Review Paper
Challenges and opportunities in IoT healthcare systems: a systematic
review
Sureshkumar Selvaraj1 · Suresh Sundaravaradhan1
Received: 1 November 2019 / Accepted: 11 December 2019 / Published online: 30 December 2019
© Springer Nature Switzerland AG 2019
Abstract
In this study, the latest research articles which are involved in the Internet of Things (IoT) based healthcare system are
analyzed as the IoT is growing enormously in the healthcare systems such as health monitoring, fitness programs, etc.
Numerous research has been carried out in the IoT based healthcare system to improve monitoring efficiency. The
architecture used in the IoT especially the cloud integrated systems are investigated in this work. The factors such as
accuracy and power consumption are the important concern in the IoT, hence the research works which are involved in
improving the performance of the IoT based healthcare systems are discussed. Data management methods in the IoT
based healthcare system with cloud facilities are also systematically analyzed in this study. The performance of the IoT
based healthcare system along with its advantages and limitations are reviewed. Most research works are efficient in
detecting several symptoms and can accurately predict the diseases. The IoT based healthcare system designed especially
for elders is an efficient solution in monitoring their healthcare issues. Major limitations in the existing systems are high
power consumption, availability of fewer resources and security issues due to the utilization of many devices.
Keywords Cloud · Healthcare · Internet of Things · Security and power consumption
1 Introduction system provides an efficient monitoring and tracking that
helps to improve the resource management of people [4].
Nowadays Internet of Things (IoT) is widely adopted in Cloud computing is used to handle the healthcare data
many applications that its importance is extending in and provides resource sharing facilities like, flexibility, data
our daily life. The IoT technology is also developing in service integration with scalable data storage, parallel pro-
the healthcare monitoring system for providing effective cessing and security problems early [5].
emergency services to patients [1]. It is also being used The wearable or sensor implanted in the patients in the
as E-health application on different aspects such as early IoT based healthcare system has very limited battery sup-
detection of medical issues, emergency notification and ply. The frequent charging of these devices and mobile
computer-assisted rehabilitation. The Smartphones has devices may fatigue the patients and require engage-
become the indispensable part of the people’s daily life ment of the nurse, which affects the user experience [6].
and these are connected with the sensor to monitor the The energy consumption of the cloud data center is also
health of the subject [2]. This sensing based surveillance very large and thus increases the cost of cloud computing.
system acquires various data from the wards and diag- But actually, a health monitoring system requires cloud
nostic equipment, and mines these data for efficient and services with low latency and energy consumption [7].
automatically control of healthcare [3]. The IoT healthcare Another issue in healthcare monitoring is the security that
* Sureshkumar Selvaraj, [email protected]; Suresh Sundaravaradhan, [email protected] | 1Computer Science
and Engineering, P. A. College of Engineering and Technology, Pollachi, India.
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the data can be easily corrupted by the attacker or hack- is used to collect data from smart home, patient, social
ers. Hence, it is necessary to develop a privacy-preserving network and smart healthcare service, next type is ser-
IoT based healthcare system and has to be integrated vice provider layer which provides the sharing of physical
with patients for efficient data transfer [8]. Few pieces of resources, service management, virtualization and security
research were involved in improving the security of data and privacy, the final layer is middle layer it is managing
transmission in the IoT system [9, 10]. In this context, the services between provider and consumer based on
studies related to the IoT based healthcare systems are available resources.
investigated in terms of accuracy, computational time and Kumar and Gandhi [12] proposed an IoT architecture
current difficulties in the development. One of the con- with a machine learning algorithm for early detection of
siderable and important research is to monitor the heart heart diseases. It involves three-tier architecture for col-
patients, which is achieved by using the sensor devices. lecting sensor data from wearable devices, storing the data
ECG data are used to monitor the patients and the data has into the cloud and regression-based prediction model for
been directed to the professionals for analyzing the signal. heart diseases. This proposed framework is implemented
The remaining portion of the paper is organized as fol- by using Apache HBase and Apache Mahout for cloud
lows, IoT based healthcare architecture with its applica- storage and data prediction analytics. The outcome of this
tions is presented in Sect. 2, the IoT system integrated with research completely a patient can find early detection of
Cloud is given in Sect. 3. Security analysis of IoT is given in heart diseases.
Sect. 4, Sect. 5 contains Quantitative comparative analysis Parthsarathy and Vivekandan [13] designed for monitor-
and challenges in healthcare is discussed in Sect. 6. The ing a patient who affected by arthritis and diagnosis at the
conclusion of this paper is presented in Sect. 7. early stage. The proposed designed framework comprises
three levels, the first level collecting the data from sensors.
Second level stores the data in the cloud. The third level is
2 IoT healthcare architecture used for optimizing the collected information, which con-
and applications tains swelling and uric acid (UA). Implementation of this
proposed model by using Apache red-shift and Openstack.
IoT is the growing technology in the internet environment Kim and Chung [14] developed and plotted the sensor
in conjunction with realtime connected objects. It is popu- devices in the normal household in the living room and
lar in many different industries because of convergence other rooms where chronic disease patients lead daily lives
from the simple object into a smart object. This has a long as the context. The real-time data is not processed in this
term impact on the health monitoring, administration experiment and this method involves the high cost. The
and clinical service to patient’s physiological information. architecture of the method can be considered and the sen-
Patients are connected with sensors and the data has been sor can be used instead of a camera to reduce the expense
associated with control devices, then it forwards to the of the overall process. The overview of the IoT architecture
health-monitoring unit. Sometimes data are stored in the is shown in Fig. 1 [14].
cloud, which helps to manage the number of data with Temporal Fuzzy Ant Miner Tree (TFAMT) classifier is
security. An important area in the IoT is security because developed in [15], which is the combination of the Ant
when dealing with data transmission from the sensor to Colony Optimization (ACO), decision tree and fuzzy rules
cloud center it is a possible loss of integrity and confiden- and this are applied to classify the medical records. This
tiality and also it is complex to encrypt the data received study is used to help the aged people with the incidence
from low resource devices. Cloud is a distributed envi- of age-related illnesses and medication needs. The IoT
ronment so that it is the best option to store the medi- involves collecting real-time data from the advanced sen-
cal data which more flexible for remotely caring patients sors and the health problems are detected by analyzing
accessed by doctors and Vice Versa. The IoT and cloud physical and behavioral trends in homes.
start handshake for realtime processing which turns to Few existing research is involved in helping the elderly
give complexity in architecture to sending and receiving people using the IoT devices and that helps in monitor-
data. To reduces the complexity in IoT and cloud a novel ing the people [16–18]. The elderly monitor services are a
framework is proposed to manage the IoT realtime data module of the socializing platform and it can be effectively
and scientific-based unrelated IoT data then tested the monitored by using IoT devices. The falls are a major prob-
cloud environment provides Software as a Service (SaaS) lem to elder peoples, which present in long-duration time
in the hybrid cloud environment [11]. This research pro- may lead to death. To avoid this circumstance of uncer-
posed a Service Management Framework for IoT devices tainty, a fall detection algorithm was proposed to detect
in Cloud (SMFIC) that contains three types of layers and the people who fall on the specified area. The specified
five important components such as consumer layer which area contains RFID information and location identification
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Fig. 1 IoT healthcare architecture (Source: [14], p. 5)
data. Based on that information detect the elders where process the data. Since the IoT data are obtained from a
they fall in the specified area. These researches help the different sensor, it is effectively stored at the cloud side
elders to live in their homes where they can feel safe and server called a cloud storage repository. By using cloud
comfortable and effectively monitoring them for health technology few researcher’s medical processes are inte-
care and provide the alert to the hospitals and the fam- grated into the cloud and enhance healthcare. The physi-
ily members if the device found any urgent situation [18]. ologically based attributes of students are measured and
this is stored in the cloud storage in a different type of
format. Once the user subsystem has completed the data
3 Cloud integration collection from IoT medical devices that are sent to the
cloud subsystem for diagnosis. Based on the emergency
The mobile application based remote health monitoring alert message sent to the doctor, hospital, and caretak-
IoT data are stored in the cloud platform and cloud com- ers. This process as shown in Fig. 2 [19]. The research [20]
puting offers flexibility, scalability and more resources to developed the hierarchical computing architecture (HiCH)
Fig. 2 Cloud integration with Healthcare IoT system (Source: [19], p. 29)
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for a patient monitoring system that involves autonomous is processed locally over the real health data on the user’s
data management and processing at the edge of the layer. health profile and the recommendation process has been
The network delay is a major problem in remote health carried out at the cloud healthcare recommender service
care monitoring system and to provide a solution for the [27]. Radio-frequency identification encryption technique
network delay in healthcare processing by remotely a is used in [28] provides security to the medical data in IoT.
framework is proposed known as UbeHealth to analyze Network environment data flow is critical for health infor-
challenges in network delay and QoS (Quality of Service) mation. This research goal to develop a framework for data
parameters such that it provides performance enhance- privacy based on a biometric-based security system with
ment in healthcare at smart cities [21]. The fuzzy rule- a resource-constrained wearable health monitoring sys-
based neural classifier has been proposed for diagnosing tem [29]. Internet of Medical Things (IoMTs) information
the disease and reducing the seriousness of the health dis- is analyzed for optimizing security in medical applications.
ease. This method analyzes the data processing from the The Cloud Service Provider (CSP) consists of three serv-
cloud by a secured storage mechanism, which comprises ers, namely: the Authentication Server (AS), the Key Gener-
different phases such as data retrieval, data aggregation, ation Center (KGC), and the Database Server (DS). In smart
data partition and data merging [22]. healthcare, to secure the data, Lattice-based Secure Cryp-
tosystem is used. This consists of four phases, setup phase,
3.1 Big data in IoT healthcare key generation phase, data encryption phase, and data
decryption phase. The three phases, the lattice polynomial
In recent years, Big data storage technology is essential vectors are used as input in the first phase and the KGC is
to store huge volumes of clinical data. The cloud storage generated i.e., the private and public key, in the second
becomes huge its manage by the technology called Big phase and shared with the Database Server (DS). In the
data. The recent studies say the combination of Big data last phase, the message is used as an input parameter and
and cloud influencing remote healthcare. Amazon Elastic combines it with the random polynomial. If any user sent
MapReduce (EMR) provides a different method to handle a request to access the medical data, the KGC transfers the
the big data and get onto the cluster. The Amazon EMR secret key pair to the DS using a secure channel. The DS
has a different function to load the data into Hbase clus- process the plaintext message using the input parameters
ter. Loading the sensor data from Amazon S3 to Hbase by and the secret key pair. The architecture of the LSCSH is
using the tool as an Apace pig. Apace pig is used for ana- shown in Fig. 3., which also consist of the key exchange
lyzing the data in the distributed database hence health- process [30]. This proposed method has been compared
care application can dramatically extend the scalable fea- with existing reasonable schemes attributes like commu-
ture [23]. A lightweight model is developed for semantic nication and computation cost.
annotation of the Big data in the IoT heterogeneous data
[24]. The novel method is proposed for predicting the
air quality in urban areas and to provide a more healthy 5 Quantitative comparative analysis
life at the urban resident. The proposed UHBigDataSys is
implemented using Spring Framework and analyzed the IoT can be applied to the healthcare system and this has
Air Quality Indicators (AQIs) parameters for Urban Health- the ability to continuously monitor the patient condition.
care [25]. The wearable IoT devices play a huge role in monitoring
the patient’s condition. IoT in healthcare is developing and
recent research involved in health monitoring using IoT are
4 Security in IoT analyzed in the Table 1.
IoT based healthcare system is much helpful in monitor-
Security has been the major concern in the IoT because the ing the heart disease of patients and its efficiency can be
hackers or the attacker can easily access the sensor data, increased for medical emergency alert by using machine
so it is important to analyze the recent security methods learning. Most of the studies have higher efficiency, but
in IoT. The IoT-oriented data placement method with pri- the power consumption is needed to be reduced.
vacy preservation named IDP is developed in [26]. In this
proposed method main aim is to optimize the data access
time, increase resource utilization and reduce energy con- 6 Challenges in healthcare IoT
sumption by satisfying the constraints of data privacy.
The privacy-preserving and energy saving is achieved IoT has been adopted in the different types of applications
using the algorithm called Non-dominated Sorting and provide different support for the healthcare system
Genetic Algorithm II (NSGA-II). The trusted computation such as patient monitoring, a smart home system for the
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Fig. 3 LSCSH architecture in healthcare IoT (Source: [30], p. 27)
diabetic patient. Major problems occur in the healthcare zation algorithm can be used to reduce the usage of
system are listed as follows. energy.
• Monitoring many numbers of users in the IoT requires
• IoT paves the way for high flexibility, i.e., the patient more storage and mainframe, which can be overcome
requires constant care and he/she can live in the home by storing the data in the Cloud. However, the IoT inte-
instead of the hospital and be monitored regularly grated with the cloud increases the complexity.
using IoT technology. Some wearable devices like sen- • Another important problem in the IoT is privacy as
sors make uncomfortable for the patient’s body. the devices are more vulnerable to the attack. These
• The data transmitted from the sensor to the control devices are low resource constraints and are difficult
device and further transmitted to the monitoring to apply encryption techniques on them.
center, which will affect the quality of the data due to
noise. Better architecture helps to transmit the data
without affecting its nature. Noise removal technique 7 Conclusion
can also help to enhance the data signal.
• Most of the existing method in ECG monitoring IoT can efficiently monitor the patients from the remote
involves analyzing the signal in a supervised manner. area and provide emergency services especially for heart
This increases the cost and it may produce the error in patients. The major objective of this review work is to
detection. Machine learning can be applied in analyz- analyze the various research activities involved in the IoT
ing the signal, which helps to improve efficiency and based healthcare system. Most existing researches are effi-
reduce expenses. cient in monitoring the patient and provide the data to the
• An increasing number of sensors and the devices monitoring center. The research involves the ECG monitor-
require higher energy to process, and it increases the ing system that can use the machine learning method to
power leakage and energy consumption. An optimi- easily predict the symptoms of diseases. Some researches
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Table 1 Quantitative comparative analysis of various methods
Methods Limitation Performance analysis
This study proposes a pervasive patient health monitoring Machine learning can be used to analysis the ECG data Average response time of 50 request is 45 ms
(PPHM) system infrastructure. This involves in monitoring instead of manual monitoring. This helps to unsupervised F-measure is approximately 98 when the number of clusters
the patient health from remote area [31] the process and also involves in reducing the cost. is 2
PPHM integrates the IoT with cloud and stores the patient’s Security has to be improved and IoT is very vulnerable to the
ECG data in the cloud. The data are clustered and sequen- attacks
tial minimal optimization is applied
This research involves in the detection of voice pathology Scalability can be further increased by using the smart Accuracy LBP + ELM = 98.1% and LBP + GMM = 95.7%
through IoT. The voice signal is represented using the local devices, and microphone
binary pattern (LBP) on a Mel-spectrum representation of This method doesn’t involve in handling large amount of
the voice signal [32] data
This research involves in Health IoT-based monitoring Machine learning can be applied to monitor the signal and PSNR: existing = 58.38 and proposed = 64.35
framework involves in reducing errors and increases the accuracy Classification accuracy: While extracting 37 features = 91.1%
The framework transfers ECG and other data related to Extracting more features from the data involves in increas- Execution time: while using three instance server = 3.3 ms
the healthcare professionals. Monitoring is based on the ing the execution time
mobile devices and sensors [33]
This is a privacy preserving framework based on the IoT Flexibility and scalability are need to be increased When number of attributes is 60, Encryption cost = 0.025 s
healthcare data. IoT messages are encrypted using the IoT and access policy update query cost = 0.0011 s
group key and shared to the patient [34]
This research involves in solving the complexity and hetero- This method needs to develop an unsupervised model to Accuracy = 96%, sensitivity = 95%, and precision = 97%
geneity of data in IoT by tracing the data back to the router process in the real-time system effectively
using Petri Nets [35]
ECG data are monitored for the patient with Cardiovascular Regular battery replacement is required for the wearable Latency of the smart gateway = 43
diseases. Although the relationship between the both devices Power consumption with AES-256 = 717.82 mW
is very high [36]. To overcome this issue, the proposed Size of data has to be reduced
method monitors the ECG, glucose and body temperature
along with fall detection
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