4th WORKSHOP ON POSITIONING, NAVIGATION AND COMMUNICATION 2007 (WPNC07), HANNOVER, GERMANY

A wireless architecture for telemedicine

Martin Krohn , Heiko Kopp and Djamshid Tavangarian
University of Rostock Institute of Computer Science Chair of Computer Architecture Email: martin.krohn@uni-rostock.de Email: heiko.kopp@uni-rostock.de Email: djamshid.tavangarian@uni-rostock.de

Abstract In respect to the demographic change, currently taking place in Germany, especially in the federal state of Mecklenburg-Vorpommern, the project AGnES was started by the University of Greifswald (Faculty of Medicine) and the University of Rostock (Faculty Computer Science and Electrical Engineering). The project aims to develop an infrastructure helping to assist physicians. The essential of the project is the Community Medicine Nurse (CMN), performing home visits, physical examinations and monitoring of patients. During the examinations the CMN is in contact with the supervising family doctor. Therefore, a data connection transmitting telemedical, audio and video data has to be established. Our work handles an automatical antenna positioning system designed for the mobile WiMAX subscriber stations, which are part of the communication architecture.

I. I NTRODUCTION In Mecklenburg-Vorpommern, a federal state of Germany with a low populousness, the population is heavily regressing since the reunion of Germany. The demographic change of an increasing average age currently taking place in Germany intensies this development [1]. In this environment a home doctor is often responsible for constantly growing areas of medical care, thus the patients often have to deal with long distance approaches. Furthermore, a prognosis (gure 1) predicates that until the year 2010 about one third of all physician will retire. This is partly substantiated by the age structure in Mecklenburg-Vorpommern. Nowadays, there are physicians, unable to nd a successor [2]. In conclusion a further expansion of the medical care ranges is very likely.

The long distance approach to the family doctor is mainly an issue for older people because of mobility restrictions. They are dependent on the help of family members or the use of taxi or patient transport companies. A physical examination within a home visit of the physician is only acceptable in exceptional cases, thus otherwise the doctor would spend a large amount of time on driving to the patients. The main idea of the AGnES project is that a Community Medicine Nurse (CMN) will visiting the patients and support the home doctor. The CMN is a specically trained and skilled nurse performing activities of prophylaxis, counseling, caring and therapy-supervising. For these activities the nurse can utilise the telemedicinical equipment designed and developed in the AGnES project. Additionally, our approach depicts the requirements for the WiMAX antenna positioning system as result of the special data communication infrastructure used when transmitting telemedical data. II. N ETWORK A RCHITECTURE For the data communication between the CMN, the patient and the family doctor, the availability of relative high bandwidth is the neccessary. It can not be guranteed that all patients have broadband access to the Internet or a low bandwidth Internet connection like ISDN or Modem. The use case implies a mobile operation, which can be implemented by using wireless network technologies. In respect to the large supply radius of the physician, the network has to be available over large distances. Concurrently, the bandwidth needs to be constantly at a relative high level of at least 3.0 Mbps. WiMAX-Networks (Worldwide Interoperability for Microwave Access) [3] were introduced with the adaption of the IEEE 802.16 standard in 2001 as wireless technology for Metropolitan Area Networks (MANs). The IEEE 802.16-2004 standard [4], adopted in 2004, contains many complements and unites several proprietary solutions. Devices according to the standard provide bandwidths of 40 MBit/s and ranges up to 10 km. The devices are portable but not handy. Currently, WiMAX is not supported by the CMNs equipment. Thus the exclusive use of WiMAX for the implementation of the AGnES-architecture is not feasible. The requirement of mobility leads to a combination of WLAN and WiMAX presented in gure 2.

Fig. 1. Prognosticated Age Structure of Home Doctors in MecklenburgVorpommern; Source: KV M-V 2003; Diagram: Institute of Community Medicine, University of Greifswald

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4th WORKSHOP ON POSITIONING, NAVIGATION AND COMMUNICATION 2007 (WPNC07), HANNOVER, GERMANY

Fig. 2.

Architecture of the WiMAX/WLAN network

Fig. 3.

Positioning system

The WiMAX point-to-multi-point infrastructure supports connections of several subscriber stations. The WiMAX base station is installed at a xed place at the doctors practice. The mobile nurses visiting the patients uses a WiMAX subscriber station to establish a connection to the base station. As the WiMAX subscriber station is portable only in a limited way, a WLAN-802.11g access point spanning a cell is connected to the subscriber station. The WLAN enabled Tablet PC of the nurse to connect to the access point and thus allows connections to the PC in the doctors practice. The WiMAX antenna of the subscriber station always has to be optimally aligned with the antenna of the base station. For the daily use of the system its usage must be easy and straight forward. Thus, it is unacceptable to adjust the antenna manually. As a solution, a automatical positioning system will be described in the next section. III. T HE P OSITIONING S YSTEM The adjustable antenna is mounted on the car of the nurse. With GPS and compass information, a PDA calculates the target direction for the WiMAX subscriber antenna. The following section describes the system design in detail. a) PDA: The central element of the positioning system is the PDA (gure 3). It collects all necessary information regarding the geographical position, the point of compass, and the WiMAX signal quality. The PDA is connected to the subscriber station via a connection to the WLAN access point receiving information about the WiMAX signal quality. Furthermore, the PDA uses a bluetooth connection for accessing the GPS module. The connection to the compass system is established via a serial interface. The PDA software collects the positioning data from both the compass and the GPS module. The geographical position of the doctors practise is stored in the PDA memory during the initial setup. Based on this data the target direction of the antenna is calculated. For the rst attempt of adjustment the optimum target direction for the antenna will be calculated by taking the linear distance as a basis. With information concerning the accuracy of all measured data a small sector

where the optimum lies in is calculated. The software will scan the sector for the best connection quality. If the signal quality lays over a congurable threshold, the positioning is completed after 2 seconds. If the signal strength is not sufcient to establish a connection of the demanded quality the scanning sector is set to full 360 . This ensures that possible wave reections are utilised. To ensure that the scanning is done in an adequate amount of time, we implemented an algorithm using successive approximation. At rst the full circle is divided into 8 sectors of each 45 . The position with the best signal is used as the start point for the algorithm. The rst 45 sector where the start point lays within will be subdivided in smaller sectors. The adjustable values for the sector sizes were chosen on the basis of the properties of our antenna. If there is no sufcient signal strength available at the current position of the car, the algorithm terminates with a negative result after 256 seconds of scanning. The PDA software provides a Graphical User Interface (GUI) for conguration tasks and information about the WiMAX connection quality. If the signal quality is still under a usable level the nurse will be advised to move the car to another position. b) Microcontroller module: The mircocontroller (C) is used as an abstraction layer from the motor control protocol. The serial interface supports the submission of angular dimensions. The C responds with a positive acknowledge when the motor has been adjusted. Due to the use of the C we are able to connect various motors with different interfaces. Servo motors, stepping motors and DiSEqC [5] motors are supported. The module can be equipped with different drivers. IV. C ONCLUSION The networking architecture consisting of WLAN devices for the use in the close-up range in the patients homes together with the long distance WiMAX technology are suitable for the AGnES project. During a eld test the whole system will be tested and evaluated by the medical staff. With the help of the positioning system the usability of the data transmission architecture is greatly increased.

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R EFERENCES
[1] Raumordnungsbericht 2005, Bundesamt f ur Bauwesen und Raumordnung (BBR), 2005, http://www.bbr.bund.de/. [2] Sozialministerium und Kassen arztliche Vereinigung pr asentieren Master rztlichen Versorgung, Gemeinsame press release plan zur Sicherung der a of the ministry of social Mecklenburg-Vorpommern and the association of panel doctors Mecklenburg-Vorpommern, August 2005.

[3] IEEE 802.16a Standard and WiMAX Igniting Broadband Wireless Access, Worldwide Interoperability for Microwave Access Forum, White Paper. [4] 802.16-2004 Standard for Local an metropolitan area networks Part 16: Air Interface for Fixed Broadband Wireless Access Systems, IEEE Standard. [5] Diseqc specication, Eutelsat, Internet presence, http://www.eutelsat.com/satellites/4 5 5.html.

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