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Machine Learning and Mobile Health Monitoring Platforms: A Case Study on Research and Implementation Challenges

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Abstract

Machine learning-based patient monitoring systems are generally deployed on remote servers for analyzing heterogeneous data. While recent advances in mobile technology provide new opportunities to deploy such systems directly on mobile devices, the development and deployment challenges are not being extensively studied by the research community. In this paper, we systematically investigate challenges associated with each stage of the development and deployment of a machine learning-based patient monitoring system on a mobile device. For each class of challenges, we provide a number of recommendations that can be used by the researchers, system designers, and developers working on mobile-based predictive and monitoring systems. The results of our investigation show that when developers are dealing with mobile platforms, they must evaluate the predictive systems based on its classification and computational performance. Accordingly, we propose a new machine learning training and deployment methodology specifically tailored for mobile platforms that incorporates metrics beyond traditional classifier performance.

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References

  1. World Health Organization (2010) Chronic disease prevention and health promotion

  2. Clifton L, Clifton DA, Watkinson PJ, Tarassenko L (2011) Identification of patient deterioration in vital-sign data using one-class SVMs. In: 2011 federated conference on computer science and information systems (FedCSIS), pp 125–131. https://doi.org/10.1109/icma.2007.4303943

  3. Melillo P, Izzo R, Orrico A, Scala P, Attanasio M, Mirra M, De Luca N, Pecchia L (2015) Automatic prediction of cardiovascular and cerebrovascular events using heart rate variability analysis. PloS One 10(3):1–14. https://doi.org/10.1371/journal.pone.0118504

    Article  Google Scholar 

  4. Jung EY, Kim J, Chung KY, Park DK (2014) Mobile healthcare application with EMR interoperability for diabetes patients. Clust Comput 17(3):871–880. https://doi.org/10.1007/s10586-013-0315-2

    Article  Google Scholar 

  5. Luo G, Stone BL, Fassl B, Maloney CG, Gesteland PH, Yerram SR, Nkoy FL (2015) Predicting asthma control deterioration in children. BMC Med Inform Decis Mak 15(1):84–92. https://doi.org/10.1186/s12911-015-0208-9

    Article  Google Scholar 

  6. Katsaras T, Milsis A, Rizikari M, Saoulis N, Varoutaki E, Vontetsianos A (2011) The use of the Healthwear wearable system in chronic patients’ early hospital discharge: Control randomized clinical trial. In: 5th international symposium on medical information & communication technology (ISMICT), pp 143–146. https://doi.org/10.1109/ismict.2011.5759815

  7. Yin RK (2013) Case study research: design and methods. Sage Publications, Thousand Oaks

    Google Scholar 

  8. Boursalie O, Samavi R, Doyle T (2015) M4CVD: Mobile machine learning model for monitoring cardiovascular disease. In: The 5th international conference on current & future trends of information & communication technologies in healthcare (ICTH ’15), pp 384–391. https://doi.org/10.1016/j.procs.2015.08.357

  9. Andreu-Perez J, Leff DR, Ip H, Yang GZ (2015) From wearable sensors to smart implants—Toward pervasive and personalized healthcare. IEEE Trans Biomed Eng 62(12):2750–2762. https://doi.org/10.1109/TBME.2015.2422751

    Article  Google Scholar 

  10. Bellos C, Papadopoulos A, Rosso R, Fotiadis DI (2011) Heterogeneous data fusion and intelligent techniques embedded in a mobile application for real-time chronic disease management. In: Annual international conference of the ieee engineering in medicine and biology society (EMBC ’11), pp 8303–8306. https://doi.org/10.1109/IEMBS.2011.6092047

  11. Comito C, Talia D (2015) Evaluating and predicting energy consumption of data mining algorithms on mobile devices. In: IEEE international conference on data science and advanced analytics (DSAA ’15), pp 1–8. https://doi.org/10.1109/DSAA.2015.7344848

  12. Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J (1999) Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. a pilot study in a tertiary-care hospital. Med J Aust 171(1):22–25

    Google Scholar 

  13. Saeed M, Villarroel M, Reisner AT, Clifford G, Lehman LW, Moody G, Heldt T, Kyaw TH, Moody B, Mark RG (2011) Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II): a public-access intensive care unit database. Crit Care Med 39(5):952. https://doi.org/10.1097/CCM.0b013e31820a92c6

    Article  Google Scholar 

  14. World Health Organization (2010) Burden: mortality, morbidity and risk factors. Global Status Report on Noncommunicable Diseases

  15. Averill RF, Goldfield N, Hughes JS, Bonazelli J, McCullough EC, Steinbeck BA, Mullin R, Tang AM, Muldoon J, Turner L et al (2003) All patient refined diagnosis related groups (APR-DRGs) version 20.0: methodology overview. Wallingford, CT: 3M Health Information Systems 91

  16. Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12(11):975–977

    Article  Google Scholar 

  17. Patel S, Hughes R, Hester T, Stein J, Akay M, Dy JG, Bonato P (2010) A novel approach to monitor rehabilitation outcomes in stroke survivors using wearable technology. Proc IEEE 98(3):450–461. https://doi.org/10.1109/JPROC.2009.2038727

    Article  Google Scholar 

  18. Hripcsak G, Albers DJ (2013) Next-generation phenotyping of electronic health records. J Am Med Inform Assoc: JAMIA 20(1):117–21. https://doi.org/10.1136/amiajnl-2012-001145

    Article  Google Scholar 

  19. Bellifemine F, Fortino G, Giannantonio R, Gravina R, Guerrieri A, Sgroi M (2011) SPINE: A domain-specific framework for rapid prototyping of WBSN applications. Softw: Pract Exp 41(3):237–265. https://doi.org/10.1002/spe.998

    Google Scholar 

  20. Lichman M (2013) UCI machine learning repository. http://archive.ics.uci.edu/ml

  21. Goldberger AL, Amaral LAN, Glass L, Hausdorff JM, Ivanov PC, Mark RG, Mietus JE, Moody GB, Peng CK, Stanley HE (2000) Physiobank, physiotoolkit, and physionet: components of a new research resource for complex physiologic signals. Circulation 101(23):215–220. https://doi.org/10.1161/01.CIR.101.23.e215

    Article  Google Scholar 

  22. Kandhari R (2009) Anomaly detection. ACM Comput Surv 41(3):1–6. https://doi.org/10.1145/1541880.1541882

    Google Scholar 

  23. Banaee H, Ahmed MU, Loutfi A (2013) Data mining for wearable sensors in health monitoring systems: a review of recent trends and challenges. Sensors 13 (12):17,472–17,500. https://doi.org/10.3390/s131217472

    Article  Google Scholar 

  24. Ellis RJ, Zhu B, Koenig J, Thayer JF, Wang Y (2015) A careful look at ECG sampling frequency and R-peak interpolation on short-term measures of heart rate variability. Physiol Meas 36(9):1827–1852. https://doi.org/10.1088/0967-3334/36/9/1827

    Article  Google Scholar 

  25. Li Q, Mark RG, Clifford GD (2008) Robust heart rate estimation from multiple asynchronous noisy sources using signal quality indices and a kalman filter. Physiol Meas 29(1):15–32. https://doi.org/10.1088/0967-3334/29/1/002

    Article  Google Scholar 

  26. Pan J, Tompkins WJ (1985) A real-time QRS detection algorithm. IEEE Trans Biomed Eng 32(3):230–236. https://doi.org/10.1109/TBME.1985.325532

    Article  Google Scholar 

  27. Rubin DB (1976) Inference and missing data. Biometrika 63(3):581–592. https://doi.org/10.2307/2335739

    Article  MathSciNet  MATH  Google Scholar 

  28. Wagstaff DA, Kranz S, Harel O (2009) A preliminary study of active compared with passive imputation of missing body mass index values among non-hispanic white youths. Am J Clin Nutr 89(4):1025–1030. https://doi.org/10.3945/ajcn.2008.26995

    Article  Google Scholar 

  29. Camm AJ, Malik M, Bigger J, Breithardt G, Cerutti S, Cohen R, Coumel P, Fallen E, Kennedy H, Kleiger R et al (1996) Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Eur Heart J 93(5):1043–1065. https://doi.org/10.1161/01.CIR.93.5.1043

    Google Scholar 

  30. Hampton JR (2013) The ECG made easy. Elsevier, New York

    Google Scholar 

  31. Peng H, Long F, Ding C (2005) Feature selection based on mutual information: criteria of max-dependency, max-relevance, and min-redundancy. IEEE Trans Pattern Anal Mach Intell 27(8):1226–1238. https://doi.org/10.1109/TPAMI.2005.159

    Article  Google Scholar 

  32. Moody GB, Mark RG (2001) The impact of the MIT-BIH arrhythmia database. IEEE Eng Med Biol Mag 20(3):45–50. https://doi.org/10.1109/51.932724

    Article  Google Scholar 

  33. Eekhout I, de Boer RM, Twisk JW, de Vet HC, Heymans MW (2012) Missing data: a systematic review of how they are reported and handled. Epidemiology 23(5):729–732. https://doi.org/10.1097/EDE.0b013e3182576cdb

    Article  Google Scholar 

  34. Müller KR, Mika S, Rätsch G, Tsuda K, Schölkopf B (2001) An introduction to kernel-based learning algorithms. IEEE Trans Neural Netw 12(2):181–201. https://doi.org/10.1109/72.914517

    Article  Google Scholar 

  35. LeCun Y, Bengio Y, Hinton G (2015) Deep learning. Nature 521(7553):436–444. https://doi.org/10.1038/nature14539

    Article  Google Scholar 

  36. Chang CC, Lin CJ (2011) LIBSVM: A library for support vector machines. ACM Trans Intell Syst Technol 2(3):1–27. https://doi.org/10.1145/1961189.1961199

    Article  Google Scholar 

  37. Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39(4):561–577

    Google Scholar 

  38. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A, Investigators MS et al (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365 (9477):2091–2097. https://doi.org/10.1016/S0140-6736(05)66733-5

    Article  Google Scholar 

  39. Sun J, Wang F, Hu J, Edabollahi S (2012) Supervised patient similarity measure of heterogeneous patient records. ACM SIGKDD Explorations Newsletter 14(1):16–24. https://doi.org/10.1145/2408736.2408740

    Article  Google Scholar 

  40. Hashem I, Yaqoob I, Anuar N, Mokhtar S, Gani A, Ullah Khan S (2015) The rise of big data on cloud computing: review and open research issues. Inf Syst 47:98–115. https://doi.org/10.1016/j.is.2014.07.006

    Article  Google Scholar 

  41. Hossin M, MN S (2015) A review on evaluation metrics for data classification evaluations. Int J Data Mining Knowl Manag Process 5(2):1–11. https://doi.org/10.5121/ijdkp.2015.5201

    Article  Google Scholar 

  42. Anguita D, Ghio A, Oneto L, Parra X, Reyes-Ortiz JL (2012) Human activity recognition on smartphones using a multiclass hardware-friendly support vector machine. In: International workshop on ambient assisted living, pp 216–223. https://doi.org/10.1007/978-3-642-35395-6_30

  43. R Core Team (2013) R: a language and environment for statistical computing r foundation for statistical computing, Vienna, Austria

  44. Hall M, Frank E, Holmes G, Pfahringer B, Reutemann P, Witten IH (2009) The WEKA data mining software: an update. ACM SIGKDD Explorations Newsletter 11(1):10–18. https://doi.org/10.1145/1656274.1656278b

    Article  Google Scholar 

  45. Gattinoni L, Radrizzani D, Simini B, Bertolini G, Ferla L, Mistraletti G, Porta F, Miranda DR et al (2004) Volume of activity and occupancy rate in intensive care units. association with mortality. Intensive Care Med 30(2):290–297. https://doi.org/10.1007/s00134-003-2113-4

    Article  Google Scholar 

  46. Iapichino G, Mistraletti G, Corbella D, Bassi G, Borotto E, Miranda DR, Morabito A (2006) Scoring system for the selection of high-risk patients in the intensive care unit. Crit Care Med 34(4):1039–1043. https://doi.org/10.1097/01.CCM.0000206286.19444.40

    Article  Google Scholar 

  47. Barlow H (1989) Unsupervised learning. Neural Comput 1(3):295–311. https://doi.org/10.1162/neco.1989.1.3.295

    Article  Google Scholar 

  48. Greene D, Cunningham P, Mayer R (2008) Unsupervised learning and clustering. Springer, Berlin. https://doi.org/10.1007/978-3-540-75171-7_3

    Book  Google Scholar 

  49. Gravina R, Alinia P, Ghasemzadeh H, Fortino G (2016) Multi-sensor fusion in body sensor networks: state-of-the-art and research challenges. Inform Fusion 35:68–80. https://doi.org/10.1016/j.inffus.2016.09.005

    Article  Google Scholar 

  50. Liggins MII, Hall D, Llinas J (2008) Handbook of multisensor data fusion: theory and practice. CRC Press, Boca Raton

    Book  Google Scholar 

  51. Yang GZ, Hu X (2006) Multi-sensor fusion. Springer, London. https://doi.org/10.1007/1-84628-484-8_8

    Book  Google Scholar 

  52. Chen C, Jafari R, Kehtarnavaz N (2015) A survey of depth and inertial sensor fusion for human action recognition. Multimed Tool Appl 76(3):1–21. https://doi.org/10.1007/s11042-015-3177-1

    Google Scholar 

  53. Graf AB, Smola AJ, Borer S (2003) Classification in a normalized feature space using support vector machines. IEEE Trans Neural Netw 14(3):597–605. https://doi.org/10.1109/TNN.2003.811708

    Article  Google Scholar 

  54. Heart and Stroke (2013) The canadian heart and stroke foundation. Heart disease recovery road http://www.heartandstroke.com

  55. Rumelhart DE, Hinton GE, Williams RJ (1985) Learning internal representations by error propagation. Tech. rep., DTIC Document

  56. Depari A, Flammini A, Sisinni E, Vezzoli A (2014) A wearable smartphone-based system for electrocardiogram acquisition. In: IEEE international symposium on medical measurements and applications (MeMeA’14), pp 1–6. https://doi.org/10.1109/MeMeA.2014.6860030

  57. Bellos CC, Papadopoulos A, Rosso R, Fotiadis DI (2010) Extraction and analysis of features acquired by wearable sensors network. In: 10th IEEE international conference on information technology and applications in biomedicine (ITAB’10), pp 1–4. https://doi.org/10.1109/itab.2010.5687761

  58. Guidi G, Pettenati MC, Melillo P, Iadanza E (2014) A machine learning system to improve heart failure patient assistance. IEEE J Biomed Health Inform 18(6):1750–1756. https://doi.org/10.1109/JBHI.2014.2337752

    Article  Google Scholar 

  59. Clifton L, Clifton DA, Pimentel MA, Watkinson PJ, Tarassenko L (2014) Predictive monitoring of mobile patients by combining clinical observations with data from wearable sensors. IEEE J Biomed Health Inform 18(3):722–730. https://doi.org/10.1109/jbhi.2013.2293059

    Article  Google Scholar 

  60. Oresko JJ, Jin Z, Cheng J, Huang S, Sun Y, Duschl H, Cheng AC (2010) A wearable smartphone-based platform for real-time cardiovascular disease detection via electrocardiogram processing. IEEE Trans Inf Technol Biomed 14(3):734–740. https://doi.org/10.1109/titb.2010.2047865

    Article  Google Scholar 

  61. Anliker U, Ward JA, Lukowicz P, Troster G, Dolveck F, Baer M, Keita F, Schenker EB, Catarsi F, Coluccini L et al (2004) AMON: a wearable multiparameter medical monitoring and alert system. IEEE Trans Inf Technol Biomed 8(4):415–427. https://doi.org/10.1109/titb.2004.837888

    Article  Google Scholar 

  62. Kunnath AT, Nadarajan D, Mohan M, Ramesh MV (2013) Wicard: a context aware wearable wireless sensor for cardiac monitoring. In: International conference on advances in computing, communications and informatics, pp 1097–1102. https://doi.org/10.1109/ICACCI.2013.6637330

  63. Solar H, Fernández E, Tartarisco G, Pioggiam G, Cvetković B, Kozina S, Luštrek M, Lampe J (2013) A non invasive, wearable sensor platform for multi-parametric remote monitoring in CHF patients. Health Technol 3(2):99–109. https://doi.org/10.1007/978-3-642-30779-9_18

    Article  Google Scholar 

  64. Liu N, Lin Z, Koh Z, Huang GB, Ser W, Ong MEH (2011) Patient outcome prediction with heart rate variability and vital signs. J Signal Process Syst 64(2):265–278. https://doi.org/10.1007/s11265-010-0480-y

    Article  Google Scholar 

  65. Leite C, Sizilio G, Neto A, Valentim R, Guerreiro A (2011) A fuzzy model for processing and monitoring vital signs in ICU patients. Biomed Eng Online 10:68–85. https://doi.org/10.1186/1475-925X-10-68

    Article  Google Scholar 

  66. Bellos C, Papadopoulos A, Rosso R, Fotiadis DI (2011) A support vector machine approach for categorization of patients suffering from chronic diseases. In: Wireless mobile communication and healthcare, Springer, pp 264–267. https://doi.org/10.1007/978-3-642-29734-2_36

  67. Gao H, Duan X, Guo X, Huang A, Jiao B (2013) Design and tests of a smartphones-based multi-lead ECG monitoring system. In: 35th international conference of the ieee engineering in medicine & biology society, pp 2267–2270. https://doi.org/10.1109/embc.2013.6609989

  68. Kailanto H, Hyvarinen E, Hyttinen J (2008) Mobile ECG measurement and analysis system using mobile phone as the base station. In: Second international conference on pervasive computing technologies for healthcare, pp 12–14. https://doi.org/10.1109/PCTHEALTH.2008.4571014

  69. Shih DH, Chiang HS, Lin B, Lin SB (2010) An embedded mobile ECG reasoning system for elderly patients. IEEE Trans Inf Technol Biomed 14(3):854–865. https://doi.org/10.1109/titb.2009.2021065

    Article  Google Scholar 

  70. Pandian P, Mohanavelu K, Safeer K, Kotresh T, Shakunthala D, Gopal P, Padaki V (2008) Smart vest: wearable multi-parameter remote physiological monitoring system. Med Eng Phys 30(4):466–477. https://doi.org/10.1016/j.medengphy.2007.05.014

    Article  Google Scholar 

  71. Juen J, Cheng Q, Schatz B (2015) A natural walking monitor for pulmonary patients using mobile phones. IEEE J Biomed Health Inform 19(4):1399–1405. https://doi.org/10.1109/jbhi.2015.2427511

    Article  Google Scholar 

  72. Esfandiari N, Babavalian MR, Moghadam AME, Tabar VK (2014) Knowledge discovery in medicine: current issue and future trend. Expert Syst Appl 41(9):4434–4463. https://doi.org/10.1016/j.eswa.2014.01.011

    Article  Google Scholar 

  73. Bellos CC, Papadopoulos A, Rosso R, Fotiadis DI (2014) Identification of COPD patients’ health status using an intelligent system in the CHRONIOUS wearable platform. IEEE J Biomed Health Inform 18(3):731–738. https://doi.org/10.1109/jbhi.2013.2293172

    Article  Google Scholar 

  74. Krause A, Ihmig M, Rankin E, Leong D, Gupta S, Siewiorek D, Smailagic A, Deisher M, Sengupta U (2005) Trading off prediction accuracy and power consumption for context-aware wearable computing. In: Ninth IEEE international symposium on wearable computers, pp 20–26. https://doi.org/10.1109/ISWC.2005.52

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Acknowledgments

Support from the McMaster School of Biomedical Engineering, McMaster Science & Research Board (SERB), Vector Institute for Artificial Intelligence, and Natural Sciences & Engineering Research Council of Canada (NSERC) is acknowledged.

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Boursalie, O., Samavi, R. & Doyle, T.E. Machine Learning and Mobile Health Monitoring Platforms: A Case Study on Research and Implementation Challenges. J Healthc Inform Res 2, 179–203 (2018). https://doi.org/10.1007/s41666-018-0021-1

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