IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 18, NO.

3, MAY 2014

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Enabling Smart Personalized Healthcare: A Hybrid

Mobile-Cloud Approach for ECG Telemonitoring
Xiaoliang Wang, Qiong Gui, Bingwei Liu, Zhanpeng Jin, Member, IEEE, and Yu Chen, Member, IEEE

AbstractThe severe challenges of the skyrocketing healthcare

expenditure and the fast aging population highlight the needs for
innovative solutions supporting more accurate, affordable, flexible, and personalized medical diagnosis and treatment. Recent advances of mobile technologies have made mobile devices a promising tool to manage patients own health status through services
like telemedicine. However, the inherent limitations of mobile devices make them less effective in computation- or data-intensive
tasks such as medical monitoring. In this study, we propose a new
hybrid mobile-cloud computational solution to enable more effective personalized medical monitoring. To demonstrate the efficacy
and efficiency of the proposed approach, we present a case study
of mobile-cloud based electrocardiograph monitoring and analysis
and develop a mobile-cloud prototype. The experimental results
show that the proposed approach can significantly enhance the
conventional mobile-based medical monitoring in terms of diagnostic accuracy, execution efficiency, and energy efficiency, and
holds the potential in addressing future large-scale data analysis in
personalized healthcare.
Index TermsElectrocardiograph (ECG), medical monitoring,
mobile cloud, telemedicine.

I. INTRODUCTION
CCORDING to the World Health Organization (WHO)
[1], the United States spends about 17.6% of its gross
domestic product on healthcare, the highest level in the world
and far higher than the percentage for other developed countries
(9.3% on average). Nevertheless, the use of healthcare services
in U.S. is far below that of comparable countries [2], reflecting
greater inefficiency and higher prices for healthcare services in
the United States. The skyrocketing medical expenditures and
continuous aging of the worlds population demand transformative technological innovations to provide more effective and
affordable healthcare services, available to anyone at any time
and in any place [3].
A critical and costly part of current healthcare systems is
the monitoring of patients vital signs and other physiological signals, all of which play significant roles in physicians

Manuscript received May 16, 2013; revised August 15, 2013; accepted
October 7, 2013. Date of publication October 17, 2013; date of current version May 1, 2014.
X. Wang, Q. Gui, B. Liu, and Y. Chen are with the Department of Electrical and Computer Engineering, Binghamton University, State University of
New York, Binghamton, NY 13902 USA (e-mail: xwang90@binghamton.edu;
bliu11@binghamton.edu; qgui1@binghamton.edu; ychen@binghamton.edu).
Z. Jin is with the Departments of Electrical and Computer Engineering,
and Bioengineering, Binghamton University, State University of New York,
Binghamton, NY 13902 USA (e-mail: zjin@binghamton.edu).
Color versions of one or more of the figures in this paper are available online
at http://ieeexplore.ieee.org.
Digital Object Identifier 10.1109/JBHI.2013.2286157

diagnostic processes. Modern inpatient and outpatient facilities

can provide a high level of protection to clinically ill patients,
through a set of resting, bedside medical monitoring equipment.
However, less attention has been paid to long-term, off-site or
in-home care that is believed to be one of the most effective
ways for addressing increasingly severe chronic diseases [4].
The highly specialized and extremely expensive medical monitoring equipment found in hospitals is neither easily accessible
nor affordable for those scenarios.
Recent advances in wireless body sensors and mobile technologies have promoted the use of mobile-based health monitoring and alert systems (usually referred as mHealth). Such systems aim at providing real-time feedback about an individuals
health condition, while alerting in case of health-threatening
conditions. In the United States, it is reported that 88% of adults
are cellphone owners [5], and the number of smartphone users
is expected to be approximately 200 million by 2016 [6]. The
increasing popularity of mobile devices can forge new opportunities toward the grand vision of pervasive healthcare [7].
Recently, many mobile-based medical monitoring devices have
been developed with the capability of processing a wide variety of classes of physiological signals [8], [9]. However, the
limited computational power, storage space, and battery life
of existing mobile devices significantly limit their ability to
execute resource-intensive applications [10]. Recently, the fastgrowing cloud computing technology has led to a novel computing paradigm, called mobile cloud computing (MCC), which
allows users an online access to unlimited computing power
and storage space. This paradigm not only enables users to
enjoy convenient, versatile, and efficient computing services,
but also raises the possibility of providing more accurate offsite personalized medical diagnosis and treatment, as shown in
Fig. 1.
In this study, we propose a new solution to renovate and promote the use of mobile devices in healthcare, leveraging the
emerging cloud computing. Under the proposed architecture,
mobile devices can be used to acquire various physiological
signals from a set of ambient/body sensors and perform the
regular lightweight on-site diagnostic processing tasks. To accelerate those intensive computations and extend the battery
life of mobile devices, the acquired physiological signals will
also be transferred to a cloud service environment to perform
computation-intensive algorithmic processing (such as the training procedure demanded in most of the machine learning algorithms). The algorithmic processing results, normally in the form
of a patient-specific, finer-tuned, or updated diagnostic processing engine, will be immediately deployed on the mobile device
through a nearly seamless interaction between the mobile and

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Fig. 1.

IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 18, NO. 3, MAY 2014

Diverse telemedicine applications based on the cloud.

the cloud. Such an interaction will enable the mobile device to

effectively detect physiological abnormalities and, thus, raises
diagnostic alarms. This application mode can be of particular
significance to patients whose physiological signals need to be
monitored continuously. Physicians can also perform more accurate diagnoses by accessing the archived physiological data
via web applications.
The rest of the paper is organized as follows. Section II provides a survey of related work on the applications of MCC in
healthcare. Section III describes the architecture of the proposed
hybrid mobile-cloud approach in addressing the needs of personalized pervasive medical monitoring. Section IV presents
a case study of mobile-cloud-based electrocardiograph (ECG)
monitoring. Section V illustrates a set of experiments to evaluate
the efficacy and efficiency of the proposed solution. Conclusions
and future work are provided in Section VI.
II. RELATED WORK
According to Kovachev et al. [11], Mobile cloud computing is a model for transparent elastic augmentation of mobile
device capabilities via ubiquitous wireless access to cloud storage and computing resources, with context-aware dynamic adjusting of offloading in respect to change in operating conditions, while preserving available sensing and interactivity capabilities of mobile devices. MCC has created a tremendous
amount of momentum toward increasing access to healthcare
via telemedicine [12]. However, the potential application of
cloud computing in telemedicine is not yet clearly recognized
and identified [13], [14], and a lot of open problems need to be
investigated.
A proof-of-concept, patient-centric, home healthcare service
platform has been developed by a European Union consortium,
based on an advanced trustworthy cloud infrastructure [15]. This
cloud-based platform can remotely monitor, diagnose, and assist patients outside of a hospital setting. Patients medication
records will be stored securely in the cloud and, thus, be acces-

sible by the patient, physicians, and pharmacy staff. The main

goal of this project is to demonstrate how the quality of in-home
healthcare can be improved cost efficiently through the use of
cloud computing.
Hsieh and Hsu [16] presented a 12-lead ECG telemedicine
cloud service enabling ubiquitous delivery of interhospital ECG
records. This cloud-based telemedicine service enables hospitals to store and manage patients ECG records via web access through the Internet connection of clinically used ECG
instruments, and thus can realize interoperability across various
mobile and fixed devices.
Two mobile-based self-reporting and monitoring telemedicine sytems were developed on Google App Engine, named
SickleREMOTE [17] and caREMOTE [18], respectively,
to facilitate the care of pediatric sickle cell diseases and investigate the health-related quality of life of cancer patients. Shen
et al. [19] proposed a cloud-based electroencephalograph signal
analysis system to detect epileptic seizures and brain disorder
diseases, where the computation-intensive functions of feature
extraction, feature selection, and support vector machine (SVM)
classifier are implemented and deployed using cloud services.
Many other similar studies [20][22] have also fully demonstrated the potential of mobile- and cloud-based telemedicine
solutions in enabling continuous monitoring of patients health
status and, thus, ensuring timely treatment and care.
III. SYSTEM ARCHITECTURE
Wearable body sensors and mobile devices have been widely
used to monitor the health status of patients or the elderly and
generate alarms in case of imminent medical conditions. However, the limited computational power and energy supply of mobile devices result in either high false alarm rate or short battery
life, prohibitive for continuous pervasive medical monitoring.
Cloud computing embraces new opportunities of transforming
healthcare delivery into a more sustainable manner. In this study,
we will examine the performance of a hybrid approach by taking advantage of the real-time, on-site monitoring capability of
mobile devices and the abundant computing power of the cloud.
We seek to investigate a dynamic workload balancing strategy
to meet the needs for both high processing accuracy and high
energy efficiency.
As shown in Fig. 2, in telemedicine, the mobile devices can
be connected wirelessly to physiological body sensors to collect data, such as blood pressure, temperature, heart rate, and
ECG [23]. Those medical monitoring data can be routed to the
physician for detailed evaluation or to a computer-aided diagnostic program to automatically identify any abnormalities in
physiological measurements and provide the alerts or warnings
to caregivers for timely response [24]. The use of portable physiological and cognitive monitoring systems will enable physicians (and patients) to closely monitor patients health status and
effectively prevent major medical conditions without the costly
and time-consuming hospital visits. This type of telemonitoring
is particularly effective for managing chronic diseases for elderly adults such as diabetes, hypertension, and cardiovascular
diseases (CVDs), and has been shown to reduce hospitalization
and mortality rates [25].

WANG et al.: ENABLING SMART PERSONALIZED HEALTHCARE: A HYBRID MOBILE-CLOUD APPROACH FOR ECG TELEMONITORING

Fig. 2.

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Telemedicine in a mobile cloud.

Conventional diagnostic analysis is usually based on fixedvalue thresholds, or simple combinations of rules based on predetermined thresholds [26]. However, the lack of individualspecific applicability and adaptivity makes it less effective in
capturing real, clinically significant medical conditions and results in substantial number of false alarms. More sophisticated
machine learning techniques have also been extensively investigated and used in identifying imminent medical problems
by automatically comparing and recognizing the abnormal behaviors from a huge amount of physiological signal and vital
sign data. Those algorithms have shown superior performance
in correctly classifying various medical conditions, based on
well-established supervised training procedures. For instance,
according to our earlier studies, the artificial neural network
(ANN)-based ECG signal processing algorithm can achieve over
95% accuracy in detecting various cardiac arrhythmia [23], and
the SVM-based multiparameter vital sign analysis can significantly reduce the amount of false alarms [10].
However, in order to achieve a satisfactory training performance, those machine learning approaches usually demand a
large set of a priori knowledge as the training dataset and iteratively perform the computation-intensive training processes,
which make it impossible and unfeasible to execute on a mobile platform. It may take more than 16 weeks to sufficiently
train the neural network implemented for cardiac arrhythmia
detection [27] using the entire MIT-BIH database [28], [29].
Our previous study [10] also presents the findings that a fully
charged smartphone can only last about 6 h when using a moderate fuzzy logic algorithm to perform the multiparameter vital
sign analysis.
To address the increasing demands on more sustainable use
of mobile devices in telemedicine applications, it is imperative
to explore novel alternative solutions to strategically manage the
workloads on the mobile devices. Cloud computing embraces
new opportunities of alleviating the computing loads of mobile
devices by providing a flexible and scalable computing platform,
which also results in a more cost-effective and energy-efficient
solution for future large-scale medical data management. In this
study, we propose to migrate the highly involved supervised
training procedure, which represents the most computationintensive and resource-consuming tasks in all those machine
learning techniques, into the cloud computing infrastructure.

The mobile devices will, thus, transmit all sensing data acquired from wearable body sensors or portable physiological
monitors to the cloud, which now can provide a large pool of
easily accessible dataset for the supervised training procedures.
On the other hand, the implementations of those machine learning algorithms deployed on mobile devices can continue their
regular classification processing without any cease, based on
the latest trained configurations. Once the supervised training
on the cloud is finished, the well-trained configurations will be
sent back to the mobile devices and, thus, to update the existing
implementation instance of the machine learning algorithms on
the mobile.
In addition to the benefits of substantially reduced power
consumption and extended battery life of the mobile devices,
this bidirectional, dynamically adaptive workload migration approach can constantly improve the performance of the deployed
machine learning techniques by regularly tuning and updating
them based on the most recent training results. As new sensing
data of a specific human subject is continuously processed on the
mobile and backed up on the cloud, the whole system holds the
potential to gradually evolve itself toward an even higher diagnostic accuracy through unrelenting individual-specific training
and adaptation. In this paper, we will also show how this synergistic interaction can improve the diagnostic accuracy by incorporating patient-specific physiological characteristics through
the periodical fine tuning and training for the deployed processing engine.
IV. CASE STUDY: MOBILE-CLOUD-BASED ECG MONITORING
AND ANALYSIS
Among all medical monitoring services, the monitoring of
ECG signals is of particular interest and value to the whole
society [30]. CVD is the single leading cause of death in the
United States, and according to the American Heart Association [31], an estimated 83.6 million American adults have one
or more types of CVD and over 2150 Americans die of CVD
each day. Cardiac arrhythmia is a very common type of CVD
and is believed to be responsible for most of the sudden cardiac deaths. The most common test for a cardiac arrhythmia is
through screening and analyzing the ECG, which measures the
electrical impulses of the heart via electrodes on the skin.

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Fig. 3.

IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 18, NO. 3, MAY 2014

Processing flow of ECG signals on the proposed mobile-cloud platform.

Over the past several decades, ECG-based CVD detection has

been extensively studied in both research and clinical settings.
A typical ECG processing flow includes the following stages:
signal preprocessing, feature extraction, heartbeat classification,
and diagnostic decision making. Specifically, the signal preprocessing is intended to remove any noise or artifacts [32], such as
baseline drift and power-line interference. The processed ECG
signals will then be screened to extract statistical and morphological features, among which the most representative features
are the QRS complexes [33]. After that, the extracted features
will be compared against standard patterns or individual-specific
characteristics to be classified into different categories that represent a wide variety of medical conditions [34]. Based on the
classification results as well as the clinical significance and duration of the detected medical conditions, physicians can confirm
the presence of CVDs and make diagnostic decisions.
Given the increasing demands on pervasive healthcare and
the recent advances in mobile technologies, many portable ECG
monitoring and diagnosis systems have been developed based
on a wide variety of handheld devices, like PDAs and smartphones [8]. However, as discussed in Section III, the limited
computational capability, storage space, and battery life of mobile devices make it less effective to perform more sophisticated
tasks on site, especially for the computation- and data-intensive
training in machine learning approaches that are often used for
the classification of heartbeats and other ECG features. For instance, it may take hours to days to complete the training of an
ANN-based ECG classification algorithm on the smartphone,
according to our previous study [27].
In this case study, we adopt the classic Pan-Tompkins algorithm [35], a very popular real-time QRS complex-based heartbeat detection approach that reports a predictive accuracy of
up to 99.3%. The heartbeat classifier is developed based on a
30-neuron ANN whose inputs are the raw ECG signals. For
each identified heartbeat, a total 41 sample points are used as
the ANN inputs, including 14 points before the fiducial mark
and 26 points after [36]. For the training process, without loss
of generality, three types of heartbeats are considered: normal,
premature ventricular contractions, and other beats. In this way,
the target ANN contains 41 inputs and three outputs (i.e., three
types of heartbeats).
We implemented and deployed the entire ECG processing
flow onto a hybrid mobile-cloud prototype. The mobile device
was a Google Galaxy Nexus smartphone with the Android 4.2

Jelly Bean system. The smartphone contains a 1.2-GHz dualcore ARM Cortex-A9 microprocessor, 1-GB memory, and a
1750-mAh battery. The cloud computing infrastructure was developed based on the Xen Cloud Platform and a Dell PowerEdge
M620 server, equipped with 12 Xeon 2.5-GHz cores and 64GB memory. All the experiments were performed based on the
MIT-BIH arrhythmia database [28], [29].
The ECG processing flow on the developed prototype has
been illustrated in Fig. 3. All incoming ECG samples will first
be processed to detect and extract the heartbeats (not shown in
the figure) that are then forwarded to the ANN-based processing
engine for heartbeat classification. The ANN engine is initially
set to the default configuration, with which all the internal synaptic weights are randomly determined. When the mobile device
launches the ECG processing, the patients historical ECG data
along with physicians diagnostic annotations (golden alarms)
are sent to the cloud server to train the ANN engine that is deployed on the cloud server with exactly same configuration as
the one deployed on the mobile device. Given the fact that medical monitoring is supposed to be performed in a continuous
(nonstop) manner to ensure any abnormal conditions can be accurately detected and recognized, we implemented two separate
execution threads on the mobile device in order to minimize
the interference. While the training data (e.g., 1/3 of a patients
record from the MIT-BIH database) are transmitted to the cloud
via Thread 1, the newly acquired ECG signals (e.g., the remaining 2/3 of a patients record in our study) will be concurrently
processed based on the ANN engine (with default configuration)
on the mobile, through the other computing threadThread 2.
Based on the received training dataset, the ANN engine on
the cloud will be well trained (t0 ), which results in an optimized weight matrix and a TRAINING_READY signal. The
Thread 1 on the mobile keeps snooping the communication
channel with the cloud, and immediately starts to receive the
optimized weight matrix when the TRAINING_READY signal is detected. During this period, the Thread 2 on the mobile
continues to process all incoming ECG signals (t1 ) through the
ANN engines feed-forward calculations, though still based on
the initial synaptic configurations. When the Thread 1 has completely received the entire trained weight matrix, the Thread 2
will cease the current processing and temporarily discard all incoming ECG samples to update the ANN engine on the mobile
using the trained weight matrix. It is manifest that this updating
procedure (tc ) will lead to a vulnerable off-line state for users

WANG et al.: ENABLING SMART PERSONALIZED HEALTHCARE: A HYBRID MOBILE-CLOUD APPROACH FOR ECG TELEMONITORING

TABLE I
EXPERIMENTAL DATASET (NUMBER OF HEARTBEATS) AND CARDIOVASCULAR
ARRHYTHMIA DETECTION ACCURACY (IN PERCENTAGE) ON THE
MOBILE-CLOUD PLATFORM

because no ECG analysis will be performed during this period

of time. Therefore, one of our design goals is to minimize the
off-line duration (tc ) caused by updating the ANN engine on
the mobile. Once the ANN engine has been updated, it will
immediately resume the standard feed-forward calculations for
all new incoming ECG samples (t2 ), with the optimized synaptic weight configurations. This mobile-cloud interaction will be
periodically iterated when the current ANN configuration is no
longer effective in capturing the patients personal physiological
characteristics, given the patients changing physical activities
or the changing surveillant environment.
V. EXPERIMENTAL RESULTS
In order to evaluate the performance of the proposed hybrid
mobile-cloud solution for ECG signal processing and demonstrate the potential of this approach in addressing future largescale data analysis in personalized telemedicine, we conducted
a set of experiments to investigate the efficacy and efficiency of
the developed prototype, in terms of CVD detection accuracy
and execution efficiency. We chose nine representative patients
records (#118, #119, #200, #203, #205, #207, #208, #221, and
#223) from the MIT-BIH database [28], [29].
Table I presents the composition of the experimental datasets
used in our study. About 1/3 of the ECG data in each patient
record has been used for training purpose. In order to make an
objective comparison of ECG classification accuracy between
the stage with untrained/dated ANN (t1 ) and the stage with
well-trained ANN (t2 ), we use exactly same testing dataset
in both stage t1 and stage t2 . Table I also shows the ECG
classification accuracy for the testing dataset based on different
ANN configurations (i.e., untrained/dated ANN versus welltrained ANN). The accuracy metric is defined as
Accuracy(%) =

TP + TN
100%
TP + FN + TN + FP

(1)

where the true positives (TP) indicate correctly classified abnormal beats and the true negatives (TN) indicate correctly
classified normal beats. Accordingly, the false positives (FP)
represent the normal beats that are classified as abnormal ones
and the false negatives (FN) represent the real abnormal beats
that are not correctly detected. It is shown that the classification accuracy based on a well-trained ANN classifier is very
satisfactory (i.e., over 98% on average) and higher than the one

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TABLE II
EXECUTION EFFICIENCY ON THE MOBILE-CLOUD PLATFORM (IN SECONDS)

based on an untrained/dated ANN classifier (i.e., around 65%

on average). More interestingly, we can observe that patients
#118, #200, and #208 have very low classification accuracy
(i.e., 48.16%, 37.30%, and 12.62%), which is caused by the default synaptic weight configuration of the ANN classifier (i.e.,
randomly generated weight matrix), while remaining six patients have relatively higher accuracy in stage t1 . This scenario
clearly demonstrate the impact of a well-calibrated training process on the classification results. All remaining six patients are
using an ANN classifier that is well trained based on another
patients data (i.e., optimized for another patients data), named
as dated ANN. Such dated ANN may give generally correct
results since it is able to capture the general characteristics of human population through the training for a specific patient (i.e.,
#118, #200, or #208); however, it cannot precisely recognize
individual-specific characteristics of the current human subject
and the performance can be further improved by applying new
training processes.
The execution efficiency is another critical metric of concern.
Table II illustrates the elapsed time for difference stages, including the training time on the cloud (timet 0 ), the training time on
the cloud plus the data communication overhead (timet 1 ), and
the off-line time (timet c ) used for updating the ANN classifier
with a newly trained weight matrix. The results show that the
training process on the cloud can be done using a fairly small
amount of time (i.e., less than 1 min), which still remains at
an acceptable level even considering the data communication
overhead (i.e., about 1 min). Since during the off-line time, the
ANN classifier on the mobile has to be terminated in order to
update the weight matrix, so our goal is to minimize the off-line
time to reduce the risk of patients due to lack of monitoring. It
is shown that the off-line time has been reasonably maintained
at the level of only a few seconds.
The most significant impact of the proposed solution is to improve the execution accuracy and efficiency. Through the periodical training, the ANN classifier on the mobile can accurately
detect cardiovascular arrhythmia for difference patients, or even
for the same patient who have varying ECG conditions due to
changing physical behaviors. In terms of execution efficiency,
we thus make explicit comparison between the mobile and the
cloud. It is worthy to note that we will consider the data communication overhead in the training time needed by the cloud,
and compare it against the training time needed on the mobile (no communication overhead), as shown in Table III. The
results unsurprisingly highlight the superior advantage of the

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TABLE III
COMPARISON OF EXECUTION EFFICIENCY (I.E., ELAPSED TRAINING TIME)
BETWEEN THE MOBILE-CLOUD APPROACH AND THE MOBILE-ONLY APPROACH
(IN SECONDS)

TABLE IV
COMPARISON OF ENERGY EFFICIENCY (I.E., REDUCED BATTERY LEVEL)
BETWEEN THE MOBILE-CLOUD APPROACH AND THE MOBILE-ONLY APPROACH
(IN PERCENT)

proposed approach (about 37X speedup) in handling

computation- and data-intensive tasks in medical monitoring.
This advantage could be further enhanced by optimizing the
data communications in our approach.
Another far-reaching advantage of the proposed solution is
the substantial energy saving. The limited battery life of existing
mobile devices has dramatically limited their use in telemedicine
applications, which normally demand continuous processing of
incoming medical data and cannot afford frequent battery charging. It is manifest that we can achieve energy saving by strategically offloading computation-intensive workloads from the
mobile devices to the cloud. However, the intensive data communications between the mobile and the cloud may introduce
and impose new energy burdens. Therefore, it is imperative to
investigate and evaluate the actual energy consumption level for
our proposed approach. Table IV presents the energy efficiency,
in terms of the percentage of battery level reduction on the mobile device, for both our proposed approach and the mobile-only
approach. It is seen that we can achieve approximately an average of 88% energy saving for each patient record, by using our
proposed hybrid mobile-cloud approach. It is worthy to mention that the battery measurement mechanism in Android has
the resolution limit of 1% (i.e., the minimum level of battery reduction we can show), so that we can reasonably argue that our
proposed approach may have even higher energy saving given
the fact that most of their battery reduction readings are 1%.
Though the proposed approach has shown significant advantage in energy efficiency, we would like to explore other methods to further reduce the energy consumption, which will be of

TABLE V
COMPARISON OF DETECTION ACCURACY AND ENERGY EFFICIENCY
(I.E., REDUCED BATTERY LEVEL) BETWEEN RAW ECG DATA AND
DOWNSAMPLED ECG DATA ON THE MOBILE-CLOUD PLATFORM

particular interest to scenarios when extended battery life is required or the battery level is low. A common approach of reducing the amount of computation as well as the energy consumption is to downsample the input data stream [37], which however,
may unavoidably affect the processing accuracy. In this study,
we seek to achieve an optimal balance between the accuracy and
execution efficiency, by investigating the system performance
based on downsampled data. Table V compares the detection
accuracy and energy efficiency between the scheme based on
raw ECG data and the one based on half-downsampled ECG
data. According to the table, we can only observe a slight degradation in detection accuracy: less than 2% for the well-trained
ANN and less than 8% for the untrained ANN. For energy consumption, given the resolution limitation of battery measurement in Android, we aggregated all nine patients records and
kept track of the overall energy consumption. It is observed that,
by downsampling the input data stream, we can achieve a further
energy saving of 40% (i.e., energy level reduction from 10% to
6%). Such observation will allow us to pursue high-accuracy,
ultralow-power, personalized telemedicine solutions.
VI. CONCLUSION
Medical monitoring and diagnosis usually involve largescale, knowledge-based data processing and analysis. Recently
mobile-based personalized medical monitoring has emerged as a
promising solution in providing affordable and effective healthcare services and allowing people to keep track of their own
health status in a more convenient manner. However, the limited
computational power, storage space, and battery life of mobile devices make it inefficient to use those mobile devices for
computation- and data-intensive tasks, which significantly limit
the potential and opportunity of mobile-based healthcare.
In this study, we propose a new hybrid solution to address
the increasing demands for large-scale data processing in personalized healthcare, leveraging the fast-growing mobile and
cloud computing technologies. The combination of mobile and
cloud computing provides a unique way to synergistically utilize
the strengths of each party. Based on a case study of mobilecloud-based medical monitoring, we show the application of the
proposed hybrid approach in real healthcare applications. Moreover, the experimental results fully demonstrate the efficacy and
efficiency of the proposed approach. Unfortunately, this study

WANG et al.: ENABLING SMART PERSONALIZED HEALTHCARE: A HYBRID MOBILE-CLOUD APPROACH FOR ECG TELEMONITORING

also suffers from some practical issues. For instance, the security
is an another key factor of concern for mobile-based healthcare,
besides the diagnostic accuracy, computational performance,
and energy efficiency. Though our proposed approach shows
tremendous advantages and holds the promise of transforming
future personalized healthcare, the intensive data communications between the mobile and the cloud may expose users to
higher security and privacy threats, which need to be specifically addressed.
In our future study, we will precisely profile and characterize
the power consumption caused by various data communications
and, thus, explore alternative ways to extend the battery life
(e.g., optimize the training dataset to be transmitted), while
maintaining the desired performance and accuracy. Also, the
application of the proposed hybrid mobile-cloud approach in
other healthcare areas will also be investigated.
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