Technology of Diagnosis Illnesses

In Pervasive Healthcare Systems:

A Literature Review

Danang Wahyu Utomo1, Ramadhan Rakhmat Sani1, Syahrulnaziah Binti Anawar2,

Mohammad Radzi Motsidi2

Universitas Dian Nuswantoro Semarang, Indonesia

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1
danang.wu@dsn.dinus.ac.id
1
ramadhan_rs@dsn.dinus.ac.id
2
Universiti Teknikal Malaysia Melaka
Hang Tuah Jaya, 76100 Durian Tunggal, Melaka, Malaysia
2
syarulnaziah@utem.edu.my
2
radzi@utem.edu.my

Abstract. Technologies in pervasive healthcare especially for diagnosis

illnesses play important role for prevention in healthcare service. The
technologies have to understand characteristic of the user and the disease. Recent
development indicates that novel technology can recognize and identify
characteristic of the user and the disease. This paper is aim to discuss the
technologies of pervasive healthcare and their characteristics in order to help the
work of doctor. There are many technologies in pervasive healthcare such as
wireless and networks, sensors, mobile devices and wearable technologies were
discussed. Wireless technologies provide quality of healthcare service that can be
combined with other technologies.

Keyword: diagnosis, technology, pervasive healthcare

1. Introduction

Technology of pervasive computing can be done in daily activities such as sport,

education, and healthcare. Pervasive computing is allowing healthcare to help the
patient with disabilities having disease need to test. In addition to the technology should
be able to give feedback to the patient.
The development of technology in pervasive healthcare allowing care
professional such as in hospital to home care and self care. The goal of pervasive
healthcare system is provide healthcare service at anytime, anywhere for anyone with
limitations. Recent development in mobile devices, wireless, networks, sensors and
wearable technologies indicate that the technology mostly provide early prevention and
detection in the healthcare service especially for elderly and patient with disability.
Several technologies overcome time consuming and error process for doctor to diagnose
illnesses may have more than one test result with different characteristics of patient.
Technology in the diagnosis illnesses is important in pervasive healthcare. The
technology plays important role for prevention in the healthcare. It should be support

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the work of doctor to give feedback for different characteristic of people may have
different illnesses. In addition to, recent development of technology can reduce
healthcare cost.

2. Research Background

Pervasive healthcare should be able to support healthcare service anytime to

anyone at anywhere and other limitations. For example, people with disabilities need
healthcare service that can support daily activities at homes. Healthcare service can be
done using self care, mobile care and home care[1]. Patient with internal disease need
many tests and the test result may have more than hundred results. It can be cause error
process during diagnose the result and need more time for doctor to give feedback to the
patient[2].
Several technologies provide solution to support pervasive healthcare. The
technology involves characteristics of user, environment and technologies. The
technology expected to deliver novel healthcare system to be addressed healthcare
issues in the future[3]. Characteristics of technology are important to improve early
prevention in the healthcare system. Many research indicate that novel technology have
to understand characteristics of the disease and the user[4]. Smart homes are applicable
for people with disability, restriction and other limitation. Mobile devices are suitable
for patient with illnesses can learn their test result anywhere, anytime[2].

3. The Research Method

The literature research method starts with research question, define the keyword,
search the literature on the online database, and define studies based on inclusion and
exclusion criteria.

A. Research Question
1. What are the technologies that able to support diagnosis illnesses in pervasive
healthcare?
2. What are the characteristics of technology in the pervasive healthcare that
supports diagnosis illnesses?

B. Identification of Relevant Literature

1) Keyword
The strategy to search the literature can be defined from keyword. Keyword
can be derived from major terms of problem. All keyword use Boolean OR, AND
to search the terms and reduce irrelevant result. The keyword as follows:
1. Pervasive healthcare system
2. Pervasive healthcare application
3. Characteristic of technology
4. Technology
5. Diagnosis
6. Illnesses
All keyword used for the searching of literature as follows:

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 (Pervasive healthcare system OR pervasive healthcare application) AND
(Characteristic of technology) AND (Diagnosis) AND (Illnesses)
2) Online Database
The searching of literature use six online databases :
1. Science Direct
2. IEEE Explore
3. ACM Digital Library
4. Scopus
5. EBSCO Host
6. Engineering Village

C. Selection of Studies
Selection of studies can be derived from inclusion criteria and exclusion criteria.
1) Inclusion Criteria
1. Studies that described about diagnosis of internal illnesses and
technique was proposed in pervasive healthcare system.
2. Studies that described the technology in pervasive healthcare system.
3. Studies that described characteristics of technology in pervasive
healthcare system.

2) Exclusion Criteria
1. Studies published less than 2009.
2. Studies outside the technologies of pervasive healthcare system.

4. Result
The following section will discuss the result from the research question :

A. Research Question (1): “What are the characteristics of technology in the pervasive
healthcare that supports diagnosis illnesses?”
Pervasive healthcare technologies are applicable in many areas of healthcare
service such as home care, self care and mobile care. The technologies provide
healthcare service according to area and assistance. Characteristic of technology which
is depicted in fig. 1, defines two categorizes; area and assistance. Each area and
assistance has different characteristics in pervasive healthcare system.
1) Area
The goal of pervasive healthcare is to be able to provide healthcare anytime
and anywhere. It indicates that development of healthcare system influenced by
technology according to area (areas of use). Characteristics of area can be defined;

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 a. Home Care
Home healthcare service provide healthcare that can support people to stay in
home manage their tasks, daily activities. Home healthcare equipped with sensors,
networks and devices. Web services [5] can be used to monitor vital parameter of
patient that can store and observe in devices at home. It also supports assistance
system such as sensor for patient in emergency situation. Web services equipped
with web camera can be used for interaction between doctor and patient in order to
diagnose patient’s illnesses and to give quick feedback about the result.
Recent development indicates that monitoring technologies can be done in
home healthcare. Monitoring provide early detection of emergency situation for
people especially with have disabilities. Monitoring equipped with remote
monitoring used to monitor and to understand the condition of people. Web based
real-time [6] provide healthcare using interactive consultation. Wireless sensor
networks [7] can be used to minimize the need for caregiver and provide
continuous monitoring to help chronically ill. Agent-based pervasive healthcare
that applied in mobile application [8] support patient (pregnant woman) with have
gestational diabetes mellitus (GDM). The application provide continuous
monitoring and quick feedback to doctor give diagnose for multiple patient.

Characteristic

Area Assistance

Home Care Communication Assistance Guide

Monitoring Conversation /
Scenario Discussion

Assistance Communication
Scenario devices
Fig 1 Characteristics of healthcare technologies
b. Communication
The increased of disease (chronic disease) and healthcare cost is a factor to
develop healthcare system according to communication[9]. Communication
characteristic provide healthcare service using devices such as mobile devices to
communicate with another user. Mobile technology was introduced [2], [4], [10]
provide information (such as patient history, medical, and test result) to doctor,

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 nurse, and patient. This technology such as PDAs, smartphones, and small mobile
devices can be used to communicate and send data. For example, mobile devices
as a client and PC as a server enable to diagnose diabetes and send test result.
2) Assistance
Assistance characteristic enable healthcare service according to user’s
need and purpose of use. The goals of pervasive assistive healthcare
technologies are able to support user with some task, guide or reminding
about schedule. Characteristics of assistance can be defined;

a. Assistant
The technology enables assistant healthcare service to manage the tasks
without caregiver. It designed without hand tremor. Assistant healthcare
equipped with sensors, wearable technologies, and wireless sensor networks.
RFID technology [11] can be used to identify and to locate the presence of
tagged object. BAN (Body Area Network) is one of wearable wireless sensor
[1] provide medical sensor and temperature sensor used to measure condition
of people or physiological signal of people especially for elderly and
disability.
b. Guide
Healthcare system equipped with user assistance that can support people
to finish tasks. The systems give some direction, route or step by step to
manage tasks. Smart RFID care [12] is the smart assistance for nurse to check
patient history and support the work of doctor to diagnose patient’s illnesses.

B. Research Question (2): “what are the technologies that able to support diagnosis
illnesses in pervasive healthcare?”
There are many technologies have been developed on pervasive healthcare such as
healthcare service using wireless, networks, sensors and mobile devices. There are
many studies indicates that the technology focused on how to increase prevention in
health risk and disease.
The recent developments in mobile devices have seen advances in the new
software techniques and mobile services on pervasive computing especially for
pervasive healthcare. Mobile device was used to diagnose illnesses. A simple client
server, PDA as a client and PC as a server apply neural network to diagnose diabetes.

Table 1 technology in pervasive healthcare

Area Assistance
Home Care Communication Assistance Guide
Mobile device [14] [2] [4] [10] [2] [4] [10]

Wireless [11] [13] [8] [12] [16] [11] [13] [8] [12] [16]
network [15] [15]

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 Sensor [17] [18] [17] [18]

Wearable [19] [19]

technologies

Neural network was used to classify diabetes on PDA/PC. The concept is PDA
as a input and output for data and PC as a server for computation[4]. Other study[2], use
ANN to diagnose internal illnesses. ANN as classifier in server, diagnoses internal
illnesses and the result can be reported to the patient using PDA. Patients have the
opportunity to learn their result anywhere and anytime. In addition to,novel technique
and technology facilitate the work of doctor to diagnose illnesses, in some cases may
have long report. Doctor can give quick feedback to the patient about the test result. A
novel mobile service, mPHASIS[10], mobile medical sensor that can uses to monitor
diagnostic procedure. mPHASIS focuses on monitoring, how to detect disease early and
pervasive access using alert messages on smartphones. mPHASIS combine with
sensors, give benefit from continuous monitoring such as monitoring in ambulatory
setting and early detection. Wireless sensor networks technologies are another way to
deliver healthcare service with continuous monitoring[7]. Wireless sensor networks
provide monitoring service for elderly, and children to survive in homes without
caregiver. In addition to provide constant monitoring to increase early prevention and
detection for people have illnesses. Wireless sensor networks provide quality of
healthcare service and healthcare monitoring to survive in homes. Healthcare
monitoring focuses on daily living, fall and movement, location, and medical status.
Wireless broadband medical [13] is a cloud devices by medical wearable wireless
sensor and antenna to meet the requirement of ubiquitous healthcare. The cloud device
applied in medical mobile station provide healthcare for elder or chronic patient who
need continuous treatment and monitoring. In addition to, it reduce cost of healthcare.
RFID technology is one of healthcare monitoring application which automatic
identification using radio waves. RFID technology can be used as smart assistant for
nurse to provide automated reviewing record and giving medicine for patient[12].
Sometimes, manual ways of reviewing record and giving medicine cause error. It
caused, nurse may have mistake when manage patient record. RFID technology
provides automated way for manual reviewing record and giving medicine. RFID as
smart assistance for nurse can support diagnosis of doctor in order to give medicine. In
application, RFID can captures patient ID and all patient record can be displayed
include specify of medicine for patient’s disease. In another way, RFID technology is
applicable in remote location[11]. It focuses on locating and identifying the object
where tagged in the field of reader. Patient with disabilities have opportunity to get
diagnose when stay in homes. RFID tags can identify objects in different angles.
CARA (Context Aware Real Time Application) System provide healthcare service
real time for patient with chronic disease especially for elderly and caregiver. The
component of CARA system consists of wearable wireless sensors; non intrusive
movement sensor; remote monitoring; and data & video review system. CARA system
can be applicable using wireless medical BAN (Body Area Network) [19]. It used to
support continuous monitoring via movement sensor. This CARA system used internet-

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connected PC, aim to remote caregiver and elderly when measure physiological. The
result stored on a server, it benefit for doctor to diagnose the result when stay in
hospital. in web based [6], CARA system provide remote monitoring using adobe flash
plug-in. In other application, [1] use fuzzy logic based reasoning framework to get
accuracy in emergency situation detection.

5. Discussion
A. Healthcare issues
Some studies indicate that cost of healthcare is important issues in the healthcare
service. People need low cost healthcare service that can continuous their treatment.
Sometimes, people do not continue their treatment because of high cost of healthcare.
Time consuming and error process prone is another issue in healthcare service.
Sometimes, nurses give wrong medical data and medicine because of manual way of
patient’s record. Nurse need long time to manage patient’s record and give feedback to
doctor about history of patient.

B. Technology of healthcare
According to healthcare issues above, pervasive healthcare technologies have seen
significant advances such as wireless, mobile device and network, sensor and wearable
technology provide healthcare professional. Recent developments of technology provide
early prevention and detection in the healthcare services.
Home care (home monitoring) and communication technologies was proposed to
provide quality of healthcare service and to reduce cost of healthcare and clinical check-
up. It technologies addressed for people to get daily treatment at anywhere and anytime.
For example, wireless technology can be used to monitor elderly and patient with
disability to get treatment in their home.
We focused on characteristics of technologies in area characteristics, because
several technologies in assistance characteristics can be used to support area
characteristics. In home monitoring, assistant and guide characteristic can be used to
support monitoring scenario.

1) Home Care
Home care

Monitoring Assistance
Scenario Scenario
Fig 2 Home Healthcare categories

Human activity of daily living is a factor to build home healthcare. Home

healthcare is solution for elderly to live safely in their home. The characteristics of
technology in home healthcare should be able to recognize daily activity of people such

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as how to recognize human behavior when standing, walking, running and exercising.
In emergency condition, the technology should be able to identify location, different
degrees of cognitive and physical abilities of patient.
Home Monitoring provide healthcare service to address recognition of human
behavior and identification of emergency condition. In fig 2, home healthcare divided
into monitoring scenario and assistance scenario. Monitoring scenario focus how the
parameter of the patient are stored in database of server through device at home.
Assistance scenario consist of movement sensor for environmental condition like
temperature and gas, and actor as health professional or caregiver to support the patient
in order to check the health status or medicine. Sensor technologies can be used to
identify and to recognize human behavior (how people moved) and environment.
Patient is monitored by different sensors within BAN (Body Area Network) that can be
used to monitor medical sensor, temperature sensor, and mobility sensor. In addition to,
it can be used to monitor environment of patient such as surrounding of patient’s home.
Real time identification can be used to identify emergency situation like heart
attacks or sudden falls of patient in a few minutes. Context information helps in
identifying the pattern of situation. For example, in emergency situation, the location
information can be used to track the person with vital signs. This information helps to
active video sensor and the images as result can be delivered to the caregiver via
cellular network or internet through gateway server.
Considering the issues above, we conclude that the characteristics of home
healthcare technologies can be summarize:

1. Able to recognize and to identify daily activities

The applications have to identify activities of patient everyday such as eating,
sleeping, sitting, and walking and to recognize condition of around of patient.
2. Able to identify fall and movement detection
The applications focused on the conditional of patient, such as physiological of
patient and detection for elderly that need early healthcare which may lead
recovering from chronic disease.
3. Able to identify location
The applications focused on reminder and monitoring impaired patient such as alarm
can be used to be reminder or signal when patient need early healthcare.
4. Able to monitor medication
The applications have to check environment of patient to obtain health status of
patient such as information of blood pressure, oxygen, heart, and temperature of
patient.
5. Able to monitor medical status
The applications provide information of medical status in order to deliver healthcare
especially for elderly and patient with limitations.

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2) Communication
Communication

Conversation / Communication
Discussion devices

Fig 3 Communication categories

The innovation of healthcare provided the improvement of productivity of medical

facilities. Doctor, patient and caregiver must be able to communicate at anywhere and
anytime. In fig 3, communication can be divided into conversation / discussion and
communication devices.
Conversation / discussion provide communication scenario include starting, and
change of ideas, spoken, and written between one or more patient and hospital. For
example, communications between doctor and patient have diabetes through web
services. Patient can discuss with doctor about how to prevent diabetes, about the
treatment. In this scenario, patient and doctor do interchanges of ideas carried out by
spoken or written.
Communication devices provide communication using devices such as
smartphone, PDA and other mobile devices. In addition, describe communication
technique on the devices such as what are the technique to provide communication
between patient and hospital. The improvements of healthcare apply communication
technology in the system. Healthcare system can be categorized: patient-centered and
hospital-centered [16]. Patient-centered consist of: 1) body worn used to monitor
patient 2) hospital information system as storage and management of health data, and 3)
mobile device as personal gateway between body worn and hospital system.
Architecture of Patient-centered provides periodical feedback, health status and plan of
care update. This technology is suitable for patient with periodical treatment. Hospital-
centered consist of three subsystems 1) central subsystem as personal medical device
(integrate with RFID, smartphone), 2) hospital subsystem identified by wireless devices,
and 3) hospital information system as storage and management of health data. This
communication involve mobile device to communicate between hospital subsystem and
hospital information system. In addition to, mobile device can be used to manage
wireless technologies and communication protocols. Recent development indicate that
mostly, communication technologies involve mobile device as personal server that can
use at anywhere and anytime, and the server (hospital server) as a management of health
data that provide the information about history of patient. Communication technologies
provide health status update and reduce clinical check-up. For future, the technology
may emerge novel features to address different disease and people.

6. Conclusion

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 Technologies in pervasive healthcare provide improvement of healthcare quality.
Technologies focused on how to increase early prevention in health risk and disease.
Each technology in pervasive healthcare have different characteristics in order to deliver
healthcare service especially to support the work of doctor.
Characteristic of technologies can be defined two categories: area and
assistance. Area characteristic discuss technologies should be able to recognize and to
identify daily activities of patient and their environment, and to monitor health status of
patient. Communication characteristic discuss technologies should be able to support
communication between doctor, patient and caregiver. Recent development indicate that
communication characteristic involve mobile devices as personal server to check health
status.
Wireless technologies provide better healthcare service than other technologies.
Wireless technologies can be combined with other to provide healthcare service at
anytime and anywhere.

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