**REMOTE PATIENT MONITORING SYSTEM FOR COVID-19 PATIENT USING WI-FI BASED PULSE OXIMETER READING SENSOR**
\*\*This is a Double-blind review, please do not include authors information in this version \*\*
Received Date: 28 July 2022
Accepted Date:
Published Date:
**HIGHLIGHTS**
- COVID-19 is coronavirus disease caused by the SARS-CoV-2 virus.
- Monitoring system is a method that can be used to persistently updated on the Heart rate and Oxygen level status.
- Pulse Oximeter sensor is noninvasively measures the oxygen saturation of a blood and heart rate patient.
- Web server is software and hardware that uses HTTP and other protocols to respond to client request made over the World Wide Web.
ABSTRACT
*Continuous Heart disease and high blood pressure is a problem that must be addressed immediately. Heart disease is one of the world's most serious disease today at hospital, as it will lead the patient to died. Continuous measurement, analysis, and Pulse Oximeter Reading monitoring in real-time are necessary to ensure that appropriate measures can be taken when necessary. To achieve this, this proposed model leverages the concept of IoT to inform users about the concentration of heart disease and high blood pressure to all people about their healthy every day. The Remote Patient Monitoring System for Covid-19 Patients Based On Oximeter Reading Sensor uses the Web Server ESP 32 MAX30100 to replace current Oximeter Reading monitoring and public broadcasting methods using the Wireless Sensor Networks (WSN) concept. The proposed Oximeter Reading monitoring system can monitor indoor and outdoor heart rate and Oxygen level. The MAX30100 Pulse Oximeter sensor is used to determine the concentrations of various heart rate and oxygen level using the industry-standard Heart Rate and Oxygen Level Index, which is available from the manufacturer. Furthermore, the devices can store data in a cloud-based system when connected to the internet, enabled by the NodeMCU ESP32 Wi-Fi and Bluetooth module. As a result, by combining the MAX30100 Pulse Oximeter sensor and Arduino with the Internet of Things (IoT), it is possible to develop real-time and effective Heart Rate and Oxygen Level monitoring. Subsequently, the results indicate that users of this system and the Arduino IDE software can access and monitor Heart rate and oxygen level using the Web Server ESP32 MAX30100 regardless of their location relative to the monitoring area. Correspondingly, include an LCD for viewing the readings and ensuring that the owner receives information about the Pulse Oximeter Reading monitoring while the system is operating.*
*Keywords: Covid-19, Internet Of Things (IoT), Monitoring system, NodeMCU, Pulse Oximeter Reading sensor.*
# INTRODUCTION
> Healthcare IT systems may communicate with medical equipment and software through the Internet of Medical Things (IoMT), a collection of internet networks (S. Marathe, 2019). Using digital technology, remote patient monitoring, also known as remote physiologic monitoring, transmits patient medical and health data electronically to healthcare practitioners for evaluation and, if required, suggestions and instructions known to as remotely physiologic monitoring (Lakmini.P, 2019). Red blood cell percentage and oxygen saturation may be measured using an oximeter, which provides a reading known as a "Oximeter Reading" (Kadhim Takleef, 2020). Pulse Oximeters are becoming significant in the medical field. Many people are suffering from heart problems, high cholesterol and low blood sugar during this year's covid-19 (Lesley Ryan MD, 2020).
>
> COVID-19 sufferers might experience "Happy hypoxia" in which their oxygen levels are very low yet they otherwise look healthy. Because these individuals may be more seriously unwell than they realise, they require additional treatment in a medical context, which is quite worrisome (Katie McCallum, 2020). There are also instances of heart illness, high blood pressure, and low blood pressure that are really severe throughout this Covid-19 (Lesley Ryan MD,2020). An reliable measurement from the oximeter can only be obtained by using one finger to measure heart rates (Anita Chaware,2021). Next Many parts of the data life cycle for the Remote Monitoring System might be outsourced to other parties, which increases the danger of patients having their personal information hijacked (JT IoT Group, 2019). Hospitals have similar difficulties, since they run the danger of implementing a following system that is vulnerable to attack, compromising the safety and privacy of their patients. Because of this, that must be secured enough to fulfil healthcare requirements. Strong data management techniques, clear ownership boundaries as well as iron-clad security standards are required (Absalom E. Ezugwu, 2020). Secondly, pulse oximeters have limits and the potential for inaccuracies in specific situations. Although the degree of error may be minor and not clinically significant in many circumstances, it is possible that an erroneous measurement can lead to low blood oxygen levels that are not noticed. Pulse oximetry has a number of limitations, and it is vital to know how accuracy is computed and interpreted (N Engl J Med, 2020).
>
> Previous work related to Pulse rate monitoring system using pulse rate sensor, piezo electric sensor and NodeMCU was published by (Anita Chaware, 2021). A pulse rate monitoring system using the Internet of Things is at the core of the system being suggested. In addition to hospitals, this concept may also be utilised in residential areas to monitor patients. Data may be measured with or without a network, through the internet, for example. Heart rate is measured and recorded using simply a human finger in this development's findings. Using a piezoelectric sensor, a person's resonance frequency may be measured.
>
> Another previous research was proposed by (J.David, 2021) that suggest the use of NodeMCU in an IoT-based patient monitoring system. There is a link between the patient monitoring program and the Internet of Things (IoT). Connected devices and the Internet's infrastructure are just the beginning of the Iot technology (IoT). This model uses a pulse sensor to calculate the heart rate using the NodeMCU. A similar microcontroller, NodeMCU, may be used to link IOT devices to the internet. This project makes use of Thinkspeak as a cloud service for storing and analysing data in real time from mobile devices. It is the purpose of this project to efficiently gather and transmit data from different sources (clients) to destinations (e.g., a database) (physicians).
# METHODOLOGY
The Pulse Oximeter monitoring system based on Wifi network was adapted in this project. Five phase in this model have been adapted, which were the planning phase followed by information gathering phase, development phase, implementation and gathering phase and lastly, the documentation phase. All this phase will be used as a guide in this research until completion.
**Proposed Architecture**
Figure 1 shows the general purpose of the system. This project was developed for monitoring Pulse rate rate and Oxygen level in real-time status. The oxygen level and pulse rate was measured by using an MAX30100 Pulse Oximeter sensor connected to a microcontroller. The architecture from the prototype, that takes data from sensors were sent to the NodeMCU to be analysed. The NodeMCU with built-in Wi-Fi and Bluetooth was connected to the access point that has been configured to connect to the Internet. The following process was continued and then the message was sent to a WebServer MAX30100 ESP32 Pulse Oimeter, which the result will show at the webserver when ping the private host IP Address. Users then could easily monitor heart rate and oxygen level status using the WebServer on the phone or the laptop just by typing the Ip address that appear at the LCD Display through the devices.
**Figure 1:** Pulse Oximeter monitoring system based on wifi network architecture
Heart rate and oxygen level was measured by the pulse oximeter reading sensor connected to the microcontroller. Figure 2 showed the flowchart for pulse oximeter monitoring. The pulse oximeter sensor combines two LEDs, a photodetector, optimized optics, and low-noise analog signal processing to detect pulse oximetry and heart rate signals. First, user must put finger on the sensor give a signal to processing and data will transmit a heart rate and oxygen level to the receiver. The duration from transmits and receive of heart rate and oxygen level will be used to measuring the network testing. NodeMCU will perform calculations, and if the heart rate and oxygen level exceeds the limit of level, the result will be sent to the user.
**Figure 2**: Flowchart for monitoring pulse oximeter reading
**Circuit Diagram**
Figure 3 showed that the circuit diagram that was used in the project. For the prototype, NodeMCU ESP32 version one was used as a microcontroller and as the component to transmit the data with its built in wi-fi and bluetooth. Breadboard Power Supply Module was used because NodeMCU only supplied 3.3V instead of 5V used by the sensor. The Pulse Oximeter sensor was used in the project to measure the Pulse rate (BPM) and Oxygen level (Spo2). An LCD display was used to display the reading from pulse oximeter sensor and the brightness of LCD was controlled by 12C-module. For the source code, Arduino IDE software was used as a platform to write the code and upload the code to the microcontroller which was NodeMCU ESP-32. The WebServer was created as a platform for the user to receive the information about the status of Pulse Rate and Oxygen level that the user can also access it from smartphone or computer.
**Figure 3:** Circuit diagram for the prototype
**Design Scenario**
Figure 4 showed the design scenario for remote patient monitoring system for covid-19 patient using wifi based pulse oximeter reading sensor. In this scenario, the user as a patient will be use the monitoring pulse oximeter reading sensor from home because of the covid-19 quarantined. The patient will connect the microcontroller nodeMCU with wifi and get the IP address for webserver and see the result for heart rate and oxygen level at the LCD display. The result will be stored in cloud database and the doctor from hospital will be able to monitor the heart rate and oxygen level the patient every day.
**Figure 4:** Design Scenario for monitoring pulse oximeter reading sensor using wifi based
**FINDINGS AND DISCUSSIONS**
The system was evaluated by testing of prototype’s sensitivity. This testing was conducted to see the accuracy output from the prototype through the LCD, and the result was sent to the WebServer ESP32 MAX30100 Pulse Oximeter. The prototype was able to send the pulse rate and oxygen level result when the user put their finger on the sensor. The LCD would display the pulse rate and the oxygen level. Five candidates have participated in order to evaluate this test. Each of them has tested the Pulse Oximeter prototype and compared the reading with the original Pulse Oximeter via 10 times.
Table 1 showed that the Pulse Oximeter monitoring system sensitivity test result. It shows that LCD display and WebServer has succeed to display a real time reading from the Pulse Oximeter sensor. The result also showed the MAX30100 Pulse Oximeter sensor is accurate. The comparison testing also shows that the proposed device reading value of the heart rate (BPM) only give the average of 6 BPM difference when it is compared to the conventional oximeter reader. The SPO2 reading results also have indicate that the proposed device has give only the average of 0.5% difference comparing to the results given from the conventional oximeter reader.
**Table 1:** MAX30100 Pulse Oximeter Sensor Sensitivity Test result
| 1 |
USER 1 |
Thumb Finger |
accurate
|
72 |
79 |
7 |
98% |
98% |
0% |
| 2 |
USER 2 |
Index Finger |
accurate
|
78 |
76 |
2 |
97% |
98% |
1% |
| 3 |
USER 3 |
Middle Finger |
accurate
|
79 |
76 |
3 |
97% |
98% |
1% |
| 4 |
USER 4 |
Ring Finger |
accurate
|
80 |
78 |
8 |
98% |
98% |
0% |
| 5 |
USER 5 |
Little Finger |
accurate
|
83 |
73 |
10 |
98% |
98% |
0% |
Table 2 shows the network testing results for pulse oximeter monitoring system. There are three users to test this prototype, Primary User (PU1), Secondary User one (SU1), and Secondary User two (SU2). All users have used the Pulse Oximeter Reading system separately, starting with PU1, SU1 and finally SU2. This test aims to check the network and duration of time taken from Pulse Oximeter MAX30100 to send pulse rate and oxygen level (Sp02) result from NodeMCU ESP32 to LCD Display 20x4 and Web Server MAX30100 ESP32. Table 5.3 show the activation time, uplink, downlink and end-to-end delay for this test. The results have concluded that it only took the average of 5.6 seconds of end-to-end delay for the system to complete the data transmission activity.
**Table 2:** Pulse Oximeter reading network testing result
| Time Slot | 1 | 2 | 3 | 4 | 5 | Average (s) |
| -------------------- | -------- | -------- | -------- | -------- | -------- | ----------- |
| Primary User (PU1) | | | | | | |
| Activation time | 01:57:05 | 01:57:10 | 01:57:21 | 01:57:32 | 01:57:42 | |
| Uplink time | 01:57:15 | 01:57:20 | 01:57:30 | 01:57:40 | 01:58:51 | |
| Downlink time | 01:57:10 | 01:57:15 | 01:57:27 | 01:57:37 | 01:57:48 | |
| End-to-end delay (s) | 5 | 5 | 6 | 5 | 6 | 5.4 |
| Secondary User (SU1) | | | | | | |
| Activation time | 02:57:11 | 02:57:22 | 02:57:32 | 02:57:43 | 02:57:53 | |
| Uplink time | 02:57:20 | 02:57:30 | 02:57:41 | 02:57:51 | 02:57:02 | |
| Downlink time | 02:57:17 | 02:57:27 | 02:57:38 | 02:57:48 | 02:57:59 | |
| End-to-end delay (s) | 6 | 5 | 6 | 5 | 6 | 5.6 |
| Secondary User (SU2) | | | | | | |
| Activation time | 02:57:27 | 02:57:38 | 02:57:48 | 02:57:59 | 02:57:10 | |
| Uplink time | 02:57:36 | 02:57:47 | 02:57:57 | 02:57:08 | 02:57:18 | |
| Downlink time | 02:57:33 | 02:57:44 | 02:57:54 | 02:57:05 | 02:57:15 | |
| End-to-end delay (s) | 6 | 6 | 6 | 6 | 5 | 5.8 |
Figure 5. summarized respondent feedback regarding the Pulse Oximeter Reading system's overall performance for usability testing. The majority of respondents chose either 'Strongly Agree' is (30.4%) and 'Agree' is (60.9%). This show that the system was beneficial for monitoring Heart Rate and Oxygen level people conditions in the community.
> **Figure 5:** Pie Chart about useful of the system
**CONCLUSION AND RECOMMENDATIONS**
The prototype system had successfully passed all the testing that had been conducted. the project was a success and met all of the project's objectives. The first objective was to develop alternative option to remotely monitor Covid-19 patients in recording their oxygen levels using oximeter reader connected with the Web Server using private hosting and. The prototype developed in this project functioned well as a real-time air Pulse Oximeter system. The LCD Display 20x4 will display the result of Pulse rate and Oxygen level(SpO2) accurately. The second objective was to implement a performance testing regarding a propose system in accuracy testing, network testing and usability testing. Evaluate functional and prototype testing results on Pulse Oximeter monitoring system that measured standard and limit values.. Next, network testing was conducted to ensure the connectivity rate from NodeMCU ESP32 with Web Server PMAX30100 Pulse Oximeter. As a result, the connectivity is working well. Finally, the MAX30100 Pulse Oximeter sensitivity test was conducted to determine the sensor's accuracy for various finger types. We tested various finger, including thumb finger, index finger, middle finger, ring finger and little finger. For the future work, this system can be improved by testing the system in real patient that have problem with heart rate and oxygen level and improvising the proposed system with a much later technology of notification system.
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