healthcare

Review
IoT-Based Healthcare-Monitoring System towards Improving
Quality of Life: A Review
Suliman Abdulmalek 1,2 , Abdul Nasir 1, * , Waheb A. Jabbar 3 , Mukarram A. M. Almuhaya 1 ,
Anupam Kumar Bairagi 4, * , Md. Al-Masrur Khan 5 and Seong-Hoon Kee 5

1 Faculty of Electrical & Electronic Engineering Technology, Universiti Malaysia Pahang, Pekan 26600, Malaysia
2 Faculty of Engineering and Computing, University of Science & Technology, Aden 8916162, Yemen
3 School of Engineering and the Built Environment, Birmingham City University, Birmingham B4 7XG, UK
4 Computer Science and Engineering Discipline, Khulna University, Khulna 9208, Bangladesh
5 Department of ICT Integrated Ocean Smart Cities Engineering, Dong-A University, Busan 49315, Korea
* Correspondence: Correspondence: abdnasir@ump.edu.my (A.N.); anupam@ku.ac.bd (A.K.B.)

Abstract: The Internet of Things (IoT) is essential in innovative applications such as smart cities,
smart homes, education, healthcare, transportation, and defense operations. IoT applications are par-
ticularly beneficial for providing healthcare because they enable secure and real-time remote patient
monitoring to improve the quality of people’s lives. This review paper explores the latest trends in
healthcare-monitoring systems by implementing the role of the IoT. The work discusses the benefits of
IoT-based healthcare systems with regard to their significance, and the benefits of IoT healthcare. We
provide a systematic review on recent studies of IoT-based healthcare-monitoring systems through
literature review. The literature review compares various systems’ effectiveness, efficiency, data
protection, privacy, security, and monitoring. The paper also explores wireless- and wearable-sensor-
based IoT monitoring systems and provides a classification of healthcare-monitoring sensors. We
Citation: Abdulmalek, S.; Nasir, A.; also elaborate, in detail, on the challenges and open issues regarding healthcare security and privacy,
Jabbar, W.A.; Almuhaya, M.A.M.; and QoS. Finally, suggestions and recommendations for IoT healthcare applications are laid down at
Bairagi, A.K.; Khan, M.A.-M.; Kee, the end of the study along with future directions related to various recent technology trends.
S.-H. IoT-Based Healthcare-
Monitoring System towards Keywords: IoT; IoWT; healthcare; monitoring; remote
Improving Quality of Life: A Review.
Healthcare 2022, 10, 1993. https://
doi.org/10.3390/healthcare10101993

Academic Editor: Tin-Chih 1. Introduction

Toly Chen The term Internet of Things (IoT) was invented by Kevin Ashton in 1999 and refers to
Received: 11 August 2022
data on the Internet that are connected to evolving global service architecture [1,2]. IoT is
Accepted: 6 October 2022
the product of advanced research on information and communications technology. It can
Published: 11 October 2022
potentially enhance urban residents’ quality of life. Since the global population is increasing
at an astonishing rate, and the prevalence of chronic diseases is also on the rise, there is
Publisher’s Note: MDPI stays neutral
growing demand for designing cost-effective healthcare systems that can efficiently manage
with regard to jurisdictional claims in
and provide a wide range of medical services while reducing overall expenses [3–6]. The
published maps and institutional affil-
IoT has become a key development area recently, enabling healthcare-monitoring system
iations.
advancement. The IoT healthcare-monitoring system aims to accurately track people and
connect various services and things in the world through the Internet to collect, share,
monitor, store, and analyze the data generated by these things [7]. However, the IoT is a
Copyright: © 2022 by the authors.
new paradigm where all connected physical objects in any intelligent application, such
Licensee MDPI, Basel, Switzerland. as smart city, smart home, and smart healthcare, are addressed and controlled remotely.
This article is an open access article Diagnosing disorders and monitoring patients is essential to providing medical care, and
distributed under the terms and applying sensor networks to the human body will significantly assist in this endeavor. In
conditions of the Creative Commons addition, the information is readily accessible from any location in the world at any given
Attribution (CC BY) license (https:// time [8].
creativecommons.org/licenses/by/ Patients with severe injuries or from certain areas may have difficulty reaching the
4.0/). hospital. Therefore, they can use video conferencing to communicate with their doctors

Healthcare 2022, 10, 1993. https://doi.org/10.3390/healthcare10101993 https://www.mdpi.com/journal/healthcare

Healthcare 2022, 10, 1993 2 of 32

to improve their health while saving money and time. Patients can use this technology to
record their health conditions on their phones [9]. It is anticipated that the benefits of the
IoT will be improved and result in individualized treatment, improving patient outcomes
while saving healthcare management costs. IoT systems allow physicians to keep an eye on
their patients remotely and schedule their appointments more efficiently. Patients also can
improve their home healthcare to reduce their need for doctor visits and the likelihood of
receiving unnecessary or inappropriate medical treatments in hospitals or clinics. For this
reason, the quality of medical care and the overall safety of patients may improve, while the
overall cost of care may decrease. The IoT holds significant potential in healthcare [7,10].
It will not be long before we have access to a health-monitoring system that can be used
from the comfort of our homes and streamline hospital processes. IoT sensors should be
densely deployed to monitor the body and environment continuously. This effort will
enable the tracking of chronic-disease management and rehabilitation progress. In the
future of virtual consultations for remote medical care, the IoT will be able to provide
efficient data connections from multiple locations [11].
Most of the current implementations of the IoT and research on it are undeveloped
and focus on deploying and configuring technology in various contexts and conditions.
However, these practices are not widely used today. Therefore, this paper aims to evaluate
related research on designing and implementing an IoT-based healthcare-monitoring sys-
tem that improves quality of life. These systems rely heavily on IoT devices and sensors to
connect patients with the healthcare providers best suited for their care.
The main contribution of this research paper is to highlight IoT-based healthcare-
monitoring systems in detail so that future researchers, academicians, and scientists can
easily find a roadmap to understand the current healthcare-monitoring systems and can
easily provide solutions and enhancements for such critical applications. In this research
paper, we provide a general idea of IoT-based healthcare-monitoring systems in a systematic
way, along with their benefits and significance, and a literature review. Moreover, we
discuss the concepts of wearable things in healthcare systems from an IoT perspective. The
paper also provides a classification of healthcare-monitoring sensors, addresses security
and protocols for IoT healthcare-monitoring systems, and details challenges and open
issues. We also suggest solutions to overcome these challenges and issues in the future.
The paper is divided into eight sections as follows: Section 2 discusses the IoT-based
healthcare system and its applications and the significance of using the IoT in the healthcare
domain, followed by a review of the recent related studies in Section 3. Section 4 describes
the Internet of wearable things and wearable sensors in the healthcare-monitoring system;
this section also provides a classification of heath-monitoring sensors. Section 5 emphasizes
security and protocols for IoT healthcare-monitoring systems. Section 6 describes IoT
healthcare challenges and open issues. Suggestions and recommendations are described in
Section 7, and Section 8 provides the conclusion of the overall review. Figure 1 shows the
overall paper structure.
 Healthcare 2022, 10, x FOR PEER REVIEW 3 of 30
Healthcare 2022, 10, 1993 3 of 32

Introduction
Significance of IoT-
Based healthcare
IoT-based monitoring system
healthcare systems
and their
application
Benefits of using
IoT in healthcare
Review of recent
studies
Wireless network Use cases of Health
Use cases
technologies for Monitoring
/Applications
IoT-healthcare Sensors
Internet of
wearable things Wearable sensors
Classification of
in healthcare
health moitoring
Security and monitoring
sensors
protocols for IoT systems
Research healthcare Performance
Overview monitoring Security Evaluation of IoT
systems Sensors

QoS

Comutational
Intelligence
IoT healthcare
challenges and
open issues
Integration
Suggestions and
Recommendation
Energy

Conclusion

Disease prediction

Figure 1. Research overview.

Figure 1. Research overview.
2. IoT-Based Healthcare Systems and Their Applications
2. IoT-Based Healthcare Systems and Their Applications
IoT-based healthcare systems and their applications facilitates people’s lives in differ-
IoT-based
ent ways, such as: healthcare systems and their applications facilitates people’s lives in dif-
ferent ways, such as:
1. Remote healthcare: Wireless IoT-driven solutions bring healthcare to patients rather
1. thanRemote healthcare:
the patient Wireless IoT-driven
to healthcare. solutions
Data are collected bring healthcare
securely to patients
through IoT-based rather
sensors,
than the patient to healthcare. Data are collected securely through
and the data are analyzed by a small algorithm before being shared with health IoT-based sensors,
and the datafor
professionals areappropriate
analyzed byrecommendations.
a small algorithm before being shared with health pro-
fessionals for appropriate recommendations.
2. Real-time monitoring: IoT-driven non-invasive-monitoring sensors collect compre-
2. hensive
Real-time monitoring:information.
psychological IoT-driven non-invasive-monitoring
Gateways and cloud-based sensors collect
analysis managecompre-
the
hensiveofpsychological
storage data. information. Gateways and cloud-based analysis manage the
storage of care:
3. Preventive data. IoT healthcare systems use sensor data, which help with the early
3. detection
Preventive of care: IoT healthcare
emergencies systems
and alerts familyuse sensor data,
members. whichlearning
Machine help withforthe early
health-
detection of emergencies and alerts family members. Machine learning for health-
trend tracking and early anomaly detection is achieved through the IoT approach [12].
trend tracking and early anomaly detection is achieved through the IoT approach
2.1. The Significance of IoT-Based Healthcare-Monitoring Systems
[12].
The development of monitoring systems for healthcare is receiving a great deal of
2.1. The Significance
attention of IoT-Based
from researchers Healthcare-Monitoring
and leaders in the medicalSystems
field. Several successful research
projects have been conducted in this area, and
The development of monitoring systems for healthcare many more areiscurrently
receivingunderway [13].
a great deal of
The number of gaps in care provided by healthcare providers is increasing
attention from researchers and leaders in the medical field. Several successful research significantly,
directly
projectsresulting
have been from the rapidly
conducted growing
in this area, andnumber
many of older
more areadults and underway
currently patients with
[13].
chronic illnesses. The major shortcoming is that healthcare is only provided
The number of gaps in care provided by healthcare providers is increasing significantly, in hospitals;
therefore, it is unsuitable
directly resulting from thefor seniors
rapidlyand peoplenumber
growing with disabilities
of older and cannot
adults and always
patientsmeet
with
their
chronic illnesses. The major shortcoming is that healthcare is only provided in provides
needs [14]. The IoT, with the help of sensor values and telecommunications, hospitals;
Healthcare 2022, 10, 1993 4 of 32

an effective and practical solution to the issue of real-time monitoring of the health status
of the elderly. It has been shown that the IoT, in conjunction with smart technologies,
can provide various improved and enhanced services. Using sensors, researchers have
developed various emergency systems using technologies that enable intelligent and remote
wireless communication. These technologies have been used for various medical purposes,
particularly in monitoring the health of the elderly. This way, data can be collected on
general health and dangerous situations by capturing important vital signs [15].

2.2. Benefits of Using IoT in Healthcare

The IoT will reshape healthcare as we know it, with profound implications. In terms of
how apps, devices, and people communicate with each other to deliver healthcare solutions,
we have reached a whole new level of evolution. The IoT has given us a new perspective
and tools for an integrated healthcare network, greatly improving healthcare quality.
The IoT has made it possible to automate healthcare procedures that previously
required a significant amount of time and left room for error due to human involvement.
For example, to control airflow and temperature in operating rooms, many hospitals now
use networked devices.
There are almost endless ways the IoT can improve medical care; however, the follow-
ing are some of the key benefits:
• Reduced cost of care.
• Human errors are reduced.
• Elimination of the limitations of distance.
• Reduced amounts of paperwork and record keeping.
• Chronic diseases are detected early.
• Improvements in medication management.
• The need for prompt medical care.
• Better treatment outcomes.

3. Review of Recent Related Studies

Healthcare is a vast arena that is composed of many different components. Delivering
healthcare involves clinical practices, hospitals, pharmacies, home health providers, long-
term care providers, pharmaceutical companies, and medical-device manufacturers. It also
involves health and wellness products and services, insurance companies, and governments
providing services to end-users [6]. This section provides a review with an analysis of the
recent research on IoT-based healthcare-monitoring systems. Table 1 summarizes some of
the recent studies regarding IoT-based healthcare-monitoring systems.
The wearable device developed by Wu et al. [16] monitors various physiological
parameters, including body temperature (BT), electrocardiograph (ECG), and heart rate
(HR). Using Pulse Arrival Time (PAT) to measure ECG and PPG, it is possible to estimate
blood pressure (BP). The interaction between humans and remote monitoring programs
is straightforward because all the components are designed within a rigid framework. In
addition, the power consumption of the devices is low, and they can communicate wire-
lessly to make tailored measurements of a specific physiological signal. The physiological
measurements can be wirelessly transmitted to a gateway using a BLE module. The data
are encrypted at the sensor patch and gateways to maintain privacy, ensuring transmission
security. The wearable sensor system is connected to the cloud using a smartphone and
a Raspberry Pi module as a gateway; the data can be retrieved and analyzed from the
cloud. Despite its low energy consumption, BLE technology is unsuitable for wireless
communication over long distances and high data rates.
Islam et al. [17] developed an intelligent monitoring system for use in a hospital. It not
only collects data on patients’ BT, HR, and other vital signs but also monitors environmental
factors in the hospital room, such as CO, CO2 , and humidity. The success rate of modern
healthcare systems is ~95% agreement between monitored and actual data in all cases.
Medical staff can view the data in real-time, either on-site or remotely. Hypothetically, the
Healthcare 2022, 10, 1993 5 of 32

technology would be helpful during medical crises and epidemics, as medical personnel
would have almost instant access to raw data. The prototype created is incredibly easy to
design and use. Such devices could be helpful in managing infectious-disease outbreaks,
such as COVID-19. Potentially, this system could save more lives by improving the effi-
ciency of the existing healthcare system. However, at this stage, the system still lacks some
epidemic-related sensors that need to be evaluated once implemented.
In [18], Al-Sheik and Ameen propose an IoT health-monitoring system for cell phones
that remotely monitors patients’ vital signs, including BT, ECG, and blood-oxygen satu-
ration (SpO2). Arduino was used to measure and process this system. This system uses
Wi-Fi to send the data to a cloud service on the IoT platform called Blynk; the data can be
monitored in real-time. For security and privacy reasons, the results are sent to a specific
smartphone that the doctor can monitor. Therefore, two microcontrollers, Arduino and
NodeMCU, are used, which still need to be improved. For long-distance transmission,
Wi-Fi technology is not the ideal option.
Hamim et al. [19] present an IoT-based healthcare-monitoring system for patients and
older adults based on an Android application. The sensors in this prototype collect BT,
HR, and Galvanic Skin Response (GSR) data that are fed into a single system, the Arduino
Uno platform. Raspberry Pi transfers the data to cloud storage. Android Studio was used
to develop the Android app, in which health parameters collected from patients can be
visualized. Doctors can use the application to prescribe necessary prescriptions and track
the patient’s health over time.
Using Raspberry Pi 3, Swaroop et al. [20] developed an IoT-based real-time health-
monitoring system. Data creation, acquisition, processing, communication, and access
are the main phases of the system structure. Health data such as HR, BT, and BP were
measured. The data are transmitted through modes such as BLE, GSM, and Wi-Fi, i.e.,
mobile applications, messaging services, and the Internet. It was found that the latency
is low, and there is no significant delay between sending and receiving data. Thus, the
system’s accuracy is limited to the accuracy of the sensors.
Gupta outlines a healthcare-monitoring system using the IoT for obese patients [21].
The prototype is a fully functional device that measures body characteristics such as HR,
SpO2, BP, and BT. This device is ideal for regular monitoring of body conditions. The
system uses an Arduino board to store medical data for multiple patients simultaneously,
and then, sends the information to healthcare providers via a Wi-Fi module for remote
monitoring. Clinicians can use the recorded data to examine patients’ health patterns over
time in order to detect any changes that may indicate an underlying, undetected health
problem. Consequently, long-distance communication can be a challenge with this system.
To help physicians diagnose and monitor their patients’ health status, Alamsyah and
Ikhlayel developed a monitoring system based on an IoT that can detect vital signs [22].
The system uses sensors to collect vital signs such as HR, BP, and BT. The data from the
sensors are gathered and processed by Raspberry Pi before being uploaded to the cloud.
The data can be retrieved remotely through a mobile app that allows easy access for medical
staff. The results of retrieving vital-sign data show that the instrument was developed and
the system was tested and evaluated reasonably.
An IoT-based real-time health-monitoring system can save a patient’s life by con-
tinuously monitoring the patient’s vital signs. The real-time health-monitoring solution
proposed by Sangeethalakshmi et al. [23] continuously monitors patients wirelessly via a
mobile app and GSM. Sensors capture vital signs that are transmitted to the cloud via Wi-Fi.
The system consists of a data-acquisition module, a microcontroller (ESP32), and software.
This system regularly measures and stores the patient’s BP, BT, ECG, HR, and SpO2 and
transmits the data to the physician’s cell phone for analysis. The system also includes an
alert system in which the physician’s cell phone receives a message when the patient’s vital
signs are outside acceptable parameters. However, the system is only a prototype that still
needs to be evaluated, tested, and calibrated.
Healthcare 2022, 10, 1993 6 of 32

Another IoT-based vital-sign-monitoring system is described in [24] by Sahu et al.

Similar to other systems, vital signs are monitored in real-time, and the data that are
collected are locally stored, and then, transferred to the cloud, from where they can be
evaluated. The system detects abnormalities, sends alerts, and calculates early-warning
scores. By storing the data on a personal server, the Android app reduces the burden placed
on central medical servers and minimizes the server’s maintenance costs. The system is
compact, portable, and easy for patients to use. Additionally, the system has been tested
and evaluated against most other systems in the field.
A. D. Acharya and S. N. Patil designed and implemented an IoT-based smart medical
kit for critical medical conditions [25]. This kit can provide a versatile connection to data
from the IoT and can support emergency medical services such as intensive care units. The
model collects, stores, analyzes, and distributes Big Data in real-time, enabling users to
lower their health risks and reduce healthcare costs. This research aimed to reduce patient
anxiety about regular doctor visits. With the help of this project proposal, patients’ and
doctors’ time will be saved, allowing doctors to help patients in critical condition as much
as possible.
Jennifer S. Raj [26] proposed a novel information-processing system for IoT-based
healthcare-monitoring systems to manage Big Data in an IoT environment effectively. The
entire data-processing process is divided into three stages: collection and aggregation,
the classification and analysis of collected data, and decision-making. The experiments
were conducted using Python. This model was experimentally verified in a simulation by
using different health sensors. The parameters were compared with existing hierarchical
clustering and backpropagation neural network models to validate the performance. This
model leverages Apache Kafka and Hadoop to address the need for real-time data collection
and offline processing. According to the authors of this study, the proposed method
outperforms the more traditional hierarchical clustering model and the backpropagation
neural network model in data processing and information extraction; they claim that their
proposed model achieves 97% accuracy. The study does not provide a comparative analysis
of time-efficiency for the model.
Kishor and Chakraborty designed a healthcare model using seven classifying algo-
rithms [27]. Nine different disease related datasets were organized based on classifications.
AUC, accuracy, sensitivity, and specificity were the four variables used to measure the
classifiers’ performance. The three phases of this work were data collection, pre-processing
and computation, and determining the results’ visibility to physicians or end-users, with
the results stored on a cloud server. This study compared machine learning-based health
models with previously developed work. Unlike other classifiers, the RF classifier has
the highest accuracy, sensitivity, specificity, and AUC for a variety of common diseases,
according to the study authors. This model can be extended for various purposes, such as
weather forecasting, military, and food availability prediction.
In another study that is very similar to [27], Souri et al. suggested an IoT-based system
for monitoring student health [28]. This model aimed to monitor students’ valuable metrics
and identify behavioral and biological changes in students using cutting-edge student-
support technologies. This approach consists of three levels: identifying the required data
for the student using biological and behavioral factors, capturing the information using
biosensors and intelligent IoT devices, and pre-processing the data. In this process, four
classifiers were employed to assess the validity of the proposed model. The experiment
results showed that the classification algorithms performed superbly in terms of precision,
recall, accuracy, and F-score. The authors stated that SVM achieved the highest possible
performance in predicting diseases in the proposed scenario. This system requires a local
repository to reduce the time needed for emergency services, which saves bandwidth
within the system. The response time of this system is not fast enough.
A healthcare system based on a Random Forest Classifier and the IoT was proposed by
Kaur et al. [29] to improve interactions between patients and healthcare professionals. The
experimental results were compiled using eight datasets on different diseases to determine
Healthcare 2022, 10, 1993 7 of 32

whether the proposed work is successful or not. Five different machine learning approaches
were used in this work. According to the authors, the Random Forest learning technique
achieved a maximum accuracy of 97.26% when applied to the dermatology dataset. In
addition, it was claimed that Random Forest provided good and accurate results for each
dataset considered. Accuracy and area under the curve (AUC) were the two-performance
metrics used for different machine learning techniques and datasets, respectively.
Gera et al. [6] concentrated on an IoT-based Cloud Talk platform-connected patient-
health-monitoring system. This system streamlines the conventional workflow by provid-
ing all systems—including medical examinations, facilities, and tests—in one location. This
system is capable of being implemented in a real-world setting because it consists of five
fundamental components that are able to carry out a variety of tasks, such as collecting
patient data from wearable IoT sensors, uploading the report to a cloud platform, analyzing
the findings, and providing medical check-ups, diagnostics, and facilities to patients. In ad-
dition to these benefits, the system facilitates better decision-making and makes navigating
the conventional workflow of the normal healthcare system simpler. In addition, it acts as
a point of contact for the patient, the doctor, the pharmacist, and the diagnostician. There
are restrictions on the system’s ability to manage patient healthcare.
SoonHyeong et al. [30] proposed an intelligent health-related monitoring system that
detects abnormal movements such as falls based on sensor readings from accelerometers.
After detecting abnormal movements, the system analyzes basic bio-signals such as a
person’s BP, HR, and BT. Users, caregivers, and professionals can check that the patient has
measured biometric data anytime, anywhere, using a smartphone. This monitoring system
includes a JAVA-based Android service environment. The performance of this monitoring
system was evaluated using datasets with information from fifty different individuals. In
this model, blockchain technology is used to protect individuals’ medical data by increasing
the data’s reliability while maintaining its confidentiality. With the help of a sensor chip,
technology that is part of the IoT, the accumulation of personal medical information is
stored and monitored in real-time. The transmission of sensitive medical data occurs in
real-time via a mobile device only, such as a smartphone.
Piyush et al. [31] present a positive strategy for monitoring the daily life of Alzheimer’s
patients and providing quality care to those affected by the disease. This work is based on
data collected from sensors connected to the IoT that determine various parameters of the
patient’s body, such as temperature, BP, pacing, and walking speed, to name a few. The
Atmega microcontroller is used for collecting all this sensory data and information. All
the collected information is transmitted to a cloud server using parallel communication to
analyze the data. It is possible to retrieve the patient’s desired parameters, which helps
provide real-time patient support. In addition, this work cannot predict the patient’s
condition before the emergency becomes more serious.
An IoT-based healthcare-monitoring system with numerous sensors and an intelligent
security system was presented by Hashim et al. in [32]. The system uses many sensors to
collect vital signs such as humidity and room temperature using a DHT11 sensor, HR using
a pulse sensor, and BT using an infrared thermometer. Data from the sensors that used
the Arduino to gather information on the condition of the patient are sent to ThingSpeak
and stored using the Wi-Fi module. The collected data are displayed on the LCD (cloud
platform). When the sensor detects an abnormal reading, an SMS is sent to the smartphone
using a GSM module to contact the patient’s family or doctor promptly. The performance
of the temperature and pulse sensors was evaluated using various experiments. According
to the authors, the percentage error of the infrared thermometer sensor is 1.2% lower than
that of the current model. The user and physician can view the results when uploaded to
ThingSpeak, but this system cannot monitor the patient remotely in real-time.
A platform for IoT-based health monitoring was proposed by Mostafa et al. [33] that
uses a NodeMCU microcontroller to obtain readings from a DS18B20 temperature sensor
and a Max30100 pulse oximeter to determine BT, HR, and SpO2 values. The readings
are displayed on an LCD in front of the patient and on the Blynk app-enabled phones of
Healthcare 2022, 10, 1993 8 of 32

the physician and everyone else involved. This project also included an infrared sensor
(IR) that detects objects in front of it and activates a relay to pump disinfectant without
being touched. According to the authors, the application takes only one minute, and
their project works flawlessly compared to the conventional method. NodeMCU, a less-
expensive and -complicated processor with built-in Wi-Fi, is used in this system, making it
more cost-effective than other existing systems. Although the system is only for cardiac
patients, it surpasses the traditional systems by providing a safer, easier, faster, and more
affordable service.
A Wi-Fi-connected smartphone and an electronic wearable device ere used by
Jenifer et al. [34] as part of an IoT-based health-monitoring system. This system uses sensors
to measure the patient’s physiological parameters, including HR, BT, BP, and SpO2. The
patient’s data are collected via Wi-Fi from a remote location and stored in a cloud server,
and the health parameters are continuously monitored. If abnormalities occur, an automatic
alert is sent to medical professionals with the patient’s location. However, this study does
not include experimental data or a comparative analysis.
Dhruba et al. [35] use the IoT to monitor sleep apnea. They developed a simple
application using a basic microcontroller and a selection of key health-related sensors.
After analyzing data from five different people, the system provided results that were
quite suitable for determining whether or not someone is suffering from sleep apnea.
According to the authors, two people did not have any sleep apnea symptoms, although
they had been diagnosed. The individuals in question were between 36 and 50 years old
and had significant problems with their sleep patterns. The system successfully detected
the presence of sleep apnea in these individuals. This system can also detect obstructive
sleep apnea when a person is screened. In addition, a person with OSA is considered a
patient if he or she is 50 years of age or older. With the help of this type of monitoring,
people can detect sleep apnea at an earlier stage. People can learn more about sleep apnea
and its detection with the help of this system. It will also help people solve any problems
related to their ability to sleep. However, when the patient is sleeping, the worn devices
may come off and cause an uncomfortable feeling.
Kshirsagar et al. [36] suggest an ongoing, low-effort electronic saline-monitoring and
-control system that can automatically keep track of the rate of saline flow, the amount of
time left, and the rate of infusion. This system can send data to the server from a distance
and show the results, such as the saline bead rate, the condition of the failure, and how
much time is left to empty the saline bottle, on the main screen. It can also show the volume
of the mixture. However, this system only entertains a single purpose (electronic saline
observation), and the contribution does not match the research title.
The research conducted by Tiwari et al. [37] focuses on developing an IoT-based
remote monitoring system for healthcare using NodeMCU and the Arduino IDE. Ubidots
is the IoT platform discussed in this article. The open-source IoT application is required for
Ubidots to function correctly. It is also an application programming interface (API) that
allows users to shop and retrieve data via HTTP and MQTT protocols while connected to
the Internet or a local network. With this IoT device, it is possible to read pulse rate and
measure temperature and BP. This configuration allows for round-the-clock monitoring
of a patient’s vital signs and detects abnormalities that may be present. The results of
the ECG test showed that the subjects’ average HRs were 72, 75, and 78 beats per minute,
respectively. The recorded SpO2 percentages were as follows: 94, 97, and 98%, respectively.
Finally, the participants in the experiment had a temperature of 94.78, 95.6, and 97.4 degrees
Fahrenheit, respectively, when their temperature was taken. The authors noted that the
design concept is simple and inexpensive to implement, considering its cost-effectiveness.
On the other hand, transpiration could affect the design.
Healthcare 2022, 10, 1993 9 of 32

Table 1. Summary of the existing healthcare-monitoring systems based on IoT.

Authors with Hardware/Software Features Evaluation Limitations

Aims and Contributions Methodology Protocol
Reference Technology Metrics
A patient
health- Improves
monitoring Used method decision-
making Minimal
system that is known as LM35, Temperature, contribution to
software SEN-11574, abilities and SpO2 level, IEE the
Gera et al. [6] built on IoT
development MAX30102, streamlines 802.11 administration
technology BP, and pulse
life cycle and BMP 180. the normal of medical care
and is rate
flow of the for patients
connected to (SDLC) healthcare
the Cloud system
Talk platform.

- The system
Uses a
smartphone as is designed
the mobile in a
gateway, rigid-flex
AD8232, PPG, structure.
Raspberry Pi 3 and Si7051 - Measures Range and
ECG, HR, BT,
Wu, Wu [16] Developed a small wearable sensor patch that can assess a variety of physiological signals. as a fixed sensors, ECG, HR, MQTT bandwidth
and BP.
gateway, and a RFD77101 and and BT and limitations.
BLE module Raspberry Pi 3. estimates BP
for via PAT.
transmission - Data are
parameters. encrypted.

- The system
Data from appears to
sensors are be big.
gathered, LM35, Heartbeat In cases of
Sensor Module, BT and HR, - Need
Islam, Rahaman Proposed a real-time IoT system to monitor patients’ vital signs and the room’s processed, and infectious disease,
DHT11, MQ-9, the system is CO, CO2 , and HTTP addition of
[17] environmental conditions. uploaded to MQ-135, and humidity. some vital
the cloud ESP32. helpful.
sensors to be
using an useful in an
ESP32. epidemic.

The system - Developed

uses Arduino as a mobile
Uno to collect Max30102, app. - System uses
and process AD8232, LM35, - Secures data HR, SpO2, two micro-
Al-Sheikh and IEEE 802.11
Designed an IoT healthcare-monitoring system that uses a mobile phone. sensors’ data, NodeMCU, and by sending controllers.
Ameen [18] ECG, and BT
followed by Arduino. data to - Wi-Fi range.
Wi-Fi specific
transmission
to the cloud. smartphone.
Healthcare 2022, 10, 1993 10 of 32

Table 1. Cont.

Authors with Aims and Contributions Methodology Hardware/Software Features Evaluation Protocol Limitations
Reference Technology Metrics

- Designed as
an Android
The system app to
collects and access the
processes LM35, HR Sensor Google
Firebase System uses two
sensor data Module, GSR
Hamim, Paul [19] Developed a prototype of IoT-based remote health-monitoring system. using Arduino sensor, Arduino, database. HR, BT, and IEEE 802.11 microcontrollers
and Raspberry Pi - Data are GSR that make it
UNO and quite big.
sends it to the 3. encrypted
cloud using and can be
Raspberry Pi 3. accessed by
authorized
personnel.

- The data can

be accessed
in multiple
modes.
DS18B20, - Sends alerts
Monitoring to caregivers
three Sunrom BP/ HR
monitor, without
Swaroop, Enhances healthcare delivery by communicating multiplexed data over three modes—BLE, GSM, parameters delay. HR, BT, and MQTT, BLE Accuracy depends
Raspberry Pi 3,
Chandu [20] and Wi-Fi. and sending - Reduces the BP. CSR Mesh on the sensors.
BLE adaptor, and
data using USB GSM risk of
three modes. module. losing track
of patient if
one mode is
interrupted
or fails.

The MCU
includes a
built-in - Uses two
keyboard, - The device microcon-
LCD, and all is efficient, trollers to
the linked MAX30100,
LM35, wrist BP portable, process and
sensors. The transfer
keypad gives and pulse rate and user-
Gupta, Parikh Designed a real-time IoT monitoring system to track and evaluate the health of obese adults. Can monitor, Atmega friendly. BP, BT, pulse data.
the user access IEEE 802.11 - For
[21] store the data of multiple patients. to the device’s 328, keypad, - The doctors rate, and SpO2.
menus and the LCD, and and patients long-range
LCD display. ESP8266 Wi-Fi are alerted application,
The data are Module. in abnormal Wi-Fi is not
gathered by situations. recom-
mended.
the ESP8266
and uploaded
to the cloud.
Healthcare 2022, 10, 1993 11 of 32

Table 1. Cont.

Authors with Aims and Contributions Methodology Hardware/Software Features Evaluation Protocol Limitations
Reference Technology Metrics
This system
uses Raspberry
Pi for MCP3008, Medical staff can Wi-Fi technology is
Alamsyah, processing and HRM-2511E, access patients’ not preferred for
Built an IoT-based system to monitor patients’ vital signs. Helps clinicians to make diagnoses. communicat- DS18b20, HR, BP, and BT IEEE 802.11
Ikhlayel [22] MPX5050DP, and data through an long-range
ing with the
LCD. Android device. application.
Internet using
Wi-Fi
technology.

- An
application
has been
developed
Detects vital for doctors’
parameters smart-
and sends phones to
them to ESP32 LM35, AD8232, monitor
for processing patients’ Temperature, System needs to be
Sangeethalakshmi MAX30100, BP Wi-
Devised a real-time IoT-based system to track the condition of patients and save lives. parameters. HR, ECG, BP evaluated, tested,
et al. [23] and sensor, and Fi/802.11
and SpO2. and reorganized.
transferring to ESP32. - An alert is
the cloud sent to the
using Wi-Fi doctor’s
module. mobile
phone in
case
abnormal
readings.

Small electrical
sensors are
fitted to
different
ECG electrodes, System has an
bodily parts.
pulse Oximeter, Android HR, SpO2,
Body sensor Not suitable for
Sahu, Atulkar NIBP, BT sensors, application and temperature, Wi-Fi/802.11
Created an IoT-enabled vital-sign-monitoring system. network long-range
[24] STM32F103xC, shows high BLE
transmits vital BP, and ECG. communication.
CY8C58LP, and accuracy
indicators to a BLE 4.0 module. measurements.
controller via
wireless or
wired means
(BSN).
Healthcare 2022, 10, 1993 12 of 32

Table 1. Cont.

Authors with Aims and Contributions Methodology Hardware/Software Features Evaluation Protocol Limitations
Reference Technology Metrics

The patient’s - Designed as

body has Android
sensors application
attached. AD8232, LM35, Wi-Fi technology is
A. D. Acharya These send for doctors ECG,
- IoT-based smart doctor kit. MPX10, Arduino, and not preferred for
and S. N. Patil body data to temperature, IEEE 802.11
- Portable, simple, and low-cost kit. and Raspberry Pi patients. long-range
[25] the MCU; then, - Monitors and BP.
Module. application.
they send the patients’
data to the real-time
cloud via a condition.
Wi-Fi module.

- Data-
Data
processing is accumulation
and data-
divided into aggregation In comparison to
Data
three stages: the traditional
methods. management,
collection and - model, it is efficient storage, Data-processing
Jennifer S. Raj in the process of Not
Innovative Big Data-processing platform for IoT-based healthcare-monitoring system. aggregation, time is not
[26] Classification f-measure, provided
classification handling data and entertained.
and sensitivity, and
and analysis of analysis extracting
specificity
collected data, of the information.
and decision- collected
making. data.

Three phases
are involved.
First, data are - Seven
machine Heart disease,
collected; then, This model assists diabetes,
they are learning
medical breast cancer,
pre-processed classifica- professionals in hepatitis, liver
Kishor and and computed; tion Not Predicts only the
An approach to medical care that is underpinned by fog computing and makes use of AI and IoT algo- making accurate disorder,
Chakraborty [27] and lastly, the dermatology, provided common diseases
rithms. and timely
results are diagnoses of the surgery data,
made visible to - Four per-
disease. and thyroid
doctors or formance
metrics. data.
end-users and
stored in the
cloud.
This
methodology - Four data-
mining - Longer
has three response
levels: finding algo- Utilizes innovative
Biological and time.
rithms. medical Not
Souri et al. [28] A student healthcare-monitoring system based on the IoT. the relevant technologies and behavioral provided - Limited for
data, collecting - Four per- changes. emergency
identifies changes.
the data, and formance services.
pre-processing metrics.
the data.
Healthcare 2022, 10, 1993 13 of 32

Table 1. Cont.

Authors with Aims and Contributions Methodology Hardware/Software Features Evaluation Protocol Limitations
Reference Technology Metrics
Eight datasets The performance
on different comparison
Five machine Accuracy and
diseases were Provides automatic Not displayed here only
Kaur et al. [29] Enhancing the interaction between patients and medical professionals learning area under the
used to test the recommendations. provided includes accuracy
proposed techniques. curve
and area under
work. curve (AUC).

- User-
This study friendly
used JAVA-based Stored
blockchain- BP, HR,
SoonHyeong Android temperature, data/information
based IoT. Integrated sensor service envi-
Enhanced reliability and security through the implementation of blockchain technology. BLE can be transferred
et al. [30] Several sensors module ronment. weight, and through
were used to - Detects ECG
smartphone only.
assess ECG
data. irregular
movement.

The study
utilized
IoT-based
sensor data to
LM35, pulse
determine Cannot predict the
sensor,
various patient
Offers a mechanism for improving the quality of life of Alzheimer’s patients, and also benefits the Gyroscope BT, BP, striding condition of the
body MPU6050, Dynamic
Piyush et al. [31] action, and IEEE 802.11 patient before the
people who care for them. parameters. Atmega328 estimation.
speed. situation becomes
All these microcontroller, worse.
sensors, and ESP8266.
attached to the
MCU, are then
transferred to
the cloud.
Multiple
sensors are
connected to
Arduino, and DHT11, pulse - Sensors are
HR, BT, room The size of the
the collected sensor, mlx 90164,
Developed an IoT-based healthcare-monitoring system with multiple sensors and a smart wearable temperature, prototype needs to
Hashim et al. [32] data are Arduino, LCD, IEEE 802.11
security system. presented on and safe. be reduced and
and ESP8266 - SMS. and humidity.
enhanced.
an LCD. The Wi-Fi module.
Wi-Fi module
transmits data
to the cloud.

- Cost-
Three sensors effective
are read by Max30100, system.
MCU with DS18B20, IR - Automatic The prototype’s
Mostafa et al. Designed an IoT that can monitor patients’ readings continuously; keeps the data on display in availability to HR, SpO2, and Wi-
sensor, Hand size should be
[33] front of the patient and on the screen of the doctor’s mobile device. Sanitizer. temperature Fi/802.11
represent the NodeMCU, and minimized.
data locally LCD. - Short time to
and remotely. perform all
processes.
Healthcare 2022, 10, 1993 14 of 32

Table 1. Cont.

Authors with Hardware/Software Features Evaluation Limitations

Aims and Contributions Methodology Protocol
Reference Technology Metrics

- No
Sensors collect comparison
data on with the
various Automatic HR, existing
physical LM35, Arduino emergency alert temperature, systems is
Jenifer et al. [34] Designed an IoT based on electronic sensors to monitor patient healthcare remotely. factors and Uno, SIM300, IEEE 802.11 provided.
message and BP, and SpO2
upload them to GPS shield. -
location can be sent. level
the cloud Experimental
database over
Wi-Fi. data are not
presented.

Takes readings
of sensors and
measures Max 30102, pulse - Mobile
several sleep sensor, GSR application During sleep, the
sensor, AD8232 provided. GSR, ECG, HR,
indices, and worn device can be
and sound - Diagnoses sound, and BLE
Dhruba et al. [35] Developed a real-time sleep apnea-monitoring system based on the IoT. alerts users via detached and feel
sensor, Arduino SpO2.
a mobile sleep apnea uncomfortable to
application Uno, and
Bluetooth in earliest the patient.
when anything module. stages.
unusual
occurs.
Performs
ongoing LM35, - Number of
observation of MAX30100, Simple to operate subjects is
a patient’s vital HR, MQTT, very low.
AD8232 and IR and affordable due temperature,
Tiwari et al. [37] Designed a system for remote monitoring of healthcare based on IoT. HTTP
signs and sensors, to its high level of - Product may
and ECG. IEEE 802.11
detects the NodeMCU, and cost effectiveness. be affected
presence of Arduino IDE. by sweating.
abnormalities.
Consists of
three primary
steps: data This system will
collection, data send an alert to the
MLX90614 and Need to increase
processing, attending doctor or
MAX30100 BP, HR, SpO2, the security of
Vaneeta et al. [38] Conceived and built an intelligent health-monitoring system based on the IoT. data storage, sensors, BP serial physician if there IEEE 802.11 patients’ data and
and
and the display port, LCD, and have been any temperature. decrease the
of patients’ Raspberry Pi. deviations from the data-transfer delay.
parameters normal values of
the patient’s health.
locally and
remotely.
Healthcare 2022, 10, 1993 15 of 32

Table 1. Cont.

Authors with Aims and Contributions Methodology Hardware/Software Features Evaluation Protocol Limitations
Reference Technology Metrics
Sensors
capture
information on
various LM35,
physical MAX30100, Data can be The size of
Arduino UNO, monitored using BT, HR, and prototype needs to
Khan et al. [39] Established a mechanism for measuring multiple health indicators quickly. factors and BLE
Bluetooth SpO2.
upload them to mobile app. be enhanced.
module, and
the cloud LCD.
using the
Bluetooth
module.
Note: Aims and Contributions refers to the aim of the research work. Methodology refers to methods and techniques used. Hardware/Software Technology refers to hardware and
software used. Features refers to main features addressed. Evaluation Metrics refers to evaluation metrics. Protocol refers to protocol utilized. Limitations refers to drawbacks of
research works.
Healthcare 2022, 10, 1993 16 of 32

In order to monitor a person’s temperature, BP, HR, and SpO2, Vaneeta et al. [38] built
a system based on the IoT. The ability of nearby clinics to communicate with city hospitals
about their patients’ medical conditions makes this a valuable system for rural areas and
small towns. The IoT system can alert the doctor or physician in case of any deviations
from the standard values in the patient’s health. The maximum relative errors (percentage
r) in the HR measurements, patient BT, and SPO2 were discovered to be 2.89%, 3.03%, and
1.05%, respectively. These values are comparable to the commercial health-monitoring
system. This IoT-based health-monitoring device makes it effortless for physicians to
collect real-time data. The system can monitor the parameters regularly because high-speed
Internet is accessible. Additionally, the cloud platform enables data archiving, so those
earlier measurements may be retrieved quickly. This system would make it possible to
diagnose and treat COVID-19-specific patients early on.
Khan et al. [39] built an IoT-based health-monitoring system utilizing Arduino to
measure a patient’s BT, HR, and SpO2. The data were then transmitted to an app using
Bluetooth. The patient can gain a quick understanding of their current health status
thanks to the information that is also transmitted to the LCD panel. COVID-19 patients,
older adults patients, asthma patients, COPD patients, patients with chronic diseases, and
diabetic patients can keep their condition under control with the assistance of this system
over time.
The authors of [40] presented an ECG monitoring system for cardiac patients based
on the IoT. The system is comprised of many components, including an ECG sensing
network (data gathering), an IoT cloud (data transmission), and estimation results (data
prediction). Based on the system, the authors operated Arduino Mega to process the
received patients’ data and transfer them to the cloud using the Wi-Fi module in this
system, ESP 8266. ECG information was stored in the cloud and was accessible using
MQTT and HTTP servers. The linear regression approach determined the relationship
between the properties of the ECG signal and the error rate. A prediction was performed
to determine how much of a difference there was in PQRST regularity and whether it
was enough for an ECG monitoring device. Acceptable outcomes have been attained by
recognizing the quality-parameter values.
In this paper, we have discussed various healthcare-monitoring systems that are based
on the IoT. These systems are very beneficial for both patients and medical professionals.
Arduino, Raspberry Pi, NodeMCU, and Atmega are the four main embedded systems used
to develop most existing health-monitoring systems. These embedded systems monitor
patients’ health in real-time to ensure they receive the appropriate treatment on time.
There are several research holes in the currently available IoT-based healthcare-monitoring
systems. Most of the recent healthcare systems monitor HR, HR, SpO2, and BP. However,
many other significant factors have not been considered, such as physiological, therapeutic,
behavioral, and rehabilitation-related factors.
This may be another serious and urgent situation that a sophisticated health-monitoring
system needs to consider, ensuring that prompt assistance and medical support are pro-
vided. Because the monitoring is performed in real-time, specific existing systems are
deficient in their ability to aggregate data from the monitoring device. These data should
be stored in the cloud to be analyzed later to determine whether or not an emergency
exists in a patient’s profile. The differences and similarities between various IoT-based
health-monitoring systems are outlined in Table 1.
The gaps in the existing system can be summarized as follows:
1. The IoT has the potential to be integrated with a wide variety of devices, which is not
possible with most of the systems that are currently in use.
2. There is the possibility that the data that are stored will not be protected.
3. Complex systems have many disconnects between the various people, stages,
and procedures.
4. An investigation into the circumstances surrounding an accident will typically reveal
the existence of several gaps, but gaps themselves are rarely the cause of accidents.
 1. The IoT has the potential to be integrated with a wide variety of devices, which is not
possible with most of the systems that are currently in use.
2. There is the possibility that the data that are stored will not be protected.
3. Complex systems have many disconnects between the various people, stages, and
Healthcare 2022, 10, 1993 procedures. 17 of 32
4. An investigation into the circumstances surrounding an accident will typically reveal
the existence of several gaps, but gaps themselves are rarely the cause of accidents.
5. The ability to understand and reinforce the normal ability of practitioners in order to
5. The ability to understand and reinforce the normal ability of practitioners in order to
bridge gaps contributes to an increase in overall safety.
bridge gaps contributes to an increase in overall safety.
6. The conventional viewpoint, which maintains that systems ought to be shielded from
6. The conventional viewpoint, which maintains that systems ought to be shielded from
the unreliable influence of humans, is challenged by this point of view.
the unreliable influence of humans, is challenged by this point of view.
7. We have a limited understanding of how professionals pinpoint newly formed gaps
7. We have a limited understanding of how professionals pinpoint newly formed gaps
and devise solutions to close them when systems undergo transformation.
and devise solutions to close them when systems undergo transformation.

4.4.Internet
Internetof ofWearable
WearableThings
Things
TheInternet
The Internetof ofWearable
WearableThings
Things(IoWT)
(IoWT)aims aimstotoimprove
improvepeople’s
people’squality
qualityofofdaily
daily
life. It involves sensors fitted into wearable devices, monitoring the
life. It involves sensors fitted into wearable devices, monitoring the individual’s activity, individual’s activity,
healthfactors,
health factors,and
andother
otherthings.
things.The
Thedata
datacollected
collectedfromfromthetheIoWT
IoWTcan canbebefed
fedinto
intomedical
medical
infrastructure, giving clinicians remote access to their patients’ data
infrastructure, giving clinicians remote access to their patients’ data as they go about theiras they go about their
dailylives.
daily lives.Building
Buildingon onthe
theIoT
IoTarchitecture,
architecture,aanovelnovelintegrative
integrativeframework
frameworkfor forIoWT
IoWTisis
currentlybeing
currently beingdeveloped.
developed.The TheIoWT
IoWTisisaarevolutionary
revolutionarytechnology
technologythat thathas
hasthethepotential
potential
totochange
change the healthcare
healthcareindustry
industrybyby creating
creating an an
ecosystem
ecosystem for automated
for automated telehealth treat-
telehealth
ments [41].[41].
treatments
Asshown
As showninin Figure
Figure 2, the
2, the architecture
architecture of theof IoWT
the IoWT and
and its its connections
connections consistsconsists
of threeof
three elements:
elements: the WBAN,the WBAN, the gateway
the gateway connected connected to the Internet,
to the Internet, and theThe
and the cloud. cloud.
WBAN The
isWBAN
a front-end component
is a front-end of IoWT of
component that
IoWTwraps thataround
wraps the bodythe
around to body
collecttohealth-related
collect health-
data unnoticed.
related The WBAN
data unnoticed. Thecollects
WBANdata from
collects sensors
data frominsensors
direct contact
in directwith the body
contact or
with the
from
bodysensors
or frominsensors
the environment that can collect
in the environment that canindirect
collect data aboutdata
indirect a person’s
about abehavior.
person’s
The WBANThe
behavior. canWBAN
either analyze
can eithertheanalyze
data orthe transmit
data orthem for remote
transmit them foranalysis.
remoteInanalysis.
addition, In
mobile computing devices such as smartphones, tablets, and laptops
addition, mobile computing devices such as smartphones, tablets, and laptops must be must be connected to
the Internetto
connected tothe
send data totopowerful
Internet send data computing
to powerful resources
computing [42]. resources [42].

Figure2.2.Architectural
Figure Architecturalelements
elementsofofIoWT
IoWT[42].
[42].

4.1. Wireless Network Technologies for IoT Healthcare

Healthcare systems can be monitored remotely using various wireless network tech-
nologies. The existence and operation of IoT emerging technologies, such as RFID, wireless
network technologies (BLE, Wi-Fi, Zigbee), and low-power wireless area network (LPWAN)
technologies (such as LoRa and SigFox) are engaging in terms of the IoT’s long-term de-
velopment and deployment. They enhance device connectivity to the Internet, and the
efficiency of IoT application operation [43].
BLE, LoRa, and Zigbee are wireless sensor network technologies; meanwhile, to
identify and trace products, RFID is used. BLE can transfer data between different mobile
devices [44]. Communication methods can be long in their range (LoRa, SigFox, and Wi-Fi)
or short-range (Bluetooth, RFID, and Zigbee) [24]. Due to new communication protocols
being created exclusively for IoT devices, such as LoraWAN, NB-IoT, and Sigfox, it is
anticipated that the popularity of these applications will increase, enabling a far-reaching
remote monitoring system [11,45].
An essential component of the IoT is the WSN. The IoT, which has already been
established, can connect things to the Internet, allowing humans to interact with computers
 vices [44]. Communication methods can be long in their range (LoRa, SigFox, and Wi-Fi)
or short-range (Bluetooth, RFID, and Zigbee) [24]. Due to new communication protocols
being created exclusively for IoT devices, such as LoraWAN, NB-IoT, and Sigfox, it is an-
ticipated that the popularity of these applications will increase, enabling a far-reaching
Healthcare 2022, 10, 1993 remote monitoring system [11,45]. 18 of 32
An essential component of the IoT is the WSN. The IoT, which has already been es-
tablished, can connect things to the Internet, allowing humans to interact with computers
andfor
and forcomputers
computerstotointeract
interactwith
withother
othercomputers.
computers.Thus,
Thus,the
thecombination
combinationofofthe theIoT
IoTand
and
WSNfacilitates
WSN facilitatesmachine-to-machine
machine-to-machinecommunication.
communication.Figure
Figure33illustrates
illustratesthe
thearchitecture
architecture
ofofIoT
IoTwith
withthe
theWSN.
WSN.ItItshows
showssensor
sensornodes
nodescommunicating
communicatingwithwitha agateway
gatewayinina aseparate
separate
network.
network. Many
Many devices are linked
linked to
to the
thegateway
gatewayvia
viaWi-Fi
Wi-Fiororthe
theInternet,
Internet, ensuring
ensuring in-
interoperability [46].
teroperability [46].

Figure3.3.Relationship
Figure RelationshipofofWSN
WSNtotoIoT
IoT[46].
[46].

Theresearchers
The researchers in [24]
in [24] counted
counted the existing
the existing wireless
wireless applications
applications in connected
in connected health-
healthcare
care facilitiesfacilities
to study tooperational
study operational
wirelesswireless
methods methods for transmitting
for transmitting data short
data across across
short distances.
distances. The systemThe system
designdesign and implementation
and implementation of family
of family mobile mobile
medical medical care
care are are
pre-
presented
sented in this
in this study.
study. TheThe Android
Android mobile
mobile client,
client, data
data transmission,
transmission, andanda asystem
systemserver
server
arepart
are partofofthethesystem.
system.Wireless
Wirelessdata
datatransfer
transferisispotentially
potentiallypossible,
possible,atatleast
leastinintheory.
theory.AnAn
example
exampleofofthe themobile
mobilehealthcare
healthcaresystem’s
system’ssuccess
successisisshown
shownhere.
here.InInthe
thefirst
firstplace,
place,family
family
members’
members’sign signcharacteristics
characteristicsmight
mightbe becollected
collectedviaviasensors
sensorson onmedical
medicalequipment.
equipment.ECG, ECG,
BP,
BP,SpO2,
SpO2,respiration,
respiration,and andsleep
sleepareareparameters
parametersofofinterest.
interest.The
Themobile
mobileterminal
terminaluploads
uploads
data
datatotoa aback-end
back-end Web
Web server
serverwith
witha wireless network,
a wireless network,Bluetooth,
Bluetooth,andandWi-Fi. DataData
Wi-Fi. storage,
stor-
computation,
age, computation, and analysis are all handled by the MySQL database server [24].family
and analysis are all handled by the MySQL database server [24]. A A fam-
member’s
ily member’s smartphone
smartphone or tablet may
or tablet be be
may used to to
used show
show data icons
data iconsoror
text,
text,making
makingititeasy
easy
for
forthem
themtotomonitor
monitortheir
theirloved
lovedone’s
one’shealth
healthatatany
anytime
timeandandlocation.
location.Family
Familymembers
members
may
mayprevent
preventsignificant
significanthealth
healthissues
issuesthrough
throughearly
earlyintervention,
intervention,encouragement,
encouragement,and and
healthcare maintenance.
healthcare maintenance.
4.2. Wearable Sensors in Healthcare-Monitoring Systems
In real-time, the healthcare sector may use wearable devices to monitor and save
patients’ activity and physiological functions. Such devices have one or more sensor nodes,
but each sensor node typically has a radio transceiver, a low-speed processing unit, and
small memory. The sensors can measure various physiological parameters and activity,
including SpO2, BP and temperature, electrodermal activity (EDA), ECG, electromyography,
HR, and RR [2,47].
Bluetooth, infrared, near-field communication (NFC), RFID, Wi-Fi, and Zigbee wireless
transceiver technologies can support wearable devices communicating with smartphones
and other devices. The technology promotes care by facilitating remote diagnosis and
monitoring [11]. An important issue of discussion in this period revolves around the IoT in
healthcare. One of the essential parts of healthcare is identifying and treating illness. In
order to achieve this, the body sensor network will be valuable. Additionally, the data may
be accessible from any location in the world [8].
A wearable sensor gadget created by Vedaei can monitor and analyze the actions of
patients. An IoT technology that measures social distance might help prevent a COVID-19
sufferer from becoming sick. Three layers of IoT sensors, machine learning algorithms,
and smartphone apps are used to monitor BP, SpO2, cough rate, and temperature daily.
The frameworks outlined by the authors helped the users keep a safe distance between
 treating illness. In order to achieve this, the body sensor network will be valuable. Addi-
tionally, the data may be accessible from any location in the world [8].
A wearable sensor gadget created by Vedaei can monitor and analyze the actions of
patients. An IoT technology that measures social distance might help prevent a COVID-
Healthcare 2022, 10, 1993 19 sufferer from becoming sick. Three layers of IoT sensors, machine learning algorithms, 19 of 32
and smartphone apps are used to monitor BP, SpO2, cough rate, and temperature daily.
The frameworks outlined by the authors helped the users keep a safe distance between
themselvesand
themselves andthe
the transmission
transmission of the
of the virus
virus andand update
update theirtheir information
information often.often. A dis-
A distance-
tance-monitoring
monitoring systemsystem
based on basedRadioon Frequency
Radio Frequency
(RF) was(RF) was
also also presented
presented in the re-
in the research,
search,
which which
may mayin
be used beboth
usedindoor
in both andindoor andcontexts.
outdoor outdoor contexts.
In order to Incompare
order to the
compare
findingsthe
findings under environmental restrictions, the authors looked at two
under environmental restrictions, the authors looked at two alternative situations. Those alternative situa-
tions.
who Those
wrote thewho wrote
article thetoarticle
claim have claim
helpedtoexpose
have helped expose
COVID-19 COVID-19 [48].
[48].
Anotherstudy
Another study[49]
[49]demonstrated
demonstratedan anIoT-connected
IoT-connectedwearable
wearablesensor
sensornetwork
networksystem
system
forindustrial
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[49].

4.2.1.
4.2.1.Use
UseCases
CasesofofHealth-Monitoring
Health-MonitoringSensors
Sensors
Medical
Medical science research is currentlydominated
science research is currently dominatedby bymedical
medicalhealthcare,
healthcare,which
whichmostly
mostly
relies on how it integrates with the IoT. This integration is receiving a lot of attention
relies on how it integrates with the IoT. This integration is receiving a lot of attention due
due to its crucial role in utilizing technological paradigms to save human lives. These
integrated systems contain three crucial phases, namely, the modules for data collection,
data processing, and data evaluation. Healthcare monitoring plays a significant role in the
data collection module due to its active involvement in gathering data from various sources
and specimens. Most healthcare-monitoring systems use sensors to obtain the necessary
input data. The more concise and timely the data, the more accurate the results.
Sensors are employed for more than just data collection; they can also be used for
various ongoing and post-monitoring tasks in IoT-based healthcare systems. Blood pressure,
body temperature, pulse oximetry, and blood glucose are a few examples of heterogeneous
wearable sensing devices developed to collect patients’ biomedical data [50] in the era
of fast-growing IoT. The proper quality and development of these IoT-based healthcare-
monitoring systems are directly related to reliable data from sensors or sensor networks,
which necessitates using advanced signal-processing techniques, sensor data fusion, and
data analytics. In medical science, sensors that measure heart rate, body temperature, and
other things are used to find and diagnose diseases at the earliest stage.
It has been observed that health-monitoring sensors are utilized in various use cases
of medical science for healthcare purposes, such as the monitoring of hemoglobin concen-
tration, molecular diagnostics, clinical diagnosis of albumin-related diseases, heart-rate
detection, blood-oxygen-saturation detection, respiratory-rate detection, anemia detection,
Alzheimer’s disease, and many more.
Healthcare 2022, 10, 1993 20 of 32

There are many applications for wearable sensors. IoT-assisted wearables are widely
used these days. The friendliness of such devices has created a boom in their application in
all fields. With the healthcare field being no exception, the IoT’s exploits in healthcare are
enormous. Various technologies are linked to existing technology that helps generate data
for monitoring and analysis.
We have seen a lot of use cases for IoT-based sensors in real-time environments, which
are mentioned below:

Use Cases/Applications
1. Heart-rate detection/Cardiac monitoring systems/Stroke
The first application of health-monitoring sensors was through IoT-based healthcare-
monitoring systems; these can gather and measure the necessary data, transmit these
data through various stages reliably to the gateway and the cloud server, and perform
some edge tasks to provide low-latency decision-making for cardiac-related diseases and
prediction. Some of the pieces utilize sensors to determine heart rate [51]. Several projects
involve using WSN technology to continuously monitor heart patients who need a real-time
monitoring system [52]. This WSN has several medical-grade sensors and devices that can
track blood pressure, body temperature, heart rate, and pulse. A critical patient’s real-time
ECG is also preserved so that the patient is continuously watched [52–56].
2. Body-temperature measuring
During the pandemic, IoT-based smart health-monitoring devices with sensors for
COVID-19 patients based on body temperature, pulse, and SpO2 were beneficial. Through
a mobile application, these systems can measure a human’s body temperature, oxygen
saturation, and pulse rate [57].
3. Activity recognition
One of the many uses for medical wearables now being used is activity recognition.
Almost all fitness trackers perform this kind of recognition. Fitness trackers are now the
most popular wearables for tracking a person’s activity. A lot of guesswork is being carried
out in the background, but most of them include a highly sensitive 3D accelerometer that
allows the sensor to determine the acceleration [51].
4. Blood-glucose monitoring and hemoglobin concentration
Heart-rate sensors, blood-glucose monitors, endoscopic capsules, and other devices
make up the Internet of Medical Things (IoMT), which together, create the IoMT diabetic-
based WBSN monitoring system [58,59].
5. Respiration-rate detection and monitoring
We can keep an eye on the human body’s respiratory system in several ways. Some
writers employed sophisticated sensors that keep track of breathing patterns. A bio-
impedance sensor can be useful [51,60,61].
6. Sleep monitoring
This sleep-tracking app assists the user in adjusting their sleep patterns and maintain-
ing a healthy life cycle. For this, various sensors are utilized. Wearables often track heart
rate, pulse rate, SpO2 levels, and breathing patterns, and by taking these measurements
into account, they may make an educated decision regarding the quality of sleep [62].
7. Alzheimer’s disease monitoring and Anemia detection
Monitoring for Alzheimer’s disease has several issues and needs to be handled care-
fully. When a patient is alone, diagnosing them with Alzheimer’s is impossible [63–66].
8. Molecular diagnostics and Clinical diagnosis
Due to quick and affordable healthcare applications with reduced risk of infection, re-
cent developments in biosensors for patient-friendly diagnosis and implantable devices for
Healthcare 2022, 10, 1993 21 of 32

patient-friendly therapy have attracted a lot of attention. The rapid development of point-
of-care (POC) sensor platforms and implantable devices with specialized functionality
has been made possible by incorporating recently created materials into medical equip-
ment [67,68]. A lot of work has been conducted on the clinical diagnosis of albumin-related
diseases [69,70].
9. Blood-oxygen-saturation detection
Along with precise, ongoing monitoring of intravascular oxygen levels, it is crucial
to monitor patients’ cardiovascular health following cardiothoracic surgery [71]. There
are new types of data, such as oxygen saturation, which are continuously collected us-
ing oxygen-saturation (SpO2) sensors and represent the percentage of oxygen-saturated
hemoglobin compared to the total amount of hemoglobin in the blood; these are becoming
available for market wearables. Other behavioral and physiological biometric types are
already available in many market wearables [72–74].
Thus, it has been shown that health-monitoring sensors are used in various applica-
tions and can be used in the future for various diseases, particularly those that focus more
on sample or data collection, monitoring, or evaluation. We may assert that whenever
a sensor is employed, there is a possibility to collect the necessary data and deliver the
desired outcomes, depending on precision and accuracy. Additionally, incorporating the
cloud, geographic information systems, and mobile devices has improved the process of
sensor-based data gathering and monitoring while allowing for flexible remote sharing
and communication.
Numerous case studies and applications are possible for health-monitoring sensors.
They can be used to measure hemoglobin concentration; for molecular diagnostics; to
provide clinical diagnoses of disorders associated with albumin; to measure heart rate,
blood-oxygen saturation, respiration rate, and anemia; to diagnose Alzheimer’s; and for
many other things.

4.2.2. Classification of Health-Monitoring Sensors

With advancements in wireless communications, medical sensor technology, and
data-collection methods, it is now possible to remotely monitor a person’s health by
putting wearable technology on them and analyzing the data collected. These sensors and
wearable devices can be integrated into various accessories such as clothing, wristbands,
glasses, socks, hats, and shoes, as well as other devices such as smartphones, headphones,
and wristwatches.
Pawan Singh [75] classified medical sensors into two categories: contact sensors (i.e.,
on-body or wearables) and non-contact sensors (i.e., peripherals). Contact sensors are
further classified into two sub-categories: monitoring and therapeutic. Again, non-contact
sensors are further classified into three sub-categories. All the sub-categories are further
classified based on their use. Figure 5 illustrates the classification of health-monitoring
sensors with examples of their use.
Primarily, health-monitoring sensors can be divided into contact (i.e., on-body) and
non-contact (i.e., peripheral) sensors. Contact sensors are attached to the body to monitor
physiological behaviors, chemical-level identification, and optical measurement-related
monitoring. Contact sensors are also used in therapy-related monitoring such as medica-
tion, stimulation, and emergencies. Non-contact sensors are used for monitoring fitness-
and wellness-related factors, behavior, and rehabilitation. An example of each type of
monitoring is shown in Figure 5.
 Pawan Singh [75] classified medical sensors into two categories: contact sensors (i.e.,
on-body or wearables) and non-contact sensors (i.e., peripherals). Contact sensors are fur-
ther classified into two sub-categories: monitoring and therapeutic. Again, non-contact
sensors are further classified into three sub-categories. All the sub-categories are further
Healthcare 2022, 10, 1993 classified based on their use. Figure 5 illustrates the classification of health-monitoring
22 of 32
sensors with examples of their use.

Physiological Behavior ECG, EMG, EEG

Monitoring Sensors Chemical Identification Sweat, Glucose, Saliva

Optical Measurement Oximetry, Tissue Properties

Contact
Sensors
In Medication Drug Delivery Patches

Therapeutic Sensors In Stimulation Chronic Pain Relief

In Emergency Defibrillator
Health
Monitoring Physical Activity, Calorie
Sensors Measuring Motion
For Fitness and Wellness Count
Monitoring
Measuring Location GPS, Indoor Localization

Activity Fall, Sleep, Exercise

Non-contact For Behavioral

Emotion Anxiety, Stress, Depression
Sensors Monitoring
Calorie Intake, Eating
Diet
Habits

By Speech Language Development

For Rehabilitation
By Camera Technology for Blinds

Figure 5. Classification
Figure 5. Classification of
of health-monitoring
health-monitoring sensors
sensors [75].
[75].

The following are some of the medical applications that could benefit from the use of
Primarily, health-monitoring sensors can be divided into contact (i.e., on-body) and
medical sensors and wearable devices [76]:
non-contact (i.e., peripheral) sensors. Contact sensors are attached to the body to monitor
•physiological
Monitoring vital signs
behaviors, in hospitals. identification, and optical measurement-related
chemical-level
•monitoring.
Aging inContact
place and in motion.
sensors are also used in therapy-related monitoring such as medica-
•tion,Assistance
stimulation,with
andmotor and sensory
emergencies. impairments.
Non-contact sensors are used for monitoring fitness-
•and Large-scale medical and behavioral research in the field.An example of each type of
wellness-related factors, behavior, and rehabilitation.
Healthcare 2022, 10, x FOR PEER REVIEW monitoringBased on the applications
is shown in Figure 5.in which they are most frequently used, we have 21 of divided
30
health-monitoring
The following are some of the medical applications that could benefit from the These
sensors into different groups for performance-wise evaluations. use of
sensors
medicalcan be divided
sensors into many
and wearable categories,
devices [76]: which are covered in the subsections. Figure 6
6 is a is a collection
•collection
of several
of several
Monitoring
wearable
vitalwearable
sensorsapplied
sensors
signs in hospitals.
appliedininvarious
variousresearch
research projects
projects and
andemployed
em-
in IoT systems in healthcare.
ployed • in IoT systems
Aging in healthcare.
in place and in motion.
• Assistance with motor and sensory impairments.
• Large-scale medical and behavioral research in the field.
Cardiac
Based on the applications
Monitoring Glucose in which they are most frequently used, we have divided
Load
Systems
health-monitoring Monitoring
sensors into different groups for performance-wise evaluations. These
Strain Gauge;
Glucose sensor;load cell
ECGcan
sensors sensor;be divided into many categories, which are covered in the subsections. Figure
AD8232; INA219
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FigureFigure
6. Various application
6. Various of useof
application cases
use and
casesIoT
andsensors for healthcare
IoT sensors monitoring
for healthcare [62,77–82].
monitoring [62,77–82].

4.2.3. Performance Evaluation of IoT Sensors

Any healthcare-monitoring system’s sensors serve as its brain and heart. Thus, they
must be reliable. Almost all types of sensors used should be small, quiet, accurate, have
short data-transmission delays, use little power, and perform well overall. Wearable sen-
sors must be both precise and compact, which presents a challenge. However, in case of
Healthcare 2022, 10, 1993 23 of 32

4.2.3. Performance Evaluation of IoT Sensors

Any healthcare-monitoring system’s sensors serve as its brain and heart. Thus, they
must be reliable. Almost all types of sensors used should be small, quiet, accurate, have
short data-transmission delays, use little power, and perform well overall. Wearable
sensors must be both precise and compact, which presents a challenge. However, in case
of wearable sensors, the more value is given to outputs, and they need to be reasonably
accurate, too, so that the doctor can use these values to make decisions. Medical-grade
sensors are large and difficult to transport and require specialized equipment and trained
personnel [51].
Additionally, various IoT sensor-based applications constantly require authentica-
tion, security, and privacy. Numerous protocols are readily available on the market to
assist with security and help offer some solutions over an extended period. Nevertheless,
these integrated and crucial data-based apps’ security measures are constantly vulnerable
to intrusion.

5. Security and Protocols for IoT Healthcare-Monitoring Systems

Along with the utilization of the IoT, there has also been an increase in the risk of
new security assaults and weaknesses in healthcare systems. Healthcare data are highly
sensitive and contain personal identifying information such as social security numbers.
This is because many medical devices collect and share critical and sensitive patient-related
data on the Internet via various connected devices for further evaluations and decisions. IoT
technology’s nature presents complexity and incompatibility difficulties in medical-related
IoT devices [83]. As a result, security issues such as a lack of availability, confidentiality,
and integrity arise. Some of the IoT healthcare solutions include software and hardware
that monitor and regulate patients’ vital signs in the form of monitoring services, which are
connected to the IoT for data processing. However, these solutions are always at a high
risk of security threats such as authorization, privacy, and authentication breaches [84].
Cybersecurity in healthcare has emerged as a big problem. Device flaws could be exploited
by hackers, resulting in IoT system operational disruption. More importantly, due to
the limitations of medical equipment, such as their scalability, power consumption, and
interoperability, standard security criteria for countermeasures for attacks are not relevant.
Moreover, when it comes to criteria for security, privacy, and dependability, the medical IoT
technology should be trusted too. Additionally, some physical and technical protections to
prevent data leakage are available on the market. However, these measures have fallen short
of what is needed; stronger and more modern security standards should be implemented,
and a resilient strategy should be implemented to save the crucial data [85,86]. Therefore, to
better understand and develop a secure IoT-based healthcare infrastructure, it is necessary
to also determine security requirements [87].
The available solutions could include more secure overlay networks such as the Onion
Router (TOR) network, which might be used to transfer confidential data. Moreover,
authentication and identity-verification methods such as signatures, voice patterns, finger-
print scanning, passwords, and smart cards could be employed in application protocols.
Existing security solutions, such as RSA, seed phrases, and DSS, may also be used at
all connection endpoints. Technologies such as SDN, blockchain, and NFT tickets could
be used to provide authentic and customized service. Last but not the least, artificial
intelligence-based approaches that can be used to detect anomalies in IoT networks [87,88]
could be implemented to overcome the issues and challenges of security in IoT-based
healthcare-monitoring systems.
Eventually, with the advancements in the IoT’s common standards, many protocols
have been created to evaluate the services that are used for IoT solutions, and their relevance,
to connect a variety of devices to the Internet and various architectures. IoT protocols
for a particular application are selected considering the application’s requirements [89,90].
Wearable technology, smart medical equipment, smart homes, and remote monitoring are
some of the IoT’s most exciting healthcare applications. Some recent studies emphasized
 healthcare-monitoring systems.
Eventually, with the advancements in the IoT’s common standards, many protocols
have been created to evaluate the services that are used for IoT solutions, and their rele-
vance, to connect a variety of devices to the Internet and various architectures. IoT proto-
cols for a particular application are selected considering the application’s requirements
Healthcare 2022, 10, 1993 24 of 32
[89,90]. Wearable technology, smart medical equipment, smart homes, and remote moni-
toring are some of the IoT’s most exciting healthcare applications. Some recent studies
emphasized IoT interoperability, which includes the healthcare-domain aspects of the IoT,
IoT interoperability,
which which includes
should compulsorily includethe healthcare-domain
the standardization of aspects of the IoT,
dependable which should
communication
compulsorily include the standardization of dependable communication
protocols for improved and enhanced mobile and wearable technology. In addition, protocolslow-
for
improved and enhanced mobile and wearable technology. In addition, low-cost,
cost, low-power embedded processors are useful solutions. The most popular emerging low-power
embedded
IoT processors
communication are useful
protocols solutions.
that The most
are extensively popular
used emerging
to develop smartIoTIoT
communication
applications
protocols
include that are
CoAP, extensively
MQTT, XMPP,used
AMQP, to develop smart IoT BLE,
DDS, LoWPAN, applications include
and Zigbee. TheCoAP,
most MQTT,
prom-
XMPP, AMQP, DDS, LoWPAN, BLE, and Zigbee. The most promising IoT-based
ising IoT-based healthcare apps for patient monitoring, therapy, and diagnosis are de- healthcare
apps for patient
pendent on thesemonitoring,
protocols. therapy,
The main and diagnosis
uses of theseare dependent
protocols are on these protocols.
to enhance The
the perfor-
main uses of these protocols are to enhance the performance of telehealth,
mance of telehealth, medication management, chronic-disease detection, bio-physical pa- medication
management,
rameter chronic-disease
monitoring, home and detection,
eldercare, bio-physical parameter
and chronic-disease monitoring,
monitoring [88]. home and
eldercare, and chronic-disease monitoring [88].
6. IoT Healthcare Challenges and Open Issues
6. IoT Healthcare Challenges and Open Issues
Although the IoT can provide personal health benefits, building data-collecting
Although the IoT can provide personal health benefits, building data-collecting
schemes that are efficient and secure to use in IoT healthcare-monitoring systems still pre-
schemes that are efficient and secure to use in IoT healthcare-monitoring systems still
sents numerous limiting issues. These various open research challenges, which include
presents numerous limiting issues. These various open research challenges, which include
functionality, performance, data privacy, reliability, security, and stability, are considered
functionality, performance, data privacy, reliability, security, and stability, are considered
in this section. We have divided the challenges and open issues into various categories:
in this section. We have divided the challenges and open issues into various categories:
security-based, performance-based, computational-intelligence-based, integration-based,
security-based, performance-based, computational-intelligence-based, integration-based,
energy-based, and disease-prediction-based (see Figure 7).
energy-based, and disease-prediction-based (see Figure 7).

Figure 7. IoT healthcare challenges and open issues.

Figure 7. IoT healthcare challenges and open issues.
6.1. Security-Based: Security and Privacy
There are ethical challenges to privacy and security. Hackers can easily access medical
records, which are transformed into digital records (stored in electronic health records)
and stored in the cloud. In a security breach of the cloud server, hackers can access
patients’ medical data. This causes problems with user authentication, data ownership,
data-protection policies, and misuse of health information [21,30,91].
Security and privacy must be addressed in IoT system design and development to
improve confidence in employing the IoT in healthcare. Each IoT layer and component
must have security protocols to reduce security risks and protect privacy. Developers
must ensure that IoT “things” and the systems they connect to are secure, so that users
can rely on sensors, devices, gateways, and IoT services, and so that their identity, safety,
and privacy are protected. Numerous commercial and personal technologies are built
without ensuring these security and privacy factors [92]. Various health IoT-based remote
monitoring applications are majorly influenced by the integrated security mechanisms
with built in hardware and software components of sensors and transceivers for wireless
communications. Applications that collect data from these sensors and devices are typically
designed with privacy in mind, using strong authentication and encryption measures and
other safeguards, during both storage and transmission. Commonly, these apps integrate
with pre-existing healthcare information providers, whose own security measures and
Healthcare 2022, 10, 1993 25 of 32

privacy policies are put into effect. It is still possible that they have not adopted the most
recent measures to secure data [11,93].
Solutions aimed at protecting individuals’ privacy should give people the power to
choose who can lawfully view and make changes to their data. Users of the IoT need to
trust that their personal information will be handled securely and responsibly. Multiple
laws and policies, such as HIPAA and the EU’s General Data Protection Regulation, have
already addressed privacy concerns when creating IoT applications (GDPR). There is,
nevertheless, a requirement to think about the secondary use of the data gathered via home
IoT remote monitoring. Patients using these systems may provide their permission for
their information to be used just for the home health-monitoring system [11,94].
Indeed, securing data and assuring privacy remains a key challenge to the health IoT.
Data that are transmitted to the data-processing unit could be spied upon, or the data could
be manipulated, leading to a flawed analysis of Big Data. Therefore, ensuring the data are
transmitted securely from the nodes to the processing unit is critical. Furthermore, during
data processing, the identity of the individual yielding the data must be protected. By
adopting cryptographic methods, the algorithms that process the data do not need to map
the data to the user [91,95,96].

6.2. QoS-Based: Performance, Fuctional Stability and Reliability, and Cost

The priority of Quality of Service (QoS) is not consistent but varies depending upon
needs; it safeguards a particular level of data-transmission performance. The primary
challenge is maintaining the integrity of sensitive patient data while exchanging data from
the end node to the server node. In the IoT, latency is the duration needed to send a packet
of data between node devices [97].
QoS indicators apply to all the IoT architecture sub-components, from the home
of the individual to the healthcare cloud services. Memory consumption needs to be
checked to ensure there is no leakage of memory or data being cached inappropriately.
Delays and interruptions to data transfer due to wireless disruption result in unexpected
disconnection or erratic connectivity, poor signal, and slow network speeds. Another
performance metric is energy-consumption management, which can also lead to reduced
functionality, reliability, performance, and stability. The process of continuously collecting
data is energy expensive for the devices. Following a period of battery discharge, the
battery needs a period in which to recharge, but during that period, the device is unable
to monitor continuously. When the charge of the battery is low, the device can experience
a symptom comparable to wireless interference [11]. Where there is insufficient power
for the wireless sensor nodes to operate, a severe issue is presented. To enable the nodes
to function at low power, more effort should be dedicated to devising energy-efficient
solutions, renewable technology, and green energy [8].
The IoT offers flexibility for monitoring patients who require ongoing medical eval-
uation, allowing the patient to live at home rather than being in the hospital. However,
some patients find wearable devices to be uncomfortable. The data can become noisy as
they are first transmitted from the sensor to the control device, and then, forwarded to the
monitoring center. With superior architecture, data can be shared with minimal loss of
integrity. Data signals can also be enhanced by applying noise-removal techniques. Most
methods currently used to monitor ECGs require the signal to be analyzed in a supervised
manner, which makes the process more expensive and can result in detection errors. To
reduce costs and improve efficiency, machine learning can be used to analyze signals [98].
Another parameter is the cost of medical services, and treatment equipment is more
important than ever. Researchers need to discuss and put more effort into minimizing
the costs associated with IoT healthcare systems. The high cost of monitoring equipment
in the IoT healthcare system is a serious issue. IoT has not yet made treatment services
accessible to the average individual at a reasonable price. The cost of medical equipment is
increasing [99,100].
Healthcare 2022, 10, 1993 26 of 32

To improve users’ perceptions and experiences of such expensive devices, it is incum-

bent upon device developers, manufacturers, assessors and testers to address these issues
without compromising on cost or quality [11]. If the challenges outlined above can be
resolved, the future IoT in the healthcare sector will be improved.

6.3. Computational Intelligence-Based

Computational-intelligence technologies are still in their infancy. Advanced intelligent
computational services are needed for IoT-based healthcare-monitoring systems since
computational intelligence is always a backbone of healthcare; it is associated with Internet-
related data collection, computations, and evaluation because computing in IoT-based
healthcare-monitoring systems is performed on edge devices to optimize data, networks,
and traffic accordingly. However, we cannot ignore the fact that edge devices have limited
resources and processing power, so we cannot ignore their limitations [11,101].

6.4. Integration-Based
Integration refers to the connection of current devices or tools with external technology
to ensure the accuracy and consistency of data over the course of their lifetime for future
expansion. The integrity of the data is still plagued by unresolved problems. IoT-based
monitoring systems, when extended and fused with other external device that have various
advantages, will improve quality of life. The development of integrated tools will have a
significant positive impact on the communications, processing, and services provided by
integrated information systems. This means that the IoT healthcare-monitoring systems
needs to be extended using various technologies or related technologies such as the cloud,
SDN, etc. [11,102].

6.5. Energy-Based
Monitoring-based healthcare-related IoT devices have a limited battery life. These
gadgets still use energy even when they are in energy-saving mode and are not expressly
required to read sensors. Some functions must be performed even when the device is in
energy-saving mode, but it has a power limitation. Many pieces of medical equipment
always need batteries, especially wearables and equipment for patients who need continu-
ous condition monitoring [99]. An ideal system that integrates low-power communications
with a power-efficient hardware architecture is needed to allow prolonged monitoring.
Reduced power consumption is an exciting area of study for activity-aware energy models.
The performance can be changed from low to high by utilizing context-aware episodic
sampling [101,103].

6.6. Disease-Prediction-Based
The IoT helps to diagnose and treat conditions including chronic diseases, helps with
geriatric care, and is used in fitness programs, by accelerating early disease detection [87].
The projected healthcare system’s future scope will advance the development of medical
care that can foretell a patient’s ailment at an early stage. This disease-prediction system
will shorten the time it might take to diagnose a condition and assist clinicians in providing
treatment as early as possible. This will improve medical services, improve outcomes for
the medical healthcare business, and lower medical costs (such as lab tests, X-rays, and
some other needless medical tests). Hence, for patients’ benefit, there is also a need to
develop a low-cost, independent system that tracks key indicators, transmits information
to the cloud or NLP, and notifies the patient early via the appropriate APP [100,104,105].

7. Suggestions and Recommendations

Based on existing studies and their limitations, there is a need to enhance and integrate
wearable healthcare devices to connect with other future technology trends, to solve
the communication problems and drawbacks of previous studies. Researchers need to
ensure that any proposed systems are user-friendly, adaptable, and secure if they want to
Healthcare 2022, 10, 1993 27 of 32

retain satisfied customers. Disease management and healthcare can benefit from the new
opportunities presented by integrating wearable sensors into healthcare systems. The IoT
can provide a solution by connecting health-monitoring devices and sensors to the cloud
for 24/7 monitoring. Health records are secured on the server and are available instantly.
In the future, a system could be created to diagnose patients’ conditions for chronic
diseases and COVID-19; this could help doctors to make the right decision and optimize
health conditions, which could improve the functionality of healthcare systems based on
the IoT by combining different technological approaches.
Such integration approaches include artificial intelligence (AI), fog computing, Big
Data and Nano-Things (IoNT), software-defined networks (SDNs), and the tactile Internet
(TI). AI, when integrated with IoT-based healthcare-monitoring systems, can help to gen-
erate meaningful and accurate results from sensor data. The fog/edge paradigm can be
used to bring computing power closer to where it is needed. Big Data computing can also
be utilized in IoT healthcare-monitoring systems because Big Data can make it possible
to manage extremely large amounts of data efficiently. In addition, the other most recent
technologies of the future, such as the IoNT, software-defined networks (SDNs), and the
tactile Internet (TI), have the potential to further enhance the functionality of IoT-based
healthcare systems and expand their capabilities in the future.

8. Conclusions
There are endless ways in which the IoT can improve medical care. These include
reduced cost, and increased efficiency, accuracy, and performance. The benefits of using the
IoT have made it possible to automate healthcare systems in the best way. In this respect,
this work aims to be an introductory guide for those who will work in this field in the
future, providing them with a detailed reference document related to the IoT and healthcare-
monitoring systems. In this work, recent research on IoT-based health-monitoring systems
have been reviewed and analyzed in a systematic way. The paper provides in-depth
information on their benefits and significance, and a literature review. We also discuss IoT
wearable things in healthcare systems and provide a classification of health-monitoring
sensors, including the challenges and open issues regarding security and privacy and
Quality of Service (QoS). Suggestions for future work have also been included.
In the future, we plan to analyze and evaluate various types of disease-based classi-
fication and IoT-based healthcare-monitoring systems. We also plan, in our next phase,
to stress the integration of various recent technology trends, such as SDN and AI, with
IoT-based healthcare-monitoring systems.

Author Contributions: The authors of this article have contributed to this research paper as follows:
Writing and preparation, S.A.; Review and visualization, A.N., W.A.J., M.A.M.A., A.K.B., M.A.-M.K.
and S.-H.K.; Editing and revision, S.A., A.N. and A.K.B. All authors have read and agreed to the
published version of the manuscript.
Funding: This research was funded by University Malaysia Pahang under Product Development
Grant Scheme No. PDU203229 and RDU No. 210317 as well as supported by the Korea Agency for
Infrastructure Technology Advancement (KAIA) grant funded by the Ministry of Land, Infrastructure
and Transport (Grant21CTAP-C163815-01).
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments: The authors would like to thank University Malaysia Pahang for providing
financial support and laboratory facilities under Product Development Grant Scheme (PDU) No.
PDU203229 and RDU No. 210317 as well as to thank the Korea Agency for Infrastructure Tech-
nology Advancement (KAIA) grant funded by the Ministry of Land, Infrastructure and Transport
(Grant21CTAP-C163815-01).
Conflicts of Interest: The authors declare no conflict of interest.
Healthcare 2022, 10, 1993 28 of 32

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