessary. Usually, the mobile phone is able to auto- Mobile phone-based diabetes control
matically alarm when an abnormal situation occurs [17,202] . The Diabetes is one of the most troublesome chronic diseases that can,
doctor’s unit, as well as a medical expert and emergency opera- at present, only be controlled and not cured. It has a significant
tor, receive information from the mobile phone and respond in impact on a person’s quality of life if a person or their family mema timely way. In the system, network services and protocols are ber has to cope with a chronic disease, especially for older people.
essential for communication.
Luckily, telemedicine systems provide a means to transfer the
One can see that the mobile phone plays a
very important role in this system (Figure 6) .
Hospital
It is a junction between patients and doctors, and provides an interaction to users.
The user interface and algorithms built
in the mobile phone have constantly been
improved. As described in [202] , the mobile
Medical expert
phone in this proposed system is able to
detect irregular heart rhythm in real time,
measure QT interval (the time between the
start of the Q wave and the end of the T
wave in the heart’s electrical cycle) and identify atrial fibrillation. Furthermore, it can
Patient
correctly identify whether the user’s arrhythEmergency operator
Network
mia is abnormal or the user is just under
certain circumstances such as motion state.
The mobile phone-based ECG service
ensures the patients get informed of the
latest happenings of their heart activities at
anytime, anywhere. The system could be
more powerful in dealing with other heart
problems with more functional modules
added on. From the perspective of early
Grid equipment/solution
detection, the system is useful for healthy
Service provider
provider
people who have potential heart problems,
helping them to detect abnormalities early
Figure 5. A design of a mobile phone-based ECG service.
when no symptoms are present and prompt
Modified from [112] .
them for a medical check-up so that they
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Data/command flow
Person with
ECG sensor
Mobile phone
Figure 6. Data stream in the system.
point of care to the patients and allow them to be better informed
and actively involved in the self-care process. Several systems have
been proposed for the remote monitoring of a patient’s vital physiological parameters, allowing better treatment of patients at home
or in isolated areas. Since mobile phone-based remote monitoring
is an important method for diabetes treatment, many people have
investigated this system [27–30,117] .
As shown in Figure 7, the design of the mobile based remote service system for diabetes is similar to the one used in ECG remote
monitoring, and in fact, it is simpler. There is a blood glucose
meter that measures the glucose concentration in the patient’s
blood, and this has a connection with the mobile phone. Often
both glucose monitors and blood pressure sensors are needed at the
user end [27] . Measured results are transferred from the sensors to
the patient’s mobile phone using a USB or Bluetooth connection.
The data are then transmitted from the phone to a web server via
general packet radio service (GPRS), or 3G service [28,29,117] . The
data can be stored for later retransmission if connectivity is low.
At the monitoring centre, the read-out sensor data are combined
with historical records as well as the patient’s qualitative data and
transferred to the analyzing unit. The analyzing unit then uses
Blood
glucosemeter
Internet
GPRS
Database
Server
Phone
Figure 7. Cell-phone-based remote monitoring for diabetes.
GPRS: General packet radio service.
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this information to generate a personalized
course of action that is appropriate for the
patient at the given moment [27] . Some
systems allow the patient to use their own
phone to input and record their measurement results via speech, and the visualized
web allows consultants to monitor those
patients on a daily basis and to respond to
alerts generated by the system [29] . There
Computer
are also real-time systems where blood
glucose data, information about insulin
dose, eating patterns and physical exercise
information are collected immediately [30]
and feedback of data is sent to the patient
through the mobile phone. More detailed
graphical displays of data, which are used to
provide information about control of insulin dose and the degree of diet and exercise, probably including
a color histogram, will be sent back after the clinician’s analysis.
The system is available for both people suffering from diabetes
Type 1 and Type 2. It can be anticipated that with the development of the mobile phone-based remote monitoring system, selfcare process will make it more patient-friendly and encourage
patients to take care of their condition in a more effective way,
which will lead to longevity and reduce the risk of complications.
Mobile phone-based dermatosis care
In this section, a simple introduction about mobile phone-based
teledermatology systems to support the self-management of
patients suffering from psoriasis will be illustrated [31] .
Psoriasis is one of the most common chronic skin diseases,
affecting approximately 2% of the population worldwide.
Currently, there is no cure for psoriasis; however, there are many
treatment options that can clear psoriasis for a period of time [118] .
Continuous clinical monitoring with periodic assessment of the
state of the disease is essential for long-term therapy optimization.
Here, we do not intend to describe the design of the whole system
since it is almost the same as the cases given earlier. The difference
lies in that people do not need a sensor for
data acquisition in this system; they can use
the camera of a mobile phone to take photographs of lesions (Figure 8) . Of course, several
other health parameters are also requested
for the physicians to draw a conclusion.
Clinician
The recorded data, including health
parameters as well as pictures of the lesions,
are stored in the mobile phone and sent to
the remote monitoring centre for analyzing.
The camera, the memory and the multimedia transmission of the mobile phone
should be considered thoroughly for betPatient
ter monitoring outcomes. Additional software, such as user interface or processing
algorithms, may be installed on the mobile
phone to improve the performance.
Review
Detect & control vital parameters by combining the
mobile phone with biomedical clothing
Biomedical clothing for ambulatory telemonitoring of human
vital parameters has been developed. Weber et al. have presented a T-shirt made from fabric with woven wires and embedded with four smooth, dry ECG electrodes, a breath rate sensor, a shock/fall detector and two temperature sensors, and is
equipped for signal precomputing and transmission through a
miniature GSM/GPRS module [32] . Prototypes have been tested
on persons in a normal state of health using a medical protocol
to obtain the biomedical data, including ECG data, pneumogram, temperature and detecting falling cases in mobile situations. It employs a GSM/GPRS module, which closely connects
the biomedical clothing with mobile phones. Furthermore, one
could not only transmit data but also do some analysis and
display the results on the phone. The mobile phone could even
be used as a control centre of the biomedical clothing, and
will provide particularly useful care for old people, professional
sportsmen or people in high-risk professions such as firemen,
police or the military.
Mobile phone-controlled devices for wireless healthcare
Mobile phone
with camera
Patient
Figure 8. Take photographs of skin lesions using the
mobile phone.
is for the elderly and disabled assistance. Modem mobile phones
can now be used for mobile robot control. Mobile phones may
control the robot by voice, through the internet or by other interaction mechanisms [10,11,34] . Applying these technologies to home
robots for the elderly and disabled people will provide great convenience for these people and their families. A mobile phone-based
portable stroke monitoring system for patients or elderly people
has been designed with the intent to prevent patients from sudden death after heart operation or falling over [35] . This mobile
phone-controlled system is indeed useful for the everyday life and
rehabilitation of physically handicapped people. In fact, people
are trying to add an application for use with an iPhone to control the wheelchair and show chair information, such as speed,
in real time. There are even plans to add diagnostics features in
the future [119] .
Embedded with smaller processors and systems, a new level of
mobile communication in everyday life is now available. Using
wireless services and handheld technology, as well as low-cost sensors, real-time patient service is becoming possible in the home,
the workplace and in conventional point-of-care environments,
such as outpatient clinics and rehabilitation centers [33] . A new
notion of ‘wireless healthcare’ has been put forward. Here we Challenges in mobile phone-based control
illustrate a smart cushion controlled by a mobile phone wirelessly in healthcare
for healthcare application.
Although mobile phone-enabled controlling systems have their
As depicted in Figure 9, the system has three parts: on-cushion advantages, there are currently many technical difficulties associcircuitries; the software in the mobile device; and the remote server ated with the application of such technologies. In this section, we
and database. When the cushion is attached to any chair, it will choose to discuss several representative major challenges within
automatically collect various information describing the user’s sit- the area.
ting behavior, including posture and duration, and the ambient environment, for
example, vibration strength. This information is sent to a mobile phone periodically.
Internet
The mobile phone then analyzes this inforWarning
mation and feeds it back to the user in real
You have been leaning
left for 20 min.
time if an inappropriate posture is detected.
Please
sit straight
In addition, the portable phone will auto
matically synchronize with a remote database to upload the user’s seated posture data.
Users can also see a more comprehensive
Key features of
annual heath assessment as reported by a
Health
the smart cushion
personal physician based on the historical
assessment
Portable
record from the database [33] . This cushservice
Cheap
Easy to deploy
ion is more portable, cheaper, easier to
User
Intelligent
deploy, more intelligent and more conveConvenient
nient, and better for health than traditional
Smart cushion
healthcare methods.
Another critical area of mobile phoneFigure 9. A cushion controlled by mobile phone wirelessly.
controlled wireless healthcare application
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Control algorithms
Safety & security
Mobile phones should not only transmit data and orders, but also
provide some complicated functions. With built in algorithms,
signals like ECG, blood pressure or blood glucose could be processed and analyzed locally in the phone to produce immediate
medical information for diagnosis [36,37] . Being restricted to relatively simple algorithms, mobile phones have a low processing
speed and small data size, which limits their control functions.
Actually, even simple algorithms easily run by PCs could hardly
be accomplished by a mobile phone. Algorithm complexity that
mobile phones could reach should be improved. Mobile phones control data transmission in the systems while
the users should control the access of vital data. When applying mobile phones to an operation, one problem is whether the
electromagnetic radiation of mobile phones is dangerous to people
under long-time service and actions should be taken for this protection. Also, the electromagnetic interference between mobile
phones and other devices needs to be tested. Another big problem
is security of data transmitted through networks, which has to
protect people’s privacy. Clearly, security and privacy mechanisms
should be established to improve telemonitoring solutions [41–43] .
Communication protocols
Medical device regulations
Data exchange could not be performed without necessary communication protocols. Mobile phones could transmit information
through Bluetooth, WAP, Wi-Fi, GSM and code division multiple
access (CDMA) among others [38] . Since each of them has both
merits and shortcomings, the matter lies in how to choose proper
protocols for the specific application. The general requirements
may be high accuracy, rapid transmission rate or reliable service.
Furthermore, specific communication protocols between mobile
phones and sensors need to be established for different situations.
Since there are many researchers trying to create their own protocols in the systems, various protocols have been proposed, but
most of them are for private use [39] . Clearly, standardization
or normalization of communication protocols is needed for the
mobile phone to be used in different systems.
When used in medical fields, mobile phones work as part of medical devices so much testing must be carried out on the system.
The feasibility and reliability of the system, the performance and
portability of the software, the security and privacy of communication protocols and the safety of the human body are crucial.
High-confidence medical device software and systems are essential to help ensure advances in healthcare delivery [44] . As mobile
phones communicate wirelessly, electromagnetic interference
presents a risk to patient safety and medical device effectiveness,
which requires rigorous testing on mobile phone-enabled control
systems and other medical devices in the environment [45] . In
addition, medical devices have different definitions or standards
in different countries and organizations, resulting in different
requirements for testing [121] .
Mobile phone software platform
Expert commentary
Together with control algorithms, high-quality user interface is
an important part of mobile phone control because it provides
support for interaction between users and other electric devices [1] .
Both algorithm realization and user interface programming rely
on the software platform of the mobile phone. The platform
decides the outcome of programming, including feasibility, reliability, complexity, portability and so on, which dictates whether
the mobile phone services are performed satisfactory or not. The
current major operating systems in mobile phones are Symbian
OS, Linux, REX, Nucleus, and Windows Mobile. Different platforms reduce the transformation and portability of programs, and
most handset manufacturers have tried to change their software
to an open platform or just made a new platform using Linux [40] .
The mobile phone is developing rather rapidly and has changed
people’s lives tremendously. So much so that they are almost indispensable to everyone now. Apart from basic communication functions like sending messages or making a call, mobile phones now
show good performance in controlling in many emerging fields,
especially in people’s daily assistance and health care.
With the mobile phone, one can easily control their PC as well
as other devices connected with the computer [46,47] . Home and
office appliances (including televisions, lights, projectors and dimmers) could be manipulated by the mobile phone through SMS,
Bluetooth or wireless networks [48–54] . Furthermore, environmental or weather data collecting and transmitting, as well as traffic
management control, may be achieved by mobile phones [55–57] .
This will significantly improve the life quality and health recovery
for people, especially those with physical disabilities.
Meanwhile, as telemedicine projects are gradually carried out
all over the world and play an increasingly important role in the
health service and provide tools that are indispensable for home
healthcare, remote patient monitoring and disease management,
concepts of mobile phone-based telemedicine systems have been
put forward and a lot of research is being tried [58,59,122] . Mobile
phone-enabled systems for remote monitoring of blood pressure
and pulse, ECG, glucose or dermatosis, and even for urinalysis test, have been designed or implemented for people suffering from chronic diseases [60–62] . Such systems provide a feasible
solution for consistent medical service. Moreover, mobile phone
Hardware connection
Mobile phones need to contact other devices or modules while
different devices have varied ways of connection, which might
be serial or parallel ports, wired or wireless. We know that there
are various ports in computers, while there are very limited ports
or interfaces in mobile phones. USB and Bluetooth modules are
options for connecting mobile phones with other devices, which
are wired and wireless, respectively [102,103,120] . Trying to use one
phone to connect different devices is not always available considering the set specific interface of mobile phones. Therefore,
in addition to deciding proper communication protocols, port
matching between different devices is another difficulty.
764
controlling is especially useful in personal assistance for the elderly
and disabled people. One example is that one may soon be able
to control the wheelchair through a mobile phone. Furthermore,
mobile phone-controlled biomedical clothing is emerging, which
is certainly good for the healthcare of ordinary people. With
mobile phones, Ubiquitous Health (U-health) System, called the
U-health system, has been designed and is now in action [60–63] .
Overall, owing to their advantages in improving people’s life,
the application of mobile phone-enabled controlling systems will
almost certainly be further developed even though many difficulties remain. As the mobile phone goes further with advanced
biomedical sensors and actuators, people are expected to have a
better service from mobile phone-based controlling systems. In
the near future, m-health and U-health will be rapidly developed.
Personal body-signal monitoring, mobile medical diagnosis and
treatment, daily health keeping systems, as well as personal online
databases will be enabled by mobile phones to improve universal
health for all [61,62,123] .
Five-year view
Wide use of mobile phones brings more convenience to people’s
life. Clearly, one of the promising developments for the mobile
phone is as a controller. In addition to what has been discussed earlier, the following emerging directions for mobile phone-enabled
controlling in the near future are worthy of being emphasized.
Interaction between mobile phones & wireless networks
It is clear that a wireless network is a must in the mobile phonebased controlling systems, especially in telemedicine. Bluetooth
modules, GPRS or the internet are often used in the wireless
transmission, and there exists different protocols among various devices, such as WAP and Wi-Fi [64] . It has been said that
there are many similarities between mobile phone usage and the
internet [65] so, with mobile phone as the control tool in telemedicine systems, new networks could be established for mobile
phone communication, for example, 3G mobile communication
systems, which also have lower electric radiation effect [66] . The
evolution of current 3G wireless communication and mobile network technologies will be the main driving force for the future
developments in telemedicine [7,67] . In fact, the concept of 5G has
even been put forward [68] . On the other hand, multifunctional
mobile phones will be made to fit the current networks. And
with the growing abilities of mobile phones, various networks
may be unified.
Review
will be easier for information exchange and data processing, as
well as multiparameter monitoring. However, suitable ports and
interfaces are needed to follow integration. Naturally, new problems, such as data storage or energy supply for the mobile phone,
will also appear in time and call for a solution.
Mobile phone-based actuator
Obviously, mobile phone controlling is the central part in a whole
system including sensors and actuators. The functions that mobile
phones could perform are not just data transferring or order
transmission. Integrated or embedded with feasible devices, the
mobile phone could become an actuator itself and implement
corresponding programs. This is the concept of mobile phonebased actuators. With actuators, mobile phones would bring more
convenience to people’s lives, in particular better medical care,
advanced personal assistance and even therapy. There may be
various ways to connect mobile phones with actuators and other
control methods, except for what has been mentioned earlier,
to accomplish different tasks. One thing for sure is that mobile
phone-based actuators will be further developed rapidly.
Development platform & operating system of
mobile phones
The popular operating systems running on the mobile phones are
mainly PalmOS, Symbian, Windows Mobile, Linux, Android,
iPhone OS and BlackBerry ®. Furthermore, each operating system corresponds to different programming language, like Java
or C Language. During the process of market testing, operating
systems or programming languages may centralize, which would
mean that the mobile phone will be more easily used for multiple
control and additional functions.
Cost-effective healthcare & its industrialization
Telemonitoring can be implemented by many devices and in
various forms. The reason people choose mobile phone-based
controlling systems lies in that mobile phones are now widely
used over the world and could accomplish the task of information transmission or data processing with a relatively low cost.
Also, mobile phones are convenient, flexible and easy to use for
most people. In fact, some users may be unable to work or feel
that they can lead a normal life without a mobile phone. In this
sense, it is a good choice to realize efficient low-cost medical care
via mobile phones. It would be a big accomplishment to use the
mobile phone in medical care and it will be a milestone to market
mobile phone-enabled medical devices.
Mobile phones integrated with biomedical sensors
In some ways, mobile phones are serving as an information transmission tool as well as a data controller in the aforementioned
telemedicine systems. To lower the frequency of data transmission from one device to another, some biomedical sensors can be
integrated into the mobile phone, establishing a mobile phonecentered body sensor network platform [124] . Then, mobile phones
will be smarter, the system will be simplified and the detection
module will be wearable or more portable. Furthermore, one can
integrate several biomedical sensors into the same phone [18] . This
Financial & competing interests disclosure
This work was partially supported by the National ‘863’ Program of China,
Tsinghua National Laboratory for Information Science and Technology
Cross-Discipline Foundation, and Tsinghua-Yue-Yuen Medical Sciences
Fund. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial
conflict with the subject matter or materials discussed in the manuscript
apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
765
Review
Liu & Liu
Key issues
• Mobile phones are now widely used in people’s daily lives, not only for daily communication, but also for medical care and
personal assistance.
• Mobile phones could control home and office appliances and transmit environmental or weather data through short message service,
Bluetooth® and wireless application protocol, among others.
• Mobile phone-enabled control systems play a crucial role in remote monitoring, including telemonitoring of ECG, glucose and dermatosis.
• Mobile phone-enabled biomedical clothing and assistant devices bring convenience to people, especially the elderly and disabled.
• Control algorithms, communication protocols, mobile phone software and hardware, and safety and security are challenges for
system development.
• With advanced biomedical sensors and actuators, as well as development of wireless networks, mobile phone-enabled controlling systems
will be pushed forward to a high level.
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Mobile phone-enabled control of medical care and handicapped

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