A Tele-home Care System Exploiting the Digital Terrestrial Television

Paolo Randaccio A Tele-home Care System Exploiting the Digital Terrestrial Television Università di Cagliari Dipartimento di Fisica Istituto Nazionale di Fisica Nucleare Sezione di Cagliari P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

MPEG-2 Video encoder Video encoder ES MUX Splitter Audio encoder TS MUX ES MUX Audio encoder Data encoder Data encoder MUX adaption energy dispersal External encoder External interleaver Internal encoder Internal interleaver MUX adaption energy dispersal External encoder External interleaver Internal encoder Mapper Frame adaption TPS and Pilot signal Antenna VHF/UHF Front end D/A conversion Guard interval OFDM The digital TV : Video+Audio+Applications • The digital TV signal transmits not only moving pictures and sounds, it carries also data, like EPG or Java code for some interactive applications. • Video, Audio and Data are compressed in a MPEG2Transport Stream • The decoder must select the TS and decompress video, audio and data • The typical applications in digital TV are videogames, learning, and tele-home care P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Why this project • The decoder (or Set Top Box or STB) for the reception of the digital TV signal is a real computer. • It can execute programs, and can be interfaced with external appliances and can connect to the web. • It is simple to use, cheaper than a normal computer, and is common to every household. • The installation of the application programs and their updates are done directly from the TV broadcaster. • Moreover, the decoders are equipped with a smart card reader for identification of the patient (the TV viewer) avoiding the need to insert any user Id or password. • These features make this instrument ideal for tele-home care for the elder people who are less skilled with computers, but are familiar with the television. P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Set Top Box = Computer The Decoder (or Set Top Box) is a real computer with an operating system, a file system and a programming language It uses the TV set as a monitor and the remote control as a keyboard The MHP (interactive) models areequipped with a modem to connect to the web WWW P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

System overview Radio Link DBV-T Production center UHF Patient Home Applications development HW & SW Transmission network UHF Amplifier Modulator Set Top Box Xlets (JavaTV) Server DVB - T ECG NIBP Modem TCP - IP Patient Central clinic Server Doctor P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

At Patient home • The Patient is supplied with: • A Base Station • Medical Devices • A Smart Card • In most of the cases also a Set Top Box with right features The Patient has to connect to the channel transmitting the Tele-home care service and activate the interactiveapplication P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

We are on broadcast • The local TV broadcaster Videolina gave us the opportunity to test Telehomecare application developed at our department. We own the logic channel 53 • Pressing the red button on the telecontrol you have access to the tele-home care menu: ECG, NIBP, SPO2, Glucosimetry, Weight meter P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

At Patient home The patient can watch the TV program (in this case just a still picture!) during biomedical parameter acquisition * … if he changes the TV channel the application doesn’t end! P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

The simplest analysis: measuring the blood pressure During the acquisition one can visualize the graphical representation of the pressure inside the sphygmomanometer cuff. At the end, the maximun and minimum pressure and the cardiac frequency are shown. P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

The Base Station: many biomedical devices interfaced to Set Top Box • Each device has its connection, its protocol, its timing • Typical connections are serial (both TTL and RS232), IRDA, PWM, or simply analog or digital signal • The Base Station must provide the hardware connection and the software to control and listen to each device TV set Set Top Box Base Station Balance ECG NIBP SPO2 Gluco P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

A prototype Base Station • On the top side the serial cable to the STB • A microcontroller (PIC) drives the data exchange and sets interface protocol • Some biomedical devices have a serial interface • But in many cases you have to provide a custom solution • Easy job for good designers P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

The choose of medical devices • Not made-by-yourself devices • Simple commercial devices • Easy to use and cheap • Battery powered with long life • Storage for measurements • Clock and calendar for time stamp • Open interface (or easy to understand) • We found a set of devices with above features P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Let’s divide Medical Devices in two categories YES • Off-line acquisition • The medical device is independent during the acquisition • The MD store data into internal memory, multiple data can be stored for a long time • STB drives the MD just to read data • The patient must be active just to measure the biomedical data • This is the case in most MD, like glucosymeters and NIBPs (sphygmomanometers) • On-line acquisition • The medical device is a slave of Set Top Box • The STB drives the MD for switching on, start acquisition, send data • The patient must be active during each phase and have to follow many steps • This is the case of our first prototypes, ECG and NIBP, made in our lab P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Patient Smart Card • Purpose: patient identification, avoid abuse • The SC stores few data: • Service provider Phone number, login & PWD • Patient name, ID code • MD interf. param., port, baud rate, … • We produced the Smart Cards ourselves because our regional government did not provide them • The file system of our Smart Card emulates the Italian CNS (Carta Nazionale dei Servizi) • Our SC can be used just for test purposes P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Patient identification through SC • The application running on the Set Top Box reads data from Smart Card after its insertion on the SC reader • Personal data are copied into the STB File System in a non volatile memory (\flashusr\persistent\oid\aid) • We don’t forsee a PIN code, at least for this application • The SC stores Internet connection parametes (service provider phone number, log, pwd, home page) and MD’s configuration (port, baud rate) P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Web data exchange Set Top Box • There are many protocols to interface computers on the web • We choose HTTP, the data exchange is made by statements like this: • www.sctm.it/ServerPEC.asp?Patient=803800011324&Code=31&Value1=122&Value2=75&Value3=68 • This is the GET mode, otherwhise you can use POST mode • Cryptography? Not yet The web InternalModem Remote Server • The operating system of Set Top Box has the Java classes to access the web through an analog modem • RCManager.Connect(this); • URL url1 = new URL(URLaddr); • HttpURLConnection … url1.openConnection(); P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Patient  Server  Doctor • On a MHP decoder an analog modem is present which functions as Return Channel (RC) • The RC makes a connection to the web through a service provider • The connection to the server is made using GET or POST methods to send identification data of the patient • After the patient identification, the biomedical data are transmitted • At the end of the transaction the Server sends an e-mail to the patient’s Doctor with biomedical data and a link to a web page where the data analysis are presented in a graphical form • The Doctor can visualize the historical data of his patients by browsing the web site . P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

All the analysis can be viewed on the web page P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

The Doctor interface • Among the web pages accessed by the doctor there is a dynamic Java Applet • The doctor can see in a graphical form the recent history of the patient • He can find relevant changes from the clinical point of view P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Not only tele-home care … Among the objectives for the care of the elderly there is also food for the brain The games requiring reasoning are good instruments for this purpose The DVB-T decoder can substitute the PC for developing videogames which do not require fast manouvres, just thinking P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Solitaire, a relaxing game The game is played with the coloured keys, arrows and OK button on the TV remote control P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

Acknowledgement from Italian Ministry of Health Recently the AGENAS (National Agency for Public Health Services) has acknowledged our project as an emerging technology The aim is to inform the Public Health Services about efficient and innovative technolgies and support their introduction . P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

They didn’t leave us alone • The INFN (Istituto Nazionale di Fisica Nucleare) has supported the project as a technology transfer • The University of Cagliari gave the knowhow, under-graduate and graduate students. • The Department of Physics gave the infrastructure and resources • Videolina has provided a TV channel • @ITIM and Ghirlanda gave the knowhow on Smart Cards • The CINECA of Bologna gave the knowhow and equipments for DVB-T • OMRON, MENARINI e TAKEDA gave biomedical devices • And finally we have the support of the local Health service (ASL 8 of Cagliari) Thanks for your attention P.Randaccio Telematics and Robotics for the Quality of Life of the Elderly

A Tele-home Care System Exploiting the Digital Terrestrial Television