Transformer-based Mobile Health Text Analytics System: Intelligent Symptom Monitoring and Alert for Pervasive Healthcare Environments
DOI:
https://doi.org/10.4108/eetpht.11.11667Keywords:
Transformer models, Mobile Health, Clinical decision support, Federated learning, Healthcare equityAbstract
Healthcare accessibility challenges disproportionately affect underserved populations, with communication barriers between patients and providers contributing to diagnostic errors and suboptimal outcomes. This study develops and validates a transformer-based lightweight mobile health text analytics system for intelligent symptom monitoring in pervasive healthcare environments. The system employs a DistilBERT-based architecture compressed to 45MB, integrated with medical knowledge graphs incorporating ICD-10 and SNOMED CT standards, and trained on 15,000 medical records from ten hospitals. A three-tier pervasive computing architecture enables cross-platform deployment across iOS, Android, and HarmonyOS, while a four-tier risk stratification framework classifies conditions into self-observation (70%), community consultation (20%), hospital evaluation (8%), and emergency intervention (2%) categories. Privacy preservation utilizes federated learning with differential privacy mechanisms. Clinical effectiveness was evaluated through a randomized controlled trial involving 1,500 participants across diverse demographics. Results demonstrated 86.8% diagnostic concordance versus 70.2% in controls, achieving 93.7% sensitivity and 98.4% specificity for critical symptoms, while reducing emergency department visits by 35.7% and achieving $847 cost savings per patient. Patient experience improvements included 82.7 System Usability Scale scores and 78.4% sustained engagement. This research establishes a paradigm for responsible AI deployment in healthcare that prioritizes clinical effectiveness and social responsibility, contributing to universal health coverage through innovative, accessible, and ethically sound technologies.
Downloads
References
[1] A. Motwani, P. K. Shukla, and M. Pawar, "Ubiquitous and smart healthcare monitoring frameworks based on machine learning: A comprehensive review," Artificial Intelligence in Medicine, vol. 134, p. 102431, 2022.
[2] N. C. Coombs, D. G. Campbell, and J. Caringi, "A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access," BMC Health Services Research, vol. 22, no. 1, p. 438, 2022.
[3] M. E. Cyr, A. G. Etchin, B. J. Guthrie, and J. C. Benneyan, "Access to specialty healthcare in urban versus rural US populations: a systematic literature review," BMC health services research, vol. 19, no. 1, p. 974, 2019.
[4] A. Natarajan, M. Gould, A. Daniel, R. Mangal, and L. Ganti, "Access to healthcare in rural communities: A bibliometric analysis," Health Psychology Research, vol. 11, p. 90615, 2023.
[5] D. E. Newman-Toker, Z. Wang, Y. Zhu, N. Nassery, A. S. S. Tehrani, A. C. Schaffer, C. W. Yu-Moe, G. D. Clemens, M. Fanai, and D. Siegal, "Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”," Diagnosis, vol. 8, no. 1, pp. 67-84, 2021.
[6] H. Singh, A. N. Meyer, and E. J. Thomas, "The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations," BMJ quality & safety, vol. 23, no. 9, pp. 727-731, 2014.
[7] A. Chapman, A. Buccheri, D. Mohotti, A. Wong Shee, C. E. Huggins, L. Alston, A. M. Hutchinson, S. L. Yoong, H. Beks, and K. Mc Namara, "Staff-reported barriers and facilitators to the implementation of healthcare interventions within regional and rural areas: a rapid review," BMC Health Services Research, vol. 25, no. 1, p. 331, 2025.
[8] K. Cortelyou-Ward, D. N. Atkins, A. Noblin, T. Rotarius, P. White, and C. Carey, "Navigating the digital divide: barriers to telehealth in rural areas," Journal of health care for the poor and underserved, vol. 31, no. 4, pp. 1546-1556, 2020.
[9] W. Peng, J. McKinnon-Crowley, J. Han, and J. Bryant, "Explaining Health-Related Internet Use for Three Patient Engagement Activities in Rural Pacific Northwest," Family & Community Health, p. 10.1097, 2025.
[10] S. Madan, M. Lentzen, J. Brandt, D. Rueckert, M. Hofmann-Apitius, and H. Fröhlich, "Transformer models in biomedicine," BMC medical informatics and decision making, vol. 24, no. 1, p. 214, 2024.
[11] X. Yang, J. Bian, W. R. Hogan, and Y. Wu, "Clinical concept extraction using transformers," Journal of the American Medical Informatics Association, vol. 27, no. 12, pp. 1935-1942, 2020.
[12] J. Lee, W. Yoon, S. Kim, D. Kim, S. Kim, C. H. So, and J. Kang, "BioBERT: a pre-trained biomedical language representation model for biomedical text mining," Bioinformatics, vol. 36, no. 4, pp. 1234-1240, 2020.
[13] A. Turchin, S. Masharsky, and M. Zitnik, "Comparison of BERT implementations for natural language processing of narrative medical documents," Informatics in Medicine Unlocked, vol. 36, p. 101139, 2023.
[14] K. C. Maita, M. J. Maniaci, C. R. Haider, F. R. Avila, R. A. Torres-Guzman, S. Borna, J. J. Lunde, J. D. Coffey, B. M. Demaerschalk, and A. J. Forte, "The impact of digital health solutions on bridging the health care gap in rural areas: a scoping review," The Permanente Journal, vol. 28, no. 3, p. 130, 2024.
[15] L. J. Hand, "The role of telemedicine in rural mental health care around the globe," Telemedicine and e-Health, vol. 28, no. 3, pp. 285-294, 2022.
[16] K. Denecke, R. May, and O. Rivera-Romero, "Transformer models in healthcare: a survey and thematic analysis of potentials, shortcomings and risks," Journal of Medical Systems, vol. 48, no. 1, p. 23, 2024.
[17] Y. Kim, J.-H. Kim, J. M. Lee, M. J. Jang, Y. J. Yum, S. Kim, U. Shin, Y.-M. Kim, H. J. Joo, and S. Song, "A pre-trained BERT for Korean medical natural language processing," Scientific reports, vol. 12, no. 1, p. 13847, 2022.
[18] L. Rasmy, Y. Xiang, Z. Xie, C. Tao, and D. Zhi, "Med-BERT: pretrained contextualized embeddings on large-scale structured electronic health records for disease prediction," NPJ digital medicine, vol. 4, no. 1, p. 86, 2021.
[19] K. Klug, K. Beckh, D. Antweiler, N. Chakraborty, G. Baldini, K. Laue, R. Hosch, F. Nensa, M. Schuler, and S. Giesselbach, "From admission to discharge: a systematic review of clinical natural language processing along the patient journey," BMC Medical Informatics and Decision Making, vol. 24, no. 1, p. 238, 2024.
[20] M. Garifulla, J. Shin, C. Kim, W. H. Kim, H. J. Kim, J. Kim, and S. Hong, "A case study of quantizing convolutional neural networks for fast disease diagnosis on portable medical devices," Sensors, vol. 22, no. 1, p. 219, 2021.
[21] S. Ö. Bursa, Ö. Durmaz İncel, and G. Işıklar Alptekin, "Building lightweight deep learning models with TensorFlow Lite for human activity recognition on mobile devices," Annals of Telecommunications, vol. 78, no. 11, pp. 687-702, 2023.
[22] A. Kline, H. Wang, Y. Li, S. Dennis, M. Hutch, Z. Xu, F. Wang, F. Cheng, and Y. Luo, "Multimodal machine learning in precision health: A scoping review," NPJ digital medicine, vol. 5, no. 1, p. 171, 2022.
[23] F. Krones, U. Marikkar, G. Parsons, A. Szmul, and A. Mahdi, "Review of multimodal machine learning approaches in healthcare," Information Fusion, vol. 114, p. 102690, 2025.
[24] T. Shaik, X. Tao, L. Li, H. Xie, and J. D. Velásquez, "A survey of multimodal information fusion for smart healthcare: Mapping the journey from data to wisdom," Information Fusion, vol. 102, p. 102040, 2024.
[25] R. A. Taylor, C. Chmura, J. Hinson, B. Steinhart, R. Sangal, A. K. Venkatesh, H. Xu, I. Cohen, I. V. Faustino, and S. Levin, "Impact of artificial intelligence–based triage decision support on emergency department care," NEJM AI, vol. 2, no. 3, p. AIoa2400296, 2025.
[26] N. Yi, D. Baik, and G. Baek, "The effects of applying artificial intelligence to triage in the emergency department: A systematic review of prospective studies," Journal of Nursing Scholarship, vol. 57, no. 1, pp. 105-118, 2025.
[27] S. Tyler, M. Olis, N. Aust, L. Patel, L. Simon, C. Triantafyllidis, V. Patel, D. W. Lee, B. Ginsberg, and H. Ahmad, "Use of artificial intelligence in triage in hospital emergency departments: a scoping review," Cureus, vol. 16, no. 5, 2024.
[28] J. Badr, A. Motulsky, and J.-L. Denis, "Digital health technologies and inequalities: a scoping review of potential impacts and policy recommendations," Health Policy, vol. 146, p. 105122, 2024.
[29] R. Haripriya, N. Khare, and M. Pandey, "Privacy-preserving federated learning for collaborative medical data mining in multi-institutional settings," Scientific Reports, vol. 15, no. 1, p. 12482, 2025.
[30] S. Oei, T. Bakkes, M. Mischi, R. Bouwman, R. van Sloun, and S. Turco, "Artificial intelligence in clinical decision support and the prediction of adverse events," Frontiers in Digital Health, vol. 7, p. 1403047, 2025.
[31] H. Koehle, C. Kronk, and Y. J. Lee, "Digital health equity: addressing power, usability, and trust to strengthen health systems," Yearbook of Medical Informatics, vol. 31, no. 01, pp. 020-032, 2022.
[32] S. Labkoff, B. Oladimeji, J. Kannry, A. Solomonides, R. Leftwich, E. Koski, A. L. Joseph, M. Lopez-Gonzalez, L. A. Fleisher, and K. Nolen, "Toward a responsible future: recommendations for AI-enabled clinical decision support," Journal of the American Medical Informatics Association, vol. 31, no. 11, pp. 2730-2739, 2024.
[33] G. D. Giebel, P. Raszke, H. Nowak, L. Palmowski, M. Adamzik, P. Heinz, M. Tokic, N. Timmesfeld, F. Brunkhorst, and J. Wasem, "Problems and barriers related to the use of AI-based clinical decision support systems: interview study," Journal of Medical Internet Research, vol. 27, p. e63377, 2025.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Lei Wang, Simin Cheng, Yajun Liu, Lin Yang, Gang Wang, Yifan Meng, Muxun Ji

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open access article distributed under the terms of the CC BY-NC-SA 4.0, which permits copying, redistributing, remixing, transformation, and building upon the material in any medium so long as the original work is properly cited.
