IEEE Solid-State Circuits Magazine - Fall 2017 - 35

by wires and cables may not appear
to be a problem, in practice, this
"cable clutter" causes a number of
problems. Inadequate cleaning of
cables can lead to cross-infection, the
large number of cables can make it
difficult to access the patient to pro-
vide care, and cables can become eas-
ily disconnected, leading to loss of
signal or false readings.
Wired monitoring is not appro-
priate for the majority of patients on
general wards who are encouraged
to be mobile as part of their rehabili-
tation. These patients are monitored
by nursing staff performing regular
observation rounds at a frequency
dictated by hospital procedure and
patient status, typically once every
4-8 h. Between these observation
rounds, some patients are at risk of
deterioration and can suffer unan-
ticipated adverse events. Recent re-
ports have highlighted that many
patients do deteriorate between
manual observation rounds, result-
ing in significant illness and even
death, which might have been averted
had the deterioration been identified
earlier [1], [2]. However, there is a limit
to the frequency with which vital
signs can practicably and affordably
be measured by the nursing staff.
Electronic vital-sign measurement
could provide a solution, provided
that such devices did not impact
negatively on nursing workflow or
patient mobility.
One area where wireless patient
monitoring has become part of rou-
tine clinical practice is on telemetry
wards. In these areas, patients are typ-
ically being treated for cardio-respira-
tory disorders, and so a continuous
measurement of patients' heart rates
and echocardiograms (ECGs) allows
clinicians to closely track their recov-
ery. Telemetry systems require a rela-
tively bulky transmitter to be worn
by the patient (typically in a pouch
worn on the shoulder or around the
neck) that transmits their physiologi-
cal data to dedicated base stations
within the telemetry ward and then
onto dedicated screens monitored by
specialist clinical staff.

These systems must be of a fairly
high power to achieve a good communi-
cation range from the base station and
also due to the relatively high volume of
data being streamed. Existing systems
are typically implemented either using
custom radio-frequency (RF) protocols
operating in dedicated hospital telem-
etry frequency bands (wireless medi-
cal telemetry system frequencies) or
are based on modifications of existing
communication protocols such as Digi-
tal Enhanced Cordless Telecommuni-
cations. While telemetry monitoring is
well established, it is not suitable for
either of the patient groups discussed
previously. For ICU patients, the wire-
less telemetry link performance does
not meet the necessary reliability and
latency requirements needed by this
application. For general care applica-
tions, telemetry is too bulky, costly,
and, if used on all general care patients,
would provide an overload of real-time
data that the nursing staff would not
have the capability to process.

Wireless Medical Monitoring
Wireless connectivity potentially
offers a solution for monitoring ICU
and general care patients. For ICU
patients, replacing many of the cables
with wireless connectivity would
greatly improve workflow and usabil-
ity for nursing staff, while also reduc-
ing infection risk. For general care
patients, the wireless measurement
and transmission of vital signs could
provide notification of physiological
deterioration many hours before
the next set of manual observations
would have been due, allowing for
timely intervention. However, the per-
formance requirements of the wire-
less link in these two applications are
quite different.
For monitoring general care pa-
tients, a very "lightweight" telemetry
solution would be appropriate that
simply transmits a new set of vitals
readings at a measurement rate much
higher i.e., every few minutes, than the
current 4-h observations. The patient-
worn device should be small and un-
obtrusive, ideally disposable to avoid
cross-infection issues, with a battery

life suitable to last the duration of an
average in-patient stay (about three to
seven days).
For ICU patients, the volume of
data is higher since typically a 12-15
lead ECG is measured in real time,
but the key issue here is the latency
from skin to screen, which needs to be
lower than 250 ms. In an ICU situation,
the patient is immobile and so the
wireless connection can be a simple
point-to-point link from the patient to
bedside monitor. Table 1 summarizes
the requirements of the wireless com-
munication link for these two patient
monitoring scenarios.

Performance Requirements
for Wireless Medical Devices
To correctly define and design a wire-
less system for hospital patient moni-
toring, it is important to understand
the regulatory requirements when
deploying wireless technology in
medical devices. In 2013, the U.S. Food
and Drug Administration (FDA) pub-
lished a guidance document, "Radio
Frequency Wireless Technology in
Medical Devices" [3]. This document
does not specify which technologies
should be used and does not pre-
scribe specific ways of operating but
instead discusses key considerations
that must be addressed and assessed
for risk when incorporating wireless
technology in medical devices. It spe-
cifically highlights

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Table of Contents for the Digital Edition of IEEE Solid-State Circuits Magazine - Fall 2017

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