Applied Computational Science

Two-Tier e-Health Monitoring System

NAZHATUL HAFIZAH KAMARUDIN
YUSNANI MOHD YUSSOFF
HABIBAH HASHIM
Department of Electrical Engineering
University of Technology MARA
40450 Shah Alam, Selangor
MALAYSIA
azzfie@gmail.com yusna233@salam.uitm.edu.my habib350@salam.uitm.edu.my
Abstract: - This paper proposes a new architecture for e-Health mobile devices monitoring system by
eliminating the third party server in the system. Cloud computing is proposed to be integrated with the system
for efficient data storage and quick access in patient records. This architecture is designed to enhance the
security level of the e-Health monitoring system and to protect the confidentiality of the patients data. By
eliminating the third party server in the data transmission process, we can keep the e-Health system from
potential vulnerabilities that can happen during the data transmission from the patients to the doctors. E-Health
mobile devices monitoring system can enhance the quality of healthcare by integrating the use of Internet
communication with patient-doctor treatment.

Key-Words: - e-Health, cloud computing, secured architecture, information sharing

should have more focus in dealing with

confidentiality of the patients data. This privacy
issues regarding the health records happened due to
the involvement of the third party or public server in
the e-Health architecture.

1 Introduction
During these recent years, the need for healthcare
services has increased along with the development
of technology. People nowadays have been exposed
with the rapid growth of mobile technology system
and various applications in mobile devices. These
technologies at the same time bring potential
benefits to the e-Health mobile monitoring system
as well [1]. E Health system enhances quality of
care and provides faster access to patients medical
history besides reducing time and cost in order to
receive expert diagnosis or treatment from medical
centers [4]. The doctors also get the benefits from
the development of the e-Health system where they
can save more time to attend patients and have the
opportunity to attend more chronically ill patients
[1].

1.1 Knowledge Sharing in e-Health

Knowledge sharing in e-Health has become a
very important asset to the e-Health system since the
conducted services is extended outside of its own
architecture to the third party (public server) with
the purpose of sending the data. The most important
problem in e-Health system is when there are
different groups in the architecture providing the
same services to the receivers or patients [2].
Therefore, it is very crucial to improve the
architecture by eliminating the third party or public
server and let the medical centers to handle the
patient data themselves. Patients may be reluctant to
share their medical reports but only to their own
doctors. Privacy and confidentiality of the patients
data should be prioritized in conducting the data
transmission in e-Health.

E-Health mobile monitoring system is an

emerging application that delivers the health
services and patient data information to the medical
center thus makes it possible for the doctors to get
connected to the patients efficiently [3]. In this eHealth technology, sharing information and sending
the patient data to the health center is the most
important and challenging matter. The system

ISBN: 978-960-474-368-1

154

Applied Computational Science

Interoperability is one of the main issues when

dealing with the information sharing among the
patient and medical centers. Cloud computing
manages to integrate the e-Health system efficiently
and it is able to provide safe and reliable healthcare
information. By using cloud computing in e-Health
system, the system can support large data storage
and support authorized information system [8].
Therefore, we can have a secured data transmission
between the medical center and the patients by
implementing cloud computing in the system since
it is a new technology that offers good performance
in data storage and assessment.

1.2 Mobile Devices in e-Health Monitoring

Using mobile devices like smartphones in eHealth monitoring system propose a great assistance
for patients as they may be able to get a good
healthcare without having to visit the doctors. The
mobile devices will have the function to detect the
abnormalities from the sensors in the patients body
and send the data right away to the medical centers
[1]. Thus, the quality of healthcare can be improved
by shortened the health conducting time of patients
meeting the doctors. The doctors will be alert with
their patients health condition at any time and they
can straight away attend their patients remotely.
There are lots of past works done in improving the
mobile devices system monitoring in e-Health.

3 Current e-Health Architecture

The e-Health mobile device system is configured

by having the server to be the most important part to
perform the task. The mobile device sends the body
signals to the server and the server will reply the
data to the medical center for further actions. The
medical center will send the diagnosis of the patient
through the server back so that it can proceed with
the data signal to the patient [1]. The server is
needed for persistent data storage and processing
capabilities are very limited on mobile devices
compared with the servers. Therefore, in this paper,
we propose cloud computing system in the e-Health
monitoring in order to replace the public server and
let the medical center itself handle the data storage
and data transmission for security reasons.

E-Health is a system that integrates the use of

communication technology like mobile devices and
Internet with the need for healthcare treatment in
order to improve its quality. Current architecture for
e-Health system is basically divided into three levels
[7].

2 Literature Review

3.2 Second level or Personal Area Network

(BAN)

With the current of health monitoring devices,

people nowadays no longer need to meet the doctors
quite often since they can monitor their health at
home using those devices. E-Health system has
enhanced the quality of healthcare by integrating a
connection between the patients at home and the
doctors at hospital. However, the patients need to be
connected to the Internet so that the doctors can
access their data [1]. But the e-Health system faces
communication problems since the patient needs to
transfer the data remotely to the doctors and affects
the information sharing between them. Intelligent
server or public server has been included in the eHealth communication system to connect the patient
with the doctor for certain reasons such as efficient
data storage and quick analysis.

The PAN component of the e-Health architecture

includes the mobile devices like smartphone to
enable communication between body sensors and
the server. This is one-way connected system where
the devices are connected to the Internet, and only
sending the data from patients to the third party
database servers. To transfer data, the smartphone
devices will encode the data into a format which can
be transmitted to the server. Patients can get advices
from the internet server but without interactivity
from the medical centers and only personal oriented
services.

ISBN: 978-960-474-368-1

3.1 First level or Body Area Network (BAN)

This is a stand-alone system where the body
parameter sensors communicate with the mobile
device without connection to the Internet. It is only
the communication between sensors and the patient
body and then transmits the data to patients mobile
devices.

155

Applied Computational Science

operation
3) The doctors smartphone which is connected
with the server for patient healthcare monitoring
and report back to the server.

3.3 Third level or Wide Area Network

(WAN)
The Wide Area Network (WAN) provides
connectivity between the patients and the remote
medical centers through the public servers. This is
an interactive connected system in which the mobile
devices get connected to medical centers wirelessly
in order to get the personalized healthcare services
with decision support from the doctors. It is the
connection between the public servers that receive
patients data which we set as the third party in the
e-Health architecture with the central server in the
medical centers.

The 3-Tier approach architecture is designed in

order to have an integrated framework within the eHealth system. The first tier is to present the data to
the patients where they can get the healthcare
assistance from the medical centers through their
smartphones. This tier is called the presentation tier
as it presents patients data and healthcare results.
The middle tier is called the logic tier. It forms the
basic communication between the patients and the
doctors. The middle tier consists of the servers that
process the data application. The third tier manages
the persistent database storage in which the data
server will be accessed and the results will be
passed to the middle tier for processing and lastly
the patients will receive the result through their
presentation tier [5].

Fig.1 Network Architecture of mobile device eHealth monitoring system

Based on the current network architecture of
mobile e-Health system, data signal from the patient
will be send to the public server first before the data
reaches the hospitals server. The main concern in
this current network architecture is regarding the
confidentiality of the patients data record since the
data will be analyzed by the third party before it
goes to the medical centers for further action.
Besides, it will increase the cost of e-Health
monitoring system as we also have to pay for their
services for data storage and data transmission.

Fig.2 3-Tier Architecture Approach

We can also conclude this network architecture as

a 3-Tier approach where the development of each
tier can be modified differently but the interface
between them remains static [5]. There are basically
three areas within the framework;

4 Proposed e-Health Architecture

Based on the current architecture, data transmission
from the patient will go through the third party or
the server first before it is sent to the medical center.
As a result of this situation, it might open the
security holes of the system and the e-Health system
will be exposed to certain security issues for
instance privacy issues regarding patient record.

1) The patient smartphone which receive the

transmitted patient data from the sensors.
2) The servers the main system which manages
the patients data record and the monitoring

ISBN: 978-960-474-368-1

156

Applied Computational Science

to protect the confidentiality of the patients record

and enhance the security of the e-Health monitoring
system. By eliminating the server, the
communication from the patient to the doctor will
be more secured and the cost of the data
transmission process will be reduced since we do
not need to use the outside server for data storage.

Hence, there is a need to eliminate the function of

the public servers so that the security level of the eHealth system will be increased besides reducing
the service cost. The third party server is used for
persistent data storage and trend analysis
[1].Therefore, confidentiality of the patient record is
the main concern since the data will be analyzed
through the third party server not the medical center.

5 Conclusion and Future Works

Therefore, in this paper, we propose the 2-level eHealth architecture by eliminating the third party
server by integrating the system with cloud
computing for data storage. The patients data will
be detected from the body sensor and then will be
sent through the patients smartphone device
directly to the medical center server. Hospitals and
healthcare centers do have their own local database
and the use of cloud computing is the better solution
for quick access and efficient data storage for eHealth services [8]. The data from the patient will
then be received by the doctors smartphone device
for action. The doctor will analyze the data and sent
the results or advices back to the patient directly
without going through the third party or the public
server. It will then enhance the security level for the
e-Health system and increase the efficiency of data
transmission.

In this paper, we have proposed a two level of eHealth architecture system by eliminating the third
server for data storage and integrate cloud
computing in the system for quick access and
efficient data transmission. The main server should
be implemented in the medical center itself so that
the communication from the patients device will be
directly connected to the doctors device. The main
concern in this paper is how to enhance the quality
of healthcare and to improve the security of the eHealth system. In the next paper, we will introduce
the trusted platform authentication in BAN area to
enhance the connection from the patients body data
signal to the patients mobile devices in order to
avoid any misleading information and to improve
data protection in general. We will focus more on
the security aspects of the e-Health mobile devices
monitoring system in the future works.

References:
[1] V Chan, P ray, N Parameswaran, Mobile eHealth Monitoring an Agent-Based Approach,
IET Communication Telemedicine and e-Health
Communication Systems, Volume 2, 2008, pp
223-230.
[2] Guoha Bai, Yang Guo, Activity Theory
Ontology for Knowledge Sharing in E-health,
International Forum on Information Technology
and Applications, IEEE., July 2010, pp 39-43.
[3] Y. Guo, Y. Hu, Javed Afzal, Guohai Bai, Using
P2P Technology to Achieve eHealth
Interoperability, International Conference on
Service Systems and Service Management, June
2011, pp 1-5.
[4] 10 Benefits of Telemedicine, eHealth and
HealthIT.[Online]
Available:http://www.internetinnovation.org/pre
ss-room/broadband-news-press-releases/10benefits-of-telemedicine-ehealth-and-health-it/
[Accessed; 10-February-2014]
[5] V.Chan, P.Ray, N. Parameswaran, A MultiAgent Collaborative Framework for Mobile E-

Fig.3 Proposed network architecture of mobile

device e-Health monitoring system
By integrating the cloud computing in the system,
we are able to eliminate the function of the third
party server that is used for data storage and
analysis. We propose to have the connection
between the patient and the medical center only
without any interaction with the public server during
the data transmission. Therefore, we need to set the
server at the hospital and integrate it with cloud
computing to afford large data storage. It will help

ISBN: 978-960-474-368-1

157

Applied Computational Science

[6]

[7]

[8]

[9]

Health, 40th Hawaii International Conference

on System Sciences, IEEE January 2007, pp
134.
Amir Talaei-Khoei, P Ray, N Parameswaran,
An Awareness Framework for Agent-based
Mobile Health Monitoring, 3rd International
Conference on Next Generation Mobile
Applications, Services, and Technologies, IEEE,
September 2009, pp 108-113.
Guoha Bai, Yang Guo, A General Architecture
for Developing A Sustainable Elderly Care eHealth Systems, 8th International Conference on
Service Systems and Service Management,
IEEE, June 2011, pp 1-6.
Y Hu, F Lu, I. Khan, G Bai, A Cloud
Computing Solution for Sharing Healthcare
Information, 7th International Conference for
Internet Technology and Secured Transactions,
December 2012, pp 465-470.
M Fengou, G Mantas, D Lymberopoulos, N
Komninos, S Fengos, N Lazarou, A New
Framework Architecture for Next Generation eHealth Services, IEEE Journal of Biomedical
and Health Informatics, Vol 17, January 2013,
pp 9-18.

ISBN: 978-960-474-368-1

158