ECG Remote Monitoring and Cloud Computing

Cloud computing is the translation of the English word Cloud Computing, which only appeared in Chinese in early 2008. Dell was the first to propose Cloud Computing at the enterprise level, but the IBM-Google parallel computing project and Amazon EC2 products had a profound impact on the concept of cloud computing. Subsequently, more and more media, companies, and technicians began to pursue cloud computing, and even put many IT innovations into the concept of cloud computing, which promoted and developed the concept and industry of cloud computing, forming a complete industry chain that includes IaaS, PaaS, XaaS, and many hardware manufacturers and infrastructure operators.

1. Concept, Characteristics and Application of Cloud Computing

1. What is cloud computing?

At present, there is no unified definition of cloud computing internationally, but we can roughly divide it into two categories: one is narrow; the other is broad.

(1) Cloud computing in a narrow sense

The network that provides resources is called a "cloud". From the user's perspective, the resources in the "cloud" are infinitely scalable and can be obtained at any time, used on demand, expanded at any time, and paid for by use. This feature is often referred to as using IT infrastructure like water and electricity.

(2) Cloud computing in a broad sense

This resource pool is called a "cloud". "Cloud" refers to some virtual computing resources that can maintain and manage themselves, usually some large server clusters, including computing servers, storage servers, broadband resources, etc. Cloud computing brings together all computing resources and manages them automatically by software without human intervention. This allows application providers to focus more on their business without worrying about tedious details, which is conducive to innovation and cost reduction. To put it in an analogy: this is like the transition from the old single generator model to the centralized power supply model of power plants. It means that computing power can also be circulated as a commodity, just like gas, water and electricity, which is easy to use and inexpensive. The biggest difference is that it is transmitted through the Internet.
In general, cloud computing is the development of parallel computing, distributed computing and grid computing, or the commercial implementation of these computer science concepts. It is the result of the hybrid evolution and leap of concepts such as virtualization, utility computing, infrastructure as a service, platform as a service, and software as a service.

2. Principles of Cloud Computing

Cloud computing is the development of distributed computing, parallel computing, and grid computing. It provides services (computing, storage, software and hardware services) to Internet users by utilizing distributed computers of non-local or remote servers (clusters), thereby effectively improving the utilization efficiency of software and hardware resources, allowing users to enjoy the convenience brought by high-performance parallel computing through cloud computing.

3. Main features of cloud computing

The National Institute of Standards and Technology of the United States has summarized the five basic characteristics of cloud computing: First, on-demand self-service. Consumers can unilaterally deploy computing resources (such as server time and network storage) to automatically meet their needs without the manual cooperation of service providers. Second, ubiquitous network connection. Cloud computing resources can be obtained through the network and accessed through standard mechanisms. These access mechanisms can facilitate users to use cloud computing through heterogeneous thin client platforms or thick client platforms (mobile phones, laptops, PDAs, etc.). Third, a resource pool that is independent of geographical location: cloud computing service providers adopt a multi-user model to dynamically allocate and reallocate physical and virtual resources according to user needs. Users usually do not need to know the specific location of these resources, which include storage, processors, memory, networks, virtual machines, etc. Fourth, fast and flexible deployment of resources: cloud computing providers can quickly and flexibly deploy cloud computing resources, quickly scale up and down, and for users, cloud computing resources usually appear to be unlimited, and any amount of resources can be purchased at any time. Fifth, service billing: by billing different types of services, cloud computing systems can automatically control and optimize resource utilization. Resource utilization can be monitored, controlled, and reported, providing transparency to cloud computing providers and users on the services being used.

Combining the above meanings of cloud computing, we can derive some characteristics of cloud computing.

(1) Large scale. The scale of cloud computing is extremely large. Google Cloud Computing already has more than 1 million servers, which also makes Google search engine occupy the number one position in the world.

(2) Virtualization. Through cloud computing, users can use a laptop or a mobile phone to obtain application services through network services at any location without worrying about the specific location of the application.

(3) High reliability. Cloud computing provides a strict permission management strategy, reducing the troubles of data loss and virus intrusion in traditional methods, and the data storage reliability is high.

(4) Strong scalability. In order to meet the needs of the growth of application and user scale, the scale of the "cloud" can be expanded dynamically.

4. Application of cloud computing

For general users, the most commonly used areas of cloud computing are email, web search (Google or Baidu), photo sharing (Flickr), video sharing (Youtube, Tudou), online maps (Google Map), etc. As long as the computer or mobile phone and other Internet tools have a browser, you can quickly get the data of the remote computer in a few seconds, making information readily available, just like electricity and tap water.

In addition, cloud computing provides powerful computing power for software designers and scientists, and can simulate experiments such as nuclear bomb explosions and DNA structures. How big is the business opportunity of cloud computing? According to data from the International Data Center (IDC), the average annual growth rate of cloud services in the next five years is expected to reach 26%; Merrill Lynch estimates that the global cloud computing market will reach US$95 billion in 2013; market research institutions have ranked cloud computing as the first of the top ten trends in the IT industry in the future. The report pointed out that by 2012, 400 of the Fortune 500 companies will use various cloud computing services.

5. Current status of cloud computing development

Since cloud computing is the result of the mixed evolution of multiple technologies, it is highly mature and has been promoted by large companies, so it has developed very rapidly. Large companies such as Amazon, Google, IBM, Microsoft and Yahoo are the pioneers of cloud computing. Many successful companies in the field of cloud computing also include Salesforce, Facebook, Youtube, Myspace, etc.

In my country, cloud computing is also developing rapidly. On May 10, 2008, IBM put into operation the first cloud computing center in China established in Wuxi Taihu New Town Science and Education Industrial Park. On June 24, 2008, IBM established its second cloud computing center in China, the IBM Greater China Cloud Computing Center, at the IBM China Innovation Center in Beijing. 21Vianet launched the CloudEx product line, including a complete Internet hosting service, online storage virtualization-based services, and a series of Internet cloud computing services such as data preservation services for individuals and enterprises to perform Internet cloud backup. China Mobile Research Institute started exploring cloud computing early and has completed the cloud computing center test.

There are two main development directions for cloud computing in the future: one is to build a large-scale underlying infrastructure that is closely integrated with applications, so that applications can be expanded to a large scale; the other is to provide a richer user experience on the Internet by building new cloud computing applications. The first development trend can be reflected in the existing cloud computing research situation. In the construction of cloud computing applications, many new social service networks, such as Facebook, have already reflected this development trend, and research has begun to focus on how to integrate multiple businesses through the cloud computing basic platform.

6. Problems with cloud computing

Judging from the current application situation, cloud computing technology has the following shortcomings: ⑴ Even if the best virtualization technology is used, users cannot migrate applications to the "cloud"; ⑵ Migrating enterprise tasks to the cloud environment requires a huge workload; ⑶ Only with user consent can all IT assets be virtualized to form an "internal cloud" that seamlessly collaborates with the "external cloud"; ⑷ It does not truly provide cloud computing services based on actual needs and pays for actual resources used; ⑸ The management application software provided by the data center is poorly integrated with the company's existing management application software; ⑹ Cloud computing does not have a unified standard to regulate it, so it is difficult for companies to adopt it on a large scale.

In addition, experts at the Black Hat Security Conference in August 2009 pointed out five security flaws in cloud computing: (1) Cloud computing does not provide adequate legal protection; (2) Cloud computing does not have hardware ownership; (3) Cloud computing requires strong protocols and user training; (4) Do not trust virtual machine instances created by third-party developers; (5) In any case, enterprise information technology managers need to reconsider their configuration on the cloud.

Cloud computing is still in its infancy and still requires people to have a deeper understanding of it and spend a lot of effort to properly manage complex resources. Therefore, it will take some time for it to become popular.

2. Development and current status of ECG remote monitoring

In modern society, cardiovascular diseases seriously threaten human health and life and are currently the leading cause of death among Chinese people. The prevention and diagnosis of cardiovascular diseases are of great significance to the whole society. Since cardiovascular diseases are accidental and sudden, it is particularly important to monitor the ECG of patients in daily life.

ECG remote monitoring system originated from the Holter system. Early home ECG monitoring systems used electronic instruments to record and store patients' daily ECGs and other important physiological parameters for some patients who had undergone heart surgery, and periodically sent the data to the clinic for diagnosis, so that patients could be monitored at home away from the hospital. Early home ECG monitoring required analysis of ECG data after the monitoring was completed, which was not real-time. When the patient became ill, he could not get timely diagnosis and treatment from the doctor. Moreover, due to its small storage capacity, it could only store a very small amount of ECG data, and the integrity of the data could not be guaranteed. Some valuable ECG data was inevitably lost, which greatly reduced the accuracy of diagnosis.

With the rapid development of modern communication technology and its application in the medical field, ECG remote monitoring systems have undergone revolutionary changes in recent years. Holter has gradually evolved into the front-end device of ECG remote monitoring systems, and the trend of combining traditional Holter with computer networks and mobile communication technologies has become increasingly obvious. With the popularization and development of macro infrastructure such as the Internet and mobile communication networks, ECG monitoring has been developing rapidly in the two directions of Internet and wireless mobile monitoring in recent years.

The Internet-based remote ECG monitoring system refers to the use of ECG monitoring clients to collect ECG signals of patients, and then transmit the ECG signals to the monitoring center server through the Internet, waiting for medical staff to process and diagnose the patient's ECG. The whole system generally consists of three parts: client terminal, Internet and management center workstation. The client terminal is composed of an ECG signal collector and a workstation that can be connected to the Internet. It can complete the functions of collecting patient ECG signals, performing simple data processing and uploading data to the Internet. According to different ways of accessing the Internet, the system has different design schemes, mainly PSTN (Published Switched Telephone Network), ISDN, Ethernet and so on. The remote ECG monitoring management center workstation is generally equipped with a high-performance server, which can realize real-time reception of patient ECG data, storage and analysis of data, management of patient basic information and ECG data, network security management, etc.

The ECG wireless monitoring system based on the mobile communication network uses a portable ECG signal monitor and wireless communication technology to communicate data with the monitoring center. Wireless transmission does not require cable media, and users can be monitored by the monitoring center anytime and anywhere without being restricted by time and place. With the continuous improvement of communication technology and computer network technology, the research hotspot of ECG remote monitoring in recent years is to closely combine wireless communication technology and Internet technology. The combination of the two technologies makes up for the deficiency of limiting the subject to a fixed environment when relying solely on the Internet; it also makes up for the deficiency of only being able to transmit the subject's data between mobile monitoring terminals when relying solely on wireless technology, resulting in high costs, difficulty in popularization, and single means of data processing and analysis.

The trend of ECG monitoring system is to make it wireless, networked and user-friendly. Portable, modular, easy-to-operate and low-priced ECG monitoring products will become the mainstream in the future market. The third generation of mobile communication 3G technology, which is gradually developing, can greatly increase system capacity, improve communication quality and data transmission rate, and use seamless roaming technology between different networks to better connect wireless communication systems and the Internet, thus providing a more stable and powerful technical foundation for ECG remote monitoring systems. ECG remote monitoring systems integrate the development achievements of biomedical engineering, information technology and communication technology, and can make full use of the resource advantages of mobile communication networks and the Internet. In the near future, it will definitely play an increasingly important role in the prevention and treatment of heart diseases.

3. Application of cloud computing in medical informationization and ECG remote monitoring

Cloud computing, which has emerged in the past two years, is to centralize all computing resources and automatically manage them by software without human intervention. It means that computing power can also be circulated as a commodity, just like gas and water and electricity, which are easy to use and inexpensive. Therefore, medical and health enterprises can carry out information construction by purchasing computing power without building related facilities themselves, which allows enterprises to focus more on their business without worrying about tedious details. The emergence of cloud computing technology will bring a new understanding to medical information construction. Through the cloud computing platform, hospitals can "outsource" websites, email systems, information management systems, remote monitoring systems, data centers and security protection systems to cloud computing service providers, and no longer have to worry about how to build and maintain server environments, how to purchase and upgrade system software, application software and even antivirus software, and how to prevent hacker intrusion. Whether it is data services or application computing, everything is obtained directly from the Internet. This is like using water and electricity. End users only need to turn on the switch or faucet to obtain and enjoy the service, while power plants and water plants with huge resources are responsible for providing the most professional production and maintenance at the other end of the "cloud". Figure 1 shows the cloud storage service model in medical informationization.

Figure 1. Cloud storage service model in medical informationization

Based on the idea of ​​using "cloud computing" to achieve remote monitoring of physiological parameters, we designed a multi-parameter remote monitoring system based on B/S architecture, and its structure is shown in Figure 2. The entire system consists of the central monitoring server software (cloud) of the monitoring center, the client browser and the multi-parameter collector. The server software (cloud) can accept data transmission requests from two clients to achieve remote real-time monitoring of multi-patient physiological parameters based on the Internet. The client adopts B/S architecture, and there is no need to install any client program. As long as the browser is opened, physiological parameters and waveforms can be viewed and sent in real time (see Figure 3). The remote central monitoring system based on B/S architecture facilitates the deployment and maintenance of client software, extending the central monitoring system from hospital wards to communities or homes, and providing a new solution for the popularization and networking of medical instruments.

Figure 3 Client monitoring interface

In the new wave of medical reform, the informatization of medical services will be an inevitable trend. Through informatization, resource sharing among medical and health institutions can achieve the optimal integration of medical service resources and the maximum synergy effect. The demand for medical software and hardware will be very considerable in the future. The cloud computing concept and technology that regards computing resources as services will inevitably change the development concept and construction model of traditional medical informatization, and play a vital role in promoting the construction of medical informatization.