Internet of Things in Healthcare, A Literature Review

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Internet of Things in Healthcare,
A Literature Review
Suhail Javed Quraishi
Department of CSE-AIT
Chandigarh University
Chandigarh, India
suhail.e11364@cumail.in
Humra Yusuf
Department of CSE
Invertis University
Bareilly, India
Abstract— Over the last few decades, extensive research has
been consigned to the study of various technologies such as
information technologies in order to strengthen the existing ones.
One such field is the Internet of things (IoT). In recent times,
internet of things has been a ground-breaking technology in
almost all sectors of human life. IoT holds the tendency to make
available both value-added services and mainstream services in
all fields. Healthcare sector is one such area. IoT for healthcare
tends to keep doctors and professionals more watchful and
connected with the patients proactively. For the overall
development of a nation, healthcare is the main service center. It
is clear that technology cannot help to eradicate the issues related
to health comple tely but it can make access to healthcare easier.
In today’s s cenario where healthcare h as been drastically
despoiled, IoT has completely changed the perspective of
traditional healthcare methods. IoT tends to play a crucial role in
providing better and improved services. Real-time monitoring of
the data via smart devices use to transfer collected health data to
a physician. Patient health observation and monitoring,
emergency proceedings, remote inspection, and observation are
some vital analyses that can be made with the launch of the
Internet of Things in the respected sector. The standpoint of the
paper is to summarize the applications of IoT in the field of the
he althcare field.
Keywords— Information technologies, IoT, Healthcare,
Sensors, Remote inspection.
I. INTRODUCTION
The term IoT is not unknown for now. The IoT or internet
of things is referred to many of physical devices around the
globe that are connected to the internet, all gathering and
sharing data. With the introduction of the super-cheap
computer chips and ubiquity of wireless networks, it has now
become possible to make anything, from any small chip to any
bigger device. IoT basically is defined as the connection of
many embedded devices supplied with internet connectivity.
These devices share data with each other and with people on a
broader scale. The IoT is turning the structure of the world
smarter and responsive thus consequently combining the digital
and the physical world. There is a disparity between internet
and internet of things. It can be clearly said that Internet of
things is smarter than the internet as it connects the different
devices, analyses it and make decisions. Technically anything
can be converted into a smart device by connecting it to the
internet connection for exchange of data.
The emergence of idea of internet of things took place 17
years back. Kelvin Ashton, however in 1999 gave us the term
“internet of things” during his work in Procter & Gamble. The
progress however at that time was slow because the chips at
that time were huge and bulky. It was not possible to embed
the chips to the basic objects. Slowly and eventually with the
progress in the technology IoT emerged out to be an essential
sector in human lives.
Tagging Radio Frequency Identification (RFID) tags to
costly equipment was the first application of IoT. This was
done to keep a record of their location. Since then, cost of
tagging sensors and connection to internet in basic home
commodities has eventually fall. Many of the experts claim
that adding tags and internet connection to basic commodities
will be as cheap as 10 cents.
There is numerous application of IoT. It has been
successfully developing its roots in the healthcare field so far.
It aims at providing well organized and much effective services
to the patients. Healthcare applications of IoT have potentially
able to offer comprehensive patient care. Monitoring of the
patients health has become much organized and empowers
physicians to provide the best of healthcare. IoT eases things
not only for the patients but also for the physicians. A huge
pool of data of the history of a patient treatment can help a
doctor/physician to give a detailed description of their health
before starting a thorough treatment. Through IoT patients are
connected to the sensors and the necessary health data and
information is transferred to the health-control unit. With this,
concept of ‘virtual hospital’ can be better understood as IoT
aims at providing services at remote areas. Providing
healthcare has not remained only limited to clinical centres.
IoT here act as a boon for those people who regularly cannot
head up to a clinic/hospital for regular check-ups. Fig. 1,
illustrates the various areas of healthcare where IoT is paving
its way.
Through IoT decision making in healthcare field has been
improved drastically. The physician can take an effective
decis ion regarding patient’s health by considering the history
of his health data. The main motive of IoT is to modernize the
healthcare sector with new technologies. Some of the
parameters that IoT has covered are monitoring the health
condition, change in interaction, data collection, observing
health condition, determining new techniques for disease

prevention and self- care. IoT extremely enhances the nature of
health-care by constant consideration and lesser mistakes
thereby bringing down the cost of self-care. Today, IoT has
affected every aspect of the business platform. The main
motive of IoT is to empower the objects for the connection
anywhere at any time. The IoT is the new evolution of internet.
It aims at building a smart world with smarter areas of health
facilities.
Fig. 1. IoT implementation in the healthcare
IoT, with no doubt faces different hurdles and challenges
when implemented in health-care sector. One of the hurdle that
IoT overcomes in the healthcare sector is of safety and
violence. Sometimes violence can be seen within the staff of a
hospital, but sometimes there are life threatening acts done by
the patient’s family against the staff or patient. CCTV cameras
help to keep a record of movement of all the people inside a
healthcare centre. Also biometric sensors can be used to
identify the aggressions or anxiety of the visitors or the staff
members.
Healthcare methods based on the technology of IoT, has
benefited in improving the treatment methods and improving
patient health. In the present scenario IoT has been the focus of
many researches. But introducing it into the developing
countries where common public in still not aware of these
advance technologies, is a big challenge. IoT aims at making
healthcare better with the upcoming time. There are millions of
patient worldwide who are handled on medical technology
products. From surgical and endoscopic products to patient
handling and orthopaedics to neuro technology and more,
innovation has always been at the forefront. The work of
various firms in this field has been a big boost for everyone.
The cloud enables security and helps strike it to connect to and
have real time data. The IoT enables to really capture and
access data continuously which allows to quickly respond to
the need of the different products that are in this field to make
them better. This real time data is also accessible by the patient
themselves. This collected data allows predicting any
maintenance issue before it really happens. It also enables the
end users such as surgeons, physicians and doctors to better
control the usage of the actual instruments in the operating
room. This all positively affect patient’s outcomes. Ultimately
this all helps in providing better quality of life for more people.
II. IOT ARCHITECTURE
In this section, the basic architecture of an IoT device is
explained. Fig. 2 demonstrates an IoT device architecture
having four layers. The base layer consists of IoT devices like
sensors with the ability to sense, compute and connect other
devices. The second layer is the IoT gateway or aggregation
layer. This layer significantly aggregates data from various
sensors. These two layers form the definition engine. In order
to set the rules for data aggregation next layer is based on
cloud. It is called the processing engine or event processing
layer. It has numerous algorithms and data processing elements
that are ultimately displayed on a dashboard. This layer
basically process the data obtained from the sensors layer. The
last layer is called the application layer or API management
layer. It acts as an interface between third party application and
infrastructure. This entire landscape is supported by device
managers and identity and access managers which are useful
for security of the architecture.
Fig. 2. IoT Device Architecture
III. RELATED LITERATURE
IoT for healthcare field has been path-breaking technology.
This has been possible with the help of so many back end
technologies working up together to achieve a desired goal. A
lot of work has already been done in this area and a lot of it is
needed to be done. We here, throw light on the major areas of
healthcare sector which are already implemented with IOT.
P. Chatterjee et al.[5], in the paper discuss about the
implementation of IoT in healthcare field in the cardiovascular
diseases. In this area IoT focuses on connecting all the medical
entities together in order to get the efficient analysis. Through
this, the information of all the entities can be shared on a
common platform through all the smart inter-connected
devices. Here, the centre point was to make a decision-support
system to examine the amount of possibility a person have for
cardiovascular disease. Along this, some parameters such as
age, gender, diabetic problems, cholesterol level, smoking
habits etc. were took in consideration. A survey of 600 people
is conducted along with mentioned physiological parameters.
The Framingham’s score along with the other physiological
parameters of a person, is embedded in the reference engine
gives us the risk score of that person. It can be clearly seen that
how the physiological parameters impact on diagnosing risk of
any particular disease.
S. Sheikh et al.[9], in the paper focuses on the healthcare
monitoring system using IoT. Certain arrangements of the

raspberry pi, graphic card and memory with internet connected
to them, so that they can safely catch and share the data. This
collected data is forwarded to the physician through remote
network who can intelligently make a decision regarding the
patient’s health. This all process eliminates the physical vis its
of the patients to the clinics. A model is proposed in which all
the sensors were connected to raspberry-pi processor. Database
is responsible for storing the collected data which is on the
cloud. This stored data on the cloud is displayed on a web page
by guarded security person. Also, in case of any emergency the
doctors are sent an alert accordingly. The different sensors used
in the model were temperature sensor, ECG sensor, raspberry-
pi etc.
S. K. Routnay et al.[10], in their paper discussed about the
use of narrowband IoT. Narrowband IoT is a version of IoT
which is simpler and cost effective. NBIoT or narrowband IoT
uses smaller number of quantity of resources that is why it is
most preferable solution. Further in the paper issues and
problems related to use of NBIot is discussed. Narrowband IoT
has been proposed as a possible solution for the applications
linked to healthcare. It is a leaner and thinner translation of
IoT. NBIoT has low power wide area (LPWA) coverage
capabilities because of which it is mostly attracted in different
applications. Applying this technology to the existing system
will not only reduce the cost but is also effective in providing
the better health services. One possible field where NBIoT can
be used as an alternative to the technology is healthcare.
NBIoT is an easy technology for detecting the alterations in the
performance of human body functions.
TABLE I. RESEARCH WORKS ON IOT FOR HEALTHCARE
S. Lavanya et al.[11], in their paper proposed a model
which helps both patients and the doctors. The time can be
saved as the patient doesn’t have to visit the clinic to the
physician for his regular treatment. The health data of the
patient is stored on the cloud which helps in giving more
proper and efficient services. In the paper, ihome health-IoT
system is proposed which is home centric healthcare platform.
For the daily medication management the smart sensors are
Paper
Aim
Technology
Accuracy
Highlights
[5]
To detect and cure cardiovascular diseases
with the help of IoT
Use of Framingham score for
the detection of disease.
Was nearly successful in
diagnosing the disease.
Easy risk assessment.
Cost effective
[9]
To propose a scalable and flexible healthcare
monitoring system.
Use of raspberry-pi for the
analysis.
Had future s cope. All sensors
were connected to the
raspberry-pi which makes the
proposed system much more
accurate.
Easily accessible.
[10]
To propose a cost effective and much
simpler IoT healthcare system using
narrowband IoT.
Use of microcontrollers
inside the sensors. And use
of mobile application to
transfer the data.
Due to deficiency in the
technology total accuracy
cannot be achieved.
Remote monitoring became
easier.
Provided better services.
[11]
To propose a remote prescription and i-home
healthcare based on IoT.
Use of sensors on the patient
body to monitor the data and
use of raspberry-pi.
Improves efficiency and
make it much more accurate.
Minimizes hospital visits.
Monitor even smallest changes of
the patient body.
[17]
To discuss the ongoing advances in the
engineering field to in order to improve the
healthcare architecture system
Use of various sensors such
as ECG sensors, temperature
sensors, heart rate sensors to
The paper provides the
complete overview o f the
advances made till date.
Data could be easily accessible to
the doctors whenever they require
it.
[12]
To build a mobile based healthcare
application using IoT and cloud computing.
Monitoring ECG waves
using mobile based
application. Use of
microcontroller and signal
processing for ECG waves.
Use o f the data can be done
by the physicians for a longer
period of time and for further
analysis.
Use of IOIO microcontroller,
signal processing, and
communication protocols,
efficient and secure mechanism
for large file transfer.
[22]
To detect voice pathology with the help of
IoT
Representation of voice
signal using the local binary
pattern(LBP) on a mel-
spectrum representation of
voice signal
Using smart devices such as
microphone, the scalability
can be increased
The research involves health IoT-
based monitoring framework
[23]
To encrypt IoT messages using IoT group
key and share it with the patient
Privacy preserving
framework which is based on
IoT healthcare data
The flexibility and the
scalability of the proposal
can be further increased
This proposal work upon on
securing the confidential health
data of patients.
[24]
To process the ECG data of the patients
suffering from cardiovascular diseases
To monitor the ECG, glucose
and body temperature of the
patients
The proposal required good
battery health of the devices
that is worn by the patients
Size of data has to be reduced.

attached to human body for physiological monitoring. A
raspberry-pi processor is used which is an incredible piece of
hardware. It is so because of the amalgamation of the features
of conventional computer and an embedded machine.
I. Singh et al.[17], proposed a paper where the recent
progression in IoT based human services structure. Sensors like
ECG sensor, temperature sensors and heart rate sensors have
been used to build up the planned framework. In the software
architecture of the model a complete path of the patient’s data
is described as how the data from the cloud server reaches to
the doctor, who further takes the necessary actions.
Junaid Mohammed et al.[12], focuses on building a mobile
based application for the healthcare domain which uses the
technology of IoT and cloud computing. They build “ECG
Android Application”. In the app the data is uploaded to user
private centralized cloud from the patient’s end. This data is
retrieved from the physician’s end for doing the further
analysis. Their paper revolves around describing the
fundamental theories of IoT. Whole paper gives a detailed
description as how ECG waves are studied with the help of an
android app. The infrastructure given in this paper can be
applied to other healthcare related application also. Table I
summarizes few of the previous works in the field of usage of
IoT for healthcare
IV. CHALLENGES AND LIMITATIONS
IoT has been paving its way rapidly in the field of
healthcare. But there are numerous challenges which still
needed to be overcome in order to achieve cent percent
accuracy and success. Some of the few challenges are high
power utilization, accessibility of fewer resources and security
issue because of the use of many devices. Also continuous use
of wearable sensors can make the patient uncomfortable. The
data transferred to the doctors may contain a lot of noises.
Also, many devices and signals are used in a single network; it
may increase the power consumption. Cloud computing is used
alongside to store the data of number of user and devices it
increases the complexity of the system. Another most
important challenge to IoT is of security. Inside one frame of
network numbers of devices are deployed. These devices are
vulnerable to attack. Because of the low resource constraints
these devices are not suitable to apply techniques of
encryption. However in the recent times, work has been
carrying out in order to reduce these limitations and challenges.
As with the advancement in the work of IoT there are certain
challenges which increase. Devices used in a network of IoT
are large in number so the amount of data produces in very
large. This data may become an issue sometimes. Sometimes,
this data is interrupted and may lose. Thus, proper strategies
are taken to keep these hurdles away from a secure and proper
network of IoT. Some of the big issues with the IoT in
healthcare sector is how to integrate the new devices with a
system that may have not been updated in several years.
Further challenge is that the data that has been collected is
valid or not. So, doing research studies take time. So, as the
technology is coming out and it’s continuously advancing, by
the time research is completed there may be something better
already coming out.
Also, making sure that people’s health information is
properly protected is a really important thing. Then comes the
human factors of getting people to adopt the technology.
V. CONCLUSION AND FUTURE DEVELOPMENT
The main and focused goal of IoT for healthcare is to
provide better and advanced services in healthcare sector. IoT
has contributed in transforming the healthcare facilities. From
clinics and hospital to the home IoT has been a boon for the
elderly patients. It has reduced the headache of regularly
visiting the healthcare centre. IoT has remarkably contributed
in increasing lifespan of the people. However, some challenges
and limitations still reside in the respected area. For achieving
secure and fully developed services further works have been
carrying out.
Even after so much advancement in the field of healthcare,
wearable sensors still is a major issue of discomfort for some
patients. This is an important issue as comfort is a major
concern. Another holdup issue for the sensor devices is that,
they require continuous power supply. The solution can be use
of rechargeable batteries. But, recharging regularly may cause
burden over the patient. A sustainable solution is using sensor
device which uses low power consumption and which can be
charged over solar energy. The main threat to the IoT for
healthcare is that all the data is shared over internet thus
making it open to be used by the attackers. In order to maintain
the privacy of the patients there should be proper
authentication check over every step. All the network is
wireless and low power supply devices cannot be implemented
with complex security programs. So, much research is required
to be done in the field of security for IoT for healthcare.
REFERENCES
[1] G. Paré, K. Moqadem, G. Pineau, C. St-Hilaire, Clinical effects of home
telemonitoring in the context of diabetes, asthma, heart failure and
hypertension: a systematic review, J. Med. Internet Res. 12 (2) (2010)
e21.
[2] F. Le Gall, S.V. Chevillard, A. Gluhak, Z. Xueli, Benchmarking internet
of things deployments in smart cities„ in: Proceedings of the AINA
Workshops, 2013, March, pp. 1319–2132.
[3] M.A. Feki, F. Kawsar, M. Boussard, L. Trappeniers, The internet of
things: the next technological revolution, Computer 46 (2) (2013) 24–
25.

[4] X. Li, R.X. Lu, X.H. Liang, X.M. Shen, J.M. Chen, X.D. Lin, Smart
community: an internet of things application, IEEE Commun. Mag. 49
(11) (2011) 68–75.
[5] P. Chatterjee, L. J. Cymberknop, R. L. Armentano, IoT-Based decision
support system for intelligent healthcare- Applied to Cardiovascular
Diseases, 7th international conference on communication system and
network technologies, (2017).
[6] L.M.R. Tarouco, L.M. Bertholdo, L.Z. Granville, L.M.R. Arbiza, F.
Carbone, M. Marotta, J.J.C. de Santanna, Internet of T hings in
healthcare: Interoperatibility and security issues, in: Proceedings of
theIEEE International Conference on Communications (ICC), 2012,
IEEE, 2012, June, pp. 6121–6125.
[7] G. Schreier, Pervasive Healthcare via T he Internet of Medical T hings,
Austrian Institute of Technology GmbH, Graz, Austria, 2010.
[8] C. Doukas, I. Maglogiannis, Bringing IoT and cloud computing towards
pervasive healthcare„ in: Proceedings of theSixth International
Conference on Innovative Mobile and Internet Services in Ubiquitous
Computing (IMIS), 2012, IEEE, 2012, July, pp. 922–926.
[9] S. Shaikh, V. Chitre, Healthcare Monitoring System Using IoT,
International Conference on Trends in Electronics and Informatics ICEI
2017.
[10] S. K. Routray, S. Anand, Narrowband IoT for Healthcare,International
conference on information,communication& embedded systems
(ICICES 2017).
[11] S. Lavanya, G. Lavanya , J. Divya bharathi, Remote Prescription and I-
Home Healthcare Based on IoT, IEEE International Conference on
Innovations in Green Energy and Healthcare T echnologies
(ICIGEHT’ 17).
[12] J. Mohammed, A. Thakral, A. Filip Ocneanu, C. Jones, C. Horng Lung,
A. Adler, Internet of Things: Remote Patient Monitoring Using Web
Services and Cloud Computing, 2014 IEEE International Conference on
Internet of Things (iThings 2014), Green Computing and
Communications (GreenCom 2014), and Cyber-Physical-Social
Computing (CPSCom 2014).
[13] J. H. Youn, H. Ali, H. Sharif, J. Deogun, J. Uher, S.H. Hinrichs,
WLAN-based real-time asset tracking system in healthcare
environments, in: Proceedings of the T hird IEEE International
Conference on Wireless and Mobile Computing, Networking and
Communications, WiMOB 2007., IEEE, 2007, October, p. 71.
[14] T. Hori, Y. Nishida, Ultrasonic sensors for the elderly and caregivers in
a nursing home, in: Proceedings of the Seventh International
Conference on Enterprise Information Systems, 2005, pp. 110–115.
[15] S. Bowser, J. Woodworth, Wireless multimedia technologies for assisted
living, in: Proceedings of the Second LACCEI International Latin
American and Caribbean Conference for Engineering and T echnology,
2004.
[16] A Marco, R. Casas, J. Falco, H. Gracia, J. Artigas, A. Roy, Location-
based services for elderly and disabled people, Comput. Commun. 31
(6) (2008) 1055–1066.
[17] I. Singh, D. Kumar, Improving IoT Based Architecture of Healthcare
System, 2019 4th International Conference on Information Systems and
Computer Networks (ISCON), GLA University, Mathura, UP, India.
Nov 21-22, 2019.
[18] A.M. Rahmani, T.N. Gia, B. Negash, A. Anzanpour, I. Azimi, M. Jiang,
P. Liljeberg, Exploiting smart e-Health gateways at the edge of
healthcare Internet-of-Things: a fog computing approach. Future Gener
Comput Syst 78:641–658 (2018)
[19] L. Nawaf, Optimizing IoT Security by Implementing Artificial
Intelligence—Infosecurity Magazine. Available online:
https://www.infosecurity-magazine.com/next-gen-infosec/optimizing-
iot-ai/ (accessed on 15 March 2021)
[20] A. A. Mutlag, M. K. A. Ghani, N. Arunkumar, M. A. Mohammed and
O. Mohd, "Enabling technologies for fog computing in healthcare IoT
systems", Future Gener. Comput. Syst., vol. 90, pp. 62-78, Jan. 2019,
[online] Available: http://www.sciencedirect.com/science/article/pii/
S0167739X18314006.
[21] F. Ahmed, "An Internet of Things (IoT) application for predicting the
quantity of future heart attack patients", Int. J. Comput. Appl., vol. 164,
no. 6, pp. 36-40, Apr. 2017.
[22] G. Muhammad, SMM Rahman, A. Alelaiwi, A. Alamri, Smart health
Solution Integrating IoT and cloud: a case study of voice pathology
monitoring. IEEE commun Mag 55(1):69-73 (2017)
[23] Y. Yang, X. Zheng, W. Guo, X. Liu, V. Chang, Privacy–preserving
fusion of IoT and big data for e-health. Future Gener Comput Sys
86:1437-1455 (2018)
[24] TN Gia, IB Dhaou, M. Ali, AM Rahmani, T. Westurlund, P. Liljeberg,
H. Tenhunen, Energy efficient fog-assisted IoT system for monitoring
diabetic patients with cardiovascular disease. Future Gener Comput Syst
93:198-211 (2019)