International Journal of Innovative Technology and Exploring Engineering (IJITEE)

ISSN: 2278-3075, Volume-8, Issue-6S4, April 2019

Software Engineering for Smart Healthcare

Applications
Neelu Lalband, D. Kavitha

Abstract:Software engineering has been used by software information systems will improve the quality of medical
vendors and consultants in the development of quality health services, increase the quantity of health services and reduce
care applications ranging from electronic medical systems, significantly medical errors encountered. Contrary,
patient record management applications to medical middleware
implementation of health systems appears to be a
devices. As a discipline, it has evolved over the last decade in the
production of high-quality software across many industries. complicated process [3].
Healthcare applications demand unique expertise tailored to best It is a fact that smart healthcare significantly reduces the
project methodologies and software development models. Many cost and increases the accessibility, yet the use of the
health care providers argue that best software practices and user- technology may also depend on many other factors that
centered design principles are vital to producing quality cannot be easily quantified. In this context, a sociotechnical
applications across all domains. Lack of focus on systematic
perspective stands as an important indicator toward
software development process increases flaws in the
implementation causing a loss regarding quality, cost, and trust. understanding the use of the technology by the end users.
The survey paper seeks to analyze existing models in the area of For the success of the technologies, it is critical to develop
Software Engineering and to propose best SDLC model for Smart an understanding about existing smart healthcare
Healthcare applications which focuses on quality improvement. opportunities and what influences on the users’ decisions to
This survey also includes identifying the research challenges of use these technologies. Otherwise, lack of sociotechnical
software engineering for smart applications.
knowledge may impede the potential success of the
Keywords:Software Engineering, SDLC, Software
Applications, Smart Healthcare, Medical Services
technologies. The adoption decision of users (i.e., patients,
healthcare providers) may show changes over the time
I. INTRODUCTION considering the change in technologies and culture. [27]
Thus, there is no golden standard to assess user intentions,
The tremendous growth in technology has led to the but a continuous investigation is required to understand the
application of software systems in our day-to-day life. smart healthcare technologies as well as the influencing
Software engineering can be defined as a dynamic discipline
factors to use these technologies.
that aims at producing high-quality software systems
Moreover, engineering principles and methodologies are
through systematic project methodologies tailored to user- being applied in the health sector just like in other domains.
centered design principles. It is aided by Software Significantly, the IT specialists and software developers
Development Life Cycle (SDLC), a set of basic procedures need to consider the nature of applications in the health
used in design, development, and testing of Software industries during the development process [4]. Although the
applications. Most common SDLC models include waterfall,
systems are simple in principle, it is essential to ensure that
agile, V-model, spiral, and Rapid Application Development
they are implemented in a structured way that addresses
are the key development methodologies in software
requirements such privacy while balancing usability
production process [1]. The software models have boosted
requirements. The healthcare applications need to map the
the development of millions of software applications for
hospital model appropriately to fit the existing processes as
desktops, mobile devices as well as smart devices. During
well as align with practitioner's specialty.
the development process, it is essential to consider the user Our paper is structured as follows: In the next section, we
design principles and methodologies to ensure the quality of
discuss Systematic Review. Next, we outline Software
information systems.
Development Life Cycle with differences then presented and
Health care systems are aimed at providing best patient our findings are discussed. We conclude by presenting a
support as well as offer optimal support for medical care. As agile method is more suitable for smart healthcare
such, healthcare applications must ensure fair financial applications.
management, excellent medical services support, and overall
delivery of excellent services [2]. In the recent past, the II. SYSTEMATIC REVIEW
healthcare industry has grown rapidly both in low level and
middle-level income countries. However, implementation of First, in this paper, a review is based on the last decade of
health systems has been met by various challenges from a software development life cycle models proposed by [1], to
choice of SDLC model, elicitation of user requirements to explore different SDLC methods applied in the
design and deployment of applications. Use of health implementation of smart healthcare applications. Next, a
description of each activity is given in-depth with a
Revised Manuscript Received on April 12, 2019.
description on how to achieve it.
NeeluLalband,Research Scholar, Dept of C.S.E JNTUA
Anathapuram, A.P, India (Email: [email protected])
Dr. D. Kavitha,Professor, Dept of C.S.E G.Pulla Reddy college of
Engineering (Autonomous), Kurnool, A.P, India (Email:
[email protected])

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Retrieval Number: F10660486S419/19©BEIESP 325 & Sciences Publication
DOI: 10.35940/ijitee.F1066.0486S419
 Software Engineering for Smart Healthcare Applications

Step 1: Classify the necessity for the review Step 5: Definition of principles for inclusion or exclusion
As discussed previously, development of quality health Scope analysis for this survey paper was limited to
care systems that meet the complex nature of healthcare journals, books, conferences articles, and publications
delivery, with streamlined management of patient published between 2012 and 2017. The keywords “software
information records across the extensive medical care engineering” OR “software development life cycle” and
settings is a huge challenge. In order to achieve accuracy “smart healthcare” were vital to be included in searched
and quality, best SDLC model should be proposed. studies.
Step 6: Definition of data extraction procedure
The procedure for extracting data is defined on
conventional items present in each journal consisting the
keywords, and future technology works.
Step 7: Evaluation of quality studies
Evaluation of quality and relevant studies was centered on
relevance examination of articles or journals about Software
Engineering for Smart Healthcare Applications.
Step 8: Extraction of relevant studies
It involved the application of the data mining procedures
Fig. 1. Overview of System development process [5] stated in task 6 for all relevant critical studies gathered from
the search process.
Step 2: Definition of research questions
Step 9: Presentation of study overview
In this stage, formal research questions are defined. The
principal objectives of this survey are to respond the This task entailed discussion of all studies or information
subsequent research questions (RQ): gathered in the task as well to categorize and illuminate
• RQ.1: What are the different SDLC models to develop them concerning the RQ defined task 2.
any kind of software applications? Step 10: Presentation of results to research questions
• RQ.2: Which is the best SDLC model proposed to After an outline of primary studies in software
improve the software application quality? engineering of health care systems, a discussion is given to
• RQ.3: Which is best SDLC suitable for smart healthcare answer the research questions defined in Activity 2. The
applications? results of this activity are presented in “Discussion” section
• RQ.4: What are the research challenges of software as well.
engineering for smart applications?
Step 3: Definition of search string III. SOFTWARE DEVELOPMENT LIFE CYCLE
(SDLC)
In this stage, the keywords to be used in preferred search
tools are defined. In this paper, the next expressions of The development process of system applications is
words were adopted: “Software Engineering” AND primarily determined by different project methodologies [6].
“Software development life cycle” AND “Smart The development approach defines a structure used in
Healthcare.” planning, design and manages the implementation process
of computer systems. Aided by software engineering; a
Step 4: Definition of research sources systematic approach to the design of software, the software
In this survey, few sources and databases were utilized in methodologies result to quality software systems balanced
information gathering. Therefore, many articles, journals, with usability requirements. As such, SDLC provides a
and publications were obtained from the databases and balanced, systematic practice for the development of high
references based on applicability to the defined search quality and reliable computer systems. The SDLC
terminologies. The sources or databases and corresponding framework describes sequences of activities that are
URLs are described below. involved in the process of software production that IT
Online Databases searched specialists and software engineers must follow. It presents a
TABLE 1. Online Sources Searched for Relevant standard procedure that outlines all the activities undertaken
Primary Studies in software development and maintenance.
However, several variations of SDLC model such as
Database URL waterfall, V-model, and spiral models have evolved defining
IEEE Explore http://ieeexplore.ieee.org/Xplore/home.jsp different processes and guiding principles of software
ScienceDirect www.sciencedirect.com development [7]. The SDLC model presents a set of phases
ACM Digital www.acm.org/dl where each phase depends on the results of the preceding
Library stage. Various SDLC models are considered for different
Springer www.springerlink.com
Google Scholar http://scholar.google.com/
CiteseerX http://citeseerx.ist.psu.edu/index

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Retrieval Number: F10660486S419/19©BEIESP 326 & Sciences Publication
DOI: 10.35940/ijitee.F1066.0486S419
 International Journal of Innovative Technology and Exploring Engineering (IJITEE)
ISSN: 2278-3075, Volume-8, Issue-6S4, April 2019

projects based on their suitability to project conditions such documentation ideal for projects concerned with quality
as user's requirements, project risks, cost, and development control. The waterfall model consists of various non-
timeframe. A particular SDLC model may suit a particular overlapping phases such as:
project while at the same time other models may appear • Requirement Elicitation and Analysis
suitable for the elicited requirements but is it essential to • Design
consider trade-offs when choosing an SDLC model. A • System Implementation
formal SDLC model theoretically consists of the following • Testing
phases for developing and implementing computer software. • Deployment
• Planning • Maintenance
• Analysis The above stages are cascaded subsequently with the
• Design progression of development flowing downwards across the
• Implementation stages hence the name waterfall. In waterfall model unless
• Testing until one phase is completed another phase is not started [6].
• Deployment and Evolution The model is not a modest rectilinear method but in entails
Planning and Requirement Analysis: It’s the first basic sequential iterations defining the implementation activities.
phase in which the need for a software product is analyzed. Once the product enters the testing phase, it’s very difficult
The user-requirements are gathered for development [6]. to do the changes as per new requirements. Production and
The information gathered is used in preparation for ideal document approval through iterations are expensive to
project approach as well as feasibility examination in the require a lot of work. Not recommended for large projects.
cost-effective, functional and technical perspectives. After
analysis stage is done, a clear define document for product
development is prepared called as Software Requirement
Specification (SRS).
Design: The next phase of SDLC is Design. It is
concerned with designing a basic structural framework that
identifies the significant component of the product and the
communication between these components.
Implementation: During this stage, the actual process of
product development is executed. The product meets the
SRS is produced. Fig. 2. Waterfall Model
Deployment: In this phase verification and validation of
the product is done. Basic Principles:
• Verification: When the software product is built in • The project is divided into various stages with few
the right way.
overlaps between stages.
• Validation: When the right software is built.
• More emphasis is given to planning phase,
Evolution: It is the last phase of SDLC. Once the product timeframe, budget, and implementation of the whole
is ready after completion of testing, it is deployed into the project [6].
runtime environment. Based on the feedback of the product • There is strict control over the model cycle of the
may enhance for further development which is called as task through broad reviews, certification and
maintenance.
approval user acceptance by the management after
Common Software Engineering Methodologies: implementation phase ends.
Various models of software development have been defined
to be applied during software implementation process. Such B. Spiral Model
models can be classified into two categories. It is the first model to explain the need for iteration and
 Traditional and Classical Models why it matters. During the development process, the
 Waterfall iterations are scheduled between six months and two years
 Spiral [8]. Each stage begins with a plan objective of the design
 V model and terminates with a review from the user on the results
 Rapid Application Development
and project progress. It emphasizes on the risk analysis as
 Modern and Popular Models
 Agile illustrated in the figure below. The entire life cycle is
denoted in a spiral since the model involves a sequential
A. Waterfall Model flow of events with few back-pedaling from preceding
The waterfall model defines a classical and sequential action to another. Each loop is signified into the stage of
approach to software engineering. It is among the earlier software process [6].
models of SDLC mostly applied in significant projects in
corporate industries and government organizations [6]. It
emphasizes on early project planning in the initial stages to
eliminate design flaws before the beginning of software
development. Obstacles such as time-consumption and
unclear user requirements are identified earlier before other
phases begin. Moreover, its intensive planning and

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DOI: 10.35940/ijitee.F1066.0486S419
 Software Engineering for Smart Healthcare Applications

RAD enables fast development and implementation of

high level and quality applications, unlike the traditional
methodologies. Its main aim is to achieve a quality and
efficient software at an affordable price. RAD is integrated
with Computer-Assisted Software Engineering (CASE)
tools and practices, to ensure user-centered design balanced
with product quality [11].
E. Agile Model
Fig. 3. Spiral Model It is a model for developing software applications where
project implementation is done iteratively or incrementally
Each loop is divided into four segments: [12]. In this model change or modification of user,
• Objective Set requirements are allowed thereby encouraging constant
• Risk evaluation and elimination responses from the customer or client. In this model, the
• Implementation and validation phases don’t happen in progression but are flexible for the
• Planning adoption of any changes. As such, the cycle stages are
The software process starts at the center of spiral and executed in parallel. The figure below represents the phases
moves in clockwise direction. In each phase, intensive of the Agile model [13].
analysis efforts are applied with the primary focus on the
result of the software product. Each loop results in
deliverables or outcomes [9].
C. V-Shaped Model
This model resembles waterfall model in its sequential
path execution of processes where each stage is finalized
before proceeding to the next step [9]. Unlike waterfall
method, the testing stage is emphasized in the v-model.
Testing guidelines are formulated in initial stages before the
implementation, and other stages are preceding coding. Prior
to the development process, a system plan is designed based Fig. 6. Agile Development Cycle
on the system functionality to meet all user requirements
[10]. Testing of the project is planned in parallel of The model focuses on customer satisfaction through
corresponding to phase in V-model as mentioned in figure 3. constant delivery of a functional software product. The
Agile Development cycle involves the following activities
[6]:
• The development cycle begins with a meeting.
• User requirements are elicited, understood and
prioritized.
• A system development plan is created.
• Estimation of the complex nature of each
requirement is performed.
• Design diagrams are drawn to illustrate the
functionality of the system.
• Development of the project is carried out either in a
team or pairs.
Fig. 4. V-Shaped Model
• Continuous test of the program code is done
D. Rapid Application Development corresponding to an integration of system
components.
This model was evolved from fourth generation language
• Centered on the user feedback and review, the system
in the 80s and used for applications developed that are data
code is refactored to ensure the better design is
intensive [11]. This set of tools allows data to created,
achieved. It may involve the addition of features or
searched, displayed and presented in reports.
structuring of the user interface appearance.
The tools that are included in RAD Environment are in
figure 5. F. Difference between Traditional and Agile software
development
Agile methods are based on adaptive software
development methods, while traditional SDLC models
(waterfall model, for example) are based on a predictive

Fig. 5. RAD Environment Model

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DOI: 10.35940/ijitee.F1066.0486S419
 International Journal of Innovative Technology and Exploring Engineering (IJITEE)
ISSN: 2278-3075, Volume-8, Issue-6S4, April 2019

approach. In traditional SDLC models, teams work with a Most times, developers will find the periodic meeting
detailed plan and have a full list of characteristics and tasks (usually weekly) boring and tiring because they have to
that must be completed in the next few months or the entire present the modules repeatedly, to new members and clients
life cycle of the product. Predictive methods completely and, on each iteration, changes may happen as requested by
depend on the requirement analysis and careful planning at clients. The time frame for each iteration is short (usually
the beginning of the cycle. Any change that is to be included weeks). Developers will find the schedule too tight for each
will go through a strict change control management and module, even more so for modules that require complex
prioritization. The agile model uses an adaptive approach processing algorithms. This leads to delays in each iteration
where there is no detailed planning and only clear future and hardships in establishing an efficient communication
tasks are those related to the characteristics that must be between team members and the clients.
developed. The team adapts to dynamic changes in the On the other hand, traditional methodologies have a well-
product requirements. The product is frequently tested, defined requirements model before the implementation and
minimizing the risk of major faults in the future. Interaction coding process starts and this acts as a reference for the
with the clients is the strong point of agile methodology and development team during the coding process. Clients do not
open communication and minimal documentation are typical participate in this stage of the development life cycle. The
characteristics of the agile development environment. Teams development team will perform the coding according to the
collaborate closely and often are located in the same documentation provided by the business analysts until the
geographical space. system is complete and only then it will be presented to the
While agile SDLC is better suited for small and medium clients as final product. Developers are not concerned about
projects, on large scale traditional SDLC is still the better frequent meetings and have more time to finish the system.
choice. Therefore it is important that the development team This allows them to provide a better product. The fact that
selects a SDLC that is best suited for project at hand. There agile development allows changes in requirements in an
are criteria that can be used by the development team to incremental way lead to two dependency problems in
identify the dimension of the desired SDLC. They include design: rigidity and mobility. Rigidity means a change in the
team size, geographical location, size and complexity of the system leads to a cascade of changes in other modules,
software, project type, business strategy, engineering while mobility means the inability of the system to include
capabilities etc. Also, it is very important for the team to reusable components because they involve too much effort
study the differences, advantages and drawback of each or risk. When such problems are present throughout the
SDLC before making a decision. Furthermore, the team system, there must be a high level restructuring in order to
must study the context of the business, industry eliminate unwanted dependencies. [26]
requirements and business strategy before evaluating the
TABLE 2. Comparisons between Traditional and Agile
candidate SDLCs. It is important to have a SDLC evaluation
Methodology [22 - 24]
and selection process because it maximizes the chances to
create successful software. Therefore, selection and Parameter Traditional Agile Methodology
adoption of an appropriate SDLC is a management decision Methodology
with long term implications. Centered Systems are The software is
Although agile methodologies triumph over traditional Hypothesis completely specified with high
ones in several aspects, there are many difficulties in specified and and implemented by
making them work. One of them is the significant reduction developed based on medium project
of documentation and the claim that the source code itself planning. teams applying best
should be the documentation. [16] practices of
Thus, developers used to agile methods tend to insert development.
more comments in source code in order to clarify and Management Based on control Based on team
explain. It is difficult for beginner developers or new Approach leaders and
members of the team to complete their tasks when they collaborations
cannot fully understand the project. They ask lots of Management of Clear Inferred
questions to the experienced developers and this may delay Knowledge
completion of the iteration, which can lead to increased Communication Conventional Casual
development costs. Methodology Either waterfall or Iteratively method
On the other hand, traditional methods emphasize other models
documentation in orientation and clarification of the project Development Analytical Adaptive
for the development team, so there is no concern about not Approach
knowing the project details or not having a knowledgeable Implementation Centered on process Based on people
developer. Agile methodologies are well known for the Orientation
importance given to communication and client implication.
[25]
For each version delivered, the development team and the
clients will organize a meeting where the team will present
the work done in current iteration and the clients will
provide feed-back on the delivered software (improvements
on current features or addition of new ones).

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DOI: 10.35940/ijitee.F1066.0486S419
 Software Engineering for Smart Healthcare Applications

Quality The planning phase Controlling phases • Security: Healthcare systems are different from other
is hard to control of analysis through computer systems as it stores sensitive information
and achieve the design testing is such as patient records, confidential data, and
excellent end result. easy. financial data. Therefore, software vendors should
Project Well outlined and Interactive input consider security requirements when developing
requirements defined healthcare applications [19].
Project cost High Low • Performance: It is a most important requirement for
Direction of Fixed Flexible and can be any system. In healthcare systems, performance is
implementation changed related to data; its accuracy and availability.
Project Testing Done at the end After each • Reliability: Healthcare providers operate on a 24/7
deliverable basis and as such as the health care system should be
(iteration) reliable in every business process.
Project scale Large Medium or at times • Availability: It entails the proportion of time when
low the system is running or operational. In healthcare,
Software Based on the system Active and availability is a crucial requirement throughout the
engineers plan with knowledgeable, delicate and sensitive medical process such as
implementation collaborative. surgery and diagnostic.
abilities. C. Final Considerations
User Has access skills, Knowledgeable, During software development of a health care system,
responsive and committed and there must be a universal understanding among medical
empowered. collaborative. personnel and software developers. In each stage of
Restructuring Costly Cheap development, various concerns must be considered to ensure
Team Size Large Small delivery of a quality application [20].
Adaptability to Change Change Adaptability Planning and Analysis Phase: It is most challenging
Change Sustainability phase thus a system plan should be created to guide the
Documentation High Low project team throughout the execution process of the system.
Also, emphasized should be given to communication
IV. DISCUSSION between the development team and all other stakeholders
A. Software Engineering for Smart Healthcare Applications [20].
Design Phase: The requirements from the initial stage
Healthcare industry is very dynamic and incorporates
should be documented as well as the establishment of the
technologies into their processes so as to improve the quality
system architecture. The architecture should define
of life of patients and efficiency. At times, it is subjected to
interfaces, components and behavioral characteristics of the
regulatory policies and other health compliance
healthcare application. The by-product; design document
requirements and as such, health care systems must meet the
should demonstrate a technical plan for the system
required standards. By adapting information technology, e-
implementation [21].
health was introduced, later the widespread of mobile
Implementation Phase: The software developers build
technology introduced m-health [27]. As advancement in
the components defined in the design stage. Issues of
technology healthcare is also transforming and adapting new
performance, quality, security, and reliability should be
technology called smart healthcare. Mainly these
emphasized.
applications are developed for chronic patients, taking care
Validation and Delivery Phase: System validation
of elderly persons, physical fitness, etc. [17]. To develop a
should be undertaken by a team that knows the systems to
quality, suitable and most effective application, various
avoid mistakes and errors. As such, it should be carried by a
challenges are encountered. The challenges identified are:
joint team that encompasses the system testers, practitioners,
• Selection of process
development team, health care providers and the end users
• Software Design
[21].
• Middleware Challenge
• Software Quality
V. RESULT & DISCUSSIONS
• Software Maintenance
Compared to traditional model Agile software In this survey, a brief discussion about different software
development would be more suitable for Smart Healthcare development lifecycle models used in the software industry
Application development [27]. The challenges identified can is given. Although there are many development models,
be easily handled by the agile model as stated in comparison only a few basic models which are commonly used were
table 2. discussed. Consequently, a comparison is made in between
traditional and agile models to identify which is a better
B. Healthcare Application Issues model. As highlighted, many software industries are shifting
Health care systems are complex due to the dynamic from traditional models to agile models to achieve quality
nature of the socio-technical setting. Their concerns that
smart applications may cause errors instead of correcting
them [18]. When developing healthcare systems, it is ideal
to consider the following issues:

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DOI: 10.35940/ijitee.F1066.0486S419
 International Journal of Innovative Technology and Exploring Engineering (IJITEE)
ISSN: 2278-3075, Volume-8, Issue-6S4, April 2019

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Blue Eyes Intelligence Engineering
Retrieval Number: F10660486S419/19©BEIESP 331 & Sciences Publication
DOI: 10.35940/ijitee.F1066.0486S419