Low-Cost System for Interoperability Between Outpatient Medical

Devices with Medical Records

Christian Ovalle

, Sandra Meza

, Wilver Auccahuasi

, Oscar Linares

, Kitty Urbano

Gabriel Aiquipa

, Yoni Nicolas-Rojas

, Aly Auccahuasi

, Tamara Pando-Ezcurra

and Karin Rojas

Universidad Tecnológica del Perú, Lima, Peru

Universidad ESAN, Lima, Peru

Universidad Privada del Norte, Lima, Peru

Universidad Continental, Huancayo, Peru

Universidad Científica del Sur, Lima, Peru

Universidad Tecnológica de los Andes, Apurímac, Peru

Escuela superior la Pontificia, Ayacucho, Peru

Universidad de Ingeniería y Tecnología, Lima, Peru

Universidad Privada Peruano Alemana, Lima, Peru

Universidad César Vallejo, Lima, Peru

kurbano@cientifica.edu.pe, gaiquipa@utea.edu.pe, yoninicolas@elp.edu.pe, aly.auccahuasi@utec.edu.pe,

tamara.pando@upal.edu.pe, krojas@ucv.edu.pe

Keywords: Devices, IOT, Signal, Message, XML.

Abstract: In these times with the evolution of technology, many solutions related to the interaction between the

different actors and systems related to the health sector are being presented, it is the case of the interactivity

between the different medical equipment and health information systems. In this paper we present a method

to apply these concepts related to interoperability between medical equipment and information systems

through the use and exploitation of IoT technology with XML messages to achieve interoperability, the

method proposes the update of medical equipment through IoT devices, to export the signals captured in

patients. The method proposes the use of a signal receiving station, which must be located in the health

center, this application is responsible for generating the XML message from the signals received and finally

the methodology proposes the exploitation of the message, by using the message with the information

systems that work the health center. As a result we indicate an example of message generation from patient

data and information that can be captured in an ambulance and finally the conclusions are related to indicate

the necessary requirements for implementation and scaling, we must indicate that throughout the work

refers to a demonstration by sending information from an ambulance.

https://orcid.org/0000-0002-5559-5684

https://orcid.org/0000-0002-4650-1340

https://orcid.org/0000-0001-8820-4013

https://orcid.org/0000-0002-7952-9518

https://orcid.org/0000-0003-2009-000X

https://orcid.org/0000-0002-3755-7393

https://orcid.org/0000-0001-6493-6084

https://orcid.org/0000-0001-5069-0415

https://orcid.org/0000-0003-0301-3440

https://orcid.org/0000-0002-6867-0778

Ovalle, C., Meza, S., Auccahuasi, W., Linares, O., Urbano, K., Aiquipa, G., Nicolas-Rojas, Y., Auccahuasi, A., Pando-Ezcurra, T. and Rojas, K.

Low-Cost System for Interoperability Between Outpatient Medical Devices with Medical Records.

DOI: 10.5220/0011962800003612

In Proceedings of the 3rd International Symposium on Automation, Information and Computing (ISAIC 2022), pages 611-617

ISBN: 978-989-758-622-4; ISSN: 2975-9463

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

611

1 INTRODUCTION

When we talk about interoperability, we refer to the

way in which different automated and computerized

systems can communicate with each other

automatically, without the need for the intervention

of an operator, these automated communication

tasks are translated under an application that makes

it possible for these very different systems to

communicate with each other, thanks to the different

communication protocols, It is in this line that we

present the following work to indicate the

importance, uses, applications and techniques that

govern the ecosystems of interoperability, we found

a work where the intention is to check with a low

cost system, can improve the management of

hospital services, through communication between

hospital care systems and HIS systems (Auccahuasi,

et al. 2021).

Interoperability is also reflected in the use of

biomedical and electronic devices where an

electronic part is used, i.e. implanted in the patient's

body, which replaces the biological structure of the

heart, where iEEG signals are processed and

recorded with the use of IoMT technology (Subash,

et al. 2020).

The use and exploitation of wireless technology,

in order to provide solutions to the problems related

to the health of the population. Thanks to the use of

IoMT, which is mainly related to the use of IoT

technology applied to the health sector, solutions are

being implemented in health centers, in order to

support diagnosis, optimizing medical resources,

with which security and interoperability can be

monitored, within the framework of the coexistence

between IoMT and blockchain technology (Li, et al.

2021).

In the use of IoMT technology, applied to

medical devices, which collect information about the

health of people through the internet, where data will

be obtained from patients in order to be treated, we

found works where different samples were analyzed

for the discovery of tumors by analyzing the

characteristics of images to discover their presence.

The technique uses a set of advanced features with

which brain tumors can be discovered with respect

to their developed degree, which was first validated

10 times comparing it with traditional methods such

as CART, Random Forest, Naive Bayes and

Random Tree obtaining results that reveal that the

set of features can replace traditional techniques

with an accuracy and mean F with results on a

higher performance during the evaluation (Khan, et

al. 2020).

We found works referred about accuracy and

consistency about fetal monitoring interpretation, for

which a framework for intelligent analysis and

automatic interpretation of digital cardiotocographic

signals recorded from fetal monitors based on

Internet of Medical Things (IoMT) is developed,

which implemented a method and system with

which to assess fetal conditions during pregnancy

showing accurate warning signs being used by

media centers applied in patients from home with

which the data segment is analyzed in a record by

automatic scoring functions such as Kreb's, Fischer,

classification, where the results have been compared

with the interpretations of obstetricians concluding

that the results are accurate compared to traditional

examinations (Sridhar Raj & Madiajagan, 2021).

In the use of devices related to diagnostic

assistance, we found works where an interface is

developed to send information related to heart

activity through a framework to the doctor's

workstation, under an E-health approach, with which

the reconstruction of the signals can be performed,

thus proving that the developed framework meets

the functions of interoperability, making possible the

transmission of secure medical information (Lu, Qi,

& Fu, 2019).

The use and exploitation of IoMT technology is

addressing countless limitations of traditional

healthcare systems, as well as assessing the quality

of care provided to patients, among others. With the

use of IoMT systems and interoperability,

unparalleled benefits are being realized that are

improving the quality and efficiency of treatments

and thereby improving the health of patients

(Adewole, et al. 2021).

When we address the issues of interoperability

under the IoMT approaches, it is not only to be able

to send and receive information related to the health

of patients, but it is also related to the procedures

necessary to ensure the integrity of the signals, from

sending to receiving, trying to ensure the

consistency of the data and avoid the loss that could

bring a problem related to the variation in the

signals, which would cause a bad diagnosis, we find

works where emphasis is placed on the use of

different solutions based on the detection of attacks

through the use of applications that ensure the

information sent through the IoMT protocols

(Kumar, Gupta, & Tripathi, 2021), (Alsubaei, et al.

2019).

Among the various solutions that can be

developed, these are also the use of devices that

make possible the use of emerging technology, we

find works where reference is made to the use and

ISAIC 2022 - International Symposium on Automation, Information and Computing

612

exploitation of RFID devices, as an authentication

mechanism to enter the ecosystem of the IOMT,

which ensures the integrity of the signals from the

transmitter to the receiver, and evidenced in the

display systems (Kang, et al. 2021).

After having described several works related to

the use of IoMT, IoT and RFID technologies, we

realize that more and more equipment comes with

these built-in protocols, which enable connectivity

with information systems, allowing interoperability

between equipment and information systems

dedicated to the field of health, in this proposal, We

also present as a complement a proposal for the

design of an application based on the XML standard

to achieve interoperability. The proposal can be

scaled using different components as well as

presenting more complex developments in the part

of the applications.

From the works described, we can indicate that

the issue of interoperability between different

systems and equipment is achieved by working with

the use of IoT techniques and one of its variants

IoMT, in this work we propose to use the same

techniques, but in an environment of direct

communication between medical devices that can be

connected in ambulances, which have connection to

the information systems of health centers, for which

we use IoT devices that have the ability to acquire

signals and can be sent to various servers and

services through wireless connections. We present

the procedures to implement the method in a clinical

environment.

2 MATERIALS AND METHODS

In the development of the methodology, we present

4 main components that we describe below, with the

intention of being able to indicate the necessary

steps to be able to be replicated in this way, where

we start with an analysis of the problematic

situation, we continue with the analysis of the

various devices that we can use to update the

medical devices that we wish to interconnect, we

continue with the description of the communication

protocol where we present how an XML-based

message can perform the communication between

the medical device and the computer system and

finally we describe the protocol to demonstrate the

usefulness of the methodology.

Figure 1: Description of the methodology.

In Figure 1, we present the description of the

methods to be developed, starting with the analysis

of the problematic situation, analysis of the devices,

description of the communication protocol and

ending with the demonstration of the protocol.

2.1 Description of the Problem

Situation

The problem situation that we can describe is related

to describe a low cost mechanism to connect

between various medical devices with various

information systems, we can indicate as an example

to demonstrate the methodology presented, what

happens in a traffic accident situation, when the

patient is in the ambulance, is subjected to various

equipment to monitor vital signs, in a conventional

situation, the ambulance arrives at a health center for

care, it is at this moment that the care begins in the

health center, with which the doctors treating the

patient just begin to know the patient's condition.

With the proposed methodology, having as

interoperability mechanisms, the connection of an

IoT device in the medical device, as well as

information systems may have the ability to read an

XML file and to execute update procedures to your

system, with these implementations and / or updates

to both the medical device and information systems,

connectivity is achieved and therefore

interoperability, As a demonstrative example we can

indicate that in the case of ambulance, we have a

team that measures vital signs and these are

connected to an IoT device, which becomes a Smart

medical equipment, which has the ability to connect

with different internet services, the proposed method

consists of creating a message using XML language

with the data acquired from the patient and that can

be shared with the information systems that are in

the health center to which the ambulance is going.

The information systems must have the capacity

to receive and read the XML messages and the data

obtained to update the systems, with which

following the simulation with respect to the case of

Low-Cost System for Interoperability Between Outpatient Medical Devices with Medical Records

613

the ambulance, in the health center know at all times

the status of the patient who is about to arrive and

can be prepared to receive them to apply their

procedures, due to the knowledge in advance of the

patient's condition, doctors can know and schedule

procedures in order to reduce the time of care and

thus to reduce the risk of any complication.

2.2 Analysis of the Devices

The heart of the presented method, are the IoT

devices that we describe below, these are frequently

used in many solutions based on IoT, is used for its

ease of use, its reliability in the work and its low

cost, which allows to be used in many products,

these devices allow connectivity with web services,

allows to perform data acquisition systems which

allows to capture and send them through their

communication protocols, as well as to adapt

different communication protocols with in the case

of communication.

The bass devices that have been considered to

propose their use, are decided exclusively in the

implementation of IoT based solutions, for which

they have the following characteristics:

For the case of the ESP32 model, according to

figure 2, among the main advantages, is its high

performance processor that allows to perform

various tasks simultaneously, with this feature we

can perform the acquisition of data and send them to

a station in the cloud, has WIFI connectivity with

Bluetooth integrated into the same chip, allowing

dual band communication simultaneously and one of

its main advantages compared to similar devices, is

its low power consumption and robust design, which

allows to be very small in size, complementing the

advantages, the device has a number of modules and

development kits, allowing to integrate many

solutions.

Figure 2: IoT devices.

One of the fundamental characteristics of this device

is that it has integrated three advanced processing

modules, the first is an encryption which ensures the

sending and receiving of data, the second chip is the

WI-FI module that allows the connection to nearby

networks and the third is a module of light and

temperature sensors, which allows to complement

the different solutions that you want to complement.

2.3 Description of the Communication

Protocol

The communication protocol described, in order to

demonstrate the method, consists of three

components, each of them with a fundamental

characteristic that together allow coherence in the

exploitation of resources for the benefit of patients'

health.

The first component is made up of IoT devices

that will be connected as update mechanisms of the

medical equipment that you want to work, in the

demonstration case, described in the problematic

situation, we have that in an ambulance the most

important equipment is the vital signs monitor,

which allows us to have the information of the state

of the patients, to be able to export the signals that

allow us to monitor the patient's condition in the

ambulance, it is necessary to attach to the medical

equipment, IoT devices, so that they can connect to a

communications network that can be the WIFI

network of ambulances and transmit the signals to

the health facility that awaits the patient.

The coupling between the medical device and the

IoT device can be done through different

communication protocols that the medical

equipment may have, such as RS-232, RS-485,

universal serial port. Through these communication

protocols the signal is exported to the IoT devices

who will transmit the data.

The second component is related to the

configuration of IoT devices, as mentioned, these

devices have a particularity that can connect

different data acquisition mechanisms and at the

same time configure a wireless network to send the

data received, with this mode of operation, we can

record the signals coming from the vital signs

equipment as well as the patient's personal data.

These data are transmitted to the health center,

previously the ambulance has to be equipped with

internet communication through a WI-FI network.

A third component is related to the design of an

algorithm that can convert the values entered in the

IoT devices and convert them into a message that

has the XML format, this algorithm must be

installed on a computer in the health center, so that

when the information is received from the

ambulance, automatically becomes XML message,

Complementing this algorithm, a program should be

created to read the XML message and this data can

ISAIC 2022 - International Symposium on Automation, Information and Computing

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be displayed on a monitor and also enter the

different clinical information systems that the health

center has, such as the system of electronic medical

records, HIS systems, where you can start the

process of patient admission, know your medical

history, if you are allergic or other important

information that streamlines the care process.

Figure 3: Description of the communication protocol.

Figure 3 shows the diagram of the protocol

described, where the elements that make up each of

the components, the workflow mode as well as the

interactions with the devices and systems can be

seen. The following are the main procedures of the

protocol, as well as its corresponding flowchart,

which describes the use, application and generation

of the XML message.

1. Received a sample of the received signal

2. Retrieve the data

3. Generate the XML message

4. Verify that the data satisfies the

information need.

5. Send the XML message to the different

systems

2.4 Demonstration of the

Communication Protocol

The demonstration of the protocol is intended to

describe the data transmitted by the IoT device

located in the ambulance to the receiving station

located in the health center, where the data is

processed and the XML message is generated and

then exported to the different information systems.

Figure 4 shows graphically how the XML message

is generated.

Figure 4: Diagram for XML message generation.

Figure 4 shows the sequence of processes to

generate the XML message, one of the important

considerations is the export of the signals that allow

the identification of the patient's status by the

medical equipment, the export of the signals can be

done through the communication protocols that the

equipment has, in this case it can be RS-232 or RS-

485, through which it can be entered to the inputs of

the IoT devices, with this information is generated in

XML message and exported to the different

information systems that the health center has.

3 RESULTS

The results we present are related to present an

example of how an XML message would be

generated in an application, after receiving the signal

from the IoT device of the ambulance. Below we

present an example of the message where the

application that generates the message is identified,

the patient data that can be the name and surname,

age and document number. Also the message

contains the information of a device that measures

medical parameters; the possible values to have are

heart rate and oxygen saturation.

The data that can be contained in the XML

message can be configured depending on the

information that is available.

Information of the application that generates the

XML message.

<ns0:device medical

xmlns:ns0="http://myapplication.php">

Patient data information

Low-Cost System for Interoperability Between Outpatient Medical Devices with Medical Records

615

<lastName>Scott</lastName>

</header>

<body>

</header>

<body>

<age>

</age>

</header>

Patient data information

Heart rate

</header>

<body>

</heart rate>

</header>

Oxygen saturation

</header>

<body>

</Oxygen saturation>

</header>

We must take into account that the data with which

the XML message is generated, depends on the

parameters recorded by the medical equipment, in

our demonstration example, mention is made of a

solution that tries to send the signals that are in an

ambulance, so that the hospital center can know the

patient's condition before they arrive at the health

center. If more medical data is required, it is

necessary to have medical equipment that can

acquire the signals to be analyzed.

One of the important considerations in the

development of the application for the generation of

the XML message, is related to the computer tools

that can be used, the choice of the tool will depend

on the mechanism as the signal is received from the

ambulance, normally it can be received through a

serial console, where we can configure to a buffering

mechanism, from which you can retrieve the

information to generate the message, the

programming of this application will depend on the

experience of the programmer.

4 CONCLUSIONS

The conclusions we reached are dedicated to three

components that are part of the method presented,

first with the adequacy and updating of medical

equipment that can have the ability to export signals

wirelessly, for which it must perform a procedure for

updating and adequacy of the IoT device, in this

sense is a fundamental part of this procedure.

A second component is the application that must

have the ability to transform the received signal and

be able to transform it into a message in XML, this

work is also very important, because it is required to

be able to read the signal and transform the data, and

then be included in the message, this process can be

done continuously, if continuous values are required,

or periodically when it is required to know the status

of patients in a transfer procedure in an emergency,

this mechanism is vital because you can have the

information in a real-time configuration.

The third component is related to the exploitation

of the XML message, where it is proposed to have a

monitor in the emergency room where the patient's

status can be monitored in real time, as well as to be

able to communicate with the hospital computer

systems that the health center has, such as the

electronic medical records, to know the patient's

medical history, with the pharmacy system to be

able to have available the medicines required when

the patient arrives at the emergency room, with the

computer systems of the insurance companies, if

required to know if the patient has any insurance,

among other applications that can help to reduce the

time of care and thus minimize the effects of lack of

care.

As limitations, we can point out that the need for

connectivity, this technological requirement is very

important because the ambulance, must have the

connectivity, in this way the information can be sent

to the health center, you can also resort to mobile

internet networks, through mobile equipment, with

this configuration the IoT device sends the

information through the mobile device.

The future work that we can recommend is

related to exploiting interoperability through the use

of XML messages between different devices and

information systems, thus taking advantage of the

information and computational resources available.

Finally we can indicate that the presented

method can be applied and scaled, depending on the

ISAIC 2022 - International Symposium on Automation, Information and Computing

616

experience in the management of IoT devices, as

well as the development of applications where the

information can be used in many applications, in the

demonstration of the method two IoT devices can be

identified, but they are not exclusive, other models

can be used, as long as they meet the conditions of

connectivity.

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