Abstract:
A system and methodology for the acquisition of medical data from multiple, at-home patient measurement devices transfers the data via telephone communications to a remotely accessed data management and display system such as a Web-based data management system. The measurement device, which supports two-way communications between the patient and the database system, is extensible to support multiple plug-in medical devices and devices for patient input or identification. Collection of data is mediated through an interface device that is connected via a digital link (serial, network, or digital RF link) to single or multiple patient measurement devices. This interface device is connected to a network via wide area network means including standard phone lines. In the preferred embodiment, data transfer is mediated through pervasive DTMF phone networks. Although DTMF is the preferred format, alternative analog or digital audio tone formats may be used.

Description:
REFERENCE TO RELATED APPLICATION 
     This application claims priority from U.S. Provisional Patent Application Ser. No. 60/264,739, filed Jan. 29, 2001, the entire contents of which are incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     This invention relates generally to medical data management and, in particular, to a system and methodology for the acquisition of medical data from multiple, at-home patient measurement devices, including the transfer of such data via standard telephone or wired/wireless network communications to a remotely accessed data management and display system accessible via a global computer network. 
     BACKGROUND OF THE INVENTION 
     There are numerous medical devices that afford patients the ability to take physiological measurements in the home. Patients with certain disease states, such as heart failure, diabetes, etc., are likely to own and use more than one of these medical appliances. These appliances include, home blood pressure cuffs, blood glucose monitors, and weight scales. The devices provide information such as systolic and diastolic pressure, pulse rate, blood glucose levels, and patient weight. 
     The consumer market and associated technologies associated with such devices have been maturing steadily for the past several years, and now many of these appliances include communication ports and software to connect them to a personal computer. As a result, there is now an opportunity to collect information from multiple home medical devices, and then present that information to both the patients and their health care providers via the World Wide Web (WWW). However, this cannot be easily carried out with current technologies for several reasons. 
     1. There is currently no standard for home medical appliance data and communication protocols. Individual appliances vary greatly in this respect, even appliances produced by the same manufacturer. Without a standard, it is very difficult to unify the information. A patient may have to have several different cables to connect to his or her PC to each appliance, and must run completely different software to communicate with each. 
     2. For many patients, there is a cost barrier to set up such a system. Many elderly and low-income patients cannot afford the purchase of a PC to download and store the information from these appliances. However, healthcare providers are beginning to recognize the potential benefit of this technology for preventative medicine that can ultimately reduce healthcare costs. 
     3. Even if the information is successfully gathered by the patient, it currently cannot made available to their healthcare providers in a clear, concise format. 
     Thus, there remains a need for an interface device to directly connect at home medical appliances to a telephone line, without a PC, for transfer to a Web-based data management system. 
     SUMMARY OF THE INVENTION 
     This invention presents a device, system, and methodology for the acquisition of data from multiple at-home patient measurement devices, and the transfer of this data via telephone or alternative digital network communications to a remotely accessed data management and display system which is preferably Web-based. Collection of data is mediated through an interface device connected via a digital link (serial, network, or digital RF link) to single or multiple patient measurement devices. For data transfer, this interface device is connected to a network via wide-area network over standard phone lines, modem or DSL. 
     In the preferred embodiment, the interface device automatically dials directly into a data collection server at a data management site. The data management site possesses both Database and Remote Display Server (which include Web-based) systems that provide for storage of patient records and data, and allow for access to the data by authorized users through any Web or Viewer-enabled computer. The interface device includes support for two-way communications between the patient and the database system and is extensible to support multiple plug-in medical devices and devices for patient input or identification. 
     Also in the preferred embodiment, data transfer is mediated through pervasive DTMF phone networks. Although DTMF is the preferred format, alternative analog or digital audio tone formats may be used. The device may therefore be equipped with auto-dialer, without necessarily requiring a full chipset modem, since the vast majority of home medical appliances are low data rate devices. In alternative embodiments, however, the connection may incorporate a modem for faster data transfer, modems for DSL, cable or RF network connections, and RF or various digital connections between the medical measurement devices and the communications device itself. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 illustrates an application according to the invention involving non-invasive blood pressure (NIBP), weight measurement, and glucose measurement as the patient measurements; 
     FIG. 2 illustrates an external form for the interface device; 
     FIG. 3 is a functional block diagram for the interface device electronics; 
     FIG. 4 depicts a unit having a larger screen and additional keys for two-way patient communications; 
     FIG. 5 shows an embodiment incorporating wireless access to measurement devices and multiple WAN network access; 
     FIG. 6 illustrates a server system for acquisition and data management; 
     FIG. 7 illustrates a database model of new tables required; 
     FIG. 8 illustrates a web interface full report; and 
     FIG. 9 illustrates a web interface daily report. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     FIG. 1 illustrates in block-diagram form a preferred embodiment of the invention. Note that the data management system  102  can support other devices which do not require the Interface Device  104 , such as EKG unit  106 . In addition, different configurations can support medical measurements other than Non-Invasive Blood Pressure (NIBP)  110 , Scale  112 , and Glucose Measurement Unit  114 . 
     Also, the connection between the Interface Device  104  and the Data Management System  102  can be through other means, such as DSL, cable modem, T1, RF wireless network, and the connection from the measurement units may be also through alternative digital connections such as 802.11b (RF network), USB (alternative wired digital connections), and so forth. 
     The following outlines the preferred requirements for the device and system operation: 
     The device interface should be designed to connect to multiple low-data-rate at-home medical devices. 
     The architecture should be configurable to allow for the use of different manufactures medical devices. 
     The system must provide an easy-to-use interface for the patient. 
     The cables that connect it to the devices should to be color-coded and/or use dissimilar connectors to prevent improper connections. 
     Each Interface Device should have an electronic serial number for identification of the patient. To support multiple patients, this might include connection to a patient input or ID system. 
     At least the Interface Device should be relatively small in physical size (suitable for unobtrusive desktop placement). 
     Each Interface Device should have independent battery power. 
     The phone interface should connect to any standard network connection supported (such as RJ-11 phone connector for phone connection). 
     The system needs to operate in any time zone. 
     The system should accommodate network address programming (such as prefix (or other custom) dialing requirements for phone). 
     The physical packaging of the Interface Device should be durable and water resistant. 
     The Interface Device should be inexpensive enough for general consumer use. 
     The patient should not be required to do any configuring or programming. 
     The Interface Device may incorporate a means for patient self-reporting of information through keys or other means. 
     Any text displayed must be of large enough size for elderly patients viewing. 
     The Interface Device should store data from the device readings until successfully transferred. 
     The system should report the time and date of the data measurements. 
     The system should receive the necessary regulatory approvals and meet relevant industry standards. 
     Each Interface Device should be able to communicate with a remote data storage and management system. 
     An effective remote viewing interface (such as Web interface) should be available for display of the measured data. 
     Measurement Devices 
     Following are three examples of at-home measurement devices that possess serial communications ports for interface to the Interface Device. Any other device, preferably with serial output, may similarly be used. 
     
       
         
               
             
               
               
               
             
               
             
               
               
               
             
               
             
               
               
               
             
           
               
                   
               
             
             
               
                 1. Non-Invasive Blood Pressure (NIBP) 
               
             
          
           
               
                   
                 Manufacturer: 
                 A&amp;D Medical 
               
               
                   
                 Model: 
                 UA-767PC 
               
               
                   
                 Outputs: 
                 Systolic Pressure (mmHg) 
               
               
                   
                   
                 Diastolic Pressure (mmHg) 
               
               
                   
                   
                 Pulse Rate (per minute) 
               
               
                   
                   
                 Measurement Time and Date 
               
             
          
           
               
                 2. Weight Scale 
               
             
          
           
               
                   
                 Manufacturer: 
                 A&amp;D Medical 
               
               
                   
                 Model: 
                 UC300 
               
               
                   
                 Outputs: 
                 Weight (lbs. or kg. depending on specific device 
               
               
                   
                   
                 purchased) 
               
             
          
           
               
                 3. Glucose Measurement 
               
             
          
           
               
                   
                 Manufacturer: 
                 Lifescan 
               
               
                   
                 Model: 
                 Surestep RS232 
               
               
                   
                 Outputs: 
                 Glucose (mg/dL or mmol/L, selectable) 
               
               
                   
                   
                 Measurement Time and Date 
               
               
                   
                   
               
             
          
         
       
     
     The following tables summarize the characteristics of each measurement device, as relevant to performing and transferring measurements to our interface device: 
     
       
         
               
               
               
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
               
               
             
           
               
                   
                   
               
               
                   
                 Data 
                   
                   
                 Start 
                 Has 
                   
                 Different 
                 Has 
                   
                   
               
               
                   
                 requested 
                 Data pushed 
                 Remote 
                 collection 
                 Device 
                 Data 
                 data 
                 time 
                 Serial 
                 Baud 
               
               
                   
                 from device? 
                 from device? 
                 power-up? 
                 remotely? 
                 ID? 
                 format 
                 forms? 
                 stamp? 
                 Protocol 
                 Rate 
               
               
                   
                   
               
             
             
               
                   
               
             
          
           
               
                 NIBP 
                 Y 
                 N 
                 Y 
                 Y 
                 Y/N 1   
                 ascii/hex 
                 N 
                 Y 
                 RS232 
                 9600 
               
               
                 Scale 
                 N 
                 Y 
                 Y 
                 Y 
                 N 
                 ascii 
                 Y/N 3   
                 N 
                 TTL 
                 2400 
               
               
                 Glucose 
                 Y 
                 N 
                 N 
                 Y 2   
                 Y 
                 ascii 
                 Y 4   
                 Y 
                 TTL 
                 9600 
               
               
                   
               
               
                   1 Device is not preprogrammed with ID, but an ID may be written to the device and later retrieved.  
               
               
                   2 Device must be already powered-up (cannot remote power-up)  
               
               
                   3 Two different models of the device exist: one that outputs results in pounds, the other in kilograms  
               
               
                   4 The device may be configured for different data and time formats, as well as glucose result in mg/dL or mmol/L  
               
             
          
         
       
     
     The Interface Device 
     FIG. 2 is a simplified drawing of an Interface Device according to the invention. The preferred characteristics are as follows: 
     
       
         
               
             
               
               
               
             
           
               
                   
               
               
                 Approximate/Target Specifications: 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                   
                 Size: 
                 2¾″ × 3½″ × ¾″ 
               
               
                   
                 Weight: 
                 0.25 lbs. 
               
               
                   
                 Battery: 
                 2 AA 
               
               
                   
                 Power Duration: 
                 100-200 hours 
               
               
                   
                 LCD Display: 
               
               
                   
                 Text: 
                 2 lines × 12 characters 
               
               
                   
                 Symbols: 
                 Low battery 
               
               
                   
                   
                 Phone Connect 
               
               
                   
                   
                 Data Transfer in progress 
               
               
                   
                   
                 Recording Data 
               
               
                   
                   
               
             
          
         
       
     
     Alarm/Error 
     Phone Interface: 
     Two RJ-11 connectors (for feedthrough) 
     Auto-dial operation 
     Bi-directional DTMF communication 
     FIG. 3 is a functional block diagram depicting Interface Device electronics. In terms of alternative embodiments, FIG. 4 shows a unit that has a larger screen and additional input buttons to support two-way question and symptom reporting by the patient. FIG. 5 shows a unit that uses wireless means to communicate with each medical device and multiple means for connecting to a network that provides access to the database and web server plant. 
     Operational Overview 
     The following description outlines how the device is used by the patient and the process for measurement and transfer of data: 
     Patient receives devices from their healthcare provider(s) including: 
     One Data Interface device 
     One or more of: NIBP, Scale and Glucose Measurement. 
     The Interface Device and remain in the home with the scale device attached thereto. The Glucose and NIBP devices, on the other hand, may be disconnected from the Interface Device, with measurements being taken throughout the day in the patient&#39;s normal environment. 
     1. At (roughly) the same time each day, the patient connects all devices to the Cybernet device initiates the transfer process using interface buttons on the Cybernet device. 
     2. Directions on the Cybernet device guide the patient through the transfer process, as follows: 
     a. If a scale device is present, the patient steps on the scale for a measurement. The scale output is transferred to the Interface Device. 
     b. If a NIBP device is present, the patient may take a measurement, if desired. All stored measurements on the NIBP device are then transferred to the Interface device. Data is preferably erased on the NIBP device once successful transfer is confirmed. 
     c. If a glucose device is present, the patient powers up the glucose device and may take a measurement if desired. All stored measurements on the glucose device are then transferred to the Interface Device. Again, data is preferably erased on the glucose device once successful transfer is confirmed. 
     3. After receipt of data from each measurement device, the Interface Device automatically dials the number of the Data Management System ( 102  in FIG.  1 ). 
     4. If connection cannot be made, the Interface Device will wait for a predetermined period of time and then try to connect again. The device will attempt a number of times and then give up until the next day when the patient initiates transfer again. 
     5. Once phone connection to the Data Management System is established, the Interface Device transfers all collected data via DTMF tone communication. 
     6. If an error occurs during transmission of the data the Interface Device will reconnect (if required) and send the data again. Methods employed to account for continued errors will include reduction of the DTMF data rate, and phone line connection. 
     7. Once successful transfer of the data has been confirmed, the Interface Device will delete the data and return to power-down mode. 
     Data Acquisition and Management Processes 
     FIG. 6 presents preferred server system requirements for acquisition and management of the patient data. 
     Outline of the Data Collection Process: 
     1. Incoming phone call is received by phone interface card. 
     2. Phone interface card sends tone to calling system (the interface device) to let it know that we&#39;re ready to receive incoming data. 
     3. Data is sent via DTMF decoding of HEX values. 
     Two DTMF tones will represent one byte of data. 
     Tone 1 
     Upper 4 bits. 
     Tone 2 
     Lower 4 bits. 
     See packet and communication descriptions that follow this outline 
     Upon receipt of each packet verification of correct receipt will be done via DTMF tone back to serial-to-DTMF translation device. 
     0—Check sum invalid. Resend data. 
     1—Check sum verified. 
     4. Once data transfer has been verified the data is then decoded and sent to the database  620  where it is stored in the appropriate table based on the type of data that it is. Each device type will send data to a different table. 
     5. After confirmation that data has been stored in the database, a confirmation message is sent to the Interface Device which results in deletion of the data on the device 
     
       
         
               
             
               
               
               
               
               
             
               
             
               
               
             
               
               
             
               
               
               
             
               
             
               
               
             
               
               
             
               
               
               
             
               
             
               
               
             
               
               
             
               
             
               
               
             
               
               
             
               
             
               
               
               
               
               
               
             
               
             
               
               
             
               
               
               
             
               
               
               
               
               
               
               
               
               
               
               
               
             
               
             
               
               
             
               
               
               
               
             
               
               
               
               
             
               
               
               
               
               
               
               
               
               
               
               
             
               
             
               
               
             
               
               
               
               
             
               
               
               
             
               
               
               
               
             
               
               
               
               
               
               
               
               
               
               
               
             
               
             
               
               
             
               
               
               
               
             
               
               
               
             
               
               
             
               
               
               
             
               
               
               
               
             
           
               
                   
               
             
             
               
                 Packet Description: 
               
             
          
           
               
                 Disc. 
                 Packet Version 
                 Device Type 
                 Data 
                 Check Sum 
               
               
                   
               
               
                 Size 5   
                 1 
                 1 
                 N 
                 2 
               
               
                   
               
             
          
           
               
                  Packet Version-1 Nibble 
               
             
          
           
               
                   
                 ◯ The first nibble sent describes the packet type to follow. It may have the 
               
             
          
           
               
                   
                 following values: 
               
             
          
           
               
                   
                 ▪ 1 
                 Version 1 data packets. 
               
               
                   
                 ▪ 2-F 
                 Future Use 
               
             
          
           
               
                  Device Type-1 Nibble 
               
             
          
           
               
                   
                 ◯ This is used to describe the data type to follow. The originating device is 
               
             
          
           
               
                   
                 used to determine what information is contained and how big the data 
               
               
                   
                 packet is going to be. All packet sizes are preferably fixed. 
               
             
          
           
               
                   
                 ▪ 0 
                 Device Information 
               
               
                   
                 ▪ 1 
                 UA-767PC A&amp;D Medical Blood Pressure Cuff 
               
               
                   
                 ▪ 2 
                 Lifescan Sure Step Blood Glucose Monitor 
               
               
                   
                 ▪ 3 
                 UC-300 A&amp;D Medical Scale 
               
               
                   
                 ▪ 4-F 
                 Future use by other measurement or patient ID/input 
               
               
                   
                   
                 devices 
               
             
          
           
               
                  Data-n Bytes 
               
             
          
           
               
                   
                 ◯ This part of the packet contains the data that&#39;s being transferred. Its size 
               
             
          
           
               
                   
                 varies with the different data types. The packet descriptions are described 
               
               
                   
                 in further detail below. 
               
             
          
           
               
                  Check Sum-1 Byte 
               
             
          
           
               
                   
                 ◯ The check sum is the summation of all nibbles in the packet. It is a one 
               
             
          
           
               
                   
                 byte HEX value representing the lower byte of the summation and used 
               
               
                   
                 for error checking on the server side to verify that the entire packet was 
               
               
                   
                 received correctly over the telephone line. 
               
               
                   
                   
               
             
          
           
               
                 Data Packet Specifications: 
               
             
          
           
               
                 Disc. 
                 P 
                 T 
                 Model Number 
                 Serial Number 
                 Check Sum 
               
               
                   
               
               
                 Size 
                 1 
                 1 
                 4 
                 12 
                 2 
               
               
                 Sample 6   
                 1 
                 0 
                 0x0001 
                 123456789012 
                 0x32 
               
               
                   
               
             
          
           
               
                  0-Device Information 
               
             
          
           
               
                   
                 ◯ 8 Bytes-Hex Values 
               
             
          
           
               
                   
                 ▪  4 Nibbles 
                 Model Number (HEX) 
               
               
                   
                 ▪ 12 Nibbles 
                 Serial Number (BCD) 
               
               
                   
                   
               
             
          
           
               
                   
                   
                   
                   
                   
                   
                   
                   
                 Sy- 
                   
                   
                 Check 
               
               
                 Disc. 
                 P 
                 T 
                 Year 
                 Month 
                 Day 
                 Hour 
                 Min. 
                 Di 
                 Dia 
                 Pulse 
                 Sum 
               
               
                   
               
               
                 Size 
                 1 
                 1 
                 2 
                 2 
                 2 
                 2 
                 2 
                 2 
                 2 
                 2 
                 2 
               
               
                 Sample 
                 1 
                 1 
                 01 
                 01 
                 16 
                 15 
                 35 
                 0x12 
                 0x34 
                 0x45 
                 0xCC 
               
               
                   
               
             
          
           
               
                  1-UA-767PC A&amp;D Medical Blood Pressure Cuff 
               
             
          
           
               
                   
                 ◯ 8 Bytes-Hex Values 
               
             
          
           
               
                   
                 ▪ 2 Nibbles 
                 Year 
                 (BCD) (Years since 1900) 
               
               
                   
                 ▪ 2 Nibbles 
                 Month 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibbles 
                 Day 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibbles 
                 Hour 
                 (BCD) (24 Hour Clock) 
               
               
                   
                 ▪ 2 Nibbles 
                 Minute 
                 (BCD) 
               
             
          
           
               
                   
                 ▪ 2 Nibbles 
                 Systolic less Diastolic 
                 (HEX) 
               
               
                   
                 ▪ 2 Nibbles 
                 Diastolic 
                 (HEX) 
               
               
                   
                 ▪ 2 Nibbles 
                 Pulse 
                 (HEX) 
               
               
                   
                   
               
             
          
           
               
                 Disc. 
                 P 
                 T 
                 Year 
                 Month 
                 Day 
                 Hour 
                 Min. 
                 State 
                 Reading 
                 Check Sum 
               
               
                   
               
               
                 Size 
                 1 
                 1 
                 2 
                 2 
                 2 
                 2 
                 2 
                 1 
                 3 
                 2 
               
               
                 Sample 
                 1 
                 2 
                 01 
                 01 
                 16 
                 15 
                 35 
                 0000b 
                 500 
                 0xCC 
               
               
                   
               
             
          
           
               
                  2-Lifescan Sure Step Blood Glucose Monitor 
               
             
          
           
               
                   
                 ◯ 7 Bytes- 
               
             
          
           
               
                   
                 ▪ 2 Nibble 
                 Year 
                 (BCD) (2 digit value) 
               
               
                   
                 ▪ 2 Nibble 
                 Month 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibble 
                 Day 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibble 
                 Hour 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibble 
                 Minute 
                 (BCD) 
               
               
                   
                 ▪ 1 Nibble 
                 State 
                 (BIT) 
               
             
          
           
               
                   
                  Bit 3-Calibration 
                 (1-Yes, 0-No) 
               
               
                   
                  Bit 2-Error 
                 (1-Yes, 0-No) 
               
               
                   
                  Bit 1-Check sum error 
                 (1-Yes, 0-No) 
               
               
                   
                  Bit 0-HIGH 
                 (1-Yes, 0-No) 
               
             
          
           
               
                   
                 ▪ 3 Nibble 
                 Reading 
                 (HEX) 
               
               
                   
                   
               
             
          
           
               
                 Disc. 
                 P 
                 T 
                 Year 
                 Month 
                 Day 
                 Hour 
                 Min. 
                 Param 
                 Weight 
                 Check Sum 
               
               
                   
               
               
                 Size 
                 1 
                 1 
                 2 
                 2 
                 2 
                 2 
                 2 
                 1 
                 5 
                 2 
               
               
                 Sample 
                 1 
                 3 
                 01 
                 01 
                 16 
                 15 
                 35 
                 0000b 
                 01250 
                 0xCC 
               
               
                   
               
             
          
           
               
                  3-UC-300 A&amp;D Medical Scale 
               
             
          
           
               
                   
                 ◯ 8 Bytes- 
               
             
          
           
               
                   
                 ▪ 2 Nibble 
                 Year 
                 (BCD) (2 digit value) 
               
               
                   
                 ▪ 2 Nibble 
                 Month 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibble 
                 Day 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibble 
                 Hour 
                 (BCD) 
               
               
                   
                 ▪ 2 Nibble 
                 Minute 
                 (BCD) 
               
             
          
           
               
                   
                 ▪ 1 Nibble 
                 Reading Parameters 
               
             
          
           
               
                   
                  Bit 3-Future Use 
               
             
          
           
               
                   
                  Bit 2-Weight Type 
                 (1-OL, 0-ST) 
               
               
                   
                  Bit 1-Sign of Reading 
                 (1-“−“, 0-“+”) 
               
               
                   
                  Bit 0-Weight Unit 
                 (1-kg, 0-lb) 
               
             
          
           
               
                   
                 ▪ 5 Nibbles 
                 Weight Value 
                 (BCD) 
               
               
                   
                   
               
               
                   
                   5 Sizes = Number of Nibbles (4 bits)  
               
               
                   
                   6 Samples have the following format. #-BGD, 0xXX-Hex value, XXXXb-Binary nibble  
               
             
          
         
       
     
     Communication Specifications: 
     DTMF Tones Conversion Chart for Incoming Server Messages 
     
       
         
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
                   
               
               
                   
                   
                 Incoming 
                 Actual 
               
               
                   
                 PIC Register Value 
                 Tone 
                 Value 
               
               
                   
                   
               
             
             
               
                   
               
             
          
           
               
                   
                 0 
                 0 
                 0 
                 0 
                 D 
                 0 
               
               
                   
                 0 
                 0 
                 0 
                 1 
                 1 
                 1 
               
               
                   
                 0 
                 0 
                 1 
                 0 
                 2 
                 2 
               
               
                   
                 0 
                 0 
                 1 
                 1 
                 3 
                 3 
               
               
                   
                 0 
                 1 
                 0 
                 0 
                 4 
                 4 
               
               
                   
                 0 
                 1 
                 0 
                 1 
                 5 
                 5 
               
               
                   
                 0 
                 1 
                 1 
                 0 
                 6 
                 6 
               
               
                   
                 0 
                 1 
                 1 
                 1 
                 7 
                 7 
               
               
                   
                 1 
                 0 
                 0 
                 0 
                 8 
                 8 
               
               
                   
                 1 
                 0 
                 0 
                 1 
                 9 
                 9 
               
               
                   
                 1 
                 0 
                 1 
                 0 
                 0 
                 A 
               
               
                   
                 1 
                 0 
                 1 
                 1 
                 * 
                 B 
               
               
                   
                 1 
                 1 
                 0 
                 0 
                 # 
                 C 
               
               
                   
                 1 
                 1 
                 0 
                 1 
                 A 
                 D 
               
               
                   
                 1 
                 1 
                 1 
                 0 
                 B 
                 E 
               
               
                   
                 1 
                 1 
                 1 
                 1 
                 C 
                 F 
               
               
                   
                   
               
             
          
         
       
     
     Server Handshaking Protocols— 
     ½ second wait after each response before device starts continues. 
     Ready to Receive—“AB” 
     Packet ACK (Acknowledge)—“AB” 
     Packet NACK (No Acknowledge—Error checksum etc.)—“CD” 
     After initial connection Client waits up to 3 sec for server to send Ready to Receive. Client then sends a Device Information Packet. Waits 1 second for Packet ACK or NACK. If no ACK or NACK then client hangs up and tries dials again. If ACK received client begins sending data packets. If NACK client sends Device Information Packet again. If NACK again client increases inter digit delay and retransmits Device Information Packet. Continue to increase inter-digit delay until ACK or max delay limit is reached. 
     Estimate of Data Transfer Time (Phone DTMF Messaging): 
     Data Collection Assumptions: 
     1 NIBP reading per day 
     1 Scale reading per day 
     5 glucose readings per day 
     Data is preferably transferred once per day 
     Approximate Data Sizes (# of ASCII Words) for Each Data Component: 
     
       
         
               
               
               
               
             
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 Header: 
                 10 = 
                 10 words 
               
               
                   
                 NIBP: 
                 10 = 
                 10 words 
               
               
                   
                 Scale: 
                 10 = 
                 10 words 
               
               
                   
                 Glucose: 
                 7/reading + 2 = 
                 45 words 
               
             
          
           
               
                   
                 Words to be transferred for acquired data = 
                 75 words 
               
               
                   
                   
               
             
          
         
       
     
     Given DTMF Transfer rate=200 mSec for Each Word: 
     
       
         
               
               
             
           
               
                   
               
             
             
               
                 = 15 
                 seconds for data 
               
               
                 + 5 
                 seconds for handshaking responses (Five 1-second responses) 
               
               
                  20 
                 seconds total transfer time 
               
               
                   
               
               
                 *excludes dialing and connection time, and assumes no errors/retry  
               
             
          
         
       
     
     Other Transmission Interfaces 
     Communications through other digital transmission interfaces like DSL, wireless network, or Ethernet will code data packets in format comparable to those described in the last section; however, the packet transmission means used for Internet-compatible networks includes its own packet timing, sequencing, and acknowledgement procedures which are documented in the various RFIs describing Internet and Internet protocol operations. 
     Database Requirements 
     Initially an existing SQL database will be implemented along with additional tables to manage the data from the new device. FIG. 7 presents additional tables that may be required. Storage means through flat files or other databases is an alternative. 
     Web Interface 
     In the preferred embodiment, a simple web interface has been developed that allows a user to logon and view all data (NIBP, weight, and glucose) that has been transferred from the interface device. Viewing systems which provide remote access to the data but which are not strictly connectionless or Web-based can be alternative implementations. FIGS. 8 and 9 illustrate the envisioned form for these pages.