Survey on Smart Health Management using BLE and BLE Beacons

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978-1-7281-4177-0/19/$31.00 ©2019 IEEE
Survey on Smart Health Management using BLE
and BLE Beacons
Deepthi Rajamohanan
Amrita Centre for Wireless Networks &
Applications (AmritaWNA)
Amrita School of Engineering
Amritapuri,
Amrita Vishwa Vidyapeetham
India
deepthir@am.amrita.edu
Balaji Hariharan
Amrita Centre for Wireless Networks &
Applications (AmritaWNA)
Amrita School of Engineering
Amritapuri,
Amrita Vishwa Vidyapeetham
India
balajih@am.amrita.edu
K A Unnikrishna Menon
Amrita Centre for Wireless Networks &
Applications (AmritaWNA)
Amrita School of Engineering
Amritapuri,
Amrita Vishwa Vidyapeetham
India
kaumenon@am.amrita.edu
Abstract— Advances in Bluetooth technology focusing low
energy has brought into action the Bluetooth Smart for
wearable devices. Enhancement in Internet of Things due to
wearable devices has led to the concept of Ambient Assisted
Living (AAL). AAL is mainly devised to assist age old people to
carry on daily activities including healthcare without
dependencies. A survey to show the contribution of Bluetooth
Low Energy (BLE) technology in wearable devices is the main
focus of this paper. This paper also aims to give a good
overview of BLE and BLE Beacons as one of the successful
technologies focusing wearable healthcare applications and its
pros and cons compared to other existing wireless technologies.
Different applications of BLE included can be adapted to our
healthcare perspective for smart health management.
Keywords— BLE; BLE Beacons; Ambient Assisted Living;
Healthcare;
I. I
NTRODUCTION
Among many factors considered for evaluating progress
of a country, health conditions of its people is probably the
most important metric. Health of population is decided by
ten health indicators [1] and access to health services is one
among them. With the rural population contributing the
major chunk of the Indian population about 66.46% in 2017
(according to the World Bank collection of development
indicators) [2], monitoring their health and solving health
issues is of major concern. Currently, the available
healthcare facilities are clustered around cities, making its
reach to outskirts difficult and the unwillingness of
physicians to serve in the remote regions makes the situation
worse [3]. In such circumstances, came the idea of remote
patient monitoring system [4]. As a result, a system
integrating smartphones to healthcare devices emerged,
called Smartphone-based “Telemedicine”. It is categorized
into two: 1) online real time-based monitoring, 2) off-line
analysis based on critical parameters acquired from patient
[5].
Our daily life influenced by many miscellaneous
activities varies with person to person. In such scenario
monitoring health conditions continuously without restricting
their mundane activities and physical movement is essential.
Cost is another factor influencing rural areas to be deprived
of medical availabilities [6]. Thus, all these limitations gave
way to a new revolution in medical and engineering field
which came to be known as wearable devices. Evolution of
BLE made this dream come true[7].
These days almost all smartphones are equipped with
BLE. Increase in usage of smart phones in urban as well as
rural areas is a fact utilized for distance health analysis.
Smartphones can be used for different applications such as
messaging, voice calls, online tracking etc. [8]. So, we can
enhance our application blending all these facilities of
mobile and wearable healthcare gadgets to produce a smart
care health system [9].
This paper presents a survey of prior work in BLE and
BLE Beacons innovations in the wearable healthcare devices
domain. The recent trends in Ambient Assisted Living have
been utilized to propose an efficient system in health
perspective. Some other applications based on Smart
Bluetooth have also been reviewed to help researchers
integrate them for overall health management. There has
been constant effort to improve the performance parameters
like charging of battery [10] [11], received signal strength
(RSSI) etc.[12]-[14] of BLE. Current status of these
improvements along with comparisons with other wireless
technologies are also discussed in this paper.
This paper is divided into four sections. Section II talks
about application of BLE and BLE Beacons in medical field
presented in wearable form. Section III gives us the research
stand as of now in improving technical parameters of BLE
and also comparison of BLE with other wireless protocols.
II.
M
EDICAL
A
PPLICATIONS OF
BLE
AND
BLE
BEACONS
A. Background
In this section some of the common imbalances
associated with physical health conditions of common men
are discussed. Chronic conditions such as diabetes, cardiac
arrest, asthma, and problems related to old age are counted
among them. Life’s complicated schedules have made people
to ignore early symptoms associated with such slow
developing health ailments. So, to manage them easily many
accomplishments using BLE has evolved which is being
discussed here.
B. Diabetes self-management
Self-management of diabetic patients by checking blood
glucose (BG) levels and taking appropriate actions to keep
diabetes in control can improve quality of their lives. A
wearable system for measuring BG levels, heart rate, weight
and BP has been developed in [15] for real time observation
by integrating BLE with smartphones, which is first of its
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2019 Ninth International Symposium on Embedded Computing and System Design (ISED)
kind. BLE module’s light weight enabled it to be integrated
into wearable form. It also helps predict future risk of
getting diabetes. They have used multilayer perceptron
neural network as machine learning algorithm for future
predictions. [15]
Another study proposes photoplethysmogram (PPG)
technology for non-invasive measurement of BG, which is
easier than traditional way of pricking finger to get BG data.
Such a system could be of greater advantage when combined
with the work mentioned in[4].
C. Health monitoring in cardiac patients
Managing the existing vast healthcare system can be
simplified with e-health development which is already in
progress[16]
.
For initial diagnosis of cardiology a monitoring
system is mentioned in [5]. It uses multiple sensors to
measure various parameters such as heart rate, Blood
Pressure (BP) and body temperature, which is transmitted
through BLE to app. These three attributes are compared and
any deviation from normal functioning of heart is reported to
concerned doctor. The threshold can be set according to the
person who uses it. Even an alarm system is used which
cautions doctors in super speciality hospital at time of
emergency for immediate medical support by enabling GPS
for location tracking.[5]
Compared to the system in [5], analysis of ECG helps
early detection of heart diseases which when done remotely
can be of great advantage to reduce increasing death rates in
rural community[17]. A 5-lead ECG monitoring has been
developed by A. Vishwanatham, et.al, which transmits the
ECG via BLE to smartphone and is viewed in web page to be
monitored by doctor and patients in the preferred hospital .
As a next level contribution to this change, paper [16] gives
us a 3 lead wireless ECG monitoring system which is
capable of detecting uncommonness in heart in varied
sections of PQRST ECG waveform. 20 patients’ heart
conditions were successfully tested by comparing with
existing devices according to
P. L. Penmatsa and D. V. R. K.
Reddy [16].
In another similar work stated in [11], three textile
electrodes focusing on wearing comfort were introduced.
They have used FTPE (flexible polypyrrole textile
electrodes) as non-invasive electrodes. It is reusable, non-
irritable to skin, consumes very less power i.e., it can record
up to 30h continuously and conductivity is high compared to
other similar ECG wearable devices. Measurement of
electrical as well as mechanical capability of heart using
ECG and ICG sensors integrated in the wearable device is
mentioned in the literature [11]. Impedance cardiogram
(ICG) is important to be measured for cardiovascular
diseases along with ECG for better analysis. They have
made electrodes from gel type Ag/AgCl patch for knowing
ECG, ICG, heart rate, temperature and location of patient
[3]. Compared to battery life presented in [11] this system
runs for 24 hours on continuous monitoring which is less.
D. BLE in Daily physical activity
Obesity has become a major problem due to lifestyle
changes. People try to reduce their weight by following
many rigorous exercises without proper guidance from
experts. Thus, death due to cardiac arrests during extreme
physical exercise is observed to increase [18]. A wearable
ECG monitoring system can reduce this occurrence. An H-
health shirt fabricated with ECG electrodes used for accurate
ECG monitoring was fabricated in [19]. It can be used to
observe the heart rate of user running up to speed of
15km/hr. A high accuracy ECG algorithm capable of
detecting six types of unusual ECG signals is used. It is light
in weight and comfortable to wear during exercises. [19]
Thus wearing this shirt, physical conditions of normal as
well as abnormal people can be diagnosed while doing
physical exercise to detect exhaustion or sudden trauma
while doing exercises.
E. Intelligent Stethoscope
A wireless stethoscope referred in [20] speaks about
transferring heart sounds and ECG measurement through
BLE to be visualized in a mobile using APP. It uses single
lead for ECG measurement. As primary health check-up, it
can be utilized at homes. Another advantage is for doctors.
Doctors can distinguish heart sounds using traditional
stethoscope only through experience. So, for young doctors
this intelligent stethoscope can be a game changer to their
profession as it can help them detect irregularities more
accurately and enhance their auscultation skills.[20]
F. Emotional level diagnosis
A device having sensors such as EMG, PPG and 9 degree
of freedom (DOF) is integrated and made into wearable form
with BLE. Data generated is sent to smart phone to detect
emotional level of drivers. A trained support vector machine
(SVM) algorithm is used to determine current emotional
level of driver. It can be known if he is stressed, relaxed or
drowsy from the extracted data of sensors. The developers of
the module claim 99% accurate prediction. This device can
be worn at back of head with a cap comfortably[21]. Stress
related issues leading to depression have become common in
all age groups. Suicidal tendencies among students have
been increasing which can be detected earlier with this cap
type wearable emotional detector device[22].
BLE emitters are quite popular in various
applications due to its brevity, affordability, mountability,
stability, deployability, etc. Another attraction is beacon’s
low installation time and long battery life for ambient
intelligence at home and offices compared to other battery-
based technologies. Adaptive easiness and non-intrusiveness
make it more comfortable to ambient assisted living[13]. So,
BLE based devices to analyse diabetes, cardiac diseases and
other parameters can be integrated with BLE beacons.
G. For old age home management
A system for daily report collection is utilized in[23]
using BLE Beacons. Beacons are attached to the users which
are detected by scanners attached at various locations of their
building. The scanners help detect the area in which a
particular resident is staying without intruding the privacy of
the person. All the data collected by scanner is sent to main
server where report of activity by each individual is
automatically generated reducing the work of caretaker.
Beacon attached with accelerometer can support fall
detection can be done as future work in this case[23].
Reference [8] which is similar to above system has expanded
its ability for fall detection. Another application of BLE
beacons is indoor localization which can be used to track
Alzheimer’s or mentally imbalanced patients’ locomotion
[24]. Alerts can be issued if they go to some risky areas
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2019 Ninth International Symposium on Embedded Computing and System Design (ISED)
within surveillance saving them from injuries and even
death.
The combination of above systems makes overall
remote health management a reality.
III. T
ECHNICAL ENHANCEMENT RELATED TO
BLE
AND ITS
C
OMPARISONS
A. Technical Testing and Improvements in BLE
parameters
Energy harvesting technique in wireless implantable
device: BLE as from its name itself consumes low energy
compared to many other wireless protocols. Subcutaneous
solar energy collector along with BLE in implantable
electronics makes the referenced system energy efficient.
The given BLE in implantable electronics wakes for 5 sec in
which it works in low power and sleeps for 595 sec, thus
charging of 1 or 2 hours using subcutaneous solar energy
harvester keeps it on for a whole day. Currently this module
has a temperature sensor only. Extension of this work for
other body parameter measurement with more efficient solar
harvester can help solve energy issues in implantable as well
as non-invasive wearable devices[25].
Wireless Charging Using BLE: The work described here
in [18] uses Qi standard for wireless charging with the
principle of electromagnetic induction via BLE. This can be
explored to be implemented in various systems especially in
healthcare applications where battery replacements or
manual charging can be of great inconvenience for patients.
Emergency Situation Handling: Most of the wearable
devices designed have its gateway through smartphones to
web. If the smartphone is dead, there no communication
between our device and internet since BLE does not support
direct internet connectivity. This can be devastating at the
time of emergency. An adaptive network using 6LoWPAN
has been constructed to overcome this limitation in[26]. It
acts as a conversion gateway between BLE and Internet [27].
A system developed by W. Yoon, K. Kwon, M. Ha, and D.
Kim uses IPv6 technology applied through BLE and an
emergency protocol in advertising mode is enabled. It also
uses Raspberry Pi and a dongle for rest of the
communication[26].
Interference from other wireless modules: The robustness
of BLE from external signal interference is being tested in
this work. They did by introducing other BLE modules as
well as introducing Wi-Fi/ ZigBee signals creating a dense
environment [28].
RSSI Determination: Use of BLE in indoor positioning
applications is demanding especially in industrial as well as
healthcare fields. Determination of Received Signal Strength
Indicator (RSSI) is important to predict proper functioning of
BLE beacons which is stated to be complex. So, the
performance of RSSI of BLE in different environments
(Ideal and real) were tested by ray tracing methodology in
[12] and proved that these values are not precise since they
are heavily depended on the properties of the used BLE
beacon. Another work in [13] has presented an improved
version of RSSI (Received signal strength Indication) to get
desired location more precisely. They have obtained how
sampling rate and distance are correlated to determine RSSI
and also between variance and distance. The algorithm
developed for same is highly generalizable and accuracy for
proximity-based localization has improved to 9.14% of
existing similar systems.
In a similar work, an empirical solution was developed
with more than 3 million data samples which came to
conclusion that relation definitely exists between RSSI and
distance but per meter variation is very low. They also found
how surface material can have influence in signal strength
[14]. This fact can be inculcated for further research.
B. Comparison between other wireless connectivity
In this section, currently used and developed technologies
are compared to BLE to show pros and cons between them
and also how BLE system is superior to our current proposed
system.
A comparative study of BLE and Wi-Fi done shows BLE
consumes much less power compared to Wi-Fi. Signal
strength compared with BLE is much better in case of Wi-Fi
but by increasing number of Beacons in case of BLE it can
be improved. Installation cost per beacon is much lesser to
Wi-Fi [29].
Another study showed a hybrid model of BLE and Li-Fi,
where many features of Li-Fi offers potential solutions for
healthcare systems compared to BLE. But any obstacle
present in pathway will totally make our Li-Fi solution
meaningless. For time being a system only with Li-Fi is a
distant dream[30].
ANT which was mainly developed for health and sports
application is yet another promising solution to BLE [31]. It
is compatible with any topologies unlike BLE which can
only be used in star topology. But ANT+ has many
compatibility issues reported with smartphones when used in
applications. Above all that BLE holds good market value to
ANT+ hence services and familiarity for usage is more in
BLE [31].
An experimental comparison between UWB and BLE
has been conducted. As an indoor localization module BLE
shows superior properties to UWB with respect to tracking
mechanism, calibration process, antenna design, and
localization algorithm. However, accuracy is more in case of
UWB compared to BLE. Cost terms show BLE installation
cheaper to UWB. In terms of interferences both are affected
by obstacles. Operation range for UWB- 3.5 to 6.5Ghz and
BLE is 2.4GHz. [32]
Below Table.1 shows general parameter comparison of
wireless protocols BLE, Wi- Fi, Li-Fi and UWB taken from
[29]- [32].
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2019 Ninth International Symposium on Embedded Computing and System Design (ISED)
TABLE I. COMPARISON TABLE OF WIRELESS PROTOCOLS
CONCLUSION
The above study based on BLE and BLE Beacons and
ways to improve the technical hurdles can be used by
researches in various ways to create an efficient healthcare
system. The wearable device can be chosen according to the
requirement of subjected people at home. The wireless
charging methodology proposed by Qi using BLE, can
relieve one from checking the charge statuses of the device
in use. Thus, a system can be designed in which overall
management of health is possible from home for ages of all
people. From the above discussion and comparison with
existing wireless technologies we can see that BLE is the
most suitable protocol for smart health management, at
present.
A
CKNOWLEDGMENT
We are immensely grateful to our beloved Chancellor Shri.
Dr. Mata Amritanandamayi Devi for her inspiration and
Motivation.
R
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BLE Wi-Fi Li-Fi
UWB
Frequency/Wav
elength of
operation
2.4GHz –
2.48GHz
2.4GHz and
5GHz
380nm –
780nm
3.5GHz-
6.5GHz
Installation cost Very low High
compared to
BLE
Low High
Power
Consumption
Very less High Low High
Accuracy
Low
High
Depends on
light
intensity
and area of
exposure
High
Energy
Efficiency
1 year Continuously
charged
Comparativ
ely low
Few hours /
days
Smart Phone
Compatibility
Yes
Yes
Yes
Not with all
smartphone
s
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