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IoT in Health-care: Recent Advances in the Development of Smart Cyber-

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IJCSNS International Journal of Computer Science and Network Security, VOL.19 No.2, February 2019 181

IoT in Health-care: Recent Advances in the Development of

Smart Cyber-Physical Ubiquitous Environments
Abdulaziz A. Albesher

College of Computing and Informatics, Saudi Electronic University,Riyadh, Saudi Arabia

Summary Earlier research endeavors in the field of IoT in healthcare

With the widespread of sensors and devices with connectivity in started with the initial research and development activities
recent years, internet of things (IoT) has become very essential in based on wireless sensor networks (WSNs) [8]. Today, the
almost every field. Its application in healthcare is one of the technology is gradually transforming into lower power
primary areas of research. This paper provides an overview of wireless personal area network (6LoWPAN), which is
different aspects of IoT in healthcare. It discusses some of the
major services of IoT healthcare and its benefits to the
based on IPv6 [9]. This allows the smallest of the devices,
communities at large, including initiatives taken in different with limited processing ability and power-life, to transmit
countries worldwide. Recent and advanced wearable health information wirelessly using an internet protocol. This
technologies are also discussed along with some state of the art empowers small sensors, devices and wearable gadgets in
IoT enabled health applications. It is preceded by a thorough the healthcare industry to be a part of the huge internet
discussion on security requirements and challenges in IoT revolution and opens countless horizons of usability,
healthcare. Future trends and technological directions are connectivity, facilitation, research and development. It has
discussed at the end of this work. also restructured the usage of healthcare diagnostic and
Key words: imaging devices, monitoring systems, wearable devices and
Ubiquitous computing, Internet of Things, Internet of Healthcare sensors to be an essential part of the IoT. Some of the most
Things, pervasive networks, e-health
prominent applications in IoHT include remote patient
monitoring, elderly care programs, fitness and diet control
1. Introduction programs, mental and psychological counselling systems,
drug reaction control, and indirect emergency healthcare, to
As the world’s next-generation technological paradigm name a few.
continues to shift and grow, new devices and innovative Likewise, there is a lot of potential of new, innovative and
ways of their utilization and integration with the cost-effective medical applications and devices with the
surroundings emerge like never before. Internet of Things emergence of IoT which are expected to increase the quality
(IoT) is such a megatrend in today’s computing of life. These systems are capable of human-to-human
environment. IoT utilizes uniquely identifiable smart (H2H), human-to-machine (H2M) as well as machine-to-
devices and objects for the formation of cyber-physical machine (M2M) communication without human
smart ubiquitous networks which are also able of connect involvement [6]. These advancements have transformed the
with the already existing internet framework. Hence, any treatment methods and the way patients are looked after.
device or thing can connect to other things, people or This enables the access of health data by the patient’s
services through internet. This will increase the size of doctors, nurses and close relatives. In addition, the quality
current internet by many folds. According to a prediction by and efficiency of the medical services has also been greatly
Forbes magazine [1], by the year 2020 there are an expected improved. As an example, chronically ill patients, elderly
40.9 billion devices capable of connecting with the internet people and patients with reduced mobility can now be
and directly communicating amongst one another. This managed remotely. This can substantially minimize the
leads to a wide range of benefits and application areas such hospital visits, thus reducing the cost and inconvenience to
as smart cities [2], water quality assessment [3], security [4], the patients. Healthcare monitoring wearables, such as a
industrial control [5], disaster management, traffic smart blood-pressure cuff or gadgets like BioPatch [10], can
congestion control, stampede awareness, anomaly detection send data remotely during different times of the day. This
and health care [6], to name a few. Among these, IoT for bridges the gap between the doctor and the patient and
healthcare is one of the prime application areas using such speeds up the treatment according to the critical needs of the
pervasive networks [7], [8] and much recent research is patient. IoT has the potential to significantly reduce
focusing on it. When it come to healthcare, IoT is known as mortalities and medical complications related to non-
Internet of Healthcare Things (IoHT) communicable diseases such as stroke, heart diseases, hyper
tension, hypo and hyper glycemia, cancer, etc.

Manuscript received February 5, 2019

Manuscript revised February 20, 2019
182 IJCSNS International Journal of Computer Science and Network Security, VOL.19 No.2, February 2019

From the point of view of device-care and maintenance, IoT 2. IoT Health Services and Applications
has the prospects of device servicing, care and restocking
the about-to-finish supplies in a timely manner. Remotely With the widespread of interconnected networks and
installed devices can communicate with the healthcare propensity of devices to form ubiquitous ad hoc networks,
providers and device vendors for a possible fix or IoHT applications have evolved with much diversity and
replacement before going down. This eventually saves innovation in recent decade. One of the considerable
substantial amount of downtime in which, otherwise, the revolutions is the emergence of personalized healthcare
patient would have been facing a risk of not being services and widespread wearable devices in medical sector.
monitored. Due to the prospective benefits of IoT in health services and
Current research drift in IoHT is along the direction of IoHT applications, countries worldwide have taken plenty of
network architectures and protocols, security, innovative measures to instigate development, adoption and use of IoT
applications and services, interoperability, power services and applications in medical sector. Figure 1
optimization, among many others. The focus of this work is presents the general architecture of IoHT enable medical
to provide the reader an earlier insight into these research services. In the subsections that follow, we discuss these
trends and future of IoT. In this work we present a brief different aspects in detail.
survey of IoHT services and applications, including
personalized care and wearables. We also present and 2.1 IoT for Personalized Medical Services
analyze security and other challenges pertaining to IoHT. In
addition, we present an overview of initiatives different Recent proliferation of IoT enabled technology has paved
countries have taken in IoHT and highlight the future trends the path to the emergence of personalized healthcare
and technologies in IoT health. services. Whereby, a service is a broader term
IoHT Things encompassing a collection of solutions in a specific service
Patient
domain. Some of the most noticeable healthcare services are
discussed in this subsection.
One of the most beneficial IoT services is indirect
emergency healthcare (IEH) [11], [12]. There are many
emergency situations in which timely and effective
Router/gateway response by a medical expert is highly desirable. Sometimes,
these situations can be life threatening and the patient is
remotely located. In other scenarios, the cause of a bad
situation can be natural hazards such as fires, thunderstorms,
Cloud earthquakes, tsunamis, etc. IEH is considered to be a
dedicated service offering a set of solutions such as post-
disaster actions, information availability and record keeping
[8].
Ambient assisted living (AAL) is another very important
Router/gateway service based on IoT. It promises to fulfil a long-awaited
IoHT Healthcare Providers
need of human societies worldwide. It is a new paradigm
that deploys intelligent objects in the environment of people
with less mobility and dependency, especially elderly
people and people with reduced mobility, to support them
and monitor them continuously. This enables them to be
Fig. 1 General architecture of IoHT enables medical services.
more independent and secure.
Another very important service that IoT has enabled in
The rest of this paper is organized as follows. Section 2 recent years is the timely management of adverse drug
presents and overview of personalized healthcare reaction (ADR). Once of the most important aspects of
applications along with insight into healthcare wearable primary medical care is to make sure that patients on
devices. Section 3 covers security requirements and prolonged medication are subjected to minimal ADRs.
challenges faced by IoHT services and technologies. Future Compliance to the drug is also another concern, as severe
challenges in IoT health and country-wise initiatives for IoT health issues may result if a patient abandons or neglects the
are discussed in section 4. Section 5 presents conclusion of prescribed dose of medicine or take it in wrong times or
this work. takes a combination of them without consulting the
healthcare experts. According to a latest research, ADR
prevalence in the hospitals throughout the world is 6.7 %,
IJCSNS International Journal of Computer Science and Network Security, VOL.19 No.2, February 2019 183

with an estimated death rate of 0.32 % of the total patients 2.2 Health-Care Wearables
[13].
Behavioral, emotional and mental health problems of This subsection provides an insight into some of the latest
children, and constant monitoring of these for their IoT enabled healthcare wearable devices and applications.
wellbeing is another important aspect that IoT is benefitting IoT enabled healthcare wearables are any devices or
the societies at large [14]. To cater for this, specialized technologies that can be attached to humans in the form of
IoHT service known as children health information (CHI) utility gadgets or clothes. They then collect and
has been developed. In addition to these, special IoT based communicate health related information with the medical
devices and applications are designed to create an units, remote servers, and other persons such as relatives
awareness among young children regarding the overall and friends. The last one decade has seen a revolution in
wellbeing, nutrition and healthy lifestyle. innovative wearable technologies which the world had
Another very important area in which IoT has a been very never seen before.
effective is community healthcare (CH). Through IoT Among the most common types of healthcare wearables are
enabled devices and sensors, a network is formed in the fitness trackers and smart watches. There is a wide range
communities like neighborhoods, rural areas and remote of mobile applications that are available for these gadgets
localities. This network is connected to a centralized to connect and communicate information with remote
healthcare unit. Thus, fulfilling any medical needs or servers, artificial intelligence (AI) based agents and
emergencies and sharing and communicating health related healthcare specialists. Fitness trackers are especially helpful
information. in weight loss programs, healthy lifestyle, recovery from
and ailment such as a heart attack, and for the well-being of
Table 1: Most Noticeable IoHT Mobile Applications in different areas of elderly people. Table 1 provides a list of some of the most
healthcare prominent and highly popular applications for healthcare.
Healthcare Area Apps
MediCode, CURRENT Medical
These include applications for blood glucose level
Diagonosis and Treatment, John monitoring, blood pressure monitoring, oxygen saturation
Hopkin’s Antibiotic Guide, MS monitoring, medication management and medical education.
Diagnostics applications diagonosis and Management, Due to the limitation of this paper, all of these can not be
Your.MD: Sympton Checker and
Health Tracker, Conn’s Current
discussed here. Among these traditional gadgets and
Therapy applications, there is a list of somewhat unique and more
BetterHelp: Counseling and noticeable ones. We discuss some of these in the following
Therapy Online, Youper-Anxiety paras.
Therapy and and counseling
and Depression, Talkspace
apps Air Louisville [15] is crowdsourcing of air quality in
Counciling and therapy,
Psychologist Louisville, United States by using smart air inhalers
Harrison’s Manual and Medicine, equipped with different sensors. It is among some of the
Diseases Dictionary, I-surgery most noticeable IoT enabled healthcare wearables.
Medical education applications Notebook, Netter’s Anatomy Flash Louisville is among the worst polluted cities in the world
Cards, Oxford’s Handbook of
Clinical Specialities and people with lung diseases like asthma and chronic
IBM Micromedex Drug Ref, obstructive pulmonary disease are at a constant life threat.
Drug reference applications
RxDrugs, FDA Drugs, Lab Values, Air Louisville enrolled 1,147 citizens of Louisville and
Mosby’s Drug Reference, collected 1.2 million data points, including over 251,000
Drugs.com Medication Guide
Clinical Reach, Practice Unite,
medication puffs. It then combined these data with over 5.4
Clinical Communications million environmental data points to find the reason and
Tradassan, Vocera, Emergency
applications
Medicine Program scenarios causing lung diseases.
Breast cancer is one of the most prevailing form of cancers
Crowd based medical help is another very important service for women worldwide with an estimated number of 1.7
that IoT can provide to communities worldwide. It is million new cases yearly. One of the major reasons of its
regarded as a direct help by the community in cases of prevalence is failure of early stage detection due to
medical emergencies, financial issues and general health ignorance, unavailability of radiologists on remote
related issues. Users and devices connected to this service locations and lack of resources. Cyrcadia Health [16]
include healthcare seekers, practitioners and provider units. developed a wearable solution known as iTBra in the form
As an example, in case of an emergency blood requirement, of sensor patches worn as a bra insert and collects data
any person from the community can communicate with the related to daily heat changes that correlate to elevated
relevant node to volunteer for blood donation. In cases of cellular activity due to tumors. The data then can be
natural disasters, crowd can help rebuilding and transferred to mobile of computer and shared with
reestablishment of the communities through the information healthcare service providers.
sharing by IoHT.
184 IJCSNS International Journal of Computer Science and Network Security, VOL.19 No.2, February 2019

Kardia from AliveCor [17] is another very interesting 3. IoT Health-Care Security Requirements
wearable that monitors the circadian rhythm of the heart and and Challenges
eliminates electrocardiogram (ECG) test. User can put a set
of finger pads near the mobile phone, and then place their IoHT is flourishing rapidly in the medical sector and soon
fingers on the device to take the reading which takes only there will be a widespread of this concept in all areas of the
thirty seconds. The device then indicates whether the user’s medical practice. Along with these developments, there are
heartbeat is normal or he is facing atrial fibrillation. Another also raising concerns of a myriad of security issues and
version is in the form of a band and can use the readings challenges. In this section we discuss some of these
from Apple watch’s heart-rate sensor. important aspects concerning to security in IoHT enabled
Recently, L’Oreal introduced a new wearable called La devices and networks.
Roche-Posay UV Sense [18] that can sense and inform the Since the development of IoHT devices and applications are
users when they are exposed to high doses of ultraviolet at the infancy level, there are many limitations presently
(UV) radiation which can have adverse effects on health. that play a vital role in the onset of challenges faced by
The sensor is less than a centimeter, can be worn on a nail IoHT. These limitations include the energy limitations,
and is battery free. An NFC enable mobile phone can memory limitations and computational power limitations.
download its data and inform the user about the sun With the ongoing technological developments in the
exposure. hardware, these limitations are reducing with the passage of
The role of IoT for transforming living standards can be time and devices are continuously improved with better
evident from the applications and services for people with battery-life, increased memory sizes and higher processing
special assistance. One such example is Aira [19]. It is a speeds.
semi-automated service which consists of a camera Other challenges, which are more on the software side,
mounted wearable glasses worn by the blind person. The include confidentiality of information, integrity of sensitive
camera captures real time video which is transmitted to medical data, availability of service, fault tolerance,
remotely located specialized trained agents who then authentication and authorization. Confidentiality of
personally help the blind navigating through the scenes. It information prevents the access of medical information to
has many other extra advanced features like location unauthorized users. For this, several techniques have been
tracking in case of a blind travelling in a rented vehicle. It implemented and more are expected to be developed as the
is a service of its own kind and opens many other research technology continues to enhance. Integrity of data prevents
areas. any alteration of data during its transit stage by any
Another very honorable mention in the state-of-the-art adversary sniffing the IoHT network. Another very
devices are moodables, i.e. devices with the potential of important aspect when it comes to IoHT challenges is
enhancing a person’s mood when feeling anxious or availability of service. It ensures that the healthcare services
depressed [20]. This is a very remarkable achievement as will be available to the end users when and where needed.
depression patients are increasing worldwide. These Any downtime and denial of service would discourage the
wearables are worn on the head and are able to transmit a embracement of IoHT services and applications. In addition,
controlled low intensity current to the human brain which these services should be fault tolerant. This urges the
eliminates depression. Companies like Thync [21] and Halo services to be still available even in the times of faults and
Neurosciences [22] have made considerable progress on attacks. Lastly, one of the most important challenges related
such devices and it is expected that soon they will be to security is the mechanism for ensuring authentication and
available in the market on affordable prices. authorization. Authentication ensures that the IoHT device
When it comes to infant and child care, TemTraq [23] is yet is communicating to the peer it is supposed to communicate
another innovative IoT enabled wearable. It supports and there is no false presence. Authorization ensures that
Bluetooth and monitors the body temperature of infants up only authorized nodes are allowed to utilize and access
to 48 hours using a soft stick-able underarms patch sensor. IoHT network peers and resources. For further details on
The readings can be monitored on a mobile device through these challenges the reader is referred to [8] which presents
an application interface. It also supports many advance a detailed discussion on them.
functionalities like raising alarms when temperature Like other conventional networks, IoHT networks are also
exceeds critical set thresholds. Such a wearable is very prone to a number of hostile attacks. Since mobility is a
helpful especially during bacterial and viral infections when prime factor in IoHT based devices, therefore these are
temperatures can suddenly shoot up in response by the body prone to frequent network changes with different security
fighting against the disease. configuration settings which makes them highly vulnerable.
These include attacks based on information interference,
attacks based on host properties and attacks based on
network properties. Whether the health data is in transit or
on some storage device, it is always susceptible to
IJCSNS International Journal of Computer Science and Network Security, VOL.19 No.2, February 2019 185

information interference attacks such as Interruption, locations and unavailability of physicians, the user see it as
Interception, Modification, Fabrication and Replay attacks a ray of hope and are embracing IoHT with open arms. As
[8]. In case of attacks based on host properties, there could the research continues in eradication of security challenges
be three major types of compromises including user in future, and countries continue making policies and
compromise, hardware compromise and software shifting towards eHealth and IoHT enabled networks, the
compromise. An attacker can steal and modify the data with future of IoHT is very bright.
malevolent intent. Lastly, for the attacks based on network,
an attacker can launch attacks based on standard protocol
compromise and/or network protocol stack attacks. 5. Conclusion
Therefore, the IoHT services need to have a strong
collaboration between them and should be dynamic to IoT in one of the primary topics of research in these days as
predict and countermeasure these attacks and the attacks the world’s technological and application paradigm for new
expected in future. and innovative technologies and applications is on a
continuous shift. This paper presents an overview of IoT in
healthcare with discussion and insights into a number of
4. IoHT: Country-wise Initiatives and Future related issues. There is a plethora of IoT based healthcare
Trends services like indirect emergency healthcare, ambient
assisted living, adverse drug reaction, children health
Ranging from pilot projects to effective implementation of information and community healthcare, to name a few. New
eHealth and IoHT based health services and policies have and innovative wearable gadgets are also emerging.
been adopted successfully in many countries worldwide. Countries around the globe are making laws and policies for
Some of the countries and their policies pertaining to these including IoT in medical care practices. Along with these,
in the modern world include Japan’s u-Japan health policy there are many challenges faced by IoHT infrastructure,
[24], France’s mandatory service of object-naming service architectures, devices and services. The future of IoT based
(ONS) which requires every product to be uniquely medical services is very promising as the research continues
identifiable including IoHT enabled devices; Sweden’s in IoT.
national strategy for health of 2010; Germany’s
INDUSTRIE 4.0 strategic initiative; South Korea’s
Acknowledgments
initiative to expands it IoT market to $28.9 billion as a result
of its eHealth policy of 2008; the European Union’s policay The author highly acknowledges the support provided by
of health in 2004; China’s eHealth development strategy of Saudi Electronic University (SEU) for this research.
2003-2010; and the United States’ ongoing efforts from
2014 to introduce IoT in healthcare.
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