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Patient Monitoring System Based on Internet of Things: A Review and Related

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DOI: 10.1109/ACCESS.2024.3455900

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Received 10 August 2024, accepted 3 September 2024, date of publication 6 September 2024, date of current version 25 September 2024.
Digital Object Identifier 10.1109/ACCESS.2024.3455900

Patient Monitoring System Based on Internet of

Things: A Review and Related Challenges
With Open Research Issues
BASHEERA M. MAHMMOD 1 , MARWAH ABDULRAZZAQ NASER1 ,
AHLAM H. SHANIN AL-SUDANI1 , MUNTADHER ALSABAH2 , HALA J. MOHAMMED1 ,
HAYA ALASKAR 3 , FAHDAH ALMARSHAD 4 , ABIR HUSSAIN 5,6 , (Senior Member, IEEE),
AND SADIQ H. ABDULHUSSAIN 1
1 Department of Computer Engineering, University of Baghdad, Baghdad 10071, Iraq
2 Medical Technical College, Al-Farahidi University, Baghdad 10071, Iraq
3 Department of Computer Sciences, College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
4 Department of Information Systems, College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
5 Department of Electrical Engineering, University of Sharjah, Sharjah, United Arab Emirates
6 School of Computer Science and Mathematics, Liverpool John Moores University, L3 3AF Liverpool, U.K.

Corresponding author: Haya Alaskar ([email protected])

This paper is partially funded from Prince Sattam bin Abdulaziz University project number (PSAU/2024/R/1445).

ABSTRACT The unexpectedly high number of deaths caused by inadequate medical care is, to date,
considered as a serious problem. Moreover, the ratio of elderly people who require continuous care is rising.
Therefore, a patient monitoring system (PMS) also known as remote patient monitoring (RPM) using the
latest Internet of Things (IoT) technology becomes a viable solution that can provide efficient healthcare
from a remote distance. PMS monitors timely physiological signals of a patient’s health and can reduce
the healthcare costs of treatment significantly. In PMS, different health and vital signs issues such as body
temperature, heart rate, sleep monitoring, fall detection, and blood pressure can be checked effectively in
real-time. To this end, this paper provides a clear vision of electronic healthcare assistance based on PMS
and explores the applications of IoT that allow efficient medical services in healthcare systems. In particular,
the objective of this paper is to provide a review of PMS, current research, and the challenges associated
with this area. Besides, the essential services that can be offered by PMS for monitoring human activities
are also discussed. Furthermore, the communication networks and protocols that are required to endure
efficient healthcare systems are explained. Finally, this paper discusses several research challenges and open
issues that can be investigated for further work. Overall, this paper offers valuable insights for both industry
professionals and academic researchers, exploring potential avenues for new research directions.

INDEX TERMS Edge computing, healthcare, IoT, microcontrollers, patient monitoring system (PMS),
remote diagnosis, remote monitoring, sensors, wearable devices.

I. INTRODUCTION transmit and process this information and data in real-

The Internet of Things (IoT) is utilized in many essential time. IoT is defined as a network of things, comprising
fields and has become one of the most important technologies different physical things, encompassing embedded devices
worldwide. IoT is a revolutionary technology, which is integrated with various software and technologies [1],
able to connect multiple devices, collect heterogeneous [2]. IoT allows different types and sizes of things such
information/data from multiple sources and devices, and as cameras, vehicles, phones, home appliances, buildings,
industrial systems, and people to communicate with each
The associate editor coordinating the review of this manuscript and other and share information in real-time, hence, achieving
approving it for publication was Tao Liu . intelligent systems [3]. The primary function of IoT revolves
2024 The Authors. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
For more information, see https://creativecommons.org/licenses/by-nc-nd/4.0/
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around facilitating communication and data transmission via

the Internet, thereby enabling seamless connectivity and
interaction between these interconnected physical things.
In IoT, the term ‘‘Internet’’ denotes a worldwide network
comprising billions of computers and diverse electronic
devices. Through the Internet, users can access the desired
information and connect with other people from anywhere
and at any time through standard protocols. On the other hand,
the term ‘‘things’’ refers to any object that can be associated FIGURE 1. The estimated IoT in healthcare market sizes, 2022 to 2032
with a particular connectivity. IoT is used to connect anything (USD Billion) [19].
and get the desired service [4]. Besides, the escalation in data
transmission and repository size has increased the demand
for big data transfer, so the IoT has become very essential from 2023 to 2032, as shown in FIGURE 1 [19]. The
in data exchange. IoT represents a groundbreaking paradigm predicted market share of VR/AR by 2021 is 54.6 billion
in which objects possessing distinct identities can seamlessly USD, up from 2.5 billion USD in 2016 [17]. Consequently,
integrate into an interconnected information network to the bandwidth consumption by this industry is also increased.
provide intelligent services [5]. The connected devices in different healthcare institutes
In recent years, there have been considerable advance- and the utilization of IoT systems are considered the most
ments in sensing technologies, wearable/implantable devices, important parameters related to market growth.
and wireless communication technologies. The develop- Therefore, leveraging IoT within healthcare is highly
ment of network technology and sensors such as laser advantageous. IoT-driven healthcare minimizes human error
sensors, radar sensors, and camera devices, has allowed by networking all vital sign monitoring devices to a decision
a smart environment to be achieved with homogeneous support system, empowering physicians to deliver more
and heterogeneous devices. IoT networks leverage a range precise and timely diagnoses [20]. One of the most important
of monitoring systems that harness the benefits of data applications of IoT in the healthcare field is PMS [21],
processing and analytics, utilizing the power of the Inter- [22]. The Internet of Medical Things (IoMT) represents
net to enable informed decision-making in real-time [6]. the convergence of medical devices with the Internet of
IoT networks have evolved in many applications such as Things (IoT) [23]. IoMT leads the future of healthcare
patient monitoring system (PMS) [7], [8], [9], intelligent systems, envisaging a scenario where every medical device
energy management [10], smart city [11], smart home is interconnected and remotely monitored by healthcare
monitoring [12], [13], industrial application [14], vehicle professionals via the Internet [24]. In the medical sector,
monitoring system [15]. The integration of IoT applications the importance of IoT technologies is highlighted by IoMT,
and engineering technologies has demonstrated significant which is a collection of medical and fitness devices with
value in the biomedical domain, enhancing the efficiency various applications that are connected to the systems of
of medical practitioners and optimizing treatment processes. healthcare through online computer networks. IoMT has
The convergence of IoT with medical devices has expedited several advantages such as improving drug management,
medical interventions, streamlined diagnostic procedures, decreasing healthcare costs, enhancing patient experience,
and improved the management of chronic illnesses. From improving diagnosis and treatment, improving disease man-
the technological perspective, IoT involves some popular agement and most effectively achieving efficient PMS for
technologies such as wireless-body-area-networks (WBANs) chronic diseases [25]. This paradigm shift promises faster
to transfer the collected information from the devices to the and more cost-effective healthcare delivery as it continues
centralized cloud for analyzing and extracting meaningful to evolve. Hence, PMS is considered a major part of IoT,
information for efficient decision-making. which is related specifically to the concept of the IoMT [21].
The rapid growth of IoT devices brings innumerable In general, the network of IoMT is dedicated to various
advantages. According to Statista, there will be more than medical systems such as PMS, disease treatment, anomaly
75 billion IoT-devices connected to the Internet by 2025, detection, medical nursing and rehabilitation, remote and
resulting in an enormous data output [16]. Moreover, IoT is telemedicine care, conditioning, and screening systems.
growing on an everyday basis with many potential innovative PMS combines different equipment that constantly monitors
technologies [17]. To this end, IoT is expected to have a patients’ health through warning systems of patient vital
potential economic impact of $3-6 trillion, and the largest signs based on the detecting and tracking of the changes
fraction, $1-2.5 trillion, of this economic impact comes from in their health condition [26]. The importance of PMS has
smart healthcare applications [18]. rapidly increased due to the highly contagious diseases
The projected global market size for IoT in healthcare (such as COVID-19) and the increasing number of elderly
was valued at USD 180 billion in 2022 and is anticipated people who require constant care where the demographic
to grow to approximately USD 962.21 billion by 2032, shift toward the aging population [27]. A PMS is useful for
reflecting a compound annual growth rate (CAGR) of 18.3% all patients suffering from serious illnesses such as diabetes,

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cardiovascular disease, mental illness, cancer, hypertension, get coherent-optimized healthcare systems. Utilizing cloud
and COVID-19 [28], [29]. In addition, there is a growing computing offers several advantages for healthcare systems.
incidence of factors that negatively impact the quality of These advantages include streamlined processing of health-
life, such as busy schedules, outbreaks of epidemic diseases, related issues, simplified management of various diseases,
and increasing pollution levels. Recent statistics indicate and the capability to access real-time patient information
that over 90% of the population is exposed to polluted seamlessly and securely. Furthermore, cloud-based systems
environments, exacerbating these challenges [30]. Therefore, enable synchronized data sharing across multiple platforms,
PMS appears as an important technology, which enables ensuring scalability to accommodate varying workloads
the medical professionals to monitor the patient’s health while addressing concerns regarding scalability and security.
remotely and quickly in addition to revolving the healthcare Besides, employing cloud computing with robust algorithms
systems with lower costs and better patient outcomes. The could ensure that critical information remains readily acces-
basic functionalities of PMS are signs detection, monitoring, sible whenever needed, thereby enhancing the efficiency and
and tracking. The application of PMS allows specialists to effectiveness of healthcare delivery. A medical server refers
monitor and track patients remotely in a real-time manner to a remote computer situated within a healthcare institution,
based on their convenience at home or office. Besides, PMS tasked with real-time data monitoring and offering health
allows to warn the caregivers of potential threats to patient recommendations to patients. Physicians or a database handle
health, and hence to take quick action automatically. There monitoring and post-processing. The medical server plays a
are various detection, monitoring, and tracking methods that crucial role in remotely monitoring patients in telemedicine
have been developed for PMS [31]. settings, using a remote computer to collect and transmit
Generally, the applications of PMS have analogous vital signs to a telemedicine server for analysis. Subsequently,
architecture, which consists of wearable sensors and micro- the medical server assists healthcare professionals by recom-
controllers, wireless communication networks, and cloud mending suitable healthcare services for patients remotely
computing platforms. The work in [32] and [33] demon- based on the analyzed vital signs
strated that PMS can be implanted in real-time with multi-tier
pervasive WBAN. There are many types of sensors that A. MOTIVATION AND PAPER CONTRIBUTIONS
are used to detect vital signs and physiological conditions During epidemics and disease crises, such as the COVID-
of the patient. Examples of these physiological parameters 19 pandemic, and for individuals managing chronic health
are heart rate, body temperature, electrocardiogram (ECG), conditions like diabetes, as well as for the elderly population,
electroglottography (EGG), electroencephalogram (EEG), PMS can play a crucial role in addressing the shortcomings
blood oxygen saturation level (SpO2), blood pressure, of traditional healthcare models. PMS becomes crucial,
electromyogram (EMG), electrooculogram (EOG), magne- especially in regions with limited access to healthcare
toencephalogram (MEG), breathing rate, mechanomyogram facilities and medical professionals. PMS can facilitate the
(MMG), photoplethysmogram (PPG), respiration (RESP), efficient transmission of patient data to healthcare providers,
and electrodermal activity (EDA) [23], [34]. Sensors send enabling timely interventions and necessary actions based
data to the microcontrollers, which then analyze the data on real-time information. Given these critical needs and
and determine the process based on the algorithmic design the challenges faced by conventional healthcare systems,
implemented. For instance, if a temperature body sensor there is a compelling necessity to comprehensively study
detects a change in the body temperature, the sign will be and understand PMS. Noting that, the appropriate PMS
sent remotely to the specialist to sound an alarm and apply architecture and necessary communication technologies were
a quick treatment to the patient by the specialist. Hence, not identified in the earlier review studies. This paper aims to
efficient communication systems that are able to carry out fast provide a literature review and an in-depth study of recent
detection to send this essential information in a reliable and trends in PMS based on IoT technologies, which are required
secure way are required. to achieve efficient healthcare services.
To this end, wireless communication technology has The contribution of this manuscript can be summarized as
advanced significantly in recent years, which is considered follows:
a crucial part of the development of automated and smart • We provide a comprehensive review of the architecture
healthcare tasks [35], [36], [37]. This advanced development of PMS, discussing its essential technologies and
in such technologies allows PMS to provide fast detection components. This review serves as a foundation for
of patient conditions in real-time scenarios. Therefore, PMS understanding the complexities of PMS and its potential
continues to serve as a cornerstone in driving the evolution applications in healthcare systems.
of autonomous healthcare services, particularly as wireless • We highlight the importance and urgency of adopting
communication technology advances. Its ubiquity ensures PMS-based IoT in healthcare systems, emphasizing
widespread accessibility to healthcare while minimizing its potential to revolutionize healthcare delivery and
costs and errors, thereby contributing significantly to the improve patient outcomes. By adopting PMS-based IoT,
advancement of medical care delivery. Moreover, through the healthcare systems can become more efficient, effective,
employing of efficient cloud computing for PMS, we can and patient-centered.

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• We analyze various types of existing monitoring and systems, doctors need to visit patients physically and required
tracking methods in healthcare systems, providing a the use of traditional tools for diagnosing their cases [38].
thorough understanding of the current state-of-the- The traditional methods are considered to be cost-effective,
art approaches. This analysis serves as a basis for leading to delayed diagnosis, especially for remote distances,
identifying areas of improvement and opportunities for which leads to serious consequences. Therefore, one of the
innovation. most important goals of advanced technologies is to build
• We present the relationship between different layers in smart and efficient healthcare models that are able to close
the architecture of PMS, providing a detailed under- the gap between caregivers and patients to improve patients’
standing of how these layers interact and interoperate. well being [39]. Specifically, with the advancements of
This understanding is essential for designing and mobile technologies and smart medical devices and sensors,
implementing effective PMS-based systems. health experts become able to make a great improvement
• We identify challenges and provide recommendations on healthcare systems. Furthermore, m-health and e-health,
for future work, benefiting both academic and industrial supported by Information and Communication Technology
sectors in remote healthcare applications. These chal- (ICT), enable the efficient delivery of healthcare services
lenges and recommendations serve as a roadmap for to multiple patients, aiding in their health improvement.
future research and development in the field. Besides, the emergence of IoT presents even more advantages
• Finally, this survey paper contributes to improving by connecting diverse devices to the Internet, thereby
healthcare delivery, disease surveillance, management, providing caregivers with real-time updates on patients’
and response strategies during public health emergen- conditions [7]. In the epicenter of advanced healthcare
cies and routine care scenarios. By leveraging the technologies, PMS is considered in the advancement of a
potential of PMS-based IoT, healthcare systems can medical stream. PMS has different types of equipment such
become more resilient, responsive, and effective in as microcontrollers and sensors, which are used to collect
addressing the needs of patients and communities. the information of the patients and give the required process
using IoT. PMS is very helpful in remote monitoring patients,
B. PAPER ORGANIZATION especially in the conditions of elderly and chronically ill
The structure of this manuscript is outlined as follows. patients and those who have chronic diseases such as heart
Section II presents the basic terminologies related to PMS disease, diabetes, hypertension, and pressure. This remote
and provides introductory concepts of PMS in healthcare monitoring capability offered by PMS proves particularly
systems. Section III provides a review of remote patient beneficial for ensuring timely intervention and personalized
monitoring systems and discusses the architecture used care for elderly individuals and those managing chronic
for PMS based on IoT, which is essentially required to conditions. By enabling continuous monitoring and early
achieve effective healthcare systems. Section IV provides a detection of health issues, PMS plays a pivotal role in
thorough explanation of the sensors’ application in PMS. improving the quality of life for patients, allowing healthcare
Section V gives a detailed description of the communication providers to intervene proactively and mitigate potential
technologies required for PMS. Section VI highlights the complications. The following are some basic terminologies
cloud computing and distribution technologies and their that are used for PMS.
applications in the PMS. Section VIII provides research • Conventional healthcare system: This refers to a tradi-
challenges and discusses the future research direction in PMS tional healthcare practices, where a doctor visits patients
based on IoT in healthcare systems. Finally, this paper is with the required traditional tools, that are not essentially
concluded in Section IX. FIGURE 2 shows each section and related to information and communication technology
subsection in the paper. (ICT) [38].
• Medical emergency: This refers to the manual call to
II. BASIC TERMINOLOGIES AND INTRODUCTORY the hospital in emergency situations. This call should
CONCEPTS OF PMS IN HEALTHCARE SYSTEMS constitute some critical information such as the location,
This section discusses the essential terminologies that are the medical problem nature, and a valid available contact
commonly used in healthcare monitoring. In addition, the until the ambulance arrives. Once the patient reaches the
basic concept of PMS systems is introduced. hospital, the caregiver records the vital parameters such
as blood pressure, breath rate, heartbeat, etc., to proceed
A. SOME BASIC TERMINOLOGIES IN HEALTH CARING with the required treatment.
DOMAIN • The Internet of Medical Things (IoMT), also known
Over the last few years, the advancement in health tech- as the Internet of Health Things (IoHT), represents
nologies has demonstrated a considerable consequence on a significant advancement in healthcare, leveraging
our quality of life. In particular, the development of these IoT technologies to enhance patient care and health-
advanced technologies has a considerable impact on enhanc- care services [8]. IoMT encompasses various medical
ing patient care and diagnostics, which helps in providing devices connected to the Internet, including wearable
better and quicker treatment. In conventional healthcare sensors and implantable devices like smartwatches

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FIGURE 2. Structure of the PMS review paper.

and smartphones, facilitating the analysis of patient • Telemedicine: This term is defined as an integrated
data [39], [40]. system that has bidirectional remote contact among

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patients and medical professionals. Telemedicine uti-

lizes the emergence of ICT to provide clinical healthcare
and to exchange health information in remote loca-
tions. This strategy is especially beneficial for remote
areas with limited access to healthcare services, as it
overcomes geographical barriers and enhances medical
care accessibility. Telemedicine is crucial for delivering
urgent care during emergencies, potentially saving lives
in critical scenarios. Additionally, telemedicine plays a
role in monitoring patients at home, facilitating quicker,
more efficient, and cost-effective patient mobilization
and rehabilitation [41].
• Remote Patient Monitoring system (RPM): This term is
a standard for healthcare delivery that enables caregivers
to monitor patients remotely using smart body sensors
and build upon modern connectivity standards [8]. RPM
performs certain specific tests on the patient’s body,
which is essential in healthcare, especially for the elderly
and chronically ill. PMS term is similar to Remote
Health Monitoring System (RHMS), Mobile Health
Monitoring System (MHMS), and Wearable Health FIGURE 3. A generic PMS system with BSN, local switch, PMS server, and
Monitoring System (WHMS), each denoting similar dashboard for PMS visualization with medical staff.
systems that serve similar purposes just with different
names across literature [22].
• Sensors and wearable devices: This refers to technology- while increasing both the coverage and the quality of
enabled tools that are able to monitor physiologi- healthcare [39]. Based on the given definition, the con-
cal parameters and activity levels for many patients, cept of pervasiveness emphasizes the broader societal
facilitating continuous health monitoring and tracking impact of healthcare accessibility to all, rather than
and personalized care interventions. Typically, sensors solely focusing on technological elements. Pervasive
receive their input signals from the physical surround- healthcare also encompasses the usage of pervasive
ings and produce a response action based on the received computing principles, such as IoT, to deliver medical
signals. After the vital signs or signals are received services directly to homes or anywhere. Additionally,
by sensors, they transmit them wirelessly to the Body it involves remote data collection through mobile
Area Networks (BAN) control unit. By monitoring devices and sensor networks, often resulting in large
vital signs like body temperature, blood pressure, body volumes of data in diverse formats and with high
temperature, serum cholesterol, glucose level, arterial frequency.
oxygen saturation, and breath rate, wearable sensors • Vital patients’ signs: The human body contains different
provide enormous potential for the early detection of health signs that reflect the critical health status and
diseases. Noting that wearable devices are typically can be effectively used to help in disease detection.
attached to the human body, or they are integrated into These signs are defined as the important indicators
elastic bands, textile fiber, or patient clothes. Wearable that are used to monitor the condition of a patient by
devices are used to measure the physiological signals allowing the specialized to know the body functions
of the patients and their activity. Moreover, wireless and find if there is any delay in the patient’s recovery.
medical sensors are used to transmit vital signs to a Checking these patient signs is one of the most common
remote server for diagnostic purposes. interventions being practiced in healthcare settings. The
• Smart health system: This concept has been given most common types of these signs are heart rate, body
multiple definitions with different interpretations [39]. temperature, ECG, EGG, EEG, SpO2, blood pressure,
Smart health can be defined as an integration of EMG, EOG, MEG, breathing rate, MMG, PPG, RESP,
advanced technologies, data analytics, and digital and EDA [23], [34].
communication tools to optimize health management, Health monitoring based on IoT is considered as an
improve medical service, enhance patient outcomes, and advanced platform to provide us with a remarkable ser-
improve healthcare delivery. vice in contemporary medicine. Recent advances in cloud
• Pervasive health: This concept aims to deliver healthcare computing, mobile technologies, and wireless sensor net-
services to patients anytime and anywhere, as reducing working give a great possibility for efficient remote patient
institutionalization being a tool to face healthcare costs monitoring. FIGURE 3 demonstrates a generic PMS system

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with body-sensor-network (BSN), local switch, PMS server,

and dashboard for PMS visualization with medical staff.
The applications of IoT in the medical sector seem to be
endless, but the most promising ones are represented by
monitoring and tracking patient health using PMS. To this
end, PMS is able to perform various functions with an
aim to achieve different objectives, which can be listed as
follows:
• Affordability and automating healthcare: Affordability
in healthcare can be significantly enhanced by PMS
through measures such as reducing hospital readmis-
sions and administrative costs, ultimately lowering over-
all healthcare expenses. Additionally, PMS contributes
to automating healthcare processes, optimizing tasks
such as data collection, appointment scheduling, and
treatment reminders, thereby improving efficiency and
quality of care delivery.
• Improve work productivity and accuracy: Monitoring
patients through PMS will likely improve the accuracy FIGURE 4. The significant functions and applications of PMS in
healthcare systems.
of the diagnosis and provide a fast decision in med-
ication management and productivity [42]. PMS has
the ability to simplify healthcare workflows and reduce
administrative burdens on healthcare professionals, patient data, allowing healthcare providers to access
hence allowing them to focus more on patient care and critical information efficiently.
improve overall work productivity. • Remote monitoring and medical assistance: One of
• Real-time patient tracking: The majority of PMS the main objective of PMS is to allow healthcare
provides portable, high reliability, and wireless low-cost professionals to monitor patients’ vital signs remotely
tracking of patient health metrics and activities, hence in real-time, hence enabling timely intervention and
facilitating prompt decision-making and interventions medical assistance, especially for those in remote or
based on current patient conditions. In the sophisticated inaccessible areas.
technologies of real-time patient location monitoring, • Prevention of disease spread: By enabling remote
the location of the patients is tracked then an alarm is monitoring and minimizing in-person interactions, PMS
raised based on specific incidents. Such activity should helps prevent the spread of infectious diseases, espe-
be performed in real-time, and hence, effective rescue cially during pandemics or outbreaks, by reducing the
and immediate operations should be guaranteed. need for patients to visit hospitals and doctors.
• Security of data access: PMS can offer the security and • Reduction of care costs and patient expenses: PMS
reliability requirements for healthcare systems, which is can play an essential role in lowering healthcare
important to protect the data and prevent unauthorized costs. This can be achieved by detecting health
access by a secure communication framework. Besides, issues in an early stage, proactive management, and
PMS ensures the privacy and confidentiality of patient reduced hospitalizations, and hence, beneficial for both
information by using robust encryption and access con- providers and patients, resulting in decreased overall
trol measures, safeguarding sensitive medical informa- expenses [43].
tion from unauthorized access, and following industry • Patient self-management: PMS enables patients to
standards and regulations. The main criteria for security participate in their own healthcare by providing tools
and privacy of a cloud-based healthcare approach are and resources for self-monitoring and management of
authorization, non-repudiation, authentication, integrity, their health conditions. By promoting self-management,
and confidentiality. healthcare providers can enhance patient engagement,
• Speed up data management: in PMS, patient’s vital improve health outcomes, and optimize the efficient use
parameters can be transmitted faster in real-time to of healthcare resources.
health professionals such as doctors, nurses, or lab- • Boosts caregiver connectivity: PMS enhances commu-
oratories regardless of the geographic location of nication and collaboration among caregivers, enabling
patients. Therefore, the rapid availability of patient seamless coordination of patient care plans, sharing of
information allows rapid data analysis and provides medical information, and providing support to patients
predictive insights into the patient’s condition with and their families.
appropriate management and treatment. In addition, The aforementioned functions and applications are illus-
PMS accelerates the processing and organization of trated in FIGURE 4.

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III. REMOTE PATIENT MONITORING SYSTEMS of smart technologies on patient safety particularly (patient
ARCHITECTURE BASED ON IoT falls and hand hygiene compliance rate) and staff experiences.
Currently, one of the most critical global challenges revolves The work in [49] considered the detection and monitoring
around ensuring that healthcare services are available, of cardiovascular autonomic neuropathy in diabetes patients.
accessible, and affordable for everyone. PMS is, in particular, The work in [50] provided an empirical investigation of how
one of the most essential health systems that has a great effect wearable IoT devices would bring about a revolution in the
in health services by providing faster monitoring, diagnosis, healthcare industry. The work in [51] developed a system
and treatment for people who need continuous and/or urgent that tracks blood pressure using the Keep In Touch (KIT)
healthcare. PMS is a revolution in the digitalization of method and integrated closed-loop healthcare services. The
healthcare, and it uses a combination of software and KIT device is connected to a JAVA-based mobile phone
hardware to provide a fast and effective decision-making via near-field communication, which operates on principles
process. We aim to build a healthcare system that are of magnetic and inductive coupling, effective only at short
able to allow individuals to take an active role in the distances. Upon touching the KIT, data is transmitted to the
management of their health conditions, which can effectively mobile phone. In the closed-loop system, this data is then
improve patient engagement and enhance overall health securely sent from the mobile phone to a designated website,
outcomes. This engagement impacts individuals and commu- allowing for remote monitoring of the patient’s blood
nities profoundly, influencing health outcomes and overall pressure. The work in [52] proposed a method to monitor
well-being. Thus, by enabling people to actively engage a patient’s ECG waves from any location globally using
in their healthcare decisions and treatment plans, patient the IOIO-OTG Microcontroller. An Android application
self-management plays a critical role in tackling health was developed specifically for ECG monitoring, where the
concerns. By fostering patient engagement and responsibility, IOIO-OTG microcontroller connects to the Android phone
healthcare providers can enhance the effectiveness of care via USB cable or Bluetooth. After data collection, the ECG
delivery and the distribution of healthcare services, leading to waves are transmitted to the Android app, which allows for
improved health outcomes and a more sustainable healthcare both monitoring and storage of the ECG data. The work
system [44]. in [53] concentrated on monitoring body temperature using
One of the main objectives of using IoT and remote health a Raspberry Pi board within a cloud-based system. Their
monitoring is to transfer medical services from hospitals and approach involves using the Raspberry Pi to monitor body
extend them to convenient homes. IoT comprises a network of temperature, with the data being transmitted through wireless
interconnected electrical and wireless devices that collaborate sensor networks (WSN) to a cloud-based platform, where it
to collect and share patient data for diagnostic and analytical can be accessed for temperature monitoring. The work in [54]
purposes, as well as for securely storing patient information. introduced a system for monitoring body temperature using
This technology has revolutionized healthcare by allowing an LM35 temperature sensor connected to an Arduino Uno
real-time health monitoring, and personalized treatments board. A website in SQL database format was created and
that could significantly improve patient healthcare [45]. linked to the Arduino Uno, enabling sensor output to be sent
Various sensors and devices can be used in PMS to collect directly to the website. Through this platform, users can log
patient data. PMS-based IoT is an advancement in the in and monitor body temperature remotely. The work in [55]
medical stream for monitoring patients’ conditions. For explored the monitoring of ECG, respiration rate, heart rate,
instance, the movement of comma patients’ bodies should and body temperature using a system where various sensors
be recognized and checked continuously using temperature are connected to a PIC16F887A microcontroller. After
measuring devices, IoTs accelerometer (devices and sensors gathering data from the sensors, the information is uploaded
for measuring body movement), and eye blinkers [22]. The manually. To facilitate monitoring, an application, and a
elderly and people with chronic illnesses can benefit from webpage were developed for health status tracking. The work
these remote monitoring devices [46]. in [56] discussed a system that monitors temperature, blood
The design and implementation of PMS architectures aim pressure, and heart rate of patients. In this setup, sensors
to optimize patient care by ensuring accurate data collection, are connected to a microcontroller, which is also linked to
efficient data processing, and timely communication of a GSM module. Once data is collected, an SMS is sent to
relevant information to healthcare providers. To this end, the doctor if any values are concerning. The work in [57]
several research works have considered the real-world described a method for monitoring ECG waves using an AT
applications of PMS based on IoT in healthcare systems. For Mega 16L microcontroller. The system employs a Zigbee
example, the work in [47] provided a comprehensive survey module to transfer ECG data to the nearest connected system
discussing edge computing solutions for IoT applications, for further analysis. The work in [58] developed a system for
covering applications and highlighted the benefits of edge controlling and monitoring home appliances via an Android-
computing over cloud computing in healthcare domains. The based smartphone. An Arduino Uno board is connected to
work in [48] investigated the impact of IoT intervention in a home appliances like lights and fans. An Android application
hospital unit and provided empirical evidence on the effects was created for this smart home system, enabling users

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to control and monitor appliances remotely from anywhere wirelessly to layer 2. Layer 2 is represented by the patient’s
in the world using the internet. The work in [59] focused smartphone. Using a mobile application, the collected data
on monitoring body temperature and heart rate using a is sent to the base station via the 5G network through
C8051F020 microcontroller. Wearable sensors collect data, layer 3, which is the transmission layer. The final layer, which
which is then transmitted to the microcontroller. A Zigbee is the database layer 4 was utilized as a processing unit
module connected to the microcontroller transmits the data that stores, processes, and classifies the data using machine
to the nearest receiver. learning (ML) algorithms. Furthermore, several works have
Typically, PMS architectures consist of either three or four investigated different PMS architectures, see. e.g., [40], [62],
layers, depending on the system design. These layers share [63], [64], [65], [66], [67].
common concepts across different PMS implementations. In this paper, we propose to use five 5 layers PMS
The PMS architecture refers to the organizational structure architecture. FIGURE 5 illustrates the proposed general
that defines how the system operates and how different architecture for remote PMS, which is composed of a sensing
IoT components interact with each other. This architecture layer, wireless communication layer, edge/fog computing
typically consists of multiple layers, each serving specific layer, cloud computing layer, and application/action layer
functions and contributing to the overall operation of the that involves a user interface and medical server layer.
healthcare system. PMS architecture can be categorized into As shown in FIGURE 5, the data is obtained by different
different layers which are physical, logical, and application types of sensors and wearable devices, then it is transmitted
layers. The physical layer includes a number of different using a short-range communication protocol to the nearest
sensor nodes that are operating within a wireless network. gateway, such as a display, a smartphone, or a computer.
Then, the logical layer comes to processes the data collected After that, the processed signal is transmitted to a remote
from the sensors in the physical layer. Finally, the logic server that is used by the healthcare specialized person,
layer deals with media access control and mind-to-mind which is usually placed in a health institution. End users
communication. The application layer is responsible for are the one benefit from the PMS, which could be patients,
determining the decisions based on the data processed in medical staff, hospitals, doctors, government organizations,
the logic layer. The work in [44] defined the PMS by clinical research institutes, and manufacturing companies.
using a three-layer architecture, which involves BSN, wide- The general architecture of PMS can be summarised as
area-network (WAN) and personal-sensor-networks (PANs). follows:
Physiological parameter sensing is the responsibility of BSN, • Things layer (sensing layer): This layer is the lowest
while the final layer addresses the interrelated medical level of the architecture where data is captured from
services. PSNs, or personal surveillance networks, are made sensors and devices attached to the patient. Specifically,
to record and process contextual information about people this layer involves collecting of the patient’s vital signs
and their environment. Through personal service applications by using interoperable wearable medical devices, such
that function as a gateway layer, PSNs are important in as wearable sensors, EMG, ECG, SpO2, heart rate
facilitating integration between the first and third layers. monitors, temperature sensors, ambient sensors, blood
The work in [60] divided the architecture of the residential pressure sensors, and many other sensors and devices.
environment in an e-healthcare system into four layers. In this The sensing layer collects real-time health-related data
architecture, layer 1 refers to the BAN layer, which includes from patients and transmits it wirelessly to the higher
different types of sensor nodes operating within wireless layer.
networks. Layer 2 comes to have user interaction devices. • Communication/Networking layer: This layer acts as a
This layer works as an access-point layer to represent the user gateway layer where the data collected from sensors
interaction interface. The medical information is gathered and wearable devices is processed and aggregated
from layer 2 and transferred to layer 3 to prepare for the final locally before being forwarded to a higher-level layer or
destination using home networking possibilities. The role of the cloud. This layer can manage device connectivity.
Layer 3 is to filter and analyze the data collected, which It might also facilitate the transmission of processed
is automatically connected to the Internet. Finally, Layer data to higher-level systems or healthcare professionals.
4 provides the required healthcare to the patient based on This layer involves networking protocols to ensure that
delivered analyzed data. Another approach PMS architectures healthcare data is transmitted securely and efficiently.
is proposed in [61]. In this PMS architecture, four layers are In particular, the communication and networking layer
proposed which are: sensors, data acquisition, transmission, often communicates with devices using short-range
and database layer. In the proposed architecture, the Wi-Fi wireless protocols like Bluetooth, Zigbee, and Wi-Fi.
communication technique was used to connect the sensors to Then, the data is forwarded to the cloud using Wi-Fi or
the smartphones, while 5G technology was used to connect cellular networks.
smartphones to a cellular network, which in turn sent the data • Edge/Fog computing: This layer serves as an inter-
to the database. Besides, machine learning (ML) algorithms mediate hub that can pre-process the data, and per-
are proposed to classify the data for diagnostic purposes. The form basic analytics. Edge computing can be used
first layer was used to connect sensors and interface them to enable programmable decentralized networks, and

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FIGURE 5. The general multi-layer architecture of PMS in healthcare systems.

hence, facilitating effective processing and management •Application/action layer (medical server): The pro-
of data at the network’s edge rather than at the central- cessed data is presented to healthcare providers or
ized cloud. This is particularly useful for delay-sensitive integrated with electronic health records (EHR) systems.
applications such as PMS. Noting that fog computing This layer enables visualization, alerts, and decision
is an edge computing technology that brings cloud com- support tools for clinicians. This layer may involve self-
puting closer to the locations where data is generated and management, active assisted living (AAL), activities
collected by extending its capabilities to the network’s behaviors, emergency detection, disease prevention,
edge. Such distributed computing technique enables and mobile health (m-Health) [68] or electronic health
the processing and analysis of data to be performed (e-Health) [69].
closer to the data source, hence reducing latency, A complete review on the significant components used in
conserving bandwidth, and improving overall system PMS architecture is provided in the following section. This
efficiency. would reflect each point in architecture provided previously.
• Cloud computing layer: IoT utilizes a distributed
platform to process and store data. Data can be obtained IV. SENSORS AND WEARABLE DEVICES IN HEALTHCARE
from the communication/gateway layer. Alternatively, SYSTEM
data from sensors and wearable devices can be sent This section discusses the application of sensors, which
directly to the cloud layer for processing, storage, is considered the most essential part in PMS healthcare
and analysis. Cloud-based platforms provide scalability, architecture. Then, a description of the wearable devices and
flexibility, and accessibility, allowing for centralized their use in PMS.
data management and advanced analytics. The devices A. SENSORS FOR PMS
typically communicate with the cloud using WiFi, cellu-
Typically, the first layer in PMS healthcare architecture
lar networks, or other long-range wireless technologies.
is represented by sensor nodes. Sensors are made to be
In the cloud layer, the raw data is processed and
implanted beneath the skin (in-body), sewn into clothing
analyzed. Algorithms may be applied to detect patterns,
(wearable), or applied to the human body as tiny patches (on-
anomalies, or specific health parameters.
body) [60].

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In general, sensor is a device that receives signals and allow sensors to be connected and integrated into home
responds to a stimulus. An electrical value is translated infrastructure. Every sensor is performing one or more tasks
from a nonelectrical value via a sensor [70]. A sensor is concurrently [73].
defined as a computing device that can be installed on people, Sensors have several forms of properties of the input
animals, and objects. Sensors are ubiquitous, with applica- signals and electrical output signals. They can detect any
tions spanning homes, offices, shopping centers, and auto- small change in the sensed quantity of the input and produce
mobiles, embodying a fundamental component of the modern a change in the electrical output using their measuring
world. Sensors can sense, transmit, process information, and capabilities. It is important to distinguish between sensors
perform different works such as motion detection, image and transducers. The transducer converts any type of energy
sensing, voice control, environment perception, physiological into another, while the sensor converts any type of energy into
signal monitoring, and gesture recognition. electrical energy. For example, a loudspeaker is a transducer
In PMS, various sources are used for data acquisition that receives the electrical signal and converts it into acoustic
and gather information related to the patient, environment, waves. Sometimes, a Transducer can be used as an actuator in
activities, and behaviors. Sensors are the most important different applications, which converts electrical signals into
part in the PMS, which are used to collect information on nonelectrical energy (the opposite of a sensor). An electric
the patient’s condition. They are smaller in size, faster in motor that transforms electrical energy into mechanical
process and gathering information, and cost-efficient [66]. action is an example of an actuator [74].
It is important to mention that sensors are considered as the Sensors can be classified into different types and can be
core element or fundamental component of any wearable made based on different aspects such as uses, applications,
device [71]. Hence, it is essential to delve into the specifics and material, and based on their characteristics such as
of sensors and explore their fundamental types. accuracy, range, and cost. In general, the data generated by
In wearable technology, sensors play a pivotal role in sensors has also different formats. This format is classified as
capturing various physiological and environmental data that numerical, categorical, graphics, and video. Therefore, PMS
are essential for monitoring health parameters or activity can be categorised into two partitions. One partition called
levels. Different types of sensors, such as accelerometers, vision-based approach and the other called sensor-based
heart rate sensors, temperature sensors, and ECG sensors, approach, which is related to the formats and sensor types
are integrated into wearable devices to collect specific data as discussed in [73]. Different types of sensors with their
points. Understanding the characteristics and capabilities of applications are presented in [72]. Besides, Table 1 presents
these sensors is essential for optimizing the accuracy and a comparison of the most common types of sensors [75],
effectiveness of wearable devices in healthcare applications. [76], [77]. Noting that sensors such as sound, light, smoke,
Studying sensor technology within wearables not only color, and seismic sensors are typically employed in various
enhances our comprehension of device functionality but also innovative ways to capture physiological data by monitoring
guides decisions on device choice, data analysis, and the changes in the environment that correlate with specific bodily
creation of modern healthcare innovations. Hence, this review functions. For example, sound sensors can be used to detect
paper provides an explanation of the different types of sensors breathing patterns or heartbeats by capturing the acoustic
to provide researchers with the important information they signals generated by these activities [78]. On the other hand,
need. light sensors can measure changes in skin tone or detect
The emergence of the first thermostat in 1883 is often blood flow by monitoring variations in light absorption, often
regarded as the inception of modern sensor technology. used in pulse oximetry [79], [80], [81]. Smoke sensors,
Since then, sensors have evolved significantly, adopting though more commonly associated with detecting fire, can be
various principles and forms. Early sensors were relatively adapted to monitor respiratory functions by sensing changes
straightforward, measuring specific quantities and generat- in air quality or exhaled gases, indicative of metabolic
ing mechanical, electrical, or optical signals in response. processes [82]. Color sensors are instrumental in analyzing
However, over the past decade, the landscape of sensor changes in skin color, which can reveal information about
technology has been revolutionized by advancements such oxygenation levels or emotional states. Seismic sensors,
as computing power, pervasive communication networks, traditionally used for detecting vibrations, can be finely
internet connectivity, mobile smart devices, and integration tuned to monitor subtle movements such as those caused
with cloud computing. These developments have greatly by heartbeats or muscle contractions [83]. By leveraging
enhanced the capabilities of sensors, enabling sophisticated the sensitivity of these sensors, physiological data can be
applications in healthcare, wellness monitoring, and environ- gathered with high precision, allowing for continuous and
mental sensing [72]. The evolution of sensor technologies non-invasive monitoring of vital signs.
into pervasive sensing environments poses fascinating not Sensors can be divided into passive and active. A method
merely through integration them into sensing networks but of using passive and active sensors in road extraction is
through the way of adapted these technologies to operate in presented in [84]. The passive-type sensor does not require
diverse collective sensing applications. Network technologies an additional energy source. It is able to generate an

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TABLE 1. Different types of sensors.

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TABLE 1. (Continued.) Different types of sensors.

electric signal directly in response to an external stimulus. and chemical. On the other hand, an active sensor type
Examples of passive sensors are thermal, infrared, electric, needs an external energy source for their response, (known

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as an excitation signal). Examples of active sensors are subjects within their environment and interactions with these
thermistor sensors and resistive strain gauge sensors. The objects, PSNs offer valuable insights into the performance
work in [85] provided an extensive review of sensor levels of daily living activities. The data provided by PSNs
technologies and their transformative impact on our lives enables a deeper understanding of individual behavior and
across various fields. The author discussed how sensors are facilitates the development of personalized solutions for
able for detecting changes in the environment and collect- healthcare and lifestyle management [73]. Usually, the first
ing signals, hence enabling a wide range of applications layer of PMS architecture is termed BSN. A BSN can be
spanning lifestyle, healthcare, fitness, and manufacturing. defined as a wireless network obtained by deploying different
Specifically, the paper highlighted sensor applications in sensors in and around the human body [89], hence it is a
healthcare, where drug-delivering sensors can be used to network of wearable sensors that are used for monitoring
aid medication adherence by reminding individuals to take patients [90]. Miniaturised wearable or implantable wireless
medicine and providing doses at specific times, benefiting sensors have been employed in the introduction of the BSN
older adults, athletes, and at-risk patients. Additionally, the concept. Imperial College London proposes the BSN node,
review outlined key industrial trends such as ultrasound, a BSN hardware development platform, to support BSN
radar, and optoelectronic solutions driving sensor innovation, research and development. BSN nodes offer a flexible devel-
emphasizing their critical role in modern business operations opment environment for ubiquitous healthcare applications
and everyday activities. The work in [86] explored the because of their low power consumption, compact size,
diverse and rapidly evolving field of sensors driven by high and flexible design. The sink node in a BSN gathers data
demand and continuous technological advancements. The and sends it across the Internet for sharing. Social welfare,
authors discussed the electrochemical sensors that is known emergency treatment systems, diagnosis services, and patient
for their affordability and versatility in detecting various direct care can all benefit from having a BSN [91]. Basically,
analyses and are extensively employed across industries the identification of the sensor node is defined by a unique ID
like agriculture, food, oil, environment, and healthcare. The for each device. For example, in a single BAN, two motion
review highlighted the appeal of electrochemical sensing sensors are used: one for tracking hand motion and the other
due to its versatile reporting signals (voltage, current, power for tracking foot movement [92]. BSNs are moving towards
output, impedance) and low detection limits attributed to intelligence and multi-technology integration. Despite the
Faradaic and non-Faradaic currents. Additionally, it discusses existing challenges associated with BSNs, their future holds
recent advancements and applications of electrochemical significant promise as they have the potential to deeply
sensors, particularly emphasizing the role of nanomaterials. transform human-machine interactions.
The work in [87] presented a comprehensive review of The widespread adoption of home appliances integrated
advancements in soft sensor design and implementation, with sensors is paving the way for interactive healthcare
focusing on their critical roles in industrial process moni- environments. These integrated appliances are electronic or
toring, control, and optimization. The author also discussed electrical gadgets that have several uses in the house. Devices
how new theories, techniques, and information infrastructure such as TV sets, speakers, phones, cameras, and microphones
have improved soft sensor performance while also how to create a platform for data sharing between people and
address some related technical challenges. Furthermore, the healthcare systems. These devices enhance user engagement
author discussed the most recent developments in the soft with health applications, serving as new sources of contextual
sensor design, offering insights from a systems and control data and platforms for guidance and counseling. Multimedia
perspective, to provide up-to-date information related to devices, such as cameras and microphones, are central to
this research. The work in [88] reviewed the integration these approaches, enabling visual and audio sensing for
of artificial intelligence with health monitoring sensors to monitoring daily activities [73]. Wireless sensors, including
improve healthcare capabilities, addressing some technical smartphones, smart cameras, and devices like Raspberry
challenges such as noise, data processing, and feedback Pi with cameras, are instrumental in monitoring chronic
control. Besides, this paper explored advances in wearable disease patients, comatose patients, and newborns for smart
and implantable sensors for monitoring vital signs, soft caregiving and independent living in smart homes. These sen-
electronics for therapy, and volatile organic compound sors facilitate measurements such as respiratory and cardiac
detection. Furthermore, this paper discussed some recent rates using air quality sensors, integrated toilet seats with
developments in artificial intelligence-enhanced human- ECG monitors, cardiac and respiratory monitors, and smart
machine interfaces and self-sustainable sensor systems, beds equipped with sensor-enabled pillows and magnetic
highlighting the potential for more intelligent and secure switches. Vision-based methods extend further to include
healthcare services in future biomedical applications. posture recognition, human presence detection, movement
There are three classes of interconnected networks namely and fall monitoring, and tracking complex activities. While
as PSN, BSN, and multimedia devices. Such networks can multimedia-based approaches offer rich contextual insights,
be deployed within living environments or integrated into they are challenged by computational demands and privacy
various household objects such as sofas, tables, beds, chairs, concerns. Data acquisition methods vary across sensors,
or floors, all equipped with pressure sensors. By monitoring and the heterogeneous sensor set provides primarily raw,

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low-level data that is imperfect, uncertain, and of limited price [101]. Wearable devices have many advantages and
meaning. Thus, further advancements are necessary to are becoming more and more popular because they make
develop higher-level approaches for delivering comprehen- life easier. Wearable devices have been used in different
sive healthcare services. Besides, advanced signal processing applications such as environmental detection, physiological
techniques such as those presented in [93], [94], [95], [96], signal monitoring, human activity recognition, and most
and [97] can be used to obtain efficient healthcare systems. importantly healthcare monitoring. An example of wearable
When it comes to creating and retrieving raw sen- devices are smartwatches, smart glasses, and fitness trackers.
sor data-that is, information about the patient and their Particularly, these devices integrate low-power sensors to
surroundings-physical sensors are thought to be the most detect movement and other physiological signals. As a result,
often employed type of sensors [73]. The common types research and commercialization are now focused on wearable
of sensors used for the purpose of health sign activity sensors as functional parts of wearable technologies [71].
monitoring, which are generally attached to human body, With the recent advancements in IoT and artificial intelligent
are provided as follows [98], [99]. Electrocardiogram (ECG) technologies, wearable sensors have been developed and
sensor is used for heart rate monitor. Electromyography employed widely in the scientific and industrial communities
(EMG) sensor is used to track muscle contraction. EEG and receiving significant attention in sophisticated scenarios
(electroencephalography) sensor is used for brain electrical such as navigation systems, biomedical applications, Google
activity monitoring. Glucose sensor is used for measuring Glass, consumer goods and smart clothing. The combination
and monitoring glucose levels in the body. Pulse oximeter of IoT, augmented reality, and wearables can create new
(SPO2) is used to measure oxygen saturation of blood. Body paradigms that may potentially change the way people experi-
temperature is used to track temperature sensor. Respiration ence the world [102]. Proactive personal health management
sensor is used for detecting and measuring respiratory involves monitoring patients outside of the hospital setting,
parameters such as breathing rate, volume, or patterns often using wearable sensor devices. This approach allows
to monitor respiratory function and provide insights into individuals to actively track and manage their health status
respiratory health. Finally, motion sensors (accelerometers) remotely.
used to estimate user’s activity. The wearable devices can be placed on-body biosensors,
which should unobtrusively measure significant physiologi-
B. WEARABLE SENSOR DEVICES cal signals like blood pressure, body movement, heart rate,
Data acquisition plays a crucial role in PMS by utilizing skin, and body temperature [60]. Wearables can be worn on
smart health devices, primarily wireless sensors and wearable the body itself, concealed in clothing, or housed in semi-rigid
devices, which gather comprehensive patient data. Wearable objects like headgear, gloves, insoles, and smart watches.
devices like digital watches, smart clothing, and fitness In PMS, wearable devices cover a wide and important
tracker bands collect a diverse range of health information, range of applications. The working and characteristics of
enabling continuous PMS and data collection for wearable wearable devices in healthcare fields are mainly based on the
health monitoring systems) and general health monitoring observation of physiological data from the user’s body [71].
systems. Specialized devices like smart vests are used These wearable devices in PMS are considered simple in
for non-invasive physiological monitoring, including ECG, use, low-cost, independent devices targeting personal use
galvanic skin response, body temperature, and blood pressure without the need for medical professionals. These properties
assessment. Such data acquisition methods not only enhance make wearables devices widely deployed, and in turn, has led
athlete performance and support disabled individuals but research attention at a much faster pace to this field [103].
also enable personalized healthcare interventions based on Typically, wearable devices can be divided into three
real-time patient data. groups according to the position of wearing: hand-worn,
Since Steve Mann, who is recognised as the father limb-worn, and head-worn. Different considerations and
of wearable computing, unveiled the first Linux-based requirements of such devices should be taken into account
wristwatch at the 2000 IEEE International Solid-State such as the cost, portability, usability, wearability, intel-
Circuits Conference, the number of wearables has increased ligence, and performance. TThe development of wearable
dramatically over the past ten years [100]. The first wearable sensors grew quickly as a result of the growing need for
sensor was called Holter monitoring, which was developed telehealth and real-time health monitoring, with a compound
in the late 1940s and used in clinical settings in the 1960s. annual growth rate of 18.3% from 327.6 million in 2021 to
It is a portable gadget that tracks the central nervous 1,487 million in 2030 [29]. The statistics predict that by
system’s electrical activity continually. The field of wearable 2025, there will be multibillion wearable sensors, where
sensors has advanced during the last ten years, having over 30% of them are considered as new types of sensors
begun to take shape in the first part of the 20th century. that are just beginning to emerge [104]. There is a greater
Wearable devices have been introduced as key enabling of exchange of data across medical equipment when wearables
IoT-based healthcare systems, which attracted much attention are used. The ecosystem addresses these issues in wearables
due to their various functionalities. Besides, the wearable interoperability & intelligence by including different points.
devices become available in the market at an acceptable Standards developers, payers, providers, healthcare delivery

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developments could address the used hardware by

incorporating the parts into e-textiles. Textiles’ special
qualities of being lightweight, pliable, and comfortable
to wear make them ideal for wearable technology.
• Low cost for various applications: The cost-effectiveness
considering the initial investment, training, and main-
tenance will surely influence the integration of the
wearable devices into PMS.
• Usability: The functionality of these devices such as
data collection, transient information collection, and
user-friendly interface are required to satisfy the specific
clinical need and measure the important signs of the
patient.
• Power consumption and ease of fabrication: These are
major challenges in the design of wearable devices
as long-term maintenance-free operation is required.
Hence, advanced methods for low-power processors are
essential.
• Performance and reliability: Verification in real-life
scenarios provides essential information based on its
FIGURE 6. Key features of wearable devices in PMS. usefulness and reliability. Wearable devices should
demonstrate specific tolerances for patient activity in
the environment to contribute the reliability through
organisations, network service providers, and manufacturers the identification of mistakes, avoiding misleading the
of IT and medical device hardware, firmware, software, and collected data.
services [105]. Nevertheless, there are a number of issues Wearable device innovation is being propelled by advance-
with wearables and medical IoT connectivity and intelli- ments in wireless communication, energy harvesting, and
gence, including the possibility of wearable and implantable sensor networks, in addition to the previously mentioned
hacking. factors. In [103], the commercial wearable existing products
In general, the two key challenges that face wearables were classified under three categories: 1) Accessories, 2)
devices are security issues and power efficiency [40]. E-Textiles, and 3) E-Patches. A summary of commercial
Practically, wearable monitoring equipment is very efficient products and research prototypes are surveyed.
for patients enabling him/her to monitor his/her own health Medical sensors operating in PMS might have varying
status anywhere. Wearable medical technology is expected principles depending on factors like photoelectric, hall, and
to keep expanding, particularly in rural areas. Additionally, piezoelectric effects. The sensors attain the physiological
the vast economic market helps to fuel the quick growth of parameters of the patients and normally consist of sensitive
these gadgets [106]. Therefore, the commercially available and conversion elements [106]. In the design of wearable
wearable devices and prototypes for medical IoT need to devices, the significant issue is based on the sensors
be classified to distinguish the best devices for each patient that are embedded within the wearable devices. Different
status that is monitored [103]. It is worth mentioning that types of sensors are used for this purpose such as pulse
wearable sensors with other diagnostic platforms such as oximeter, EEG, breathing sensor, heart rate monitor or ECG,
point-of-care devices and lab-on-a-chip systems are inte- respiration rate, movement sensor, EDA, SpO2, and blood
grated with biosensors. In order to monitor the concentration pressure [111], [112]. Besides, several historical examples
of different analytes in biological fluids including blood, of wearable sensors are provided in [113]. Traditional
saliva, and urine, biosensors are widely employed in medical sensors measured the heart rate alone, where this sign is
diagnostics. Wearable biosensors, or devices with built-in considered the most important and almost all medical sensor
biosensors, can save healthcare expenditures [107]. Addi- nodes support it, then the photoplethysmography appears to
tionally, wearable biosensors are a useful tool for identifying measure the SpO2 besides the heart rate [114]. Chemical
bacteria, spotting dangerous compounds in the environment, and biological materials are integrated with optical systems,
and diagnosing ailments in people. The following are some microfluidics, electronics, and micro-machines to create
of the key features of wearable devices [108], [109], [110]. wearable technology-comfortable, wireless, battery-operated
FIGURE 6 summarizes the key features of wearable devices systems that can provide data on a regular basis [115], [116].
in PMS. The human body can serve as a transmission channel for
• Wearability: This characteristic is mostly dependent on wearable devices, or they can connect with one another via
the size of the sensors, the power supply specifica- a particular transmission medium like Wi-Fi, BLE, Zigbee,
tions, and the reduction of on-body hardware. Future and other previously covered communication protocols. They

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are able to gather, sort, and store the subject’s long-term drive communication to the closest processing node in an
physiological and activity data [117]. In essence, there are IoT architecture [124]. The most prominent application
two main strategies for implementing wearable technology: area of WBAN is PMS [124]. Because WBANs measure
using wireless technology and electronic textile solutions, physiological activity in humans, which varies more peri-
as covered in [92]. Several research works have investigated odically, the application data streams show rather constant
wearable devices and their applications highlighting their rates [39]. The tiny, samrt wireless sensors that make up
advanced technologies, significance, industrial communities, BANs are in charge of collecting and relaying to carers
materials, target analytes, and design issues, see, e.g., [114], the vital indicators of a patient [125]. WBAN can be used
[117], [118], [119], [120], [121]. FIGURE 7 presents the most in transfer the information of the patients into a wide
common types of wearable devices. communication ranges. It should be noted that the terms
WBAN, WBASN, and WBSN are used interchangeably in
V. DATA TRANSMISSION AND NETWORKING the research based on the work context. AThese terms mean
A paradigm change has occurred in recent years that makes the same type of networks which consist of sensor nodes
it possible to virtualize and softwarize networks, or create to check and monitor the human physiological conditions
programmable decentralised networks [122]. By segmenting of patients through their remotely accessed signals [126].
the network into several communication layers, this can IEEE standards like IEEE 802.15.6 and IEEE 802.15.4j,
be accomplished. These layers can help mitigate the delay which are especially designed for medical WBANs, are used
sensitivity of IoT applications by bridging the lengthy by WBAN. WBANs provide dependable communication,
propagation distance between the end-user and the cloud speed, accuracy, and energy efficiency between sensors
centre. As was already indicated, patient data and their and actuators placed inside, on top of, or next to the
physical activity can also be recorded using wearable human body. By leveraging different sensors to monitor
technology and fitness watches. At the beginning, wearables patient health vitals, WBANs can contribute to reducing
and sensors are used to collect patient health data, and healthcare costs and enhancing the quality of care [123].
connected devices exchange data with other devices while Broadband access networks (WBANs) facilitate a range of
transmitting healthcare information. IoT devices that are data rates, from ultra-wideband (15.6 Mbps) to narrowband
worn inside the body gather medical data, including blood communication (75.9 Kbps). Wireless Local Area Networks
pressure, glucose levels, pulse rate, ECG, and cholesterol. (WLANs), Zigbee, Bluetooth, mobile networks, Wireless
It is occasionally possible to perform data preparation, Personal Area Networks (WPANs), and Wireless Sensor
which entails removing noise and missing values. Thus, Networks (WSNs) are among the other wireless technologies
removing noise from data cleaning results in a higher diag- with which they are compatible.Sensors that are dispersed
nosis process detection rate. The median studentized residual geographically are typically used in WSNs to observe, record,
approach, which thoroughly analyses the relationships within and monitor environmental and physical variables. They
the dataset, can be used to filter out undesirable data. This require an infrastructure made up of relatively small nodes,
method leads to improved detection rates in the diagnostic which are the core components of WSN and are grouped in
process. Initially, missing data is addressed by replacing them groups ranging from a few tens to hundreds or thousands of
with median values across rows and columns. Subsequently, nodes. They are used to collectively transfer observed data
data normalization is performed to scale values between via the network to a central location. where one or more
0 and 1, reducing complexity in the diagnostic process. sensing devices are installed on each node. The network
This normalization involves adjusting data using various architecture is the second part of WSN. A vast region is
distribution techniques. covered by a large number of sensor nodes that are then
It is necessary to send the data that sensors capture from networked together. There is communication between sensor
the patient to the closest data collection or processing node. nodes and with a base station [127]. The development of
Wireless Body Area Networks (WBANs) are one technology WSN was first motivated by military purposes such as
that is helpful for moving data from the sensors to the nearest battlefield surveillance. WSNs are used in different fields
processing node [123]. WBSNS will be discussed in the next like industry and medical applications [127]. Note that
subsection. WSNs and Wireless Body Area Networks (WBANs) share
similarities in wireless communication technology but differ
A. WIRELESS BODY AREA NETWORKS (WBANs) in their specific applications. WSNs are designed for broader
Various components work together in the IoT architecture to environmental monitoring and data collection, while WBANs
enable different solutions for the end user. An IoT-enabled focus on wearable sensors for health monitoring and medical
network of linked devices that perceive critical data in applications, often integrated into clothing or implanted
real-time makes up the PMS-based healthcare application. on the body. In healthcare, WBANs play a crucial role
In particular, PMS makes it possible to regulate end-user in improving patients’ quality of life by enabling contin-
applications through analytics, device connectivity, data uous monitoring and personalized healthcare interventions.
transfers, and real-time data collecting. WBANs are among Three categories can be used to describe WBAN: beyond-
the technologies that enable data flow from sensors and WBAN communication, intra-WBAN communication, and

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FIGURE 7. Illustration of the the most common types of wearable devices (reproduced from [103]).

inter-WBAN communication [125]. WBANs can be either As stated in, a WBAN node is a standalone device with
wearable, i.e., used on the body surface of a human or communication capabilities that falls into one of three types
implantable, i.e., inserted inside the human body [128]. according to its capability, implementation, and network

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role [129]. In terms of functionality, nodes include personal wireless spectrum, licensing of wireless devices, and ensuring
devices, sensors, and actuators. Personal devices gather data compliance with safety and interference regulations. In the
from sensors, process it, and can communicate with other following, we discuss the communication protocols that can
devices or individuals through an external gateway or by be used for PMS.
activating actuators. These personal devices are also referred • Wireless local area networks, or WiFi, are thought
to as body gateways, sinks, or Body Control Units (BCUs) in to be the most widely utilised wireless technologies
certain contexts. Sensors transfer data to the personal device in PMS. IEEE 802.11 standards, namely 802.11b-
by capturing certain parameters from the human body either 11 Mbps, 802.11g-54 Mbps, 802.11a-54 Mbps, and
internally or outside. Actuators interact with humans based 802.11n-300 Mbps, provide the foundation of WiFi
on sensor or personal device data; for example, a physician architecture [133]. WiFi technology allows the devices
might send medication instructions via a display actuator to access the internet and communicate with each
after processing sensor data on a personal device. Nodes can other within a local area range. WiFi technology can
be further classified based on implementation into implant operate in bandwidths of 2.4 GHz, 3.5 GHz, and 5 GHz
nodes, body surface nodes, and external nodes. Based on unlicensed Industry, Scientific, and Medical (ISM)
their network role, nodes are categorized as coordinators, frequency bands. WiFi technology is able to support
end nodes, or relays. Coordinator nodes act as gateways short-range communications with a coverage range of
connecting WBANs to the Internet, and other WBANs, up to 100m. WiFi technology also allows reliable,
or serving as a central trust point. End nodes are typically secure, and high-speed data communications. A network
sensors without communication capabilities, while relay of 45 vital medical devices, including as infusion
nodes facilitate message forwarding between sensors and pumps, defibrillators, lung ventilators, and anaesthesia
gateways when they are distant. WBSN mainly collects a machines, have been equipped with WiFi technology,
large amount of real-time data and sends them to the cloud. demonstrating that WiFi can be utilised safely and
The cloud, in turn sends and/or saves them in a server and successfully for these devices’ communication [134].
then transmits them to the specialist to be analyzed based on • Based on IEEE 802.15.4, ZigBee is a wireless personal
patient statues. area network technology. ZigBee is compatible with
low data rate networks, which usually require up to
B. COMMUNICATION NETWORKS AND PROTOCOLS 250kbps, because its data rates are far lower than
As previously said, PMS is a popular healthcare tool that those of other technologies. Long battery life of up to
helps physicians keep an eye on hospitalised patients, several years is possible using ZigBee [33]. While its
elderly individuals receiving home care, and patients with power consumption is higher than Bluetooth’s, a typical
acute or chronic illnesses when they are in remote areas. ZigBee transmission range can reach up to 100 metres
Wireless network technologies control data transfer and link depending on power output and ambient factors [135].
patient devices and sensors to distant sites. Communication This distance can be extended up to 1,600m with
methods such Wi-Fi, Bluetooth, ZigBee, cellular networks ZigBee-Pro. Every Zigbee network consists of three
3G/4G/5G, NFC, and satellite are used to convey the patient’s types of devices, which are coordinator, router, and end-
signals [130]. By using efficient and reliable wireless device [120]. Keys for 128-bit symmetric encryption
networks, the data can be transmitted to several places like protect ZigBee networks. It features one channel in the
the doctors, caregiver. In order to provide data analytics 868MHz Europe band, ten in the 915MHz Australia
and cloud-based services for biometric data gathered from and US bands, and sixteen in the 2.4GHz ISM band.
physical devices and sensors, PMS models may extend big Moreover, a mesh network architecture utilising ZigBee
data processing to the cloud. Big data is essential because it wireless technology enables higher coverage range and
facilitates decision-making, data analysis, and the extraction high-reliability communication.
of valuable information [131]. Based on real-time data • Bluetooth technology is a wireless personal area net-
from connected devices, continuous patient monitoring offers work named after King Harald Bluetooth who unified
real-time surveillance, feedback, and intervention of patient Denmark and Norway and embodies the concept
parameters. The doctor can deal with emergencies cases of connecting diverse devices wirelessly. Originally
from a remote location by viewing the patient’s report. The developed by Ericsson in 1994, Bluetooth is based on
integration of intelligent communication technologies that the IEEE 802.15.1 standard, which is widely used for
can link diagnostic equipment to distant places has been linking IoT devices, smartphones, and other mobile
the subject of some research projects. The appropriateness devices. Bluetooth operates in the 2.4-2.4835 GHz [136]
of every communication technology is contingent upon unlicensed ISM band using frequency-hopping spread
multiple criteria. These factors are range, data rate, and power spectrum (FHSS) and provides a data rate of up to
consumption [130], [132]. Additionally, the Federal Commu- 721 kbps [137]. Bluetooth allows a lower transmission
nications Commission (FCC), a government organisation in coverage with a coverage distance of up to 100m.
charge of overseeing communication technologies in the US, Bluetooth is typically used for portable personal devices
defines sets of standards and guides that can be followed for and to connect between medical devices, sensors, and

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smartphones or tablets used by healthcare providers. environmental monitoring, and health monitoring.
Bluetooth-enabled devices can transmit vital signs, such It operates without batteries by harnessing energy
as heart rate, blood pressure, and oxygen saturation, from ambient sources like light, motion, or pressure,
directly to monitoring systems, enabling real-time converting them into electrical energy for use in wireless
data collection and analysis. Furthermore, Bluetooth is communication. EnOcean devices are designed to be
optimised for use in loud situations, covering both the ultra-low power, utilizing micro energy converters and
MAC layer and physical access. efficient electronics to enable wireless connectivity
• Z-Wave is a low-power and cost-effective wireless among sensors, switches, controllers, and gateways.
communication technology suitable for short-range This technology, ratified as an international wire-
applications, particularly in residential and light com- less standard (ISO/IEC 14543-3-10), offers signifi-
mercial settings [138]. With a data rate of up to cant advantages in terms of energy efficiency and
40 kbps and a coverage distance of about 30m, Z-Wave maintenance-free operation. EnOcean can contribute
supports mesh networking, making it suitable for use to the PMS by enabling wireless and battery-less
in PMS. In Australia and North America, Z-Wave sensors and switches for building, home, or industrial
uses the 900MHz unlicensed radio frequency range automation applications [60]. EnOcean technology
for its operations, providing extended coverage and allows a long communication range of up to 300m
lower power consumption compared to higher frequency and low-power consumption, and hence, makes this
bands like 2.4GHz [139]. Z-Wave immunity to Wi-Fi technology suitable for deploying sensors in various
interference ensures reliable communication alongside healthcare settings without the need for frequent battery
other wireless devices, offering a standardized and replacements, thus reducing operational costs and
stable control medium for smart home automation and simplifying maintenance tasks [142]. EnOcean devices
potentially for WBANs in healthcare applications [126]. operate at the following transmission frequencies:
Its ability to penetrate walls and solid objects makes 902 MHz, 928.35 MHz, 868.3 MHz, and 315 MHz.
Z-Wave a compelling choice for deploying sensors EnOcean is capable of up to 125 kbps of data rate.
and monitoring devices within healthcare environments, • The bi-directional radio frequency identification sys-
supporting efficient and seamless patient monitoring tem known as radio-frequency identification (RFID)
capabilities. technology comprises of a tag and reader that can
• IPv6 over low-power Wireless Personal Area Networks be interfaced with personal computers or handheld
is referred to as 6LoWPAN. This networking technology computers [143], [144]. RFID automatically recognises
makes it possible for IPv6 packets to travel via short and tracks tags affixed to items or people using
link-layer frames, as those outlined in IEEE 802.15.4, electromagnetic waves. The tag is made up of two
with efficiency. Initially, IEEE 802.15.4 low-power parts: an antenna that allows the chip to use radio
wireless networks operating in the 2.4 GHz range were waves to connect with the tag reader and a chip that
intended to be supported by 6LoWPAN. Currently, stores the object’s unique identity. By using the tag’s
6LoWPAN is being deployed over low-power RF at sub- reflected radio waves, the tag reader creates a radio
1 GHz, among other networking media. Strong AES- frequency field that allows objects to be identified [130].
128 link layer security as outlined in IEEE 802.15.4 is RFID makes it easier to follow a patient’s movements
leveraged by 6LoWPAN. Because of these features, the in real time within a medical facility. RFID adheres
technology is perfect for a variety of sectors, including to the EPC (electronic product code) standard. RFID
smart metering, residential illumination, street light is compatible with Wi-Fi and ZigBee, among other
monitoring and control, home automation using sensors technologies. RFID can detect objects within a range
and actuators, and general Internet of things applications of 10 cm to 200 m and operates across a broad range
involving Internet-connected devices. Depending on the of frequency bands, from 120 kHz to 10 GHz. RFID
benefits of IEEE 802.15.4, which include support for can help improve inventory control by monitoring the
a vast mesh network topology, reliable communication, location and use of medical equipment and supplies.
and extremely low power consumption, 2.4 GHz and RFID technology can deliver up to 4 Mbps of data rate.
sub-1 GHz bands are typically employed. Depending Because RFID technology enables asset management
on the frequency, the 802.15.4 standard offers data and patient monitoring capabilities, it is essential to
speeds ranging from 20 to 250 kbps. 6LoWPAN works healthcare systems.
well over short distances, up to 100 metres. 6LoWPAN • ONE-NET is an open-source wireless networking stan-
allows sensors and local devices to be connected dard designed specifically for low-power and low-cost
to IP networks in healthcare systems, enabling the control networks, such as those used in sensor applica-
connectivity of several sensors [140], [141]. tions, home automation, security, and monitoring. Since
• EnOcean is an energy-harvesting wireless sensor ONE-NET is not dependent on any particular hardware,
technology that finds applications across diverse it can be built with a variety of commercially available
sectors including building automation, transportation, microcontrollers and radio transceivers from companies

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including Silicon Labs, Freescale, and Texas Instru- device-to-device data sharing [148]. NFC makes it
ments. ONE-NET uses Wideband FSK modulation and simple to pair medical devices with smartphones or
operates in frequencies including 433 MHz, 868 MHz, tablets in PMS, giving medical professionals effective
915 MHz, and 2400 MHz. It can support data rates access to real-time patient data.
ranging from 38.4 kb/s to 230 kb/s. With ranges of • Medical Implant Communication Service (MICS) is a
up to 100 metres indoors and 500 metres outdoors, specialized wireless communication standard designed
its adaptable network topologies-peer-to-peer, star, and for medical implants and devices used in healthcare
multi-hop-enable effective connectivity and communi- systems, particularly in patient monitoring applica-
cation coverage across indoor and outdoor situations. tions. MICS operates in the frequency range of 402-
Because of its exceptional low power consumption, 405 MHz and enables reliable, low-power communi-
this technology can be used in battery-operated gadgets cation between medical implants and external devices
that have a five-year battery life when using AA such as wearable monitors or bedside receivers. MICS
or AAA Alkaline batteries. Furthermore, ONE-NET ensures secure and efficient communication, allowing
integrates strong security protocols, using the expanded healthcare providers to remotely monitor patients’ vital
tiny encryption algorithm to protect confidentiality and signs and device status without the need for invasive
integrity of data in wireless networks [145]. ONE-NET procedures or physical connections. Sensor signals can
can provide dependable and affordable wireless con- be collected using the MICS band, and data can then be
nectivity for sensors and devices in patient monitoring sent to a distant station. This process enables multiple
systems. It provides scalability, energy efficiency, and patients to have long-range monitoring at the same
secure data transmission, improving the capacity for time [149].
remote patient monitoring in healthcare settings. • Ultra-Wideband (UWB), also known as IEEE 802.15.3a,
• Long Range Wide Area Network (LoRaWAN) is a is a low-power, high-precision wireless communication
wireless communication technology well-suited for technology that uses a broad spectrum of frequencies
healthcare systems, particularly in patient monitoring to send data over short distances (about 10 metres)
applications. LoRaWAN enables long-range, low-power with minimal power consumption. UWB is used in
communication between sensors and gateways, making real-time applications in RF-sensitive applications, such
it ideal for collecting data from remote or distributed as hospitals, and is also used for precise positioning,
patient monitoring devices [146]. LoRaWAN technol- asset tracking, and short-range data transmission. UWB
ogy supports secure and reliable transmission of vital has been wildly used for healthcare systems with short-
signs and health data, such as heart rate, blood pressure, distance communication [150], [151], [152], [153].
oxygen saturation, and body temperature, from patients UWB can achieve a data rate from 20 Mbps up to
to healthcare providers or central monitoring stations. 1.3 Gbps. UWB is suitable for the physical layer of high
LoRaWAN is considered as a robust and scalable data rate PANs.
transmission technique, which allows for the deploy- • IEEE 802.15.6 is standard that is designed for
ment of sensor nodes in various healthcare settings, WBANs, has become widely adopted across medical
including hospitals, nursing homes, and even patients’ and non-medical wearable devices for communication.
homes, ensuring continuous and real-time monitoring This wireless communication standard enables direct
without the need for frequent battery replacements. sensor-to-device communication, alleviating the need
By exploiting LoRaWAN technology, healthcare sys- for intermediate relaying or routing devices, which
tems can enhance patient care by enabling proactive enhances efficiency and reduces complexity in data
interventions, timely alerts for critical conditions, and acquisition processes [154]. With aid of a variety of
overall improved patient care systems through remote data rates, low power consumption, and the ability
monitoring and management. to connect up to 256 wireless devices within a
• Devices can communicate with one another across a single WBAN, IEEE 802.15.6 effectively meets the
few centimetres’ distance thanks to near field commu- communication requirements of wearable devices. With
nication (NFC), a short-range wireless communication its ability to operate in the Narrow Band, Ultra-Wide
technique [147]. The foundation of NFC is Radio Band, and 2.3 GHz to 2.4 GHz frequency bands, this
Frequency Identification (RFID) technology, which standard supports a wide range of WBAN applications.
uses electromagnetic fields to wirelessly transfer data IEEE 802.15.6 remains highly appealing for wearable
between devices when they are positioned in close and body-worn medical devices, particularly due
proximity to one another. NFC allows for seamless and to its suitability for short-range, low-power, and
secure communication between devices in close prox- cost-effective communication services both within and
imity, making it suitable for healthcare scenarios where around the human body. This wireless communication
quick data exchange and authentication are crucial. standard may allow a significant advancement in
Numerous uses are made possible by NFC technology, facilitating reliable and efficient communication for
including contactless payments, access control, and PMS.

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• Sensium is an innovative low-power on-body technol-

ogy designed for continuous patient health monitor-
ing [155]. Sensium can wirelessly transmit vital sign
information to smartphones, mobile phones, laptops,
or PCs, allowing seamless communication with med-
ical entities such as doctors or paramedical staff for
timely intervention. Sensium sensors operate efficiently
by activating only during designated time slots to
transmit data, conserving energy through periods of
inactivity [126]. This technology has gained widespread
adoption as a leading patient health monitoring system,
exemplified by its practical application in PMS during
FIGURE 8. The most common types of communication protocols that are
the COVID-19 pandemic. The use of Sensium patches, used for PMS in healthcare systems.
as depicted in the accompanying image, highlights the
significance of wearable WBAN devices for remote
patient monitoring, underscoring their role in facilitating System (UMTS), CDMA2000, 4G-Long Term Evo-
effective healthcare delivery outside traditional clinical lution (LTE-A), and 5G. Due to the imperative of
settings [156]. Sensium represents a promising solution low energy consumption, cellular wireless technology
for PMS, offering real-time data transmission and has not yet seen widespread adoption in wearable
enabling proactive healthcare interventions based on WBAN devices. However, there is optimism for the
continuous monitoring of vital signs. future development of cellular technologies that are
• RuBee is a wireless protocol considered as an alternative more suitable for wearable and body-worn WBAN
to RFID, utilizing long wave magnetic signals instead applications, potentially enabling a broader range of
of traditional radio frequency signals to transmit and advanced healthcare and entertainment experiences on
receive data within local networks [60]. RuBee is a low- wearable devices. Such cellular networks enable voice
frequency (131 kHz) device that offers notable power and data communication over long distances. Satellite
efficiency advantages. It can run on a single lithium but- communication could also be used to provide coverage
ton cell battery for up to fifteen years. RuBee is designed in remote areas or to extend the reach of cellular
based on standard of IEEE 1902.1, emphasizes high networks.
security and robustness in harsh environments, offering FIGURE 8 summarizes the most common communication
advantages over RFID in terms of signal reliability and protocols, which can be used for PMS. Table 2 demonstrates
penetration through materials like steel and liquid [60]. the key features of the most common types of communication
Despite its lower data rate compared to technologies protocols.
like WiFi, Bluetooth, and ZigBee, RuBee’s unique
characteristics make it well-suited for applications VI. CLOUD COMPUTING AND DISTRIBUTED COMPUTING
requiring long-lasting, secure, and interference-resistant Connecting a multitude of physical objects, such as humans,
wireless communication. RuBee represents a robust and animals, smartphones, and PCs equipped with sensors, and
reliable technology for specific use cases, particularly linking them to the Internet generates vast amounts of data
in challenging environments where traditional wireless known as ‘‘big data.’’ Such a big data scale necessitates smart
technologies may struggle to perform effectively [157], and efficient storage, processing, and retrieval mechanisms.
[158]. However, traditional hardware and software tools often strug-
• Cellular networks offer a direct and promising avenue gle to handle such immense data volumes within acceptable
for smart wearable WBAN devices to connect without time slots. In order to accomplish this, the US National
the need for additional bridging mechanisms. While pre- Institute of Standards and Technology (NIST) invented cloud
vious network technologies were more oriented toward computing, which offers a shared programmable network
human communication, they encountered significant of networks, servers, storage, applications, and services that
challenges when applied to wearable WBAN devices, can be accessed on demand. A longer explanation of cloud
particularly as applications evolve from basic vital sign computing can be found in the next subsection.
monitoring to advanced virtual or augmented reality
experiences [159]. These advanced applications demand A. CLOUD COMPUTING
high data rates in the gigabits per second (Gbps) A revolutionary concept known as ‘‘cloud computing’’
range, a feat currently supported only by technolo- makes it possible to lease computing resources in real time,
gies like 802.11ac with a 1Gbps data rate. Cellular such as processing power, storage, and networking, without
networks may involve 2G-Global System for Mobile requiring upfront commitments from customers [123], [160].
communication (GSM), Code Division Multiple Access With cloud services, people can reliably and economi-
(CDMA), 3G-Universal Mobile Telecommunications cally use and maintain resources from a distance [161].

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TABLE 2. Summary of the key features of the most common types of communication protocols.

For healthcare applications based on IoT, which involves for the IoT, enabling efficient processing and analysis of vast
numerous embedded devices like sensors and actuators amounts of sensor-generated data within the IoT architecture.
generating big data, cloud computing emerges as an ideal With the use of cloud based technologies, healthcare systems
solution for storing and processing this data efficiently. Cloud can address the challenges posed by increasing digital
computing offers a robust platform for storing, managing, data, improve service outcomes for patients, and streamline
and analyzing vast volumes of healthcare data produced by health information management. The adoption of cloud
IoT devices [162], [163], [164]. Cloud infrastructure offers computing in healthcare, often referred to as Healthcare as
the scalability and computational power needed to manage a Service (HaaS) [169], is considered to revolutionize health
and analyze big data generated by IoT devices, facilitating information technology, benefiting healthcare research and
complex computations to extract actionable insights [165]. service delivery.
Cloud computing utilizes computing resources, networking Cloud computing offers a valuable infrastructure for
capabilities, storage, and other essential elements critical for storing and managing patient medical data efficiently,
operational efficiency without requiring substantial capital especially given the volume of data generated per patient,
investments. This technology provides rapid elasticity, self- which can overwhelm traditional storage systems. The use
healing, self-configuration, and ubiquitous access, offering of cloud-based solutions helps address the challenges of han-
significant benefits. Cloud services offer the illusion of dling large-scale healthcare data by leveraging technologies
infinite computing resources on demand, delivering various like big data analytics to extract valuable insights and present
services such as Infrastructure as a Service (IaaS), Platform information in a more accessible format for healthcare
as a Service (PaaS), Database-as-a-Service (DBaaS) and professionals [131]. This approach not only improves data
Software as a Service (SaaS). Both public and private clouds management and accessibility but also supports advanced
can be efficiently used where the public is accessible to the analytics, facilitating more informed decision-making and
general public and private clouds are dedicated to single enhancing patient care. By utilizing cloud-based infras-
organizations, while hybrid solutions integrate both models. tructure, healthcare providers can efficiently manage and
Cloud computing in the healthcare sector presents compelling analyze vast amounts of patient data, ultimately leading
opportunities to contain integration costs, optimize resources, to improved patient monitoring and personalized treatment
simplify processes, and enhance service quality [166], [167], strategies. The cloud also act as on on-demand service
[168]. Cloud computing serves as a foundational technology that is very cost-efficient solution to medical services [22].

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Cloud computing offers virtually limitless storage and ultimately enhancing the performance and reliability of
computing resources in data centers, empowering healthcare healthcare systems.
stakeholders to derive valuable insights from analyzed and Fog computing has recently been proposed by Cisco [171],
stored data. Physicians can remotely monitor patient health [172]. Fog computing, sometimes referred to as cloudlet or
status using data collected from various sensors stored edge computing, serves as a link between smart devices and
in the cloud, enabling timely interventions and treatment extensive cloud computing and storage services. [130]. Fog
recommendations. Despite its advantages, cloud computing computing can be implemented in gateways or edge devices,
introduces latency challenges due to data transmission over allowing for real-time data processing, local decision-
the internet for analysis and retrieval, which may not be suit- making, and faster response times. By processing data nearer
able for emergency healthcare services. To address latency the site of data production within the network edge, fog
issues, distributed computing such as fog/edge computing computing expands on the idea of cloud computing. This
is emerging as complementary solutions in IoT healthcare local processing approach reduces data traffic, distance,
applications, optimizing data processing and response times and latency, which is crucial in latency-sensitive healthcare
at the network edge. The work in [170] presented a net applications. At the network edge, data is initially gathered
architecture for resource preservation that combines cloud through an IoT network and then processed locally using
and edge computing, with an emphasis on maximising edge devices. Once local processing is complete, the data is
important performance metrics like average patient waiting forwarded to the cloud for further computational operations
time, length of stay for patients, and resource utilisation and memory storage. Fog computing can utilize various
rate. This framework emphasizes high reliability, efficiency, communication protocols such as Wi-Fi, Zigbee, Bluetooth,
and security in healthcare systems. By leveraging cloud and and many other communication protocols. By enabling
edge computing capabilities, the proposed framework aims customisable decentralised networks, fog computing can
to model and optimize critical metrics to enhance overall help to manage and process data at the network’s edge
system performance and patient outcomes. The integration more effectively. For delay-sensitive applications like PMS,
of cloud and edge computing allows for efficient resource where real-time data processing and minimal latency are
utilization, improved patient management, and enhanced essential for efficient operation, fog computing is very
security measures, contributing to the development of more helpful. Healthcare systems rely heavily on fog comput-
reliable and effective healthcare systems. Through their work, ing because it provides substantial benefits for real-time
Oueida et al. highlight the potential of cloud-edge integration data processing [173], [174], [175]. Data processing may
in addressing key challenges and optimizing healthcare now be done close to sensors thanks to fog computing,
operations, paving the way for advanced frameworks that which frees it from the cloud. Fog computing specifically
prioritize performance, reliability, and security in healthcare makes use of sensors, network gateways, or local nodes
environments. In the following subsection, we will discuss to store and perform initial data processing. This would
fog computing and mobile edge computing (MEC). enable doctors and other clinicians to deliver emergency
medical care and would allow for a significant reduction in
B. DISTRIBUTED COMPUTING latency.
Traditional cloud-centric architectures provide a number of Data storage within fog nodes allows for data replication or
issues that call for distributed computing paradigms like segregation, and security features ensure data confidentiality,
fog computing and MEC, especially in the context of integrity, and privacy. Fog computing defines the function-
healthcare applications. Using centralised cloud resources ality of edge computing and makes processing, storage, and
grows more and more wasteful as the amount of data networking between end devices and cloud data centres
produced by IoT sensors and devices keeps growing. easier. It operates at the perception and networking layers
In particular, conventional cloud architectures may struggle of the Internet of Things architecture. Fog nodes empower
to meet the latency requirements of real-time healthcare end-user devices to collaborate in tasks involving storage,
applications, where rapid data processing and response management, and network communication, reducing latency
times are essential for PMS. Furthermore, the geographic by executing these tasks near or at the end user’s location.
distribution of healthcare services and the expansion of IoT Similar to the cloud, a fog server can store various content
devices raise the demand for enabling distributed computing types, including health data, videos, audio, and local informa-
solutions that can bring computation and data storage closer tion like maps and nearby restaurant availability [176]. This
to the point of data generation. Fog computing and MEC architecture, depicted in typical fog computing diagrams,
offer decentralized approaches that enable faster data pro- is well-suited for IoT applications, where the proliferation of
cessing, reduced latency, improved scalability, and enhanced communication-capable objects and smart devices demands
privacy and security for healthcare applications [39]. These efficient processing at the network’s edge. Fog computing
distributed computing models facilitate efficient utilization enables higher service rates, and better Quality of Service
of resources, optimize network bandwidth, and support (QoS), and reduces the burden on the cloud, making it an ideal
seamless integration with existing healthcare infrastructure, solution for IT convergence scenarios [176].

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Fog computing offers several distinctive features that large datasets upon reception [181], [182]. MEC involves
enhance its utility within IoT systems. Positioned between decentralizing service-specific processing, computing, and
smart objects and cloud data centers, fog resources signifi- data storage from the centralized cloud core network to
cantly improve delay performance by reducing the distance edge network nodes situated near data sources and end-
data must travel. This architecture is characterized by users [172], [183]. Pushing mobile computing, network
the deployment of numerous ‘‘micro’’ centers closer to control, and storage to the network edges (base stations
end-users, leveraging their cost-effectiveness compared to and access points, for example) is the primary function
expansive cloud data centers. As IoT systems scale with of MEC. This allows resource-constrained mobile devices
increasing end-users, fog computing allows for seamless to run computation-intensive and latency-critical applica-
scalability through the deployment of additional micro fog tions [122]. By hosting compute-intensive apps, handling
centers, a feat not feasible with traditional cloud data centers massive amounts of data before transferring it to the cloud,
due to cost constraints. Fog computing also ensures resilient delivering cloud computing capabilities inside the radio
and replicated services, supporting a dense array of devices access network (RAN) near mobile users, and providing
with mobility. With its proximity to end-users, fog resources context-aware services, MEC can maximise the use of mobile
facilitate real-time interactive services and enable on-the- resources [184]. MEC has shown to have enormous potential
fly data analysis by aggregating and processing data before for improving healthcare systems’ performance, allowing
forwarding it to cloud data centers for further refinement, mobile PMS in those systems. The MEC can provide a
demonstrating interoperability with various cloud providers number of higher-level functions in these systems, including
and offering enhanced performance for critical applications. embedded data mining, local storage, real-time local data
This decentralized approach to computing optimizes effi- processing, and data transfer control [185].
ciency and responsiveness within IoT ecosystems. By leveraging a network of servers, MEC can offload
A fog node provides network-wide monitoring, prepro- intensive computation tasks, contributing to ultra-reliable
cessing, storage, and security features. While preprocessing low-latency communication (URLLC), and traffic optimiza-
entails fundamental data analysis required for emergency tion [122], [183]. Implementing MEC in PMS promises
healthcare services, monitoring capabilities allow the node to significant benefits, including increased network capacity,
track resources and services. To optimize computation and efficient handling of delay-sensitive tasks, and offloading of
energy usage without compromising functionality, models network-intensive computations to reduce energy consump-
are developed specifically for edge-dependent healthcare tion and prolong battery life in the devices [186]. MEC
sectors. The fog computing approach is an effective technique plays a vital role in enhancing network capabilities, opti-
that integrates agile computing into PMS. This approach mizing services, managing energy and resources efficiently,
involves distributing computations between the cloud and and reducing the burden on backhaul infrastructure [182].
edge devices using a hierarchical structure, leveraging By providing real-time data processing and analytics at the
the advantages of both edge and cloud environments for network edge, MEC integration with PMS may increase
healthcare data analysis from IoT devices [177]. Healthcare overall efficiency in healthcare applications by reducing
applications that require quick response times can be latency and enabling faster response times.
implemented with the help of edge computing integration, MEC represents a significant advancement in addressing
and cloud computing offers plenty of processing and memory the challenges associated with managing remote devices,
capacity. Fog computing and the cloud work together to particularly concerning security, reliability, latency, and
improve performance in the healthcare industry. energy efficiency issues in healthcare systems. Recent
The necessary tasks associated with edge computing can research on EdgeCare presented in [187], emphasizes
be completed using a virtualized software-based platform the importance of security in mobile healthcare systems.
that leverages software-defined networks (SDN) and network With strong security features integrated, EdgeCare offers a
functions virtualization (NFV) to provide a flexible, scalable, safe and effective data management solution that handles
and effective network architecture [178], [179], [180]. With medical data and enables data trading at edge servers.
NFV, a single-edge computing server can offer computing Similarly, The work in [170] proposed BodyEdge, which
services to several mobile devices. This is accomplished introduces innovative body healthcare architectures featuring
by building various virtual computers with the capacity to tiny mobile client modules and edge gateways. The proposed
perform numerous activities at once. Furthermore, network architectures enable the collection and local processing of
function virtualization (NFV) has promise for managing data from various scenarios, focusing on improving latency
computer services and improving the scalability, flexibility, and reliability performance within healthcare applications.
and dependability of network services [179]. Additionally, the work in [188] has implemented accurate and
Mobile edge computing (MEC) is considered a key lightweight classification mechanisms using edge computing
technology in the 5G network and is defined as an to detect seizures at the network edge based on vital sign
essential form of edge computing, which operates at the information. The research findings demonstrate substantial
edge of cellular networks, enabling rapid processing of performance improvements over conventional non-MEC

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remote monitoring systems, achieving high classification proactive nature of modern patient monitoring systems, aim-
accuracy for seizures, extending battery life, and signifi- ing to mitigate risks and enhance overall patient outcomes.
cantly reducing transmission delays. Through initiatives like This convergence of technologies underpins the evolution of
EdgeCare and BodyEdge, MEC demonstrates its potential electronic health (e-Health) and m-Health paradigms [69],
to revolutionize data management and processing, offering reshaping the landscape of healthcare delivery towards more
secure, efficient, and reliable solutions at the network edge. connected, data-driven, and patient-centric models.
These advancements highlight the transformative impact of The essential task of PMS is to monitor patients in
MEC in enabling real-time data processing, reducing latency, different places such as home, office, hospital, battlefield,
and improving overall system responsiveness. As researchers and other places. Using PMS can prevent transmissible and
continue to explore the potential of MEC, incorporating infectious diseases, keep the patient’s life safer, and provide
security considerations and innovative architectures, the field quick diagnostics and treatment in addition to other health
is poised to advance further, addressing critical challenges assistance tools. In addition, the economic cost, morbidity,
in remote device management and facilitating the develop- and mortality associated with human beings have been
ment of advanced applications with enhanced performance reduced using remote PMS, which appears as a promising
and reliability. solution and can succeed on a large scale. Furthermore,
The MEC network can dynamically handle various ser- one key area where PMS proves invaluable is in hospital
vices thanks to SDN. Additionally, it could separate the environments. In such environments monitoring patient’s
control and data planes [189], [190]. For an edge computing vital signs can improve patient safety and enable early
network, SDN can offer a logically centralised control detection of deteriorating conditions. In intensive care units
platform [191]. By using such a centralised control platform, (ICUs), PMS plays a crucial role in providing real-time data
the network’s scalability problem could be addressed, optimal to healthcare providers, facilitating prompt interventions,
resource allocation could be achieved, overhead could be and improving patient outcomes. Beyond hospitals, PMS
decreased, dependability could be increased, and most extends its utility to home care settings, allowing patients
crucially, latency could be decreased. with chronic illnesses or post-surgery recovery needs to
be monitored remotely. This remote monitoring capability
VII. APPLICATION LAYER AND PMS BENEFITS promotes patient independence while providing clinicians
The application/action layer in PMS serves as the central with vital data for timely interventions. Moreover, PMS
hub, typically represented by the medical server. Currently, aids in the management of elderly patients, ensuring their
most IoT services have application and user interfaces. well-being by tracking vital signs and detecting emergencies.
This layer plays a pivotal role in processing and presenting Nurses can benefit significantly from PMS to monitor
data generated by IoT devices to healthcare providers patients remotely, allowing for proactive interventions and
or integrating it seamlessly into electronic health records reducing the need for frequent clinic visits. This approach not
(EHR) systems. This layer provides data control services. only improves patient comfort but also optimizes healthcare
It can mostly be affected by the type of data traveling resource utilization. In emergency situations, PMS enables
through the IoT network [133]. Within this layer, various real-time monitoring of critical patient data, providing crucial
functionalities are enabled to support visualization, alerts, information to emergency medical personnel before arrival
and decision-making tools for clinicians. Moreover, the at the hospital. This capability enhances triage and treatment
application layer extends beyond mere data presentation, decisions, potentially saving lives. Additionally, PMS plays
incorporating advanced features like self-management, active a vital role in ensuring the security and integrity of medical
assisted living (AAL), behavioral analysis, big data analytics, data. By employing robust data encryption and secure
emergency detection, disease prevention strategies, and transmission protocols, PMS can allow safe sensitive health
mobile health (m-Health) initiatives [68]. These aspects information against unauthorized access or breaches. This
collectively enhance the system’s capability to provide aspect is critical in maintaining patient confidentiality and
efficient healthcare services. compliance with data protection regulations. Furthermore,
Through the application layer, clinicians gain access to PMS supports seamless integration with EHRs, enabling
intuitive interfaces that facilitate real-time visualization of healthcare providers to access comprehensive patient histo-
patient data and enable timely intervention when abnormal- ries and monitor trends over time. This accessibility enhances
ities or critical events are detected. This layer also fosters clinical decision-making and fosters continuity of care across
proactive healthcare management through the implemen- different healthcare settings, ultimately improving healthcare
tation of self-management tools, empowering patients to systems.
monitor and manage their conditions effectively. Addition- PMS plays a vital role in ambient assisted living (AAL)
ally, the integration of big data analytics within this layer environments by enabling continuous remote monitoring of
enables deep insights into patient trends and population individuals with chronic illnesses or disabilities. In AAL
health, facilitating targeted interventions and personalized settings, PMS empowers individuals to live independently
care strategies. Furthermore, the integration of emergency while providing caregivers and healthcare professionals with
detection and disease prevention mechanisms underscores the real-time data on vital signs and activities. This proactive

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monitoring allows for early detection of health issues trust between patients and healthcare providers. In addition,
or emergencies, enhancing overall safety and well-being integrating PMS systems into existing healthcare workflows
within the home environment. PMS in AAL environments requires substantial changes in how hospital staff operate.
facilitates personalized care plans based on individual This transition often demands extensive training and adap-
health trends and alerts caregivers to potential concerns tation. The challenge is to seamlessly incorporate PMS
promptly. By integrating with smart home systems and technologies without disrupting the delivery of care. Further
wearable devices, PMS supports seamless data collection investigation in this regard is needed. Moreover, the financial
and analysis, contributing to improved health outcomes aspects cannot be overlooked; the high initial costs associated
and quality of life for individuals. Applications for AAL with implementing PMS systems, coupled with the uncertain
track and assess a range of fundamental daily tasks, such landscape of insurance reimbursement, can be significant
eating, and cleaning. They give the subject suitable assistance challenges for healthcare institutions considering adoption.
involving carers and permit the subject to live independently. These financial hurdles, along with the need for clear
Fall detection and movement monitoring systems identify reimbursement policies, add another layer of complexity to
ambulatory behaviours such as unintentional falls, static the widespread integration of PMS technologies. Healthcare
postures, dynamic activities, and location tracking. Real-time regulators and policymakers need to create clear, consistent
applications are used by physiological PMS to monitor and reimbursement frameworks for PMS technologies. This
diagnose vital signs in dependent and chronically unwell includes establishing guidelines that recognize the value
people, including those with diabetes, hypertension, and of remote monitoring and IoT-based healthcare services,
cardiovascular disorders [73]. ensuring that these services are reimbursed similarly to
traditional in-person care. Besides, educating healthcare
VIII. RELATED CHALLENGES AND FUTURE RESEARCH providers, patients, and policymakers about the benefits
DIRECTIONS IN PMS BASED ON IoT IN HEALTHCARE and cost-effectiveness of PMS technologies is essential.
SYSTEMS Advocacy efforts can help build support for the adoption of
Despite the numerous benefits offered by PMS, which were these technologies and for the development of reimbursement
discussed above, there remain several significant challenges models that ensure sustainability.
that need to be addressed. One key challenge is related to data Additionally, scalability and cost-effectiveness pose chal-
confidentially, as PMS deals with sensitive medical infor- lenges, particularly for smaller healthcare providers who may
mation that must be protected. Ensuring the confidentiality, struggle to implement and maintain sophisticated PMS solu-
integrity, and availability of patient data in PMS is crucial tions. Overcoming these challenges requires concerted efforts
but can be complex due to evolving cybersecurity threats. in technology development, standardization, and ongoing
Several works have been proposed to address this issue in the research works. Moreover, the major components of PMS
healthcare domain and PMS networks, see, e.g., [192], [193], must be selected carefully. Examples of these components are
[194]. the types of sensors, processing methods, contact methods,
Noting that the interoperability is considered as critical and communication networks. In addition, in large-scale
challenge in integrating new IoT-based PMSs with existing PMS, there is a large amount of data collected from the
healthcare infrastructures, as healthcare facilities often use sensors. In summary, the advancement in wearable devices,
a variety of monitoring devices that may not seamlessly which aim to achieve low-cost computing, big storage
communicate with each other. As IoT devices generate vast devices, low power consumption, and the development in
amounts of real-time health data, seamless communication communications technologies are paving the way for a
and data exchange between these devices and traditional low-cost, applicable, and effective PMS. In the following,
health systems become essential. However, the lack of stan- we provide some of the related challenges in PMS-based IoT
dardized protocols and varying data formats across different in healthcare systems.
platforms create significant barriers. Ensuring that IoT-based • Data and resource management: The IoT-based health-
PMSs can effectively communicate with EHRs and other care systems consist of numerous interconnected
legacy systems requires overcoming these interoperability devices that generate massive amounts of data, which
issues, which is vital for obtaining an efficient healthcare must be assimilated, stored, and analyzed in order to
system. be analyzed effectively. IoT devices and sensors will
Furthermore, the implementation of PMS systems in generate different types of data; for instance, medical
healthcare presents several significant challenges that must devices generate image data, whereas other devices
be carefully investigated in future to ensure the successful generate video data. This gives rise to well-known
implementation of PMS in healthcare system. The issues big data issues. High processing power and large data
of informed consent and ethical considerations need to storage capacity are needed to handle this healthcare
considered. To this end, patients must be thoroughly informed data. Therefore, PMS based on IoT with healthcare
about how their health data will be collected, used, and systems will require advanced data-processing mecha-
protected, emphasizing the importance of maintaining their nisms due to the varying performance requirements for
autonomy and privacy. This transparency is crucial to build devices and applications. Besides, advanced algorithms

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for processing the data in edge computing or cloud privacy are essential for PMS, encompassing numerous
computing might be helpful in addressing the big data elements and procedures such as data gathering, com-
issue. Therefore, further research is needed to investigate munication, sensor and device use. Therefore, to protect
data management issues in PMS. Sensor nodes are sensitive data generated by devices and personal infor-
constrained in terms of store capacity and processing mation, advanced technologies are needed. To solve the
power. Therefore, efficiently managing the resources in security and privacy concerns in PMS, more research
PMS PMS-based IoT healthcare systems is essential. is required to examine the application of ML and AI
Further research regarding the resource management of approaches.
PMS is required. • Managing heterogeneity in data: Numerous data can
• Security and privacy: Due to the critical sensitivity be generated by health applications. These data are
of the data processed in the PMS, it is essential obtained from a range of heterogeneous sources.
to secure and maintain constant connectivity between Heterogeneity in PMS is mostly encountered in two
medical devices. In addition, patient privacy and security forms: sensor heterogeneity and data heterogeneity.
concerns are becoming increasingly important as the Multimodal sensors are used to gather data, and they are
number of IoT devices in healthcare systems grows diverse in terms of organization, format, and meaning.
at an exponential rate. In order to handle the plethora Consequently, datasets are challenging to distribute
of medical assets employed throughout the healthcare and reuse since there aren’t any official summaries.
system, a number of operational and interoperability Despite the efforts has been dedicated to create sensors
difficulties must also be addressed. One such challenge when describing semantics with data models, it is
is the integration of varied technologies within the IoT necessary to standardize the modeling of sensor data
ecosystem. Note that measurement data are gathered to reflect heterogeneous sources of data. Therefore,
from various instruments, sensors, and devices and sent advanced technologies are required to handle such data
via gateways to an Internet-connected server housing heterogeneity. The best possible way to address the
databases. Hence, ensuring reliable communication is data heterogeneity is to make use of advanced artificial
essential. Furthermore, security requirements for PMS intelligence algorithms. Consequently, more study is
include availability, confidentiality, integrity, access needed to determine how artificial intelligence and
control, and authentication. These requirements are machine learning approaches might be used to manage
essential for the medical data shared within hospital the variability of PMS data.
networks. Furthermore, as the quantity of IoT devices • Data integration: Data from multiple sources must be
in healthcare systems increases at an exponential rate, integrated. Scales, social networks, imaging systems,
issues about patient privacy and security are becoming blood pressure monitors, glucose metres, heart rate
more and more significant. Many operational and monitors, fitness equipment, blood oxygen monitors,
interoperability challenges need to be resolved in order and many more internet sites are some examples of
to manage the abundance of medical assets used across these sources [195]. Valid and significant results cannot
the healthcare system. The IoT ecosystem presents be obtained from the collection of data from diverse
several challenges, one of which is the integration of sources unless the syntax, structure, and meaning of
diverse technologies. Furthermore, the use of wireless the sentences are correctly understood. An accurate
technology in healthcare systems without taking security comprehension can create intelligent applications or a
precautions leaves users open to privacy problems. blending procedure. Creating efficient data integration
To this end, healthcare providers should consider and analytics platforms for clinical decision-making
privacy. Traditional security methods based on existing can consolidate disparate data sources into compre-
cryptography solutions face challenges when applied hensive and unbiased analyses, offering rapid and
to IoT-based healthcare applications due to resource insightful solutions that are not achievable through
limitations, specific IoT architecture requirements, and manual processes. Developing such systems for clinical
the high-security standards demanded. Physical security, decision support can convert static and offline data-
authentication, network security, computer security, driven guidelines, which are constantly evolving, into
and storage security are all included in data security. dynamic and interactive algorithms accessible online
The utilization of traditional cryptographic approaches for immediate execution. Integrating patient medical
becomes impractical within IoT-based healthcare appli- reports into these systems can facilitate the creation of
cations. Additionally, IoT gateways often prioritize point-of-care decision-making tools. These analytical
basic functions over critical security measures like tools can enhance healthcare response capabilities by
authorization and authentication, highlighting further enabling epidemic surveillance, geospatial analysis,
complexities in ensuring robust security within these cluster outbreak reporting, and the development of
systems. We need to design a PMS model that guarantees accurate therapeutic algorithms to address global health
that only authorized individuals have an access to a challenges, such as pandemics [196]. A heterogeneous
patient’s medical data. In brief, maintaining security and network contains a range of sensors with different

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sensing techniques or communication spans. Devices battery replacement and charging in the majority of
from various vendors will be present in a network, BAN systems currently in use are inefficient and time-
and communication between those devices must be consuming, particularly in architectures with multiple
guaranteed. Furthermore, interoperability is necessary sensors. Any communication device’s battery life is
to ensure that a system can connect to another network typically influenced by its duty cycle, transmission
that performs different functions. To process the data and range, and communication channel usage. Sensor nodes
make decisions, the data structure must be consistent. can periodically turn On/Off their radio interface with
Further research investigations to address the aforemen- a centrally assigned time slot using the widely used
tioned challenges are required. to save energy. Besides, advanced energy harvesting
• Context-awareness: Applications, interfaces, and ser- and wireless charging techniques for PMS need to
vices tailored to the user’s situation and its changing be investigated. Furthermore, low power consumption
needs are presented in a relevant, appropriate, and can also be achieved by applying smart processing
personalised manner by a health context-awareness algorithms. Consequently, further real-world research is
system. A thorough understanding of a subject’s sur- needed to determine how well energy is transferred and
roundings enables the system to ascertain the subject’s harvested in PMS. Additionally, the circuit complexity
actual help needs on the fly. In PMS, obtaining of the devices may be raised to enable efficient energy
a high-level coherent abstraction of contextual data harvesting design in PMS. To fully realise the benefits of
requires accurate interpretation of data and events. Apart energy harvesting in PMS, this can also be seen as one
from traditional monitoring methods, it is important of the technological difficulties that need to be resolved.
to reliably identify emergency scenarios and declines • Scalability: The healthcare system’s scalability is still a
in health. The two main obstacles to the creation of problem today. Billions of IoT devices on the network
context-aware medical apps are, generally speaking, will generate vast amounts of health data. In a similar
data acquisition (the amount of information gathered) vein, the amount of data that must be handled and
and data analysis methodologies, which include present- preserved will increase rapidly. This will present a
ing context-relevant services and information. Context- massive data challenge for the healthcare industry.
awareness interpretation and data representation are A scalable system is needed to store and analyse this data
critical components that impact a health surveillance from IoT devices in order to solve this problem. On the
system’s effectiveness. Rapid intervention is made future, data collected from linked IoT devices will need
easier by accurate emergency situation identification, to be stored on the cloud using big data analytics and
which raises the standard of healthcare. Although many effective edge computing approaches. Plans for therapy
current systems fall short of achieving a high degree will be improved with the use of this data. In this aspect,
of contextual awareness, gathering comprehensive and more research is necessary. It is imperative that big data
all-encompassing contextual data continues to be a analytics be integrated with Internet of Things-based
crucial unresolved issue that required further focus. healthcare solutions. Modern medical telematics and
A context-sensitive monitoring system’s design must informatics have emerged as a result of this convergence,
take behavioural, physiological, and environmental bringing about developments that are highly helpful
factors into account when observing, interpreting, for PMS sufferers, such as disease diagnosis, remote
and analysing patient situations. All pertinent context real-time health monitoring, preventive measures, and
factors, which primarily include place, time, objects, medical emergency warning systems. Consequently,
position, frequency, and human activity, must also be further research on big data analytics in the context of
considered by the system. System performance is also healthcare is needed.
influenced by historical data, which must be considered. • Safety issue: Particularly when carers are absent,
This includes health data (such as diagnoses, illnesses, PMS should keep offering care services like accident
and treatments), daily behaviour and past changes, detection and emergency assistance. In a variety of
and environmental variables (such as humidity and situations, PMS must guarantee the security of partic-
temperature). However, the same context data needs ipants and carers, including participants with mental
to be accessible across several distribution components illnesses. Simple presence sensors to sophisticated video
that employ various network protocols. This allows surveillance systems with real-time alerts and the ability
different carers to access the contextual data that they to detect and identify patterns of movement are just a few
require from the infrastructure via the network that of the tools that PMS may rely on. Therefore, especially
is available, which can frequently change in a large in healthcare facilities, biometric sensors can be utilised
setting. to identify aggressive and stressed behaviours. We think
• Power consumption: Another significant challenge that that other crucial aspects that must be taken into account
faces sensors in general, particularly in BSN, is energy are the safety, acceptability, and usability of PMS. Thus,
consumption. The sensors’ short battery life may have effective video surveillance systems for PMS must be
an adverse effect on the PMS. For monitored subjects, created.

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• Data processing: Big data is the massive amount of data of monitoring systems for senior citizens in intelligent
generated by a large number of connected IoT devices. settings. The right sensors must be chosen with care
Millions of consumer devices have interconnected in such systems and solutions in order to collect rich
sensors and actuators that interact, collect, and transmit and pertinent data for one or more topics. For the
data. Every gadget generates or detects vast amounts system to successfully comprehend complicated and
of data that need additional processing. Making sure constantly evolving human behaviour, it must choose
that these various data types are handled appropriately the most suitable approaches and strategies. To make
and effectively will be the main challenge, especially sure that these systems are effective in terms of analysis,
with a limited amount of time, processing power, and accuracy, and adaptability to the suggested monitoring,
computational resources available. It was estimated that extensive testing is required.
by 2020, the amount of data stored would have increased • Trustworthiness: Because healthcare providers utilise
from 80,000 petabytes in 2000 to 35 zettabytes. Due to data to inform decisions about patient care, data must
various data structures, only 20% of these are examined be thorough, accurate, and consistent in order for it
using conventional methods; the remaining 80% are not to be considered trustworthy. Specifically, the data
used in decision-making. It is anticipated that as 6G is produced by sensors and wearable technology is used
evaluated, the amount of data will grow even more. With by carers to inform their decisions and treatment
the aid of artificial intelligence, data-driven techniques plans. On the other hand, data corruption might
can be created to manage big data from numerous IoT result from unapproved exposure and disclosure, which
devices. Further research investigation is needed. can cause the loss of personal data. Furthermore,
• Device design issue: The healthcare sector makes use malware or viruses could contaminate or corrupt the
of PMS-based IoT devices, which have tiny sensors, medical data during transmission. Investigating the
minimal processing power, little storage, and short dependability of trust management on PMS requires
battery lives. The internet is connected to IoT devices. making use of blockchain technology’s features, which
Wearable technology requires network connectivity in include integrity, immutability, and trustworthiness.
order to offer carers access to health information. The possible catastrophic repercussions of medical
Developing IoT devices with more processing power, device trustworthiness necessitate prompt and effective
storage capacity, long battery life, and security that resolution of any problems [197]. Traditionally, general-
comply with mobility standards remains a research purpose and embedded computer systems have used
problem to this day. In this area, more research and information security and fault tolerance techniques like
investigation are needed. cryptography and redundancy. However, because of
• Monitoring accuracy: Because performing different their significant size and power limitations, they cannot
everyday activities requires a high level of skill, mon- be utilised to many wearable and implantable medical
itoring and evaluating human subjects-especially the devices [197]. Therefore, creating effective and reliable
elderly-is a challenging endeavour. Subject to subject, security methods to ensure trustworthiness is one of
the behaviour is arbitrary and varies. The majority the major issues that need to be considered in future
of recent research on activity monitoring focuses on research.
short-term, relatively easy tasks that are completed • Data transmission delay: A common issue in PMS
in a lab setting. In the actual world, however, it is development is deciding how to transfer sensor data
evident that managing complicated and long-term tasks to back-end servers for processing and analysis. Data
in terms of gathering and evaluating pertinent data transmissions in networking are divided into four
is more challenging. Activities that involve several categories: multicast, broadcast, unicast, and anycast.
subactions can also be completed in various ways and Multicast or broadcast schemes are frequently used by
in different sequences. In intelligent homes, long-term existing PMS to improve data transmission efficiency
monitoring is helpful in identifying actual behavioural and reliability. Both schemes send packets to several
patterns. Data related to single-user actions are gathered recipients at once. As a result, a high volume of
and processed in an intelligent environment in current network traffic and transmission delay result from
research experiments. In actuality, though, several topics frequent transmissions. With the least amount of traffic
can share one space and be completed concurrently overhead, the unicast scheme delivers packets to a
with daily tasks. Moreover, the majority of research single recipient; however, additional steps must be
in this area focuses on activity recognition rather than taken to locate a backup receiver in the event of
evaluating the accuracy with which participants carry a transmission failure. Anycast communication is a
out these tasks. These issues indicate that the precision brand-new routing protocol the point at which data
and reliability of the outcomes are still somewhat packets are sent to the closest recipient. This scheme is
disconnected from the unpredictable and enigmatic real more dependable than broadcast and multicast and has
world of human behaviour. We think that further work less traffic overhead. Unicast is used to discover new
has to be done to enhance the planning and creation receivers. But anycast raises the devices’ complexity

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the key fundamental benefit of PMS has been described.

In addition, this report outlined a number of unresolved
research issues and suggested fresh lines of inquiry for
further investigation. This can benefit both academic and
industrial sectors in remote healthcare applications. This
paper is essential for understanding the PMS that can be
used for enhancing medical services, health management,
and response strategies during public health emergencies and
routine care scenarios. This paper offered a comprehensive
understanding of PMS, which is crucial for business and
scholarly academics alike.

ACKNOWLEDGMENT
The authors would like to acknowledge the University of
Baghdad, the University of Sharjah, Al-Farahidi University,
and Liverpool John Moores University, for their general
support.

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[192] H. L. Pham, T. H. Tran, and Y. Nakashima, ‘‘A secure remote healthcare MUNTADHER ALSABAH received the B.S.
system for hospital using blockchain smart contract,’’ in Proc. IEEE degree in electrical engineering from the Univer-
Globecom Workshops (GC Wkshps), Dec. 2018, pp. 1–6. sity of Baghdad, Iraq, in 2007, the M.S. degree
[193] K. N. Griggs, O. Ossipova, C. P. Kohlios, A. N. Baccarini, E. A. Howson, in wireless communication engineering from Uni-
and T. Hayajneh, ‘‘Healthcare blockchain system using smart contracts versiti Putra Malaysia (UPM), Malaysia, in 2014,
for secure automated remote patient monitoring,’’ J. Med. Syst., vol. 42, and the Ph.D. degree in wireless communica-
no. 7, pp. 1–7, Jul. 2018. tion from The University of Sheffield, Sheffield,
[194] M. Antwi, A. Adnane, F. Ahmad, R. Hussain, M. Habib ur Rehman, U.K., in 2020. His current research interests
and C. A. Kerrache, ‘‘The case of HyperLedger fabric as a blockchain include wireless communications, multiple-input-
solution for healthcare applications,’’ Blockchain, Res. Appl., vol. 2, no. 1, multiple-output (MIMO) systems, mmWave fre-
Mar. 2021, Art. no. 100012.
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COVID-19 pandemic?’’ Indian Heart J., vol. 72, no. 2, pp. 61–64, HALA J. MOHAMMED received the M.Sc.
Mar. 2020. degree in computer engineering from the Univer-
[197] M. Zhang, A. Raghunathan, and N. K. Jha, ‘‘Trustworthiness of sity of Baghdad, in 2019. She is currently an Assis-
medical devices and body area networks,’’ Proc. IEEE, vol. 102, no. 8, tant Lecturer with the Department of Computer
pp. 1174–1188, Aug. 2014. Engineering, University of Baghdad. Her research
interests include speech enhancement, network-
on-chip, and computer networks.

HAYA ALASKAR received the M.Sc. degree in applied artificial intelligence

BASHEERA M. MAHMMOD received the Ph.D.
from the University of Exeter, in 2009, and the Ph.D. degree in computer
degree in computer and embedded system engi-
science from Liverpool John Moores University, in 2014. She is currently an
neering from UPM, in 2018. She is currently a Lec-
Assistant Professor with the College of Computer Science and Engineering,
turer with the Department of Computer Engineer-
Prince Sattam Bin Abdulaziz University, Saudi Arabia. She has a number
ing, University of Baghdad. Her research interests
of publications concentrated on using machine learning in various medical
include signal processing, speech enhancement,
data, such as signals and images. Her research interests include artificial
and computer vision.
intelligence applications and data science.

FAHDAH ALMARSHAD is currently a Professor (Assistant) with Prince

Sattam Bin Abdulaziz University, Saudi Arabia. She is interested in
multidisciplinary research topics related to computer science. Her research
interests include machine learning, cyber security standards, information
assurance, security risks, security policies, security culture, and the Internet
of Things security.
MARWAH ABDULRAZZAQ NASER received
the B.Sc. degree in electronics and communication
engineering from the University of Baghdad, ABIR HUSSAIN (Senior Member, IEEE) is
Iraq, in 2008, and the M.Sc. degree in wireless currently a Professor of machine learning with the
communication systems from The University of Department of Computer Science, Liverpool John
Sheffield, U.K., in 2016. She is currently an Moores University. Her research interests include
Assistant Lecturer with the University of Baghdad. machine learning algorithms and their applications
Her current research interests include wireless to medical, image and signal processing, and data
communication systems, signal processing, image analysis.
processing, and mobile networks.

SADIQ H. ABDULHUSSAIN received the B.S.

degree in electrical engineering and the M.S.
degree in electronics and communication engi-
AHLAM H. SHANIN AL-SUDANI received the neering from the University of Baghdad, in
M.Sc. degree in control and computer engineering 1998 and 2001, respectively, and the Ph.D. degree
from the University of Baghdad, in 2005. She is in computer and embedded system engineering
currently a Lecturer with the Department of Com- from Universiti Putra Malaysia, in 2018. Since
puter Engineering, University of Baghdad. Her 2005, he has been a Staff Member with the
research interests include digital signal processing, Department of Computer Engineering, Faculty of
image computing, and computer vision. Engineering, University of Baghdad. His research
interests include computer vision, signal processing, speech and image
processing, and communication.

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