Low-Cost ECG Recorder for Rural Areas

Submitted by: Heda Wang

Date: 5/12/2019

For: MDS301 Spring 2018-19

I. INTRODUCTION

In Inner Mongolia, basic healthcare can be difficult to access in many rural areas. Although there

are hundreds of hospital and thousands of clinic in big cities like Hohhot, doctors can hardly access many

rural areas. When the patient feels something wrong about his/her heart, traditionally, the doctor

usually gives the patient an ECG recorder and let them record their ECG when their hearts feel

abnormal. After the ECG is recorded, the patient needs to return the machine back to the doctor to

analysis if he or she has a disease like atrial fibrillation. This process can be very problematic in rural

areas in Inner Mongolia. The machine can be very expensive. And it can be really hard for a patient to

get the machine and return the machine because traveling to the hospital in big cities can be very

difficult. This system uses a smartphone and a low-cost probe to detect ECG and transmit the data

through the phone’s voice call to a server at hospital. With this system, the patient only needs to get a

low-cost probe and use it with a phone at home. They don’t need to spend that much money and travel

to big cities. They can know their heart condition and have treatment which can help the situation.

II. MOTIVATION

Examination of Medical Need in Inner Mongolia

The medical resources in Inner Mongolia

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 In Inner Mongolia, there are some big cities like Hohhot and Baotou. The hospitals and the

healthcare system are relatively abundant and professional. For example, there are about 108 hospitals

and 2065 clinics in Hohhot (Hohhot, 2019). In these areas, problems of medical care are not usually

because of lacking medical equipment and doctors. While the medical system in advance in big cities, in

many rural areas, medical care is very limited because they are usually far away from villages and cities,

and sometimes these areas are hard to access. To access these areas, many doctors and health care

workers need to ride a horse to get to the patients (Xinhua, 2018).

Special medical problems in Inner Mongolia

Kashin-Beck disease is a common disease in Inner Mongolia (Dianjun, Zhongbai, Hongkai, &

Zhaojun, 2002). In Inner Mongolia, they are usually caused by drinking underground water which is not

safe to drink and eat only corn as food. A common medical need is abortion in not only Inner Mongolia

but also many parts in China. There is about 900 million abortion in China each year (Douban, 2018).

And many of the patients choose to do it secretly and it can put them in great danger (Douban, 2018).

Kashin-Beck disease is mainly because of its culture. Their diet is very simple: only corn. Studies show

eating different several kinds of food will greatly reduce the chance of this disease (Dianjun, Zhongbai,

Hongkai, & Zhaojun, 2002). Also, the limitation of infrastructure cause this disease to spread. They drink

underground water which is not suitable to drink. A possible solution provides them with a different

grain like rice and wheat to reduce their consumption of corn. Also, they should be provided with water

purification equipment to make sure their water is safe to drink.

Abortion is mainly caused by the social effect. China has a “one-child” policy(Now it is changing

to “2-child” policy). Limiting every family has only one child. If a family have more than one child, the

government will have a large amount of fine on the family and sometimes the “illegal child” will have

problem register for an ID. This leads many families to abortion but they do not want to do it in a big

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hospital because it cost a lot. Instead, they find some dangerous way like buying the drug online

(Douban, 2018). A possible solution is to educate people more about birth control and make that

dangerous way of abortion illegal.

The third medical need for Inner Mongolia is people in those rural areas to need healthcare at

their home. These rural areas are hard to access so doctors usually don’t visit those place. But the

patient will suffer a lot if they travel to the nearest city. Especially for elderly people, who need a

constant physical examination and healthcare but too weak to travel a lot. Although there are a lot of

village healthcare workers, many of them are not trained professionally. For example, 77.2% of village

healthcare workers in Inner Mongolia do not sterilize their hands before providing healthcare to the

patient (Self-reported hand hygiene practices, 2015).

Existing Barriers to Medical Device Technology in Inner Mongolia

Barrier1
Cure of Kidney cancer
Cure Kashin-Beck disease
Barrier2 Barrier3
Prevention of Kashin-Beck Abortion issue
disease
Record patient ECG signal and Improper use of Chinese
bring it to the hospital. traditional medicine

Table 1. Barriers to technology use for health improvements in Inner Mongolia.

Barrier1:

For some unknown reason, people in Inner Mongolia have a higher rate of kidney cancer than

other places in China (Souhu, 2018). Cancer is hard to cure and it is a worldwide health issue. The

technology that can cure cancer very effectively is not developed. There need to be scientific

breakthroughs to achieve this.

Although Preventing Kashin-Beck disease is easy, but it is almost impossible to cure it (control,

2018). One reason is after the bone is damaged, it is hard to make it healthy again. Another reason for it

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is this disease is only common in a small area of the world and it is easy to prevent. So not many people

study who to cure this disease.

Barrier2:

Transportation of ECG recorder for rural areas in Inner Mongolia can be difficult and

problematic. Many people live in rural arear which is very hard to access (Xinhua, 2018). Cars cannot get

there because there is no road. Horses can travel there but it requires a lot of time. Helicopters are ideal

for quick medical care but are too expensive for Inner Mongolia. All the technology exist but they are

not suitable for Inner Mongolia. Also, the ECG recording machine can be expensive. Usually, they cost

about several hundred dollars. This is very expensive for those rural areas.

Prevention of Kashin-Beck disease is also a good example of Barrier2. One solution of Kashin-

Beck disease is to change grain that the patient is constantly eating (Dianjun, Zhongbai, Hongkai, &

Zhaojun, 2002). But for some rural area in Inner Mongolia, having a variety of food in dinner table can

be costly. Having clean drinking water will also prevent Kashin-Beck disease, but buying drinking water

can be costly and inconvenient so people still drinking unsafe underground water.

Barrier3:

Because of the one-child policy and the cost of raising a child, some family wants to abortion but

they don’t want others to know. Although hospitals can do it in a relatively safe way, many people

choose a dangerous way to abortion (Douban, 2018).

Some research shows that some Chinese Traditional medicine is toxic and not very effective

(Huanqiuwang, 2017). But many people both in Chinese central area and Inner Mongolia area believe

Chinese Traditional medicine is always better than western medicine. They refuse to have proper

treatment and only trust Chinese or Mongolia traditional medicine.

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Technological Approach
The problem in barrier 1 can be really hard to solve because it is limited by the advancement of

our medical technology. Cure of Kashin-Beck disease and Cancer is hard everywhere around the world.

The problem in barrier 3 is more related to politics and culture. They will not be suitable to solve by an

engineering design. Provide health care in rural areas is a very general problem and require a systematic

improvement. So I choose to solve the problem of recording and sending ECG signal for patients. The

traditional ECG recorder is very expensive and heavy. So the only hardware my design requires is a

smartphone and an ECG probe. The ECG probe is very light-weight and low cost. The probe will collect

the ECG signal and amplify it and send it to the audio port of a smartphone. The phone will record it and

do modulation with it to convert it to cell phone voice call frequency (about 300-3400Hz). Then the

patient can use the app to call the hospital server and the app will send the message by sound. The

hospital server will reconstruct the waveform of the ECG and let doctors analyze it. I choose to use the

cell phone voice call to transmit it because, in many area, 3G or 4G internet for phone can be really hard

to find.

The patient does not need to travel to big cities. The hospital will send envelop contain the

probe to them (Although slow, mail service can reach these area). The patient will record the ECG when

their heart feels bad and send it through their phone.

III. SYSTEMS DESIGN ANALYSIS

Stakeholder Model
Stakeholder Description
Patient Live in rural areas which is hard to access for traditional healthcare
givers. Travel to big cities will cost a lot of time and money. Their
abnormal ECG signal can occur at any time.
They have access to phone voice call signal. But hard to find internet
connection.
Healthcare They want to give every people in its area health care but some people
institutions live really far away which will be really hard to access.
They do not want to lose their ECG equipment so they do not want to
lend expensive equipment to patients.

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 They have a limited number of ECG equipment so they tend to make
them stay at hospital.
Doctors and health Sometimes they need to travel a long time to get to a Patient’s home.
care workers The road is hard to travel and traveling reduce their working efficiency.
Table 2. A description of stakeholders considered in the system.

Feature Description
Measure and amplify The smartphone will measure the ECG signal the cheap probe and there
ECG signal will be an amplifier in it.
Cheap and
The probe will be very cheap light. It is able to ship in an envelope
lightweight probe
Transmit the data The app will call the hospital server and play the audio contains ECG data
through voice call. and the server will reconstruct it.
Analyze the ECG
The doctors can look up the ECG and analyze it
data manually
Analyze the ECG
The server in the hospital can analyze the ECG for the patient
data Automatically
Reusable probe The probe can be used again after cleaning and adding ECG gel.
Table 3. A description of Features desired in the system.

Feature Attributes/Metrics and Value to Stakeholders

Stakeholders
Feature Attribute/ Patient Healthcare Doctors
institutions and
Metric
health
care
workers
Measure and H Have the Can get
amplify ECG ability to ECG data
signal measure without
ECG going to
the
patient’s
home
Cheap and H Can They do
light weight carry it not need
probe around. to worried
about the
Easy to
loss of
afford.
expensive
equipment
Transmit the M They do
data though not have
voice call. to find a
place

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 with
internet
access.
Analyze the H Can see
ECG data the ECG
manually waveform
and give
advice
Analyze the L Can get Save the Save time
ECG data feedback cost of for
Automatically quicker hiring helping
doctors more
analyze patient
Reusable M This can
probe further
reduce
the cost
for
them.

Table 4. A mapping of stakeholders to feature attributes. Such a map can hint at which stakeholders
have the greatest interest and which features are most important. H=High-must have, M=Medium-
probably necessary, L=Low-nice to have

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Functional Architecture Model

Figure 1: Functional architecture for the Low-Cost ECG recorder for rural areas.

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IV. HIGH-LEVEL PHYSICAL IMPLEMENTATION DESIGN

Figure 2: Signal flow diagram

Use-case Example
A patient lives in a rural area of Inner Mongolia. His heart feels bad recently but goes to the
nearest hospital will take several days. It is hard for him to access the internet but there is phone voice
call signal in his home. He calls the hospital in Hohhot and the hospital sends him a probe by mail. After
several weeks, he receives his probe and takes a measurement. Then he uses the app or manually calls
the hospital server and the server will give him instruction about how to play the sound with data. After
the server receives the data, a doctor will look at the ECG and find possible disease. Then the doctor
sends a text to the patient telling him what is wrong.

V. RECOMMENDATIONS FOR FUTURE WORK

All the data can be analyzed by a server at the hospital, further reduce the workload of

healthcare workers and make the response quicker. We can test it first in normal hospitals and check

the data with hospital grade machine and improve the system. After this, it can be used in Inner

Mongolia. If it works well, it can be used in many developing areas around the world. Because it is

continent, after some modification it even be used by developed countries.

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Bibliography
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Dianjun, S., Zhongbai, W., Hongkai, X., & Zhaojun, Z. (2002). 内蒙古呼伦贝尔盟大骨节病克山病流行病
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