2020 6th International Conference on Advanced Computing & Communication Systems (ICACCS)

A Comprehensive Review on the Emerging IoT-

Cloud based Technologies for Smart Healthcare
Vidya Priya Darcini.S Deva Priya Isravel Salaja Silas
Dept. of Computer Science and Dept. of Computer Science and Dept. of Computer Science and
Engineering Engineering Engineering
Karunya Institute of Technology and Karunya Institute of Technology and Karunya Institute of Technology and
Sciences Sciences Sciences
Coimbatore, India Coimbatore, India Coimbatore, India
darcinivp26@[Link] [Link]@[Link] blessingsalaja@[Link]

Abstract— Internet of Things (IoT) has redefined the homes, smart cities, smart healthcare systems, etc. IoT enables
operation of next-generation technologies by offering an us to visualize objects that can sense, process, communicate
intelligent framework. Cloud and IoT based system has been and share information over the network of devices. These
widely used in numerous applications for providing automated interconnected objects and sensors collect the data which are
solutions and services. One of the areas in which the IoT and analyzed and used for various purposes like classification,
cloud have been widely used in the healthcare industry. To decision making, planning etc.
strengthen the healthcare system many initiatives are undertaken
using advanced technologies such as IoT and cloud. So in this IoT has become popular due to the sensing capabilities and
paper, a comprehensive review of the different IoT health model interaction of the devices via the wireless network. The smart
that are available are presented. The paper focuses on the device's interaction is made possible through wireless
various deployment strategies for building a cloud and IoT based technologies such as RFID, Bluetooth, NFC and Wi-fi. This
system for smart home and smart hospital environment for brings in flexibility and convenience in deploying in various
handling different health-related issues. The paper highlights the environments for monitoring and communication purposes.
various benefits that the IoT offers and also presents the The machines or protocols developed from IoT include
challenges that are most prevalent in realizing the full embedded technology which is used for sharing the
automation of the healthcare system. The paper also discusses the information from one another [2].
integration of machine learning techniques for processing health
data in the cloud to provide quality healthcare and modernize the The improvement to the healthcare system with different
healthcare system. IoT capabilities by facilitating remote monitoring and
continuous tracking of patient's health conditions, long term
Keywords—Cloud, IoT, Healthcare, Machine Learning review of patient's health records, reducing medical expenses
and extending the technology for providing patient-centric
I. INTRODUCTION care instead of hospital-centric treatment. IoT system makes
use of wide varieties of sensors, portable devices, wireless
There is a huge demand on the need for a digital healthcare
handheld devices, wearable devices that are connected either
system due to the rise of chronic illness that requires timely
wired or wirelessly. These devices monitor and send the
and quality care. Providing cost-effective and preventive care
information to the nearby routers or gateways for further
for patients is challenging without innovative and advanced
processing to take faster responsive action on the patients.
technologies. There is a huge demand for an improved
personal and telehealthcare system. The traditional method of The emergence of wireless communication technologies
offering treatment is non-effective and requires a modern way and the Internet of Things gives us opportunities to assist the
of handling the operation of the healthcare system [1]. The healthcare industry by providing innovative solutions. To
healthcare system has been modernized in a number of ways support people with chronic illness and to satisfy the need for
by providing remote and continuous monitoring, quick special requirements in the home and hospital environment.
diagnosis of disease, faster response to emergency situations,
The objective of this paper is to provide a review of the
timely assistance to patients, etc.
various IoT based systems and propose a healthcare model to
The advancement in Internet networking technologies has improve the performance of processing in a ubiquitous way.
given rise to the new technology called as Internet of Things.
The introduction to IoT and cloud has enabled ubiquitous The remainder of the paper is as follows. Section 2
communication by providing connectivity across multiple highlights the benefits and challenges of the healthcare
objects for sharing data. IoT offers a platform to connect system. In section 3, the detailed study of the various key
heterogeneous devices and provides processing and interaction contributions of IoT and cloud-based mechanism is explained.
capabilities. It is deployed in several areas to build smart Section 4 discusses the application of machine learning with

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 2020 6th International Conference on Advanced Computing & Communication Systems (ICACCS)
IoT healthcare system for disease diagnosis. Finally, the wireless nature of the devices, eavesdropping can happen.
conclusion is presented in section 5. So proper authentication and cryptographic techniques
should be enabled to have access to devices and their data.
II. BENEFITS AND RESEARCH CHALLENGES In many cases, health reports contain sensitive data with
personal information that have to be secured and
In earlier days, patients can interact with doctors only maintained correctly. Therefore, the healthcare system
through hospital visits and telephone communication. The requires stringent privacy regulations.
doctor had no interaction with patients and continuous x Mobility: Despite the use of medical gadgets and IoT
monitoring seemed impossible. But now with the introduction devices in monitoring and diagnosis, huge complexities
of IoT, remote and real-time monitoring of patients is made exist with mobility. Because of mobility, data creation and
possible and this unleashes the potential to make people safe, collection becomes complicated. Establishing connectivity
healthy and helps the physicians to give suggestions or between mobile devices to get real-time in certain
treatment in a timely manner. Fig.1 depicts the benefits and situations is difficult.
challenges. The following section lists the various benefits and x Heterogeneity: This is one of the biggest challenges in IoT
research challenges faced by the healthcare industry [3], [4]. based health environments. The wide heterogeneity of
sensors, wearable devices, clinical equipment, and varied
A. Benefits of IoT in Healthcare operating systems with different platforms for new and
x Faster disease diagnosis: Real-time monitoring of patient’s improved application makes the health network complex to
health data helps to diagnose the disease at an earlier stage manage and maintain.
or even before the symptoms develop. x Legal Aspects: Legal and social aspects of storage and
x Proactive treatment: Enables to provide proactive health using the data should be maintained properly and service
care treatment of diseases through remote monitoring. collection. The integration of sensor data from different
x Cost-effective: Expenses of unwanted visits to clinics, an sensor devices has to be handled with confidentiality and
appointment with doctors and hospital stays can be integrity. Data providers should confirm that they follow
avoided with the usage of wearable and assistive handheld various international laws.
electronic medical devices. x Big data: Specific attention must be paid for storage,
x Drugs and equipment management: the connected devices processing and transportation of huge and vast data
are used in the management of equipment and drug produced from the health network. Supporting a scalable
management at a very low cost. network requires proper data management services.
x Error reduction: IoT devices reduce human errors and help Appropriate data analytics tools are required to process the
in eliminating inaccurate decision making. data to access the health data and improve patient and
x Improved treatment: Helps doctors to make accurate physician experience.
decisions on patient’s health reports and provide
III. IOT BASED HEALTHCARE SYSTEM
appropriate treatment.
A. E-Healthcare
Smart healthcare is a system that provides high-quality
healthcare by using the latest technologies such as wearable
devices, sensors, Mobile Internet, cloud platform and data
analytics with artificial intelligence. The system uses
information and communication technologies to manage and
maintain electronic health records. The system supports
dynamic access to health information via computerized entry
by physicians and patients, provides online prescriptions,
telemedicine, Tele surgery and remote monitoring. To
improve the convenience of the patients and to have timely
quality treatment, IoT systems are widely used. IoT has been
widely used to interconnect available medical resources and
offer smart, reliable, and effective healthcare services. The
development of IoT systems ranges from a simple application
of providing continuous monitoring of patient health to
provide suggestions remotely to perform Tele surgery through
surgical robots and mixed reality technology. In the paper, [7]
Fig. 1. Benefits and Challenges of IoT in Healthcare a low-cost IoT platform is designed for health monitoring
using E-health Technology. The vital health parameters are
B. Research Challenges
measured using sensors such as temperature, respiration and
There a number of challenges in handling the healthcare pulse sensors. The data measured from these sensors are sent
information and patient records [5], [6]. Some of the common to the E-health application platform. Based on the vital signs
challenges faced are listed below. of the patient's condition, the platform intelligently connects
x Privacy and Security: In an IoT environment devices are the patients with corresponding doctors. The doctors can
vulnerable to attacks if they are left unattended. Due to the

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 2020 6th International Conference on Advanced Computing & Communication Systems (ICACCS)
access the patient’s data for giving suggestions, prescriptions 2) MEDICATION REMINDER
and medication. This system is very helpful to people in remote Medication management is a critical and essential task of
areas to claim better medical facilities. anyone who is affected by sickness or disease. Especially
TABLE 1. SUMMARY OF EXISTING IOT CLOUD elderly patients find difficulty in managing a long list of
COMMUNICATION MECHANISM medications. Most of the time the dosage time is forgotten or
changed. So to assist the patients who are struggling to take
Cloud medicines on time, an IoT based medication reminder is
Microcontroller Connectivity
storage developed to remind the patient on the correct pill and take at
GPS, netbook the right time [10]. The designed system consists of an IoT
Sensor Kit [13] Yes
software enabled medicine box contains a sensor to check whether the
Arduino (IDE) [14] Wi-Fi Yes medication was taken or not. The system gives timely alerts to
Bluetooth or
users during medication time. The medicine details are stored
Arduino Yun [16] Yes in the application created which are accessible for both
Zigbee
patients and caretakers. This helps to monitor daily medicine
Arduino Uno (IDE) [15] GSM No intake, stock, dosage, etc. This system proves to be helpful for
Arduino Uno (IDE) [17] Bluetooth, GPS Yes everyone to know about their medication cycle and follows it
properly without any deviation.
Arduino Uno (IDE) [7] Bluetooth Yes
MSP430G2553, Wi-Fi or Ethernet 3) MILITARY APPLICATIONS
No
Raspberry Pi [8] connection. Another important application where modern healthcare
ESP8266 thing dev [9] Wi-Fi Yes
plays a crucial role in monitoring the safety and protection of
the soldiers working in war field. The IoT system designed in
Arduino Uno R3 [10] Wi-Fi Yes this paper explains a mechanism to track the soldier's
Raspberry Pi [12] Wi-Fi, Bluetooth Yes condition and health-related parameters to know the health
condition of the soldiers [11]. This system is an integration of
Arduino MEGA 2560 temperature sensor, ECG module with the heart-beat sensor,
Wi-Fi, zigbee Yes
[11]
and accelerometer, bomb detector and GPS module. The data
MSP430F5529LP [18] Bluetooth No collected from these sensors are transferred to the control unit
Wi-Fi, HTTP, present in the warzone and alerts are sent to the officials
STM32F103RC [19] Yes wirelessly in real-time. For long term analysis, the data are
MQTT
stored in the cloud
Wearable Band [20] Bluetooth Yes
4) ELDERLY PEOPLE
Arduino Uno [21] Xbee Yes
Health monitoring for active and assisted living is one of
the paradigms that can use the IoT to improve the elderly
1) MONITORING lifestyle. To increase the life expectancy of people, there is a
A novel low-cost IoT based device is designed in [8] for huge need for caring for elderly people. Part of providing
monitoring the patients in the hospitals simultaneously and quality healthcare services is the fulfillment of the personal
transfer the data to doctor anywhere in the world wirelessly. It and social needs of senior citizens. The aging community has
uses two microcontroller MSP430 and Raspberry pi for additional needs and requires the assistance of someone’s help
collecting and transferring the data. The raspberry pi has a Wi- to do their daily physical activities. Activities like mobility,
Fi module for sending data to any device remotely. The medication, personal care, proper nutrition are major needs for
summary of protocols used for sending data from the elderly people to lead a healthy life. IoT is employed to help
microcontroller to the cloud is listed in Table 1. The vital the elderly people to do their activities by themselves and to
signs are continuously monitored using the sensor attached to help their family members and caretakers to monitor them
the wrist band. The data gathered are stored in MSP430 are continuously. It offers cost-effective, smart and reliable
sent wirelessly to the concerned doctors for further treatment. services in healthcare and also connects the medical resources
Another application where smart healthcare can be achieved is available. To monitor the health conditions and symptoms of
the in-home or hospital environment. An IoT architecture is elderly an IoT based system. The IoT based healthcare
designed for measuring CO2 using an Indoor Air Quality architecture is built with sensors such as body temperature
(IAQ) mechanism [9]. Indoor air quality is measured to make sensor, ECG sensor, airflow sensor, pulse sensor, oxygen
sure that the air will not affect the patients in bed rest and also monitor sensor, fall detection sensor and light sensors for
normal humans. Here, the CO2 sensor is used to measure monitoring the elderly patients [12]. Using GPS, the location
carbon content in the air. The data collected from the sensor is of patients are tracked in real-time and data is sent to the
sent to the cloud via a smartphone. The user can check the cloud. The system offers continuous monitoring and the values
data periodically and appropriate people are notified of the measured from these sensors are sent to the cloud platform.
carbon level when it crosses the maximum level to take After the data analysis performed on the cloud, feedback is
corrective and precautionary measures. sent to the user after analyzing the stored data. This helps the
caretaker of elderly people to monitor patients continuously.

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 2020 6th International Conference on Advanced Computing & Communication Systems (ICACCS)
with ECG monitoring devices and a 3-axis accelerometer.
TABLE 2. SUMMARY OF SENSOR APPLICATIONS IN GPS tracker is provided for identifying the location of a
HEALTHCARE SYSTEM
stressful environment where the person is present. The ECG
device monitors the stress level using the heartbeat signal. The
Application Sensors Used Sensor Operation system helps to find the person under stress and identify the
Temperature
Measure body temperature
location and protect the person from a fatal situation. In this
sensor paper [14], the stress level of frequent computer users is
Patient identified in an ergonomic way using IoT. Continuous
Pulse rate
Monitoring Measure Pulse rate.
sensor computer use leads to some harmful effects like computer
[7]
Respiration Monitor the breath rate of a vision syndrome and work pressure leads to cardiovascular
rate sensor person disease. Ultrasonic sensor and Accelerometer is used to find
ECG the ergonomic workspace like the distance between user and
Collects ECG signals using 3 computer, angle in which the computer screen should be
monitoring
Stress lead. positioned. The work pressure is identified using the heart rate
sensor
Detection [13] from the pulse sensor. The user will get an alert message as
3-axis Measures the Tilt angles
Accelerometer between user and object. SMS or E-mail to take precautionary steps when the limited
Ultrasonic Measures the angle between
threshold is not met. This system will help to alert frequent
sensor objects. computer users to protect themselves from eye syndrome and
Position stress.
Find the tilt angle between
Alerting [15] Accelerometer
user and object.
B. IoT FOR DISABLED PATIENTS
Pulse sensor Measure the heart rate.
1) PARALYZED
Infrared It contains an amplifier that Life has become harder for people with disabilities
Paralyzed [16]
sensor acts as a comparator.
because doing simple work or even interacting with the
Uses the SONAR technique environment sometimes seem difficult and challenging. The
Visually to identify the distance disabilities might be caused due to physical ailments,
Ultrasonic
Challenged between the objects. Not psychiatric, visual complexation, hearing disabilities,
sensor
[17] affected by sunlight or black neurological function disability and so on. To facilitate the
materials.
person with disabilities to participate or do works equally, IoT
Home
MHZ-19(CO2 provides automated systems. A simple system would be to
Monitoring Measure CO2 content levels.
[9]
sensor) generate an alarm or get alert notification under bad and
Measure the amount of
critical circumstances. Many emerging systems are there to
Pulse support them without any human Interaction. The system was
oxygen dissolved in the
oximeter designed to support human-computer interaction (HCI). This
blood and detect hemoglobin
sensor system enables a disabled person to operate the system even if
content
Elderly [12] they don’t have any prior computer knowledge. The
Nasal airflow Measure the breathing rate of
sensor the user.
accelerometer and mouse emulator are connected to a
microcontroller which is fixed on head and hands respectively.
Light sensor Used to detect the light. The accelerometer detects the four head positions and the
Bomb mouse emulator detects movement of hand position. The
Military [11] Detects explosives.
detector application is installed in the PCs or smartphones which in
Detecting turn is connected to cloud for storage. All positions and
Alcohol PID sensor Detects chemical content. movements of the person are monitored and recorded based on
Content [18] the head and hands movement. Based on the movements made
by the patient, the mouse and keyboard keys are activated. In
Diabetes Pressure Measures the pressure points paper [15] a self-controlled wheelchair is designed for people
Monitoring sensor in the human body. who are partially paralyzed or fully paralyzed. This system is
[20] offered at an affordable price even for income families. The
Weight sensor Detects body weight.
wheelchair contains an infrared sensor that monitors the eye
blinks of the person to change the movement of the wheelchair
5) STRESS DETECTION in every direction. This is method is applied to prevent stress
Stress is a biological or physiological pressure experienced on the patient body. The system uses a GSM-based message
by humans. The reasons for this could be because of system which gives the alert message to emergency contacts.
conditions like work overload, poor work conditions, lack of To make the system eco-friendly solar PV technology is used
social support, health problems, etc. Therefore, to support a to charges its 12V battery.
healthy lifestyle, the detection of stress is essential. Due to the
increase in stress levels, serious health problems occur to all 2) VISUALLY CHALLENGED
people. To provide a mechanism to identify this stress, IoT has To support the visually impaired patients, IoT based
a vast range of applications from different perspectives. In prototype is proposed in [17]. This system assists the visually
[13], a mobile sensing model was proposed that uses a jacket challenged people by notifying via alerts and warning

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 2020 6th International Conference on Advanced Computing & Communication Systems (ICACCS)

generation by monitoring the surroundings and avoid collision this section, the usage of machine techniques with IoT is
with the nearby obstacle. To identify the obstacles, the ultra- explored to see how ML algorithms play a vital role in disease
sonic sensor is fixed on the spectacles of the person. The diagnosis. There are multiple sensors used for collecting
sensor senses the nearby obstacles when they are moving in health details and these data are processed by using
different directions. The sensor is connected to the smart classification algorithms. Fig. 2 depicts the machine learning-
phone and the person location is found using the GPS. When based IoT model for the healthcare system.
the person comes across any obstacles, the sensor senses and
generates a notification. The location with obstacles is
recorded in the database and this information is used to alert
the person while crossing that location.
C. USAGE OF SMART DEVICES
Humans use wearable devices to assist their basic
computing needs. Recent advances in sensor manufacturing,
telecommunication and data analytics have given rise to new
technologies in the digital ecosystem which helps to achieve
the health care diagnosis. Sensors are integrated into various
garments like wristwatches, smart phones, hats, socks, shoes
etc. Now with the advancement in cloud computing many
wearables can be used without any human installation
software. So it is easy to provide the health monitoring system
at a cheaper rate. IoT provides wearable devices not only for
normal people but also for paralyzed and disabled to detect
diseases like diabetes, heart diseases also. A system with a
miniature device comprising of a potentiostat and processing Fig.2 Machine Learning-based IoT model for Healthcare
unit with a simple auto-calibration algorithm was developed IoT based sensors are used for monitoring the basic health
[18]. It helps to detect the ethanol content in our body using parameters which are the base value for identifying many
the PID sensor. The fuel sensor is integrated with a wearable diseases like chronic disorders, diabetes and many more. Here
solution. The power management is maintained by the USB the basic health parameters like temperature, pulse rate, ECG,
port and Bluetooth is used for sending the signals and is blood pressure and airflow breathing, fall detection of the
compared with available potentiostat which gives the high person are measured using various health-related sensors. The
output. A wearable solution was proposed for monitoring ECG values measured from these sensors are sent to the cloud via
signals using 3 lead ECG contains monitoring sensors to the IoT based platform such as Thinkspeak. Thinkspeak is an
collect the data and the data are sent to the cloud platform open data visualization platform for IoT which enables an
using Wi-Fi. Both HTTP and MQTT protocols are used in Arduino or compatible hardware to write or read data to or
cloud data transfer [19]. Using this module users can get ECG from it. This helps to store the data from the sensors or API in
the cloud either as a public or private channel. The data stored
data continuously from anywhere. These protocols are used
in the channel can be stored, analyzed using machine learning
for fast data transfer which helps to continuous monitoring.
techniques. The data collected from the sensor can be used for
Another solution was designed for continuous diabetes
monitoring in [20]. This contains wristwatch, wrist neckbands. diagnosing the symptoms and identify the different diseases
It comprises of vibration sensor, strain gauge (neck), moisture that have affected the patient. To classify and identify the
sensor, Temperature sensor and heart rate sensor (wrist) and disease machine learning algorithms are used. It is widely
pressure and weight sensor (socks) for monitoring different used by the health industry to perform medical diagnosis and
movements and responses. The collected sensor data are sent make a prediction and classify the disease based on their
to the cloud for visualization and uses particle swarm symptoms.
optimization in machine learning to predict the condition of
the diabetes patient. To care for a paralyzed person a wearable ML algorithms are used in many technologies to analyze
solution was designed to interact with a computer using simple the data and to learn from it. The ML algorithm can be broadly
movements like eye blinks and head movements [21]. This classified into supervised learning and unsupervised learning.
device uses an IR sensor, accelerometer sensor to detect the The Supervised learning method predicts the values of the
movement of body parts and the accelerometer is attached to training dataset. Unsupervised learning identifies the specific
the computer. This helps cursor to move at different label from the clustered labels. Fig. 3 shows ML algorithms
movements without the help of others. The sensors which are and their applications. Some of the supervised learning
used for health related applications are listed in Table 2. algorithms that are commonly used are Classification and
IV. MACHINE LEARNING-BASED HEALTHCARE SYSTEM Regression [22]. The classification algorithms are Naive
Bayes, Discriminant Analysis, Nearest Neighbor and Neural
There has been a tremendous increase in the application of Networks [23]. The Regression algorithms are Linear
machine learning techniques for the healthcare industry. In Regression, Decision Trees and Ensemble Methods. The
unsupervised learning algorithms involving clustering
mechanism that includes K-Means, K-Medoids, Fuzzy and
Hierarchical.

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 2020 6th International Conference on Advanced Computing & Communication Systems (ICACCS)
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