Mobile phone-enabled control of medical care and handicapped
Transcription
Mobile phone-enabled control of medical care and handicapped
Review For reprint orders, please contact [email protected] Mobile phone-enabled control of medical care and handicapped assistance Expert Rev. Med. Devices 8(6), 757–768 (2011) Lin Liu1 and Jing Liu†1,2 Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China 2 Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China † Author for correspondence: Tel.: +86 106 279 4896 Fax: +86 108 254 3767 [email protected] 1 Mobile phones are now playing an ever more crucial role in people’s daily lives. They are serving not only as a way of talking and delivering messages, but also for exchanging various information. Nevertheless, the functional limit of the phone is still far from being reached. Among the many promising applications, using mobile phones as an actuating element to control data or devices is useful in quite a few emerging medical care and handicapped assistance settings owing to its wireless communication feature. In this article, selected progresses of mobile phone-enabled controlling have been summarized, with more focus on evaluating its emerging roles in medical care. Several typical applications in the area are illustrated and some potential technical challenges and key issues worthy of pursuit are outlined. The intent of the article is to provide an elementary knowledge for people with different backgrounds, such as electrical or biomedical engineers, as well as people who are working on interdisciplinary areas. It is expected that medical care at any time and anywhere will be possible via the actuation platform provided by the mobile phone and mobile medicine will be pushed forward to a new height in the coming years. Keywords : actuation • control • healthcare • mobile medicine • mobile phone • pervasive medicine • telemedicine Today, mobile phones are widely used in daily life and are playing an increasingly important role in the field of information and communication technology. In addition to its conventional talking function, the current mobile phone can already support many additional services and accessory functions, such as short message service (SMS) for text messaging, multimedia message service for sending and receiving photos and video, email, packet switching for access to the internet, gaming, MP3 player, camera with video recorder, Bluetooth®, infrared, radio and global positioning system (GPS) among others [101] . Now an emerging trend of using mobile phones to control systems is being witnessed. Mobile phones can easily communicate with many different existing machines over cellular networks and most of them have built-in short-range communication capabilities. This allows the phone to communicate well with, and control, appliances within either short- or long-distance regions [1] . When it comes to mobile phone-enabled control, we mean that the mobile phone works as the control element in a system. It is a central unit to control data and commands transmission between different devices or networks. Owing www.expert-reviews.com 10.1586/ERD.11.32 to its unique convenience, the mobile phone has been used to control a series of home and office appliances (e.g., televisions, cameras, refrigerators, lights and photocopiers) and more practical equipment that significantly facilitates users, especially handicapped people’s, daily life. Such controlling mechanisms are usually implemented via wireless application protocol (WAP) and SMS commands [2,3] . Text messaging is one of the most commonly utilized forms of electronic communication and even very cheap phones support SMS. As is well known, SMS is a globally accepted wireless service that enables the transmission of control messages between mobile phone subscribers and electrical appliances. This provides a rather low-cost and easy-to-use solution for wireless connectivity. Naturally, advanced control needs complicated systems and people are carrying smart phones with better input/output so as to improve control capabilities. With Bluetooth and third generation (3G) service, mobile phone-enabled control is being further extended. So far, people can already remotely control their personal computer (PC) by a mobile phone [102] . Furthermore, longdistance monitoring and telemedicine has also © 2010 Expert Reviews Ltd ISSN 1743-4440 757 Review Liu & Liu become a reality [4,5] . The growing power and sophistication in a cellular phone has made it an increasingly feasible platform for mobile health (m-health) applications, such as ��������������� collecting community and clinical health data, delivering healthcare information to practitioners, researchers and patients, real-time monitoring of a patient’s vital signs, and directly providing care through actuation. These mobile solutions can offer remote services to fatigued patients, increasing their independence with potentially better outcomes. Remote medical service systems generally consist of three tiers: one or more sensors that capture information about the patient; a data hub (such as a personal digital assistant, laptop or cell phone) for local data processing and display, and a medical network that records and analyzes information to detect anomalies [6] . Since monitoring in-hospital is financially more challenging than that at home, more people are getting interested in receiving telemonitoring service. This may give them freedom of staying at home and living with their family, while receiving low-cost medical care as well as having a relatively high quality of life. By means of 3G service, the increasing medical data traffic and demand from different clinical applications and mobile medical sensors will be more compatible with the growing data rate of current 3G systems in the near future [7] . Specifically, in a society penetrated by remote medical monitoring and telemedicine systems, home medical care and remote diagnosis, and even guided or automated treatment will become common in the future as a convenient service. As an actuator element, the controlling role of mobile phones in healthcare is receiving an increasing amount of attention. Therefore, there is an urgent need to better understand the basic technologies enabled from such controlling mechanisms. To push forward the innovations along this important direction, this article is dedicated to presenting a comprehensive overview on the mobile phone-enabled controlling issues in personal and medical care. Typical examples already in practice will be selected for illustration. Technical possibilities and challenges will be outlined. Finally, a brief outlook on future mobile controlling in healthcare will be given. Mobile phone control in disabled people’s daily assistance Mobile phones have penetrated nearly all aspects of people’s everyday life. As is noticed, many researchers are trying to develop smart card functions in mobile phones. In order to take full advantage of the portable, flexible and smart properties, as well as wireless communication functions, mobile phones are being used in many different control systems. In this section, a discussion will be made on the controller in people’s daily life, which is especially useful for persons with physical disabilities. Home or office appliances controlled by mobile phones Using mobile phones to remotely control home or office appliances is becoming an important function of mobile phones in the daily assistance of disabled people. Typical applications include remote mobile programming of televisions, lights, heating thermostats, security cameras and so on. This will significantly improve the life 758 quality and health recovery of a person with physical disabilities and thus help maintain good health. The architecture of controlling home or office appliances with smart phones can be depicted in Figure 1. The system, called personal universal controller (PUC) system, was designed to control appliances in their environment through a remote user interface. There are four parts in the system: a specification language (enabling automatic generation of user interfaces); a communication protocol; appliance adaptors (translation layers that bridge the gap between the PUC protocol and the appliances’ proprietary protocols); and interface generators. When the user decides to control an appliance, the controller device downloads a corresponding abstract functional description from the appliance and uses the description to automatically generate an interface. The communication channel between the controller and the appliance is two-way, through which the user sends their commands to the appliance and the appliance provides feedback for the user. The system can connect between multiple interface generators and an appliance, or between an interface generator and multiple appliances, using a peer-to-peer connection model [1] . The specific approach for interconnecting appliances and mobile networks to control electronic devices, as well as remote mobile devices, may not be the same among different systems. One common approach is to enable mobile access to home or office appliances via WAP and SMS commands. Another way has been demonstrated by a prototype implementation, in which Home Audio Video Interoperability (HAVi) and WAP are used as two of the emerging communication network technologies [3] . With regards to computers, one can use the software ‘Maxthon2 Plugin’ (M2P) to realize simple control using a mobile phone. On the other hand, people may employ a Bluetooth module to help control the PC through mobile phones [8,102,103] . With a Bluetooth module and relevant software, users can further control PCs to send mail, save files and start or stop services from anywhere in the world using the portable mobile phones. Mobile phones could also control robots via the internet, SMS or voice mechanisms [9–11,104,105] . They can also be used as a remote control, on/off switches in the car, remote monitoring or activating alarms [106,107,201] . Phones could acquire data and transmit them in time in the so-called ‘field of digitization’, which enhanced the speed and flexibility, and reduced the expense for the new data collection and transmission [12] . Controlling of mobile phones in environment monitoring for health maintenance Mobile phones equipped with certain sensors have been employed to help monitor and actively control the environment. People, especially those physically disabled, can use it to detect toxic or harmful gases, learn the state of surroundings with a wireless sensing network and even take appropriate action. This will help improve the living environment and thus better serve health maintenance. The system, as shown in Figure 2, is to detect toxic gases (toluene, ammonia, hydrogen sulfide gases) with a mobile phone taking pictures and sending them to a host computer [13] . Similarly, a remote actuation and monitoring system for the indoor environment could be set up with more environmental sensors [14] . The mobile phone connects with sensors and microcontrollers, receiving data Expert Rev. Med. Devices 8(6), (2011) Mobile phone-enabled control of medical care & handicapped assistance acquired from sensors and sending control message via a user interface. When abnormal data appears, corresponding measures are carried out through the network. There are certainly many other fields that are controlled by mobile phones and people are generally prone to control more things in their environment using their phones [108] . Mobile phone control in medical fields Review Communication protocol Home or office appliances Appliance adaptor Microcontroller and software Feedback Control Mobile phone with user interface The aforementioned examples enabled by Figure 1. The architecture of personal universal controller system. the mobile phone’s control functions are mainly for assisting people’s daily life and public health. In fact, many more applications can be found in As mobile phones can now feasibly be used in many situations, medical fields. Remote monitoring and telemedicine are among they could also play an important role in future telemedicine. In the most important aspects. the system of mobile phone-based telemedicine (Figure 3) , mobile Today, there are more senior citizens and chronic diseases than phones mainly serve as a message transmitter or information ever before. The number of people who need constant assistance controller. This system has the three-tier design, and each has its in medical care has increased a lot. Also, patients discharged from own functionality and works together for the whole system [6] . hospitals may often require additional healthcare services and The first tier is the set of sensors or monitors that discern signals monitoring of their health status, while these services are always of interest, and then relay the information to the mobile phone expensive and troublesome. Technical advances on wireless con- through wireless networks or devices like Bluetooth. The mobile nectivity and mobile devices will give practitioners, medical cen- phone receives the raw data and then displays it in charts or ters and hospitals new tools for managing patient care, electronic curves and analyzes or stores the data based on different requirerecords and medical billing to ultimately enable patients to have ments of systems. In the future, mobile phones could receive and more independence of their own well being. process the data in real-time and automatically send messages In this section, focus will be put on mobile phone-enabled con- to the service centre when abnormal data appears. The mobile trolling in medical fields. The concept and examples of application phone then transmits the data to an outside medical network via around the theme of telemedicine will be discussed. the internet, global system for mobile communication (GSM), Wi-Fi™ or some other means [7] . The third tier, the medical The concept of mobile phone-based telemedicine network, is often operated by a healthcare provider, such as a Telemedicine is a rapidly developing area where medical infor- hospital or telemedicine center where the staff are able to perform mation is transferred through interactive audiovisual media for medical procedures. Feedback will be sent to the person under the purpose of consulting or monitoring. It may be as simple as care through the mobile phone or some action will be taken to two health professionals discussing a case over the telephone, help people deal with health problems. or as complex as using satellite technology and videoconference Mobile telemedicine solutions take full use of the extensive and equipment to conduct a real-time consultation between medi- fairly reliable wireless mobile communication networks already cal specialists from different countries. There are generally three available all over the world. Moreover, it is convenient and relatypes of telemedicine: store-and-forward; remote monitoring; and tively cheap for the patient. Since mobile phones can be managed interactive services. Telemedicine could also refer to the use of communications and information technologies for the delivery of Mobile phone clinical care, which provides day-to-day monitoring and preventive and emergency care to patients with chronic conditions and diseases and to people living in isolated communities and remote regions [6,109] . Gas However, many of the currently available telemedicine systems are not so convenient. As effective as those solutions might be, they do not provide people with a satisfactory quality of life. Although many devices used in telemedicine, such as the Holter monitor (��������������������������������������������������� a portable device for continuously monitoring variDetector Microcomputer ous electrical activity of the central nervous system for at least 24 h [110]) or bedside monitor, are powerful, they are often too expensive, complicated or unwieldy, which prevents them from Figure 2. Measurement system with mobile phone. being widely accepted. www.expert-reviews.com 759 Review Liu & Liu Third party medical applications Bluetooth® Monitoring center 3G/GPRS/Wi-Fi Smartphone Server can easily exchange messages with professionals as well as get feedback through the phone (Figure 4) , and they would receive directions from the server or learn something more from a well established database. To realize all of these functions, better user interfaces are needed. According to the results of a questionnaire, more and more patients are likely to use the mobile phone in medical care [16] . The mobile phone-enabled interactive telemedicine system may assist patients and give doctors fast information or preliminary results, which would enable early detection of diseases, which is useful in early diagnosis and patients’ distance monitoring. Mobile phone-based telemedicine Nowadays, more and more people suffer from chronic diseases, such as heart disease, diabetes mellitus or asthma, and they Pateint web viewer Remote physician Home/office/travel need to be cared out of hospital. Remote environment service, also known as self-monitoring/testFigure 3. The concept of mobile phone-enabled telemedicine. ing, is an important part of telemedicine, which enables medical professionals to individually, the controlling modules that are developed will evaluate and treat a patient remotely using various technological almost certainly cost less than the traditional devices commonly devices. Mobile phone-based telemedicine can provide compaused in hospitals [6,7] . rable healthcare to traditional in-person encounters, supply greater satisfaction to patients and are usually more cost effective. Mobile phone-enabled interactive services In this section, we selectively illustrate several typical examples Using a mobile phone, telemedicine may be as simple as a of mobile phone-based telemedicine for people suffering from reminder of medical care by messages or calls, since making a different diseases. call and sending messages are two basic functions of the mobile phone. Here, interactive telemedicine service means real-time Mobile phone-based electrocardiogram interaction between the patient and healthcare provider, includ- remote monitoring ing phone counseling message transmission, online communica- Cardiovascular diseases, including coronary artery disease, heart tion, electronic medical records, remote actuation and so on, with attack, myocardial infarction, angina, congestive heart failure, the mobile phone as a major control tool. Many activities, such as hardening of the arteries, stroke and peripheral vascular disease, pathological history review, physical examination and psychiatric are now the leading cause of mortality in the developed world. evaluations, can be conducted comparably to those performed in People suffering from these diseases need constant service regardtraditional face-to-face visits. In addition, ‘clinician-interactive’ ing their health status after being discharged from hospitals. telemedicine services will be much less costly and time consuming Traditional heart monitoring solutions have existed for many than in-person clinical visits [109] . There are medical firms and years, such as the Holter monitor to record the patient’s ECG for organizations providing mobile phone medical services, which 24–48 h and provide data to be analyzed afterwards by the carcan benefit from automated telephone answering functions. Such diologist [110] . However, Holter monitors record but do not detect phones can help answer some medical questions in a professional arrhythmias when patients are out of hospital. Moreover, they and consistent manner, 24 h a day [111] . are unable to automatically transmit information at the moment With advanced communication technologies being used to when an abnormal cardio-activity occurs and appropriately actureduce healthcare barriers, doctor–patient interactions through ate in saving a patient’s life during the monitoring phase. Most periodical monitoring of health status and physical symptoms critical of all, they are too expensive for daily use. bring encouraging results. New methods, such as questionnaire As a unique telemonitoring platform, the system based on management system and messaging system, will be developed and mobile phone controlling provides a new and feasible solution, gradually improved [15] . They would transmit patients’ reported which can be easily adopted in ECG telemonitoring. Many people outcomes using mobile phones or the internet, and allow people have studied mobile phone-based ECG monitoring, proposed access to certain medical database through their phones. Patients new ideas and methods, and also conducted some experiments or 760 Expert Rev. Med. Devices 8(6), (2011) Mobile phone-enabled control of medical care & handicapped assistance Review demonstrated some practical applications [17–26,112–116,202] . There are many mobile Conversation phone-based controlling systems for ECG Message monitoring, while the design of each is more or less the same, such as one shown Database in Figure 5. This mobile phone-based ECG service Multimedia could be simply divided into four parts: system on the patient; doctor’s unit; web Patients Mobile phone Server Others server or database; and network operator. In the system on the patient, there is a wireless biomedical sensor to acquire the ECG Figure 4. Structure of phone interaction telemedicine. signal of the patient and then send the data to the mobile phone through Bluetooth or some other wireless unit. The mobile phone receives the data can arrange therapy as early as possible. Actuation mechanisms and has the task of processing raw data and detecting an abnor- can even be designed in the phone to help save the user’s life if a mality at this stage before transmission. The user interface of heart attack occurs unexpectedly. People have made attempts in the mobile phone displays the ECG curves or controls the data clinical trials to study these systems [20] . In the near future, the stream, which means that users can give orders to complete the feasibility of mobile phone-based ECG monitoring system will executive function as offered. The mobile phone processes and gradually improve to provide better telemedicine service. stores the data in a memory chip, or sends data to the monitoring centre if necessary. Usually, the mobile phone is able to auto- Mobile phone-based diabetes control matically alarm when an abnormal situation occurs [17,202] . The Diabetes is one of the most troublesome chronic diseases that can, doctor’s unit, as well as a medical expert and emergency opera- at present, only be controlled and not cured. It has a significant tor, receive information from the mobile phone and respond in impact on a person’s quality of life if a person or their family mema timely way. In the system, network services and protocols are ber has to cope with a chronic disease, especially for older people. essential for communication. Luckily, telemedicine systems provide a means to transfer the One can see that the mobile phone plays a very important role in this system (Figure 6) . Hospital It is a junction between patients and doctors, and provides an interaction to users. The user interface and algorithms built in the mobile phone have constantly been improved. As described in [202] , the mobile Medical expert phone in this proposed system is able to detect irregular heart rhythm in real time, measure QT interval (the time between the start of the Q wave and the end of the T wave in the heart’s electrical cycle) and identify atrial fibrillation. Furthermore, it can Patient correctly identify whether the user’s arrhythEmergency operator Network mia is abnormal or the user is just under certain circumstances such as motion state. The mobile phone-based ECG service ensures the patients get informed of the latest happenings of their heart activities at anytime, anywhere. The system could be more powerful in dealing with other heart problems with more functional modules added on. From the perspective of early Grid equipment/solution detection, the system is useful for healthy Service provider provider people who have potential heart problems, helping them to detect abnormalities early Figure 5. A design of a mobile phone-based ECG service. when no symptoms are present and prompt Modified from [112] . them for a medical check-up so that they www.expert-reviews.com 761 Review Liu & Liu Data/command flow Person with ECG sensor Mobile phone Figure 6. Data stream in the system. point of care to the patients and allow them to be better informed and actively involved in the self-care process. Several systems have been proposed for the remote monitoring of a patient’s vital physiological parameters, allowing better treatment of patients at home or in isolated areas. Since mobile phone-based remote monitoring is an important method for diabetes treatment, many people have investigated this system [27–30,117] . As shown in Figure 7, the design of the mobile based remote service system for diabetes is similar to the one used in ECG remote monitoring, and in fact, it is simpler. There is a blood glucose meter that measures the glucose concentration in the patient’s blood, and this has a connection with the mobile phone. Often both glucose monitors and blood pressure sensors are needed at the user end [27] . Measured results are transferred from the sensors to the patient’s mobile phone using a USB or Bluetooth connection. The data are then transmitted from the phone to a web server via general packet radio service (GPRS), or 3G service [28,29,117] . The data can be stored for later retransmission if connectivity is low. At the monitoring centre, the read-out sensor data are combined with historical records as well as the patient’s qualitative data and transferred to the analyzing unit. The analyzing unit then uses Blood glucosemeter Internet GPRS Database Server Phone Figure 7. Cell-phone-based remote monitoring for diabetes. GPRS: General packet radio service. 762 this information to generate a personalized course of action that is appropriate for the patient at the given moment [27] . Some systems allow the patient to use their own phone to input and record their measurement results via speech, and the visualized web allows consultants to monitor those patients on a daily basis and to respond to alerts generated by the system [29] . There Computer are also real-time systems where blood glucose data, information about insulin dose, eating patterns and physical exercise information are collected immediately [30] and feedback of data is sent to the patient through the mobile phone. More detailed graphical displays of data, which are used to provide information about control of insulin dose and the degree of diet and exercise, probably including a color histogram, will be sent back after the clinician’s analysis. The system is available for both people suffering from diabetes Type 1 and Type 2. It can be anticipated that with the development of the mobile phone-based remote monitoring system, selfcare process will make it more patient-friendly and encourage patients to take care of their condition in a more effective way, which will lead to longevity and reduce the risk of complications. Mobile phone-based dermatosis care In this section, a simple introduction about mobile phone-based teledermatology systems to support the self-management of patients suffering from psoriasis will be illustrated [31] . Psoriasis is one of the most common chronic skin diseases, affecting approximately 2% of the population worldwide. Currently, there is no cure for psoriasis; however, there are many treatment options that can clear psoriasis for a period of time [118] . Continuous clinical monitoring with periodic assessment of the state of the disease is essential for long-term therapy optimization. Here, we do not intend to describe the design of the whole system since it is almost the same as the cases given earlier. The difference lies in that people do not need a sensor for data acquisition in this system; they can use the camera of a mobile phone to take photographs of lesions (Figure 8) . Of course, several other health parameters are also requested for the physicians to draw a conclusion. Clinician The recorded data, including health parameters as well as pictures of the lesions, are stored in the mobile phone and sent to the remote monitoring centre for analyzing. The camera, the memory and the multimedia transmission of the mobile phone should be considered thoroughly for betPatient ter monitoring outcomes. Additional software, such as user interface or processing algorithms, may be installed on the mobile phone to improve the performance. Expert Rev. Med. Devices 8(6), (2011) Mobile phone-enabled control of medical care & handicapped assistance Review Detect & control vital parameters by combining the mobile phone with biomedical clothing Biomedical clothing for ambulatory telemonitoring of human vital parameters has been developed. Weber et al. have presented a T-shirt made from fabric with woven wires and embedded with four smooth, dry ECG electrodes, a breath rate sensor, a shock/fall detector and two temperature sensors, and is equipped for signal precomputing and transmission through a miniature GSM/GPRS module [32] . Prototypes have been tested on persons in a normal state of health using a medical protocol to obtain the biomedical data, including ECG data, pneumogram, temperature and detecting falling cases in mobile situations. It employs a GSM/GPRS module, which closely connects the biomedical clothing with mobile phones. Furthermore, one could not only transmit data but also do some analysis and display the results on the phone. The mobile phone could even be used as a control centre of the biomedical clothing, and will provide particularly useful care for old people, professional sportsmen or people in high-risk professions such as firemen, police or the military. Mobile phone-controlled devices for wireless healthcare Mobile phone with camera Patient Figure 8. Take photographs of skin lesions using the mobile phone. is for the elderly and disabled assistance. Modem mobile phones can now be used for mobile robot control. Mobile phones may control the robot by voice, through the internet or by other interaction mechanisms [10,11,34] . Applying these technologies to home robots for the elderly and disabled people will provide great convenience for these people and their families. A mobile phone-based portable stroke monitoring system for patients or elderly people has been designed with the intent to prevent patients from sudden death after heart operation or falling over [35] . This mobile phone-controlled system is indeed useful for the everyday life and rehabilitation of physically handicapped people. In fact, people are trying to add an application for use with an iPhone to control the wheelchair and show chair information, such as speed, in real time. There are even plans to add diagnostics features in the future [119] . Embedded with smaller processors and systems, a new level of mobile communication in everyday life is now available. Using wireless services and handheld technology, as well as low-cost sensors, real-time patient service is becoming possible in the home, the workplace and in conventional point-of-care environments, such as outpatient clinics and rehabilitation centers [33] . A new notion of ‘wireless healthcare’ has been put forward. Here we Challenges in mobile phone-based control illustrate a smart cushion controlled by a mobile phone wirelessly in healthcare for healthcare application. Although mobile phone-enabled controlling systems have their As depicted in Figure 9, the system has three parts: on-cushion advantages, there are currently many technical difficulties associcircuitries; the software in the mobile device; and the remote server ated with the application of such technologies. In this section, we and database. When the cushion is attached to any chair, it will choose to discuss several representative major challenges within automatically collect various information describing the user’s sit- the area. ting behavior, including posture and duration, and the ambient environment, for example, vibration strength. This information is sent to a mobile phone periodically. Internet The mobile phone then analyzes this inforWarning mation and feeds it back to the user in real You have been leaning left for 20 min. time if an inappropriate posture is detected. Please sit straight In addition, the portable phone will auto matically synchronize with a remote database to upload the user’s seated posture data. Users can also see a more comprehensive Key features of annual heath assessment as reported by a Health the smart cushion personal physician based on the historical assessment Portable record from the database [33] . This cushservice Cheap Easy to deploy ion is more portable, cheaper, easier to User Intelligent deploy, more intelligent and more conveConvenient nient, and better for health than traditional Smart cushion healthcare methods. Another critical area of mobile phoneFigure 9. A cushion controlled by mobile phone wirelessly. controlled wireless healthcare application www.expert-reviews.com 763 Review Liu & Liu Control algorithms Safety & security Mobile phones should not only transmit data and orders, but also provide some complicated functions. With built in algorithms, signals like ECG, blood pressure or blood glucose could be processed and analyzed locally in the phone to produce immediate medical information for diagnosis [36,37] . Being restricted to relatively simple algorithms, mobile phones have a low processing speed and small data size, which limits their control functions. Actually, even simple algorithms easily run by PCs could hardly be accomplished by a mobile phone. Algorithm complexity that mobile phones could reach should be improved. Mobile phones control data transmission in the systems while the users should control the access of vital data. When applying mobile phones to an operation, one problem is whether the electromagnetic radiation of mobile phones is dangerous to people under long-time service and actions should be taken for this protection. Also, the electromagnetic interference between mobile phones and other devices needs to be tested. Another big problem is security of data transmitted through networks, which has to protect people’s privacy. Clearly, security and privacy mechanisms should be established to improve telemonitoring solutions [41–43] . Communication protocols Medical device regulations Data exchange could not be performed without necessary communication protocols. Mobile phones could transmit information through Bluetooth, WAP, Wi-Fi, GSM and code division multiple access (CDMA) among others [38] . Since each of them has both merits and shortcomings, the matter lies in how to choose proper protocols for the specific application. The general requirements may be high accuracy, rapid transmission rate or reliable service. Furthermore, specific communication protocols between mobile phones and sensors need to be established for different situations. Since there are many researchers trying to create their own protocols in the systems, various protocols have been proposed, but most of them are for private use [39] . Clearly, standardization or normalization of communication protocols is needed for the mobile phone to be used in different systems. When used in medical fields, mobile phones work as part of medical devices so much testing must be carried out on the system. The feasibility and reliability of the system, the performance and portability of the software, the security and privacy of communication protocols and the safety of the human body are crucial. High-confidence medical device software and systems are essential to help ensure advances in healthcare delivery [44] . As mobile phones communicate wirelessly, electromagnetic interference presents a risk to patient safety and medical device effectiveness, which requires rigorous testing on mobile phone-enabled control systems and other medical devices in the environment [45] . In addition, medical devices have different definitions or standards in different countries and organizations, resulting in different requirements for testing [121] . Mobile phone software platform Expert commentary Together with control algorithms, high-quality user interface is an important part of mobile phone control because it provides support for interaction between users and other electric devices [1] . Both algorithm realization and user interface programming rely on the software platform of the mobile phone. The platform decides the outcome of programming, including feasibility, reliability, complexity, portability and so on, which dictates whether the mobile phone services are performed satisfactory or not. The current major operating systems in mobile phones are Symbian OS, Linux, REX, Nucleus, and Windows Mobile. Different platforms reduce the transformation and portability of programs, and most handset manufacturers have tried to change their software to an open platform or just made a new platform using Linux [40] . The mobile phone is developing rather rapidly and has changed people’s lives tremendously. So much so that they are almost indispensable to everyone now. Apart from basic communication functions like sending messages or making a call, mobile phones now show good performance in controlling in many emerging fields, especially in people’s daily assistance and health care. With the mobile phone, one can easily control their PC as well as other devices connected with the computer [46,47] . Home and office appliances (including televisions, lights, projectors and dimmers) could be manipulated by the mobile phone through SMS, Bluetooth or wireless networks [48–54] . Furthermore, environmental or weather data collecting and transmitting, as well as traffic management control, may be achieved by mobile phones [55–57] . This will significantly improve the life quality and health recovery for people, especially those with physical disabilities. Meanwhile, as telemedicine projects are gradually carried out all over the world and play an increasingly important role in the health service and provide tools that are indispensable for home healthcare, remote patient monitoring and disease management, concepts of mobile phone-based telemedicine systems have been put forward and a lot of research is being tried [58,59,122] . Mobile phone-enabled systems for remote monitoring of blood pressure and pulse, ECG, glucose or dermatosis, and even for urinalysis test, have been designed or implemented for people suffering from chronic diseases [60–62] . Such systems provide a feasible solution for consistent medical service. Moreover, mobile phone Hardware connection Mobile phones need to contact other devices or modules while different devices have varied ways of connection, which might be serial or parallel ports, wired or wireless. We know that there are various ports in computers, while there are very limited ports or interfaces in mobile phones. USB and Bluetooth modules are options for connecting mobile phones with other devices, which are wired and wireless, respectively [102,103,120] . Trying to use one phone to connect different devices is not always available considering the set specific interface of mobile phones. Therefore, in addition to deciding proper communication protocols, port matching between different devices is another difficulty. 764 Expert Rev. Med. Devices 8(6), (2011) Mobile phone-enabled control of medical care & handicapped assistance controlling is especially useful in personal assistance for the elderly and disabled people. One example is that one may soon be able to control the wheelchair through a mobile phone. Furthermore, mobile phone-controlled biomedical clothing is emerging, which is certainly good for the healthcare of ordinary people. With mobile phones, Ubiquitous Health (U-health) System, called the U-health system, has been designed and is now in action [60–63] . Overall, owing to their advantages in improving people’s life, the application of mobile phone-enabled controlling systems will almost certainly be further developed even though many difficulties remain. As the mobile phone goes further with advanced biomedical sensors and actuators, people are expected to have a better service from mobile phone-based controlling systems. In the near future, m-health and U-health will be rapidly developed. Personal body-signal monitoring, mobile medical diagnosis and treatment, daily health keeping systems, as well as personal online databases will be enabled by mobile phones to improve universal health for all [61,62,123] . Five-year view Wide use of mobile phones brings more convenience to people’s life. Clearly, one of the promising developments for the mobile phone is as a controller. In addition to what has been discussed earlier, the following emerging directions for mobile phone-enabled controlling in the near future are worthy of being emphasized. Interaction between mobile phones & wireless networks It is clear that a wireless network is a must in the mobile phonebased controlling systems, especially in telemedicine. Bluetooth modules, GPRS or the internet are often used in the wireless transmission, and there exists different protocols among various devices, such as WAP and Wi-Fi [64] . It has been said that there are many similarities between mobile phone usage and the internet [65] so, with mobile phone as the control tool in telemedicine systems, new networks could be established for mobile phone communication, for example, 3G mobile communication systems, which also have lower electric radiation effect [66] . The evolution of current 3G wireless communication and mobile network technologies will be the main driving force for the future developments in telemedicine [7,67] . In fact, the concept of 5G has even been put forward [68] . On the other hand, multifunctional mobile phones will be made to fit the current networks. And with the growing abilities of mobile phones, various networks may be unified. Review will be easier for information exchange and data processing, as well as multiparameter monitoring. However, suitable ports and interfaces are needed to follow integration. Naturally, new problems, such as data storage or energy supply for the mobile phone, will also appear in time and call for a solution. Mobile phone-based actuator Obviously, mobile phone controlling is the central part in a whole system including sensors and actuators. The functions that mobile phones could perform are not just data transferring or order transmission. Integrated or embedded with feasible devices, the mobile phone could become an actuator itself and implement corresponding programs. This is the concept of mobile phonebased actuators. With actuators, mobile phones would bring more convenience to people’s lives, in particular better medical care, advanced personal assistance and even therapy. There may be various ways to connect mobile phones with actuators and other control methods, except for what has been mentioned earlier, to accomplish different tasks. One thing for sure is that mobile phone-based actuators will be further developed rapidly. Development platform & operating system of mobile phones The popular operating systems running on the mobile phones are mainly PalmOS, Symbian, Windows Mobile, Linux, Android, iPhone OS and BlackBerry ®. Furthermore, each operating system corresponds to different programming language, like Java or C Language. During the process of market testing, operating systems or programming languages may centralize, which would mean that the mobile phone will be more easily used for multiple control and additional functions. Cost-effective healthcare & its industrialization Telemonitoring can be implemented by many devices and in various forms. The reason people choose mobile phone-based controlling systems lies in that mobile phones are now widely used over the world and could accomplish the task of information transmission or data processing with a relatively low cost. Also, mobile phones are convenient, flexible and easy to use for most people. In fact, some users may be unable to work or feel that they can lead a normal life without a mobile phone. In this sense, it is a good choice to realize efficient low-cost medical care via mobile phones. It would be a big accomplishment to use the mobile phone in medical care and it will be a milestone to market mobile phone-enabled medical devices. Mobile phones integrated with biomedical sensors In some ways, mobile phones are serving as an information transmission tool as well as a data controller in the aforementioned telemedicine systems. To lower the frequency of data transmission from one device to another, some biomedical sensors can be integrated into the mobile phone, establishing a mobile phonecentered body sensor network platform [124] . Then, mobile phones will be smarter, the system will be simplified and the detection module will be wearable or more portable. Furthermore, one can integrate several biomedical sensors into the same phone [18] . This www.expert-reviews.com Financial & competing interests disclosure This work was partially supported by the National ‘863’ Program of China, Tsinghua National Laboratory for Information Science and Technology Cross-Discipline Foundation, and Tsinghua-Yue-Yuen Medical Sciences Fund. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. 765 Review Liu & Liu Key issues • Mobile phones are now widely used in people’s daily lives, not only for daily communication, but also for medical care and personal assistance. • Mobile phones could control home and office appliances and transmit environmental or weather data through short message service, Bluetooth® and wireless application protocol, among others. • Mobile phone-enabled control systems play a crucial role in remote monitoring, including telemonitoring of ECG, glucose and dermatosis. • Mobile phone-enabled biomedical clothing and assistant devices bring convenience to people, especially the elderly and disabled. • Control algorithms, communication protocols, mobile phone software and hardware, and safety and security are challenges for system development. • With advanced biomedical sensors and actuators, as well as development of wireless networks, mobile phone-enabled controlling systems will be pushed forward to a high level. 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