A Community-Based IoT Personalized Wireless Healthcare Solution

POINT-OF-CARE TECHNOLOGIES
Received 24 November 2017; revised 13 February 2018 and 12 March 2018; accepted 24 March 2018.
Date of publication 8 May 2018; date of current version 25 May 2018.
Digital Object Identifier 10.1109/JTEHM.2018.2822302
A Community-Based IoT Personalized
Wireless Healthcare Solution Trial
PHILIP A. CATHERWOOD 1, DAVID STEELE1, MIKE LITTLE2,
STEPHEN MCCOMB1, AND JAMES MCLAUGHLIN1
1NIBEC, Ulster University, Newtownabbey BT37 0QB, U.K.
2RFproximity, Belfast BT3 9DT, U.K.
CORRESPONDING AUTHOR: P. A. CATHERWOOD ([e-mail])
This work was supported by the InvestNI Connected Health Innovation Centre.
ABSTRACT This paper presents an advanced Internet of Things point-of-care bio-fluid analyzer; a
LoRa/Bluetooth-enabled electronic reader for biomedical strip-based diagnostics system for personalized
monitoring. We undertake test simulations (technology trial without patient subjects) to demonstrate potential
of long-range analysis, using a disposable test ‘key’ and companion Android app to form a diagnostic platform
suitable for remote point-of-care screening for urinary tract infection (UTI). The 868 MHz LoRaWAN-
enabled personalized monitor demonstrated sound potential with UTI test results being correctly diagnosed
and transmitted to a remote secure cloud server in every case. Tests ranged over distances of 1.1-6.0 Km
with radio path losses from 119-141 dB. All tests conducted were correctly and robustly received at the base
station and relayed to the secure server for inspection. The UTI test strips were visually inspected for correct
diagnosis based on color change and verified as 100% accurate. Results from testing across a number of
regions indicate that such an Internet of Things medical solution is a robust and simple way to deliver next
generation community-based smart diagnostics and disease management to best benefit patients and clinical
staff alike. This significant step can be applied to any type of home or region, particularly those lacking
suitable mobile signals, broadband connections, or even landlines. It brings subscription-free long-range bio-
telemetry to healthcare providers and offers savings on regular clinician home visits or frequent clinic visits
by the chronically ill. This paper highlights practical hurdles in establishing an Internet of Medical Things
network, assisting informed deployment of similar future systems.
INDEX TERMS Clinical diagnostics, Internet of Things, LoRa, remote healthcare, sensor networks, urinary
Tract Infection.
I. INTRODUCTION
The Internet of Things (IoT) is expected to have a disruptive
impact across industry and society, with 20.8 billion IoT con-
nected devices forecast by 2020 [1]. The Internet of Things
seeks to inter-connect many physical devices such as vehi-
cles, consumer electronics, buildings, environmental sensors,
etc. to facilitate the collection and exchange of data. The IoT
market size is predicted to grow from USD 157.05 billion
in 2016 to USD 661.74 billion by 2021, a growth driven by
the proliferation of smarter and more cost-effective sensors,
the emergence of cloud computing, and the maturity and
expanse of the high speed internet [2]. Global investment will
expedite the propagation of Internet of Things technologies;
for example, Chinese manufacturers have asserted that in the
coming years they will spend an annual $127b on IoT devices
and infrastructure [3].
Significant recent interest in Wireless Sensor networks
(the key enabler for IoT-based systems) including developing
effect routing protocols, and a range of applications includ-
ing medical imaging [4], [5]. Further work has been done
to explore emerging new and emerging wireless network
strategies with an amount of work tackling IoT network
developments [6]–[10] and innovations to create smarter
IoT networks [11]–[14]. These, as well as cross-application
with supporting technologies [15]–[17] helps to gener-
ate a range of novel medical applications [18] including
imaging [19]–[21] and object detection [22] that address
growing societal needs for early cancer detection and
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P. A. Catherwood et al.: Community-Based IoT Personalized Wireless Healthcare Solution Trial
TABLE 1. Comparison of available enabling wireless technologies.
developing world healthcare solutions. A key to new remote
healthcare devices is in addressing real-world issues with
power [23]–[29].
One such enabling IoT technology is LoRa which is the
physical layer technology (using a derivative of Chirp Spread
Spectrum (CSS) [30] for a Low Power Wide Area Network
(LPWAN). LoRa infrastructure has been developed in recent
years and its expansion appears to be increasing in rate as
more countries choose to deploy full-coverage networks [31].
It operates in the license-free Industrial Scientific and Med-
ical (ISM) radio bands with devices in Europe (as well as
Africa, Russia, and Asia) operating at 868 MHz and in
USA/Canada at 915 MHz [30], [32]. Three layers of encryp-
tion ensure high levels of security; this is particularly signif-
icant for the transmission of patient’s personal data. With a
maximum of 62,500 devices per gateway (dependent on user
data rates which can be up to 50 kbps) it allows ubiquitous
IoT in urban areas, while its long range (20 Km) makes
it ideal for sparsely populated regions [30]. Target sectors
include domestic waste management, smart parking, seawater
pollution measurement, electricity/water/gas meters, high-
way tolls, vending machine monitoring, golf course irrigation
management, etc. Its key benefits include easy installation,
subscription-free service (no mobile SIM card), highly secure
two-way communication, long battery life (5-10 years) and
low cost [30]. These make it stand apart from other wireless
technologies such as cell phone networks. LoRaWAN has
been discussed, trialled, and evaluated as an e-Health Com-
munication Technology [33]–[35], however none of the pub-
lished material discusses using LoRaWAN (or any LPWAN
technology) as the basis of a care home or domiciliarypoint-
of-care automated test that is transmitted to the cloud.
A comparison of popular IoT technologies (Table 1)
highlights such LPWAN technologies as LoRa, NB-IoT,
EC-GSM, LTE-M, and Sigfox which boast very low power,
low data throughput, highly secure communications, typical
device to base-station ranges of 25Km in rural areas and 5 Km
in cities [36]–[46]. This technology is coming to fruition at a
time when healthcare systems are straining due to an ageing
population [47]. IoT-enabled remote healthcare devices can
allow patients to return to their homes more quickly after
a hospital stay, or to remove the need for a hospital stay
altogether. Patients can be monitored from the comfort and
familiarity of their own homes and clinicians can respond
rapidly to changes in conditions. Telehealth monitoring has
been shown to reduce Emergency Room visits by 15%, emer-
gency admissions by 20%, bed days by 14%, tariff costs
by 8%, and patient death rates by a remarkable 45% [48].
Telehealth monitoring has also been shown to have predictive
value in the study of early detection of heart failure (HF)
decompensation events [49].
Remote healthcare has attracted interest for some
time [50]; more recently the advancing technology has
increased potential for monitoring patients from afar. Smart
homes fitted with multitudes of sensors can monitor the
chronically ill continuously [51] however such expensive
technology is not essential to monitor people at home.
IoT facilitated remote health monitoring system has many
benefits over customary health monitoring system [52].
IoT devices can be used to enable remote health monitoring
of patients with chronic diseases such as cardiovascular
diseases (CVD) [53], while long-term Electrocardio-
gram (ECG) monitoring in residential environments have
been proposed [54].
Current challenges demand a profound restructuring of the
global healthcare system [55] and the financial viability of
such systems has been studied and verified [56] which make
the vision of a ubiquitous IoT wireless sensor network for
healthcare a valid proposition [57]. Existing IoT solutions
for industry are relatively large and cumbersome; to achieve
portable and wearable IoT-healthcare devices requires effort
to make the hardware less physically intrusive [58]. The use
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P. A. Catherwood et al.: Community-Based IoT Personalized Wireless Healthcare Solution Trial
of IoT technologies to support hospital healthcare and remote
monitoring has been presented previously [59]–[61], often
taking the form of localized body-centric wireless sensor
networks which relay data to an in-house base station which
has internet connectivity. LPWAN IoT technologies offer
connectivity over extended distances and are also suitable
for links where devices are positioned indoors [62]; this
has potential to eliminate the need for a domiciliary inter-
net connection, base station, and associated equipment. The
trade-off is with regards to the volume of data that can be
relayed back to base [63]–[65]. LPWAN techniques include
an array of technologies such as Sigfox, LoRa, LTE-M,
NB-IoT, etc. LPWAN technology has been presented as a
solution to monitor health and wellbeing remotely including
portable body-worn monitoring [66]. The LoRa solution is
particularly attractive as it requires no mobile network device
(and thus no subscription SIM card), nor does it require the
home to have Wi-Fi or even a land line.
The presented patient monitoring solution blends both
emerging and developed technologies to equip the global
healthcare system with medical solutions capable of meeting
the growing sector demands. This work is easily scalable and
could quickly be utilized to include futuristic medical body-
area sensor networks [67]–[70]. Key drivers of this work
include the global ageing population [47]; increasing vol-
ume of chronic conditions [71]; current international health
economics; and the emergence of enabling technologies. The
work is supported by the recommendations of [72] who envis-
age new technology as the key to improvements in healthcare
provision, with [73] predicting appropriate implementation
of digital technology in the health service could result in
efficiency savings up to £10 billion in England alone by 2020.
Recently there has been an amount of work published
regarding point-of-care devices. These include the novel use
of capacitive touch screens to detect urinary tract infec-
tion (UTI) to create a point-of-care device [74], the use
of a long-range surface plasmon-polariton (LRSPP) waveg-
uide biosensor for UTI detection [75], the use of Surface
enhanced Raman Spectroscopy (SERS) to test for UTIs [76],
a number of smartphone-based strip colorimetric detection
systems used to remove the subjectivity of results inter-
pretation [77]–[79] (although these are inherently affected
by ambient light conditions and require significant post
processing), etc.
Other work includes the detection of Urinary Tract Infec-
tions on lab-on-chip device by measuring photons emitted
from adenosine 5′-triphosphate (ATP) bioluminescence [80],
the use of test strips to test for UTIs with a discussion on
how an electronic reader (electrochemical sensor array) may
be developed [81], and point-of-care tests for Sickle Cell
Disease (SCD) [82].
We therefore present the findings of recent development
activity to accomplish a remote point-of-care bio-fluid sam-
ple analyzer enabled with IoT capability for residential home
use. This device employs biomarker detection strips using
a transmission-based optical sensing technique and the trial
FIGURE 1. Block diagram of the medical LoRa network.
focused on UTI diagnosis, with the results being relayed
back to the attending clinician using a long-range IoT net-
work (LoRa) (and simultaneously to the patient via Blue-
tooth (BLE) to the mobile app. for the patient’s benefit).
Such a system will save money for the NHS, reduce patient
re-admissions, and potentially saves lives [83].
II. EXPERIMENTAL METHODS
A. NETWORK DESIGN
The network was set up as depicted in Fig. 1. The gateway
(also known as the base station) that receives data from
the medical devices was the Lorank8 from Dutch company
Ideetron [84]. Onto this was attached a Sirio GP-901-C
800mm high-gain omnidirectional co-linear antenna
(1/4λ + 2 × 1/2λ co-linear) with a gain of 5-8.15 dBi
at 868 MHz. The gateway was connected to a computer
with two Network Interface Controller (NIC) cards via
RJ45 Ethernet cable; one NIC card was connected to the
internet and the other to the Lorank8 gateway. This allowed
the Lorank8 to communicate with the back-end secure cloud
server with a fixed Internet Protocol (IP) address so that
results appear on the chosen secure server and can either
be read directly from the server using a Message Queuing
Telemetry Transport (MQTT) client to monitor received
traffic on the server (we used a laptop running MQTT.fx
software) or forwarded to a visualization service to present
the data in a user friendly manner. Use of the MQTT
publish-subscribe telemetry protocol allows for bi-directional
communication between a MQTT client (PC, computing
device, etc.) and a MQTT broker. The MQTT feed presents
the payload information from the IoT-enabled bio-device
and is displayed in Base-64. This is extracted into a Matlab
program for this work and displayed in readable ASCII text.
B. DIAGNOSTIC SYSTEM DETAILS
The diagnostic system uses an emerging IoT platform
(LoRa) to transmit the results from the portable point-
of-care bio-fluid sample analyzer up to a cloud server
(via the Lorank8 gateway). The point-of-care analyzer is an
IoT-enabled version of the University’s own Qualcomm Tri-
corder XPRIZE finalist device (‘‘Diagnostic reader’’ module
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P. A. Catherwood et al.: Community-Based IoT Personalized Wireless Healthcare Solution Trial
FIGURE 2. Bio-fluid sample tester system with LoRa radio.
FIGURE 3. Disposable ‘key’ kit (left), sample being applied to lateral flow ‘key’ (center), and ‘key’ composite parts (right).
shown in Fig. 2) [85]. This diagnostic reader uses an optical
transmission technique that measures the amount of absorp-
tion caused by bio activated gold particles as controlled by
a lateral flow geometry or colour changes due to a colori-
metric process Absorption profiles relate to qualitative and
quantitative measurements of analyses such as nitrate-ions
(NIT) or leucocytes (LEU) in UTI’s. The diagnostic reader
uses a LoRa chip solution (Microchip RN2483) to enable
the diagnostic reader to connect to the LoRa IoT network.
Such technology could help meet the needs of the global
blood pressure devices market (worth US$2b by 2022 [86]),
and the global diabetes devices market (worth US$35.5b
by 2024 [87]).
The portable LoRa/BLE-enabled electronic diagnostic
reader (Fig. 2) is an optical transmission-based system
that can be used to obtain both qualitative and quantita-
tive measurements from lateral flow and dipstick tests. The
LoRa-enabled diagnostic device, together with a disposable
test ‘key’ (Fig. 3) and companion Android app (depicted
in Fig. 2), form a diagnostic platform that is capable of
diagnosing multiple medical conditions rapidly; for this trial
we emphasize the application of remote healthcare for point-
of-care screening of urine samples for evidence of a UTI.
A combination of well-defined clinical symptoms, the acces-
sible nature of the urine matrix, and the precedent set by exis-
tence of a current (albeit error-prone) point-of-care test make
UTI an appropriate use case for demonstration of improved
point-of-care diagnostics.
This diagnostics platform is however not limited to UTI
diagnosis. More complex pathological conditions are also
amenable to analysis. For these, a lateral-flow, antibody-
based biomarker detection approach has been implemented,
whereby labelled, biomarker-specific antibodies react with
patient sample before being detected through accumulation
of colored label on a detection membrane located in-line with
the optical transmission system. From a user-perspective the
mode of operation and associated costs are similar. Fig. 4 out-
lines the process flow for the system and highlights how
the test result is communicated to both the mobile app via
BLE and to the securer sever via LoRa radio. The main
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