# A Novel Smart Healthcare Monitoring System Using Machine Learning and the Internet of Things

Authors: Malik Bader Alazzam; Fawaz Alassery; Ahmed Almulihi
Journal: Wireless Communications and Mobile Computing
 (2021)

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## Abstract

The Internet of Things (IoT) has enabled the invention of smart health monitoring systems. These health monitoring systems can track a person’s mental and physical wellness. Stress, anxiety, and hypertension are key causes of many physical and mental disorders. Age-related problems such as stress, anxiety, and hypertension necessitate specific attention in this setting. Stress, anxiety, and blood pressure monitoring can prevent long-term damage by detecting problems early. This will increase the quality of life and reduce caregiver stress and healthcare costs. Determine fresh technology solutions for real-time stress, anxiety, and blood pressure monitoring using discreet wearable sensors and machine learning approaches. This study created an automated artefact detection method for BP and PPG signals. It was proposed to automatically remove outlier points generated by movement artefacts from the blood pressure signal. Next, eleven features taken from the oscillometric waveform envelope were utilised to analyse the relationship between diastolic blood pressure (SBP) and systolic blood pressure (DBP). This paper validates a proposed computational method for estimating blood pressure. The proposed architecture leverages sophisticated regression to predict systolic and diastolic blood pressure values from PPG signal characteristics.


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## Body

## 1. Introduction

The Internet of Things (IoT) is a rapidly evolving technology. The Internet of Things (IoT) is about connecting computing devices, mechanical and digital machines, objects, animals, and people with sensors and actuators to collect data and improve wellness, productivity, and efficiency [1]. Smart home, smart grid, and smart city are well-known concepts that are revolutionising our lives.Using IoT-based remote patient health monitoring is one of the most promising technological interventions emerging to bridge the global health equity gap. These IoT technologies are also known as the Internet of Medical Things (IoMT). Throughout this dissertation, we will use IoT and IoMT interchangeably, though we will focus on the healthcare domain. The Internet of Things can also improve healthcare and safety. We can get information about our lifestyle, physical and mental performance, living environments, etc., by connecting our bodies to the Internet. This allows healthcare providers to monitor human subjects’ health remotely and continuously [2]. The measured data may also support evidence-based solutions for disease, injury, safety prevention, early diagnosis, and treatment.However, unlike mechanical or digital technologies, the human body cannot be easily connected to the Internet. It is possible to connect a digital gadget to the Internet by including a sensing and networking system. However, having a sensing system built in the human body will not allow us to connect it to the Internet. Large sensing or measurement equipment is typically utilised to carry out the measurement in order to learn about the health state of the subject. Large measurement equipment, on the other hand, has a constraint in that it can only be used in controlled situations for a short period of time. It is therefore impossible to connect a person’s body to the Internet everywhere at any time using conventionally employed massive sensing and measurement equipment [3]. The inability to connect the human body to the Internet severely restricts the application of IoT in the fields of healthcare and security.Another component and its linked intricate factors may evolve as the result of an initial health concern caused by one aspect. The concept map in Figure1 helps to show the relationship between the three aspects. Figure 1 depicts some of the symptoms of stress, such as headaches and dizziness suffering can be classified as either distress or eustress, with distress being the more detrimental of the two. It is important to remember that the length of stress is likewise divided into three categories: short term, episodic, and long term. Acute stress is characterised by being short and sharp in duration, while episodic acute stress is characterised by recurrence. Stress can lead to a lack of adaptation, which can have serious consequences on relationships, employment, health, and even on one’s personal well-being in the form of emotional breakdowns [4]. It is critical to be able to develop a self-monitoring strategy for dealing with stress. A way for consumers to adapt is created by incorporating these approaches into the Internet of Medical Things (IoMT).Figure 1
Logical analysis for stress detection.Studies have shown that stress contributes significantly to the development of anxiety and hypertension. Anxiety has also been linked to hypertension in some research. Figure1 uses arrows to show this idea. Aside from that, stress-related illnesses including cognitive decline and heart disease can be triggered by worry as well. High blood pressure can potentially lead to heart disease.By keeping tabs on and controlling stress and its side effects like anxiety and high blood pressure, people are less likely to suffer from long term and often irreversible health problems in the future [4]. Furthermore, keeping track of a patient’s stress, anxiety, and blood pressure levels might assist the caregiver in establishing an informed diagnosis and initiating early intervention to prevent long-term damage.


## 2. Background

It is possible to obtain precise information about body posture and force exertions using direct methods that make use of instruments like inertial measurement units (IMUs) and electromyography (EMG) sensors, among other things. For example, Vignais et al. used an IMU in conjunction with goniometers to measure upper-body movement and angle. The magneto-resistive angle sensors developed by Alwasel et al. were proposed to measure the kinematics of shoulder movement. The use of accelerometers to detect the movement of subjects was also common [5]. These methods, however, are limited to posture recognition and do not capture information on force exertion, a significant risk factor for WMSDs60. They should be improved. Force exertion data could be recorded using EMG sensors. Due to the limited use of EMG sensors, it was difficult to obtain information on the total amount of force being exerted by the body as a whole. Additionally, these methods required the use of additional instruments or electrodes on the head, truck, or upper limbs, which was uncomfortable and inconvenient for the user [6].


### 2.1. Stress Detection

The scientific community has recently placed a high value on detecting stress levels from physiological signals. However, the majority of previously published works have either utilised adolescents or failed to mention a specific target audience. The use of cortisol as a stress reference for stress detection is another area that has received relatively little attention. As the ground truth, most studies have used stress levels calculated from self-reporting questionnaires such as the DASS 21 [7]. Because of erroneous stress perceptions, low objectivity, and inconsistent assessment, the results obtained using this method may be skewed.As shown in Figure2, we used real-time stress detection (such as programmers and testers). Physical data is collected by E4-wristband6 sensors. In this first version, the stress detector only uses electrodermal activity as an input (EDA). A brief increase in the EDA signal is linked to increased sweating and stress. The stress detector’s main job is to assess the user’s stress level [7–9]. The detector will label your body if you are stressed. We used Bakker et al.’s preprocessing steps to allow real-time processing (see Figure 2 for the involved preprocessing steps). Then, we will look at how stress is detected.Figure 2
Graph between the systolic short-term blood pressure.


### 2.2. Blood Pressure Estimation Models

There is a lot of research on calculating blood pressure from physiological cues (PWV). Repeated sensing or a dual element probe is required. Calculate PWV using a dual element PPG probe. And here, used three signals (ECG, PCG, and PP) to calculate pulse transit and arrival time to predict blood pressure (PPG). Using a Ballistocardiogram, blood pressure is calculated in [10] (BCG). We developed a new method for measuring blood pressure using a PPG-based single sensor and single probe.The current study examined two new Adobos models (MLP and DT) as well as the traditional Maximum Amplitude Algorithm (MAA) method based on predefined characteristic ratios. The classic MAA approach depends on a constant characteristic ratio to determine SBP and DBP. The SBPR and DBPR fixed values were calculated using our Reference Scoring averages (RSs).


## 2.1. Stress Detection

The scientific community has recently placed a high value on detecting stress levels from physiological signals. However, the majority of previously published works have either utilised adolescents or failed to mention a specific target audience. The use of cortisol as a stress reference for stress detection is another area that has received relatively little attention. As the ground truth, most studies have used stress levels calculated from self-reporting questionnaires such as the DASS 21 [7]. Because of erroneous stress perceptions, low objectivity, and inconsistent assessment, the results obtained using this method may be skewed.As shown in Figure2, we used real-time stress detection (such as programmers and testers). Physical data is collected by E4-wristband6 sensors. In this first version, the stress detector only uses electrodermal activity as an input (EDA). A brief increase in the EDA signal is linked to increased sweating and stress. The stress detector’s main job is to assess the user’s stress level [7–9]. The detector will label your body if you are stressed. We used Bakker et al.’s preprocessing steps to allow real-time processing (see Figure 2 for the involved preprocessing steps). Then, we will look at how stress is detected.Figure 2
Graph between the systolic short-term blood pressure.


## 2.2. Blood Pressure Estimation Models

There is a lot of research on calculating blood pressure from physiological cues (PWV). Repeated sensing or a dual element probe is required. Calculate PWV using a dual element PPG probe. And here, used three signals (ECG, PCG, and PP) to calculate pulse transit and arrival time to predict blood pressure (PPG). Using a Ballistocardiogram, blood pressure is calculated in [10] (BCG). We developed a new method for measuring blood pressure using a PPG-based single sensor and single probe.The current study examined two new Adobos models (MLP and DT) as well as the traditional Maximum Amplitude Algorithm (MAA) method based on predefined characteristic ratios. The classic MAA approach depends on a constant characteristic ratio to determine SBP and DBP. The SBPR and DBPR fixed values were calculated using our Reference Scoring averages (RSs).


## 3. Methodology

To collect, process, and analyse the massive amounts of data generated by medical sensors, the proposed framework makes use of three key steps. In the first step, a large volume of data is collected. In the second step, data storage is discussed. In this step, Hbase is the database used to store the data. Step 3 is all about making a prediction.


### 3.1. Data Collection

There are three layers to the proposed health monitoring systems. Data collection is done at the top layer, followed by storage and analysis at the bottom. Using a wearable device that is implanted in a patient, the first layer collects medical data from the patient and continuously transfers it to the second layer [11]. It records data when a value exceeds a preset limit, then issues a warning, and sends a message to family members and caregivers. An alert message would be sent via wireless networks in the framework. Data is stored on Amazon S3 in an algorithmic representation of the observed clinical values.


### 3.2. Storage of Medical Data

Because smart devices generate a lot of data, traditional query-structured databases cannot handle it. That is why I used big data in this study. The medical data is stored in a distributed fashion using Apache and Hbase in this paper [12]. There is not enough room in devices and computer memory to store all of the data that is generated. Stability and elasticity are provided by the proposed method, which makes use of the cloud. An Amazon account is created for data storage, and clinical data can be stored using Amazon’s simple storage service S3. Monitoring systems send alert messages to Amazon S3 when observed values go above threshold values, which are then forwarded to doctors along with the patient’s health records.


### 3.3. Analysis of Medical Data

The data is analysed using the decision tree algorithm, which is built on a mining algorithm for heart disease prediction [13]. There are three steps in this model. Medical data must first be collected, and then, that data must be remotely diagnosed as the second step.A system level flow chart explains the design methodologies used to develop stress-lysis, while the following subsections discuss machine learning modelling techniques for stress-level detection.


### 3.4. Logical Stress Analysis

Truth table analysis of sensor values in system determines logical relationships. Logic 0 indicates that the output stress is minimal when the sensor values are low. Logic 1 indicates that the stress level is high when all of the inputs are high [14]. It is possible that not all sensor values, no matter how low they are, will be indicative of stress.Using a truth table, the sensor values of the system can be logically analysed (see Figure2). There is less output stress when the sensor values are low. It is easy to get stressed out when everything is going well [15]. In situations where both of the inputs are high, stress levels will be high as well. For in-between values, a Sum of Product (SOP) analysis is performed:
(1)SL=TSR.ASR+HSR+ASR.HSR,where TSR is the temperature sensor reading, ASR is the accelerometer sensor reading, and HSR is the humidity sensor reading. A pictorial representation, representing the detailed explanation of the fuzzy operation, is represented through Figure 3.Figure 3
Graph between short- and long-term standard deviation vs. number of features.


## 3.1. Data Collection

There are three layers to the proposed health monitoring systems. Data collection is done at the top layer, followed by storage and analysis at the bottom. Using a wearable device that is implanted in a patient, the first layer collects medical data from the patient and continuously transfers it to the second layer [11]. It records data when a value exceeds a preset limit, then issues a warning, and sends a message to family members and caregivers. An alert message would be sent via wireless networks in the framework. Data is stored on Amazon S3 in an algorithmic representation of the observed clinical values.


## 3.2. Storage of Medical Data

Because smart devices generate a lot of data, traditional query-structured databases cannot handle it. That is why I used big data in this study. The medical data is stored in a distributed fashion using Apache and Hbase in this paper [12]. There is not enough room in devices and computer memory to store all of the data that is generated. Stability and elasticity are provided by the proposed method, which makes use of the cloud. An Amazon account is created for data storage, and clinical data can be stored using Amazon’s simple storage service S3. Monitoring systems send alert messages to Amazon S3 when observed values go above threshold values, which are then forwarded to doctors along with the patient’s health records.


## 3.3. Analysis of Medical Data

The data is analysed using the decision tree algorithm, which is built on a mining algorithm for heart disease prediction [13]. There are three steps in this model. Medical data must first be collected, and then, that data must be remotely diagnosed as the second step.A system level flow chart explains the design methodologies used to develop stress-lysis, while the following subsections discuss machine learning modelling techniques for stress-level detection.


## 3.4. Logical Stress Analysis

Truth table analysis of sensor values in system determines logical relationships. Logic 0 indicates that the output stress is minimal when the sensor values are low. Logic 1 indicates that the stress level is high when all of the inputs are high [14]. It is possible that not all sensor values, no matter how low they are, will be indicative of stress.Using a truth table, the sensor values of the system can be logically analysed (see Figure2). There is less output stress when the sensor values are low. It is easy to get stressed out when everything is going well [15]. In situations where both of the inputs are high, stress levels will be high as well. For in-between values, a Sum of Product (SOP) analysis is performed:
(1)SL=TSR.ASR+HSR+ASR.HSR,where TSR is the temperature sensor reading, ASR is the accelerometer sensor reading, and HSR is the humidity sensor reading. A pictorial representation, representing the detailed explanation of the fuzzy operation, is represented through Figure 3.Figure 3
Graph between short- and long-term standard deviation vs. number of features.


## 4. Implementation

### 4.1. Data Extraction

We built and validated our model using the MIMIC database in this study. The MIMIC database is made up of ICU patient recordings with multiple parameters. A total of 72 complete records were downloaded from the Physio Bank database, varying in length and sampling rate from 500 Hz. For the sake of thoroughness, we will only be looking at the first 20 records of each album [16]. Subjects for this study were chosen based on two main selection criteria. To begin, we only included patients whose records included data from both their PPG and arterial blood pressure (ABP) sensors. Second, only subjects with missing PPG data totalling more than 10% of the total length of the data were included in the analysis. Additionally, the value 0 was used to replace any missing PPG signal values.The first, middle, and end of each record’s three hours of data were chosen at random. The final dataset combines PPG and ABP signals. The ground truth is derived from ABP data. The next part discusses data preprocessing in depth.


#### 4.1.1. Feature Extraction

Lee et al. previously proposed amplitude class features. Amp1 was inspired by the findings of Baker’s theoretical analysis showing that MAA estimates are dependent on arterial mechanical properties, BP pulse shape, and BP pressure using duration as a basis, and a second set of features was created. Researchers Dur1 and Dur2 were inspired by their previous work, which showed that new relationships between mean cuff pressure and pseudo-envelopes linking the duration of the MA’s position to OMWE improved SBP and DBP estimates. Area measurements were used to derive the third category of features.


#### 4.1.2. Feature Selection

It is the feature extraction phase’s extracted feature that gets sent to the feature selection unit. To map features from one dimension to another, they must first be scalar converted. This helps find features with lots of interdependencies. Multicollinearity features are turned into features with a comparable look in a lower dimension, making it easy to locate and eliminate duplicates. One set of features is used for training and the other for testing after being scalar transformed (30 percent). The data is used to create the training programme, including the training feature set and the training objective data.


## 4.1. Data Extraction

We built and validated our model using the MIMIC database in this study. The MIMIC database is made up of ICU patient recordings with multiple parameters. A total of 72 complete records were downloaded from the Physio Bank database, varying in length and sampling rate from 500 Hz. For the sake of thoroughness, we will only be looking at the first 20 records of each album [16]. Subjects for this study were chosen based on two main selection criteria. To begin, we only included patients whose records included data from both their PPG and arterial blood pressure (ABP) sensors. Second, only subjects with missing PPG data totalling more than 10% of the total length of the data were included in the analysis. Additionally, the value 0 was used to replace any missing PPG signal values.The first, middle, and end of each record’s three hours of data were chosen at random. The final dataset combines PPG and ABP signals. The ground truth is derived from ABP data. The next part discusses data preprocessing in depth.


### 4.1.1. Feature Extraction

Lee et al. previously proposed amplitude class features. Amp1 was inspired by the findings of Baker’s theoretical analysis showing that MAA estimates are dependent on arterial mechanical properties, BP pulse shape, and BP pressure using duration as a basis, and a second set of features was created. Researchers Dur1 and Dur2 were inspired by their previous work, which showed that new relationships between mean cuff pressure and pseudo-envelopes linking the duration of the MA’s position to OMWE improved SBP and DBP estimates. Area measurements were used to derive the third category of features.


### 4.1.2. Feature Selection

It is the feature extraction phase’s extracted feature that gets sent to the feature selection unit. To map features from one dimension to another, they must first be scalar converted. This helps find features with lots of interdependencies. Multicollinearity features are turned into features with a comparable look in a lower dimension, making it easy to locate and eliminate duplicates. One set of features is used for training and the other for testing after being scalar transformed (30 percent). The data is used to create the training programme, including the training feature set and the training objective data.


## 4.1.1. Feature Extraction

Lee et al. previously proposed amplitude class features. Amp1 was inspired by the findings of Baker’s theoretical analysis showing that MAA estimates are dependent on arterial mechanical properties, BP pulse shape, and BP pressure using duration as a basis, and a second set of features was created. Researchers Dur1 and Dur2 were inspired by their previous work, which showed that new relationships between mean cuff pressure and pseudo-envelopes linking the duration of the MA’s position to OMWE improved SBP and DBP estimates. Area measurements were used to derive the third category of features.


## 4.1.2. Feature Selection

It is the feature extraction phase’s extracted feature that gets sent to the feature selection unit. To map features from one dimension to another, they must first be scalar converted. This helps find features with lots of interdependencies. Multicollinearity features are turned into features with a comparable look in a lower dimension, making it easy to locate and eliminate duplicates. One set of features is used for training and the other for testing after being scalar transformed (30 percent). The data is used to create the training programme, including the training feature set and the training objective data.


## 5. Results

### 5.1. Results Based on Feature Analysis

This section evaluated the performance of machine learning algorithms trained on the training set to estimate continuous blood pressure. Machine learning algorithms are trained and tested on historical data. The predictive model’s performance will be evaluated using two metrics: MAE and SD. The result is analysed in two stages:(i)
Feature Analysis. The mean absolute error and standard deviation of the top 80 features’ predictions will be examined in this study. Short-term and long-term data will be used for this analysis.(ii)
Model Performance Evaluation by Selected Feature. We will estimate the predictive model’s performance based on the chosen feature combination in this study.The Adobos Regress is used to train and test the short- and long-term data. Figures4 and 5 show the mean absolute error for diastolic prediction for the 80 feature combination. The standard deviation variation is calculated using the 80 feature combination. Figures 5 and 4 reveal the following.
(i)
On the other hand, long-term MAE and SD for diastolic prediction are not affected by feature count(ii)
The MAE and SD for systolic prediction increase with feature count. After a steep initial fall, the MAE and SD for diastolic prediction stay stable with feature count(iii)
The MAE and SD function best with 10 or more factors in diastolic predictionFigure 4
Graph between the diastolic short-term blood pressure.Figure 5
Graph between the diastolic long-term blood pressure.Based on the above, we need at least ten features to optimise systolic and diastolic prediction. A selection technique was utilised to prioritise the most critical features, which were then evaluated for systolic and diastolic prediction. The PPG signal’s spectral characteristic was ranked 8th out of 20 features. Consider the peak amplitude’s maximum and minimum, skewness and kurtosis, frequencies’ arithmetic mean, and root mean square. 12 characteristics were obtained from PPG signal and statistical measurements. Standard deviation, variance, maximum, and lowest were all present. The Fourier transform or its derivatives produced no significant selection statistics.The maximum and minimum PPGs, as well as their first and second derivatives, were the highest and minimum frequencies of the 8 distinctive traits. Our feature set consists of ten features obtained from the PPG signal. This provides us a ten-feature set.


### 5.2. Model Performance Evaluation by Selected Feature

In this section, we will look at the four regression models we created using the ten features we selected. We use metrics like mean absolute error, Tables1 and 2 variance, and percentage error less than or equal to 5 mmHg to evaluate the work.Table 1
Performance analysis of systolic term blood pressure prediction.
DT repressorMLP repressorAdaBoost (DT)AdaBoost (MLP)Short termLong termShort termLong termShort termLong termShort termLong termMAE2.342.5611.2916.201.692.0722.0519.59SD5.426.0012.3515.514.525.9714.8515.66%MAE87863623939113.817Table 2
Performance analysis of diastolic blood pressure prediction.
DT repressorMLP repressorAdaBoost (MLP)AdaBoost (DT)Short termLong termShort termLong termLong termLong termShort termLong termMAE1.691.555.236.611.0112.771.321.15SD6.746.419.128.5113.8916.386.404.05%MAE9493675445399796


## 5.1. Results Based on Feature Analysis

This section evaluated the performance of machine learning algorithms trained on the training set to estimate continuous blood pressure. Machine learning algorithms are trained and tested on historical data. The predictive model’s performance will be evaluated using two metrics: MAE and SD. The result is analysed in two stages:(i)
Feature Analysis. The mean absolute error and standard deviation of the top 80 features’ predictions will be examined in this study. Short-term and long-term data will be used for this analysis.(ii)
Model Performance Evaluation by Selected Feature. We will estimate the predictive model’s performance based on the chosen feature combination in this study.The Adobos Regress is used to train and test the short- and long-term data. Figures4 and 5 show the mean absolute error for diastolic prediction for the 80 feature combination. The standard deviation variation is calculated using the 80 feature combination. Figures 5 and 4 reveal the following.
(i)
On the other hand, long-term MAE and SD for diastolic prediction are not affected by feature count(ii)
The MAE and SD for systolic prediction increase with feature count. After a steep initial fall, the MAE and SD for diastolic prediction stay stable with feature count(iii)
The MAE and SD function best with 10 or more factors in diastolic predictionFigure 4
Graph between the diastolic short-term blood pressure.Figure 5
Graph between the diastolic long-term blood pressure.Based on the above, we need at least ten features to optimise systolic and diastolic prediction. A selection technique was utilised to prioritise the most critical features, which were then evaluated for systolic and diastolic prediction. The PPG signal’s spectral characteristic was ranked 8th out of 20 features. Consider the peak amplitude’s maximum and minimum, skewness and kurtosis, frequencies’ arithmetic mean, and root mean square. 12 characteristics were obtained from PPG signal and statistical measurements. Standard deviation, variance, maximum, and lowest were all present. The Fourier transform or its derivatives produced no significant selection statistics.The maximum and minimum PPGs, as well as their first and second derivatives, were the highest and minimum frequencies of the 8 distinctive traits. Our feature set consists of ten features obtained from the PPG signal. This provides us a ten-feature set.


## 5.2. Model Performance Evaluation by Selected Feature

In this section, we will look at the four regression models we created using the ten features we selected. We use metrics like mean absolute error, Tables1 and 2 variance, and percentage error less than or equal to 5 mmHg to evaluate the work.Table 1
Performance analysis of systolic term blood pressure prediction.
DT repressorMLP repressorAdaBoost (DT)AdaBoost (MLP)Short termLong termShort termLong termShort termLong termShort termLong termMAE2.342.5611.2916.201.692.0722.0519.59SD5.426.0012.3515.514.525.9714.8515.66%MAE87863623939113.817Table 2
Performance analysis of diastolic blood pressure prediction.
DT repressorMLP repressorAdaBoost (MLP)AdaBoost (DT)Short termLong termShort termLong termLong termLong termShort termLong termMAE1.691.555.236.611.0112.771.321.15SD6.746.419.128.5113.8916.386.404.05%MAE9493675445399796


## 6. Conclusion

The major goal of this work is to automatically detect motion distortions in BP and PPG signals. The algorithms were tested on a publicly available ICU database, healthy patients, elderly patients, and arrhythmia patients. That is, the Adobos Regress or with decision tree as a foundation outperformed all others in estimating blood pressure values. Based on this research, the suggested model’s single signal (PPG) and single probe approach are highly accurate in measuring SBP and DBP. Wearable devices benefit from PPG signal monitoring with a single sensor and probe. This method allows for discreet blood pressure monitoring, which is useful for long-term in-home care. The current study only provided a healthy people BP estimation technique. However, the algorithm’s efficacy across patient populations is unknown. Moreover, studies show that estimating BP in obese patients is inaccurate. The PPG algorithm was only tested on five older arrhythmia patients (N=5). Atrial fibrillation and ventricular arrhythmia (including fibrillation and T-waves) patients have yet to be studied.



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*Source: 5078799-2021-12-08.xml*