Wireless sensor network for IoT based healthcare system 2019-20

CHAPTER-1

INTRODUCTION

Public healthcare has been paid an increasing attention given the exponential growth human population and
medical expenses. Advances in wireless sensor networks and electronics have led to the emergence of wireless
sensor network (WSNs).

WSNs have been considered as one of the most important technologies that can change the future. These
networks consists of small battery-low powered nodes with limited computation and radio communication
capabilities. Each sensor in a sensor network consists of 3 subsystems:

1. The sensor subsystem which senses the environment

2. The processing subsystem which performs local computations.
3. The comunication

Collabration of IoT with WSN’s:

Internet of things(IoT) technology has attracted much attention in recent years for its potential to alleviate the
Strain on healthcare systems caused by an aging population and a rise in chronic illness.
Definition of IoT:-internet of things is the network of physical objects that contain electronic embedded
technology to communicate and sense or interact with their their internal states or the external environment.

Standardization is a key issue limiting progress in this area,and thus a standard model for application in future
IoT healthcare systems.
Challenges that healthcare IoT faces including security,privacy,wearability,and low-power operation are
presented,and recomendation are made for future research directions.

Biomedical engineering,body sensor networks,intelligent systems,internet of things(IoT),comunications

standards,security,wearable sensors are the key terms discussed in this report
Emergency healthcare has also been identified as a possibility by related works but has not yet been widely
researched.

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Several related works have previously surveyed specific areas and technologies related to IoT healthcare.
An extensive survey is presented with focus placed on commercially available solutions,possible applications.
In the present work, blowfifish encryption is used to transmit the examined medical data securely to the server of
diagnostic centre.
The data generated from the sensors are aggregated at this centre and transmitted further to the doctor’s personal
digital assistant (PDA). The data from the diagnostic centre must be accessed by the authorised doctors, nurses
and technicians in hospitals. So, attribute-based encryption (ABE) algorithm is also implemented
over the network. If an abnormality is detected in a patient’s data, medical professionals at healthcare centre will
quickly react to patients’ emergency condition and save their lives by sending ambulance and medical people to
the patient’s location.

Sensor types are compared with some focus placed on communications. However,it is hard to draw an image of
a complete [Link] in sensing and big data manageent is considered,with little regard for the network
That will support communications.
This report therefore makes a unique contribution in that it identifies all key components of an end-to-end
internet of things healthcare system,and proposes a generic model that could be applied to all IoT based
healthcare systems. This is vital as there are still no known end to end systems for remote monitoring of health in
the literature.

An attempt is made to provide a comprehensive survey of the state of the art technologies that fall within the
proposed model. Focus is placed on sensors for monitoring various health parameters,short and long range
communications standards,and cloud technologies.

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CHAPTER-2

ARCHITECTURE OF IoT

Fig 1: vision of internet of things

IoT is a vision which is still at very early stages, where everyone interprets the vision with their own
perspectives. There are three main visions of IoT based on the things, digital and semantic perspectives. All
these three perspectives of IoT should integrate with each other seamlessly as shown in Fig 1, for extracting the
full benefits of IoT architecture.

1. Things oriented vision

2. Internet oriented vision
3. Semantic oriented vision

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2.1 Three prespectives of IoT

1. Things oriented vision:This vision provides the perspective that all the real physical objects can have the
sensors attached to get the real time information from them. This can be accomplished by the sensors based
network of embedded electronic devices using RFID, NFC and other wireless technologies. This vision provides
the base for integration of all “things” using different sensor based networks to collaborate and co-exist together.

2. Internet oriented vision: This vision provides the perspective that all the devices can be connected through
internet and can be described as smart objects. This can be accomplished by using unique IP for each connected
object. This vision provides the base for the data integration of all the smart objects, which can be continuously
monitored.

3. Semantic oriented vision: This vision provides the perspective that all the data collected from carious sensors
need to be analyzed for meaningful interpretation. This can be accomplished with semantic techniques, which
separates raw data from the meaningful data and their interpretation. This vision provides the base for the
semantic integration through the use of semantic middleware.

Hailed as the driver of the Fourth Industrial Revolution, Internet of Things technology has already found
commercial use in areas such as smart parking, precision agriculture, and water usage management. Extensive
research has also been conducted into the use of IoT for developing intelligent systems in areas including
traffific congestion minimization , structural health monitoring , crash-avoiding cars, and smart grids. While the
aforementioned fifields appear vastly different to healthcare, the research conducted within them verififies the
plausibility of an IoT-based healthcare system. Existing systems in other fields have proven that remote
monitoring of objects, with data collection and reporting, are achievable.

This can therefore be expanded and adapted for monitoring the health of people and reporting it to relevant
parties such as caretakers, doctors, emergency services, and healthcare centres.

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2.2 Internet of things in healthcare

Research in related fields has shown that remote health monitoring is plausible, but perhaps more important are
the benefifits it could provide in different contexts. Remote health monitoring could be used to monitor non-
critical patients at home rather than in hospital, reducing strain on hospital resources such as doctors and beds. It
could be used to provide better access to healthcare for those living in rural areas, or to enable elderly people to
live independently at home for longer. Essentially, it can improve access to healthcare resources whilst reducing
strain on healthcare systems, and can give people better control over their own health at all
times.
In fact, there are relatively few disadvantages of remote health monitoring. The most signifificant disadvantages
include the security risk that comes with having large amounts of sensitive data stored in a single database, the
potential need to regularly have an individual’s sensors recalibrated to ensure that they’re monitoring accurately,
and possible disconnections from healthcare services if the patient was out of cellular range or their devices ran
out of battery.
Fortunately, these issues are all largely solvable, and are already being addressed in the literature, as will be
highlighted throughout the remainder of this paper. As progress continues to be made to reduce the
disadvantages, IoT-based systems for remote health monitoring are becoming an increasingly viable solution for
the provision of healthcare in the near future.
As a result of the many benefifits of remote health monitoring, many recent researchers have identifified the
potential of the Internet of Things as a solution for healthcare.
In several works, IoT healthcare systems have been developed for specifific purposes, including rehabilitation,
diabetes management, assisted ambient living (AAL) for elderly persons, and more. While these systems have
been designed for many different purposes, they are each strongly related through their use of similar enabling
technologies.

Rehabilitation after physical injury has been a topic of particular interest for several researchers. In a system has
been developed that generates a rehabilitation plan tailored to an individual based on their symptoms.

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The patient’s condition is compared with a database of previous patients’ symptoms, ailments, and treatments to
achieve this. The system requires a doctor to manually enter symptoms, and approve the recommended
treatment; in 87.9% of cases, the doctor agreed completely with the system, and no modififications were made to
the treatment plan it proposed.

Meanwhile, in mathematical models for the measurement of joint angles in physical hydrotherapy systems are
proposed, enabling the improvement of joint movement to be tracked through therapy.

In existing IoT technologies are evaluated for their usefulness in a system for monitoring patients suffering from
Parkinson’s Disease. Their work concludes that wearable sensors for observing gait patterns, tremors, and
general activity levels could be used in combination with vision-based technologies (i.e. cameras) around the
home to monitor progression of Parkinson’s Disease. Furthermore, the authors suggest that machine learning
could lead to enhanced treatment plans in the future.

A practical system for the monitoring of blood-glucose levels in diabetic patients was proposed. This system
requires patients to manually take blood-glucose readings at set intervals. It thereafter considers two kinds of
bloodglucose abnormalities. The first is abnormal blood-glucose levels and the second is a missed blood-glucose
reading.
The system then analyses the severity of the abnormality, and decides who to notify; the patient themselves,
caregivers and family members, or emergency healthcare providers such as doctors. This system is practical and
has been proven realizable, though could be further improved by automating blood-glucose measurements.
A system aimed at detecting heart attacks was built using ready-made components and a custom antenna.
An ECG sensor is used to measure heart activity, which is processed by a microcontroller. This information is
forwarded via Bluetooth to the user’s smartphone, where the ECG data is further processed and is presented in a
user application.
The authors identify that developing heart attack prediction software would improve the system. Further
improvements could be made by measuring respiratory rate, which is known to aid in the prediction of heart
attack.
SPHERE is a system under continuing development that utilizes wearable, environmental, and vision-based
(i.e. camera) sensors for general activity and health monitoring purposes. The aim of this project it to allow older
and chronically ill patients to live in the comfort of their own homes, while their health continues to be
monitored.

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This allows for intervention by caretakers and doctors if any issues arise. Researchers working on the project
have identifified that machine learning would be benefificial for learning about conditions and for making
decisions about the patient’s healthcare.

2.3 Model for future IoT healthcare systems:After reviewing this wide range of existing IoT-based health
care system, several requirements for the design of such systems become apparent. Each of these papers
emphasize the use of sensors for monitoring patient health. All regard wearable sensors, namely wireless and
externally-wearable sensors, as essential to their respective systems. Several works also suggest the use of
environmental or vision based sensors around the home. However, this restricts the usefulness of the system to
one physical location. It would be preferable to implement all essential sensors as small, portable, and externally
wearable nodes.

This would provide patients with a non-intrusive and comfortable solution that is capable of monitoring their
health wherever they go. This would make patients more receptive to using health monitoring technology than
they would be if implantable sensors or cameras were required. Additionally, repairing or replacing externally
wearable nodes would be simple when compared to implanted sensors or vision-based sensors installed in the
Home.

Existing systems highlight that communications are also essential for an Internet of Things healthcare system. In
several existing system models short-range communications, such as Bluetooth, are suggested for
transferring sensor data to a smartphone to be processed. Long-range communications such as LTE can then be
used to transfer the processed information from the patient to the healthcare provider, typically a doctor, through
SMS or the Internet.
The key limitation of this is that smartphones typically have limited battery life, requiring frequent recharging; a
patient with a flat battery would be a patient disconnected from healthcare providers. A low-powered node
designed specififically for managing healthcare information would be preferable.
Cloud storage capable of storing high volumes of varying data was also shown to be essential to a big data
healthcare system by several previous works. If even a thousand people wore a single pulse sensor that
communicated hourly with a cloud storage database via an LPWAN there would be 168,000 new data points per
week. This number increases drastically as more people wear sensors connected to the cloud storage framework,
and as more kinds of sensors are introduced. Using the big data that will rapidly form and continue to grow in
cloud storage, machine learning algorithms can be implemented in the high-computing environment of the cloud.

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These algorithms could be designed to mine through the large amount of data, identify previously unknown
disease trends, and provide diagnostics, treatment plans, and much more.
Based on these recurring trends in the literature to date, we propose and recommend a four-part model as that
will aid in the development of future Internet of Things healthcare systems.

2.3 Layout of IoT in healthcare

Fig 2: simplified layout of IoT in healthcare

The sensors help to transform the physical world data (e.g: temperature, pressure, humidity, etc) including
human health data (heart rate, oxygen saturation, blood pressure, blood glucose, etc) to the digital world and the
actuators transforms the digital data to physical actions (e.g: Infusion pumps, dialysis system, etc).
The IoT devices have sensors for receiving signals from the environment for analysis, or actuators for controlling
the environment based on the inputs, or both sensors and actuators. These devices connect with each other
through internet transfer and cloud storage for communication with similar devices and people, as shown in
Figure-2.

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CHAPTER-3

WIRELESS SENSOR NETWORKS

WSNs have been identified as a key component of a healthcare system founded on Internet of Things
technology, and as such the development of accurate sensors with low form factor are essential for the successful
development of such a system. Here,we focus on sensors that are non-obtrusive and non-invasive; we exclude
sensors such as implantables.
Considered are five fundamental sensors - three for monitoring the vital signs of pulse, respiratory rate, and
body temperature, and a further two for monitoring blood pressure and blood oxygen, both commonly recorded
in a hospital environment.

3.1 Types of sensors:

1. Photoplethysmographic Pulse sensors(PPG)

Perhaps the most commonly read vital sign, pulse can be used to detect a wide range of emergency conditions,
such as cardiac arrest, pulmonary embolisms, and vasovagal syncope. Pulse sensors have been widely
researched, both for medical purposes and for fitness tracking.
Pulse can be read from the chest, wrist, earlobe,fingertip, and more. Earlobe and fingertip readings provide high
accuracy, but are not highly wearable. A chest-worn system is wearable, but wrist sensors are generally
considered most comfortable for a long-term wearable system.
Commercially, several fitness tracking chest straps and wrist watches are available with pulse measurement
functionality. These include HRM-Tri by Garmin, H7 by Polar, FitBit PurePulse, and TomTom Spark Cardio.
However, these companies all disclose that their devices are not for medical use and should not be relied upon
for detecting health conditions. As such, the sensing systems employed by these devices cannot be directly
implemented into a critical health monitoring system.
Much research has been conducted into suitable methods for sensing pulse. Sensor types developed, used, and
analyzed in recent works include pressure, photoplethysmographic (PPG), ultrasonic, and radio frequency (RF)
sensors. PPG sensors operate by an LED transmitting light into the artery, with a photodiode receiving the
amount not absorbed by the blood as shown in fig 3 changes in the amount of light can be recorded and a pulse
rate can be determined.

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Fig 3: photoplethysmographic pulse sensor

PPG sensors are used to measure pulse, pulse rate variability, and blood oxygen in one small wrist-wearable
sensor. As motion affects the accuracy of pulse readings from PPG sensors, an accelerometer is used to check for
movement.
When motion is high, the device goes into a low power state and does not record pulse. This is not entirely
suitable as pulse may be relevant when motion is high, such as when a person is seizing or suffering cardiac
issues during exercise. Improving the accuracy of pulse sensors during motion would be preferred to
disregarding readings when movement levels are high.
the effects of motion on PPG sensors are reduced by using two different LED light intensities and comparing
the amount of light received at the photodiode. Signifificant improvement in signal quality is seen as motion
artefacts are greatly reduced through this technique.

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2. Pressure Pulse sensors:

Pressure sensors aim to mimic a healthcare professional manually reading the radial pulse by pressing down with
their fingers. As shown in Figure 4, the sensor is placed firmly against the wrist, and pressure is continuously
measured to acquire a pulse waveform.

Fig 4: pressure based pulse sensor

a flexible and highly-sensitive pressure sensor for pulse detection is developed and tested, showing promising
results. However, increasing the sensitivity to better detect pulse also increases the amount of noise that is
detected due to movement of the wearer. This sensor was tested in at-rest conditions, and further research would
be required to determine that it performed well during motion.

Pressure sensors and PPG sensors are combined in where pulse sensor modules are developed with arrays of nine
PPG sensors and one pressure sensor. Pulse is taken from multiple points on the wrist, providing clear pulse
readings and the potential to use these readings for diagnostics of certain diseases such as diabetes.

Diagnostics through pulse sensing is also investigated where pressure, PPG, and ultrasonic sensors are
compared. Reasonable accuracy was achieved with all three,but it is concluded that specifific diseases required
diagnosis using different sensor types; pressure was found to be best for arteriosclerosis, while ultrasonic was
superior for diabetes.

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An et al., designed a non-conventional pulse sensor using an RF array module with the aim of measuring several
locations on the wrist in case the received pulse signal at one point becomes noisy due to movement. Reasonable
pulse readings were achieved when compared to a reference signal, but still do not appear as clear as those
obtained with the traditional sensor types.
This type of pulse sensor shows promise, but further work is clearly required to make it reliable in a
critical healthcare scenario. Based on these works, it is strongly recommended that PPG sensors are used for
pulse sensing. These have repeatedly been proven to be effective for measuring pulse rate, and techniques have
already been developed to algorithmically reduce the impacts of noise on the signal quality.

3. Respiratory rate sensors:

Another of the vital signs is respiratory rate, or the number of breaths a patient takes per minute. Monitoring
respiration could aid in the identifification of conditions such as asthma attacks, hyperventilation due to panic
attacks, apnea episodes, lung cancer, obstructions of the airway, tuberculosis, and more.
Due to the importance of respiration, many previous works have developed sensors for measuring respiratory
rate. In inspecting the previous works, several types of respiratory rate sensor emerge. The first is a nasal sensor
based on a thermistor, as is used. The principle that these sensors are based on is that air exhaled is warmer than
the ambient temperature.
As such, the sensor uses the rise and fall of temperature to count the number of breaths taken. This is shown
to work reasonably well, but accuracy may be compromised by other sources of temperature fluctuations - for
example if worn by a chef working in a kitchen. It is also not highly wearable, as it is obstructive and easily
noticeable.
Echocardiogram (ECG) signals can also be used to obtain respiration rate. This is called ECG Derived
Respiration (EDR), and is used in to determine respiration patterns and detect apnea events. This method reads
respiratory rate reasonably well, but is again limited by the wearability.
ECG contacts are uncomfortable and would likely cause irritation to the skin if used continuously. Additionally,
ECG contacts are not reusable and would need to be regularly replaced.
Respiratory rate can also be calculated using a microphone to detect respiration, as was done. In this study,
focus was placed on detecting wheezing - a symptom common in asthmatics. The limitation of using a
microphone is that it would be extremely susceptible to any external noise, and would therefore not be suitable
as a long-term wearable.

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One study developed a fifiber optic sensor in an elastic substrate, that was sensitive enough to measure
vibrations caused by respiration. This was shown to work in a single test, but it is not known whether it would
work well under all conditions.
It is likely that this sensitive material would be susceptible to noise from other sources of vibration, including
walking. Further testing should be conducted. A pressure-type sensor was developed. Two capacitive plates are
placed in parallel, with one resting on the abdomen. During breathing, the plates move further apart and then
closer together during inhalation and exhalation respectively, allowing for calculation of respiratory rate. This
study showed a 95% confifidence in respiratory rate calculations when compared to a nasal sensor.
This is fairly accurate, and far more wearable than the nasal sensor it was compared to. However, the nature of a
pressure sensor may mean it is susceptible to noise if it is affected by external pressures, such as while walking
into wind.
A common method of measuring respiratory rate is to use a stretch sensor, as was done . Stretch sensors are
those where properties change in response to the application of tensile force, such as being stretched during
inhalation.
In the designed sensor was made from a ferroelectric polymer transducer, which generated a charge when a
tensile force was applied. Measuring the changes in this charge allow for calculation of respiratory rate. This
sensor appeared to obtain a clear signal, but accuracy was not verifified through comparison with respiratory rate
calculated by other means.
the respiratory rate sensors were based on changes in resistance. When a tensile force is applied to the sensor,
resistance increases. The changes in voltage caused by varying resistances can be used to calculate the breathing
rate. Each of the stretch sensor types was shown to be effective in calculating respiratory rate, but Atalay et al.
admit that motion artifacts were present during walking and other movements.

Additionally,it was found that breathing was accurate within 3.3 breaths per minute when sitting at a desk; the
margin of error increased when movement was introduced. Therefore, a limitation of these sensors is that other
movements can cause tensile force to be applied to the sensor in such a way that the sensor mistakes the
movement for breathing.

Evidently, many different sensor types exist for measuring respiratory rate. The main factor in choosing a sensor
type for a WSN thus becomes the wearability. Therefore, stretch sensors are strongly recommended for
implementation into future systems. Future work should focus on developing algorithms and techniques to
improve robustness against motion using these sensors, rather than on developing new sensors entirely.

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4. Body temperature sensors:

The third vital sign is body temperature, which can be used to detect hypothermia, heat stroke, fevers, and more.
As such, body temperature is a useful diagnostics tool that should be included in a wearable healthcare system.
Recent works surrounding the measurement of body temperature all use thermistor-type sensors.

The common negative-temperature-coeffificient (NTC) type temperature sensors were used, while positive-
temperature coeffificient (PTC) sensors were considered. In all studies, the thermistors were shown to measure a
suitable range of temperatures for monitoring the human body, with acceptable levels of error. Therefore, it is
strongly recommended that these sensor types continue to be used by future system designers.

The accuracy of temperature sensing is limited by how closely the sensor can be placed to the human body. As
such, several works focused on developing sensors printed onto thin,flexible polymers with adhesive backing
that could be attached directly to human skin. Whilst this is an interesting advancement, the work shows that
temperature can also be measured with relative accuracy using a temperature sensor embedded in textiles. Thus,
it is recommended that system designers should use textiles to hold temperature sensors until electronics printed
on flexible polymer can be more easily manufactured.

5. Blood pressure sensor:

Whilst not a vital sign itself, blood pressure (BP) is frequently measured alongside the three vital signs.
Hypertension (high BP) is a known risk factor for cardiovascular disease, including heart attack. It is also one of
the most common chronic illnesses, affecting 32% of adult Australians.
Of those affected, 68% had uncontrolled or unmanaged hypertension. As such, incorporating BP into a WSN
for healthcare would provide vital information for many patients.
Nonetheless, designing a wearable sensor for continuously and non-invasively monitoring blood pressure
remains a challenge in the field of healthcare IoT. A signifificant number of works have attempted to obtain an
accurate estimate of BP through calculation of pulse transit time (PTT) - the time taken between pulse at the
heart and pulse at another location, such as the earlobe or radial artery. Another work endeavored to measure this
property between the ear and wrist, while another looked to calculate it between the palm and the fifingertip of a
hand. PTT is known to be inversely proportional to systolic blood pressure (SBP), and is typically determined
using an electrocardiogram on the chest and a PPG sensor on the ear, wrist, or alternate location.

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The outcomes of each of these works indicate that the use of PTT to calculate BP is not yet suitable. PTT is
dependent on several other factors, including arterial stiffness and blood density. In ideal conditions, where
devices had been calibrated to the individual and the individual remained relatively still during testing,
reasonable results were acquired by the aforementioned studies that utilized one measurement at the chest and
another at the wrist.
Measurements taken between the ear and wrist were shown to be inaccurate. Additionally, PTT was measured
with reasonable accuracy between the palm and fingertip , but the study did not manage to convert this to blood
pressure. This should be investigated further, given some promise was shown in measuring PTT and given that
the design is the most wearable option for monitoring blood pressure presented in this survey.
For systems measuring between the heart and wrist, one study identifified that regular recalibration of devices
would likely be required as the human body changes over time.
Another issue with these types of systems is that, while non-invasive, they are still obstructive. Usually a chest
wearable ECG is required in addition to some other device, and the connection between them may be wired. One
study identifified this issue and opted to use two easily wearable PPG sensors - one on the earlobe, and one
on the wrist - to estimate pulse arrival time (or time taken to travel) between these locations and thus estimate
blood pressure. The results were promising, showing reasonable measurements for healthy subjects in different
positions (such as sitting and standing). However, the measurements taken were not compared to measurements
from a traditional cuff based sphygmomanometer. Such comparison would aid in analyzing the accuracy of the
PPG-based system.
While no system has yet been developed for accurately measuring blood pressure continuously using a
comfortably wearable device, this is a field worthy of further research. It is suggested that this could be achieved
by developing a device that utilizes two or more PPG sensors placed along the arm to calculate PTT. Blood
pressure is certainly a valuable parameter in healthcare, and the ability to monitor it continuously
would greatly improve the quality of healthcare that could be provided through WSN based system.

6. Pulse oximetry sensors:

Pulse oximetry measures the level of oxygen in the blood. Like blood pressure, blood oxygen level is not a vital
sign, but does serve as an indicator of respiratory function and can aid in diagnostics of conditions such as
hypoxia (low oxygen reaching the body’s tissues). As such, pulse oximetry is a valuable addition to a general
health monitoring system.

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Pulse oximeters measure blood oxygen by obtaining PPG signals. Usually, two LEDs - one red, one infrared -
are directed through the skin. Much of this light is absorbed by the hemoglobin in the blood, but not all. The
amount of light not absorbed is measured by receiving photodiodes, and the difference between the received
lights is used to calculate blood oxygen.
As highlighted in Figure 5, LED lights can either be passed through an appendage (normally a finger) to a
photodiode on the opposite side, or can be directed at an angle so that some light reflflects to a photodiode on the
same side of the appendage. These are called absorbance-mode and reflectance-mode PPG sensors respectively.

Fig 5: pulse oximetry sensors

Classically, pulse oximeters are worn as a finger clip wired to a medical monitor. Several recent works have
attempted to make more portable devices. a low-power pulse oximeter is designed with the aim of improving
wearability. Two techniques are used to reduce power consumption.
The first - named ‘‘minimum SNR tracking’’ - continuously calculates the current signal-to-noise-ratio (SNR)
and adjusts the length of time that the LED is in the ‘‘on’’ state for accordingly - the higher the SNR is, the
longer that the LED needs to be on to gain accurate readings. The second, named ‘‘PLL tracking’’, estimates
when the peaks and troughs of the PPG signal are likely to occur, and samples only at these times to acquire this
important information.
Up to 6x less power was consumed through implementing both techniques, and the worst error recorded was a
2% difference between actual and measured blood oxygen levels. This is a signifificant contribution towards
making pulse oximeters more wearable, but reductions in the level of error are desirable.
An in-ear reflflective pulse oximeter was designed in. This was designed to detect blood oxygen levels even
when the patient is suffering from shock, hypothermia, or other conditions that may cause blood centralization
and lead to pulse being undetectable at the fingertips.

The oximeter sits inside the ear canal without sealing it, ensuring there is no disruption to hearing. Reasonable
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accuracy in measuring blood oxygen levels was achieved in clinical testing on surgical patients, but the authors
concluded that their sensor should be used in addition to fifinger pulse oximeters, not as an alternative.
This is a sensible idea for wearable healthcare systems that are providing remote care, as it would be preferable
to detect when centralization is occurring.
The most wearable option would be a wrist-worn sensor, as many people are accustomed to wearing bracelets or
watches and would not find this uncomfortable. a reflective pulse oximeter was designed to be worn on the wrist.
The design is concave in shape, blocking out much external light and improving robustness against noise. The
trade-off is that it makes the device larger, but size reductions are then made by performing data processing off-
node. Overall, it is more wearable than other designs, but would still benefit from being miniaturized and made
more wearable.
Additionally, it could be used to detect pulse and skin temperature as well - combining three essential sensors
into a single, comfortably wearable node. Overall, the works in improving pulse oximetry do not focus on
finding new means to measure blood oxygen saturation, but instead focus on making wearable devices that
utilize the well-known existing techniques. Research should continue in this direction, focusing on wrist-
wearable pulse oximetry.

7. Other wearable sensors for healthcare:

Aside from the sensors that measure critical health parameters, there are several special-purpose wearable
sensors that may be useful in systems focused on monitoring a specifific condition. Echocardiograms (ECGs)
can be used to evaluate heart health, and several wearable sensors have been developed to acquire these signals.
In, an armband-based ECG sensor was developed and measures with reasonable accuracy. ECG sensors have
also successfully been developed for integration in helmets and more traditional chest-straps.
The helmet in also features an electroencephalogram (EEGs) measure brain activity, and could generally be used
to monitor seizures, sleep disorders, and progress after a head injury. Other EEG systems have been developed
for specifific purposes, such as for detecting driver drowsiness or stress management. Both systems measure
EEG through a relatively wearable headband.
Fall detection can be useful for monitoring elderly people,as they are particularly prone to falls and resulting
injuries. In a tri-axial accelerometer inside a smartphone is used by machine learning algorithms to classify the
user’s posture, which the best algorithms showing classifification accuracy of 99.01%. A related study found that
the classifification algorithms used for posture detection were much less accurate when performing fall
detection, suggesting that further training or alternate algorithms may be required for this purpose.

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In a more recent work on fall detection, a wearable camera was used with rapid changes in scenery used
to detect falls. This showed an accuracy of 93.78% and 89.8% in indoor and outdoor environments respectively.
In their earlier work accelerometer data was combined with an earlier version of their wearable camera system,
showing 91% accuracy in detecting falls.
An accelerometer, a gyroscope, and a magnetometer were used to accurately detect falls in with the authors then
adding a barometer to even more accurately detect changes in height. The latter work showed that fall detection
was performed with no lower than 99.38% accuracy and up to 100% accuracy across a series of tests. This is an
exceptional result, and suggests that this fall detection system could be implemented into healthcare applications
immediately.
Gait detection can also be useful in monitoring the elderly, as well as those with specifific conditions such as
Parkinson’s Disease (PD). Gait detection for those recovering from stroke or suffering from PD was considered
with footworn sensors designed to measure many parameters including step size and walking speed. A sensor for
gait detection in lower limb amputees was developed with the aim of Gait detection can also be useful in
monitoring the elderly, as well as those with specifific conditions such as Parkinson’s Disease (PD).

Gait detection for those recovering from stroke or suffering from PD was considered with footworn sensors
designed to measure many parameters including step size and walking speed. A sensor for gait detection in
lower limb amputees was developed with the aim of future use in controlling lower limb prosthetics. Detection
of gait events, rather than general gait patterns, has also been considered in several works. three accelerometers
are placed on the hip, knee, and ankle of advanced Parkinson’s Disease sufferers.
Features are extracted from the data, and an anomaly detection scheme is used successfully detect
freezing of gait, a common Parkinson’s symptom that causes a temporary loss of motor function and regularly
leads to falls. Detection of any gait anomaly is investigated where a waist-worn device comprised of a
microcontroller and tri-axial accelerometer is used to monitor gait.

Through the implementation of feature extraction and an advanced anomaly detection algorithm, a system is
created that can detect approximately 84% of gait anomaly periods that last for 5 seconds. Accuracy was higher
when detecting severe anamolies.
These sensors are not the only special-purpose sensors that have been researched or could be researched, but
they are some of the key types. They are applicable to many common diseases or conditions, and should be
considered for inclusion by designers of systems that will focus on monitoring of specifific ailments.

CHAPTER-4
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WIRELESS SENSOR NETWORK ARCHITECTURE

Fig 6: wireless sensor network for IoT based healthcare system

In this study, we have adopted SPL feature modeling for e-Healthcare IoT-based application to increase the
reusability of features by handling variability’s, such as alternative (indoor, outdoor sensors), Optional and OR
groups features. An e-Healthcare system consists of multiple layers of software, and sensors can be installed on
IoT devices, gateway, or at the user interface to present data etc., as shown in Figure-6. However, we are
considering the sensors variability’s (e.g., layer-1 of the IoT-based e-Healthcare system) with feature modeling.
The software application of temperature sensors is different with respect to the environment on same sensor
devices. Pulse Oximetry Sensors (SPO2) are used according to performance, quality, and cost savings to
measure the pulse rate of diverse categories of patients, such as adults and children. Breathing sensors
are used to measure the breathing effects on chest and stomach and are different for child and adult healthcare
centers.

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Fig 7: simplified overview of proposed model

4.1: Functions of different sensors

Fig 8: Types of Sensors for various functionalities of Healthcare System

For e-Healthcare systems, we consider three types of sensors for each sensing such as temperature sensor, SPO2
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sensor, and breathing sensor. Table shows the variability’s of sensors in different environments and attributes.
To develop the software application of these sensors with the environmental selection, we adopted the SPL
feature model at the architecture level to achieve high reusability.
As per the definition of SPL, these sensors need to be operational with a software application that is called core
asset development and for complete e-Healthcare system development, these core assets are reused in various
products. Therefore, feature modeling is required to categorize the variability’s for each product development.

Fig 9: : e-Healthcare Sensor Feature Model

Figure- 9 shows the feature model of e-Healthcare sensors where four variation points indicate the variability’s
of products. During each application development, these variation points must be satisfied. If any variation point
is violated, then application leads to failure at the enduser level. Variation point1 (Vp1) indicates that at least one
sensor must be part of the e-Healthcare application, Vp2 indicates that only one temperature sensor can be used,
Vp3 indicates that multiple SPO2 sensors can be used general healthcare center (e.g., for adults and kids) and,
Vp4 indicates that only one breathing sensor can be used in each product derivation.
The purpose of this study is to enhance the reusability of features of e-Healthcare systems with less cost, fast
development, and up-gradation of existing systems.

CHAPTER-5

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COMMUNICATION STANDARDS IN IoT

Communications related to Internet of Things for healthcare can be classifified into two main categories: short-
range communications, and long-range communications. The former is used to communicate between devices
within the WSN, whilst the latter provides connection between the central node of the WSN and a base station
(such as a healthcare provider). In this, both types of communications are considered with equal importance.

5.1 Short range communication: In the context of wearable healthcare systems, short-range communications
are often used between nodes, particularly between sensor nodes and the central node where data processing
occurs. Although short-range communications standards can be used for other purposes (i.e. developing mesh
networks for smart lighting), this survey focuses on the purpose of developing a small WSN that is comprised of
only a few sensors and a single central node.
Many short-range communications standards exist, but perhaps the most commonly used ones in IoT are
Bluetooth Low Energy (BLE) and ZigBee. The key features of these two standards are highlighted in Table
below, and this section further analyzes these standards and considers their suitability for implementation into an
IoT healthcare system.

Table-1: comparison of short range communication standards

5.1.1: Bluetooth low energy

BLE was developed by the Bluetooth Special Interest Group (SIG) to provide an energy-effificient standard that
could be used by coin-cell battery operated devices, including wearables. It also aimed to enable IoT, connecting
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small peripheral devices to processing devices such as smartphones.
BLE is used in a star topology, which is suitable for healthcare applications. The central node would act as the
center of the star topology, with sensors linked to it. The sensors will have no need to communicate with each
other directly. The range for BLE is 150m in an open field ; it would be much less in non-ideal conditions. It also
has a low latency of 3ms, and a high data rate of 1Mbps. The range is clearly suffificient for use in a healthcare
WSN where nodes are physically proximal, and the extremely low latency is ideal for applications such as
emergency health.
BLE operates in the 2.4GHz band, a band also used by classic WiFi and ZigBee. This may subject it to some
noise, but robustness to interference is implemented through frequency hopping across carefully selected
channels and a 24-bit cyclic redundancy check (CRC). This method makes BLE robust enough to noise for use
in a healthcare system.
Power consumption in BLE is extremely low. In, it is shown that a 180 mAH coin cell battery could run a BLE
chip for 18 continuous hours, making 21.6 million transactions.
However, if the chip was powered off when not needed, battery would last much longer. If a health sensor
transmitted its data every 30 seconds (or 2,880 times per day), then the battery could theoretically run the BLE
chip for around 20.5 years if not for the fact that it would die from selfdepletion well before then. With careful
hardware design and low-energy programming, BLE would clearly be suitable for healthcare applications.
Security has been implemented in a variety of ways for BLE. Firstly, there are four possible pairing models. The
newest and most secure of these, LE Secure Connections, implements a numeric comparison method and an
Elliptical Curve Hellman-Diffifie (ECHD) algorithm, which uses a public key and private keys unique to each
device, to secure key exchange. Two keys are exchanged between master and slave - a Connection Signature
Resolving Key (CSRK) and an Identifying Resolving Key (IRK). The former is used to provide authentication
for unencrypted data, whilst the latter provides privacy and the device’s identity Encryption is also available in
BLE, using Advanced Encryption Standard (AES).
Specififically, a 128-bit AES cypher is used to protect the data from potential attackers. Man-in-the-middle,
eavesdropping, and identity attacks are effectively protected against by the security features of
BLE. This is crucial in a healthcare environment where sensitive patient data is being exchanged.

Classic Bluetooth has previously been used in IoT for healthcare works including a blood pressure monitoring
system and a system for early detection of Alzheimer’s disease, as it has been optimized for IoT; unlike Classic
Bluetooth. Overall, BLE is extremely well suited to healthcare applications. It is secure and features good range,
low latency, low power consumption, and robustness to interference. This standard is highly recommended to
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designers, as it is currently the most suitable standard for implementation into wearable healthcare systems.

5.1.2: ZIGBEE

The ZigBee standard was designed by the ZigBee Alliance, specifically for providing low-cost, low-power
networks for M2M communications. It builds on the IEEE 802.15.4 physical standard. It is commonly known as
the standard for mesh networks, but it can also be used in the star topology required of a WSN with one central
node and many sensing nodes.
Different ZigBee modules provide different characteristics in terms of range, data rate, and power consumption.
The simplest XBee has a range of up to 30m in an urban environment, and outputs only 1mW of power for
transmission.
The XBee Pro has a higher range of 90m in the same conditions, but the transmit power output is signifificantly
higher at 63mW, the XBee Pro 900 XSC can reach up to 610m in an urban environment, but with 250mW of
power being used to transmit. There are ZigBee-based solutions for a wide variety of applications, but for the use
case of a healthcare WSN the XBee 1mW would be suitable. Only a small range is needed for on-body
communications, so choosing the lowest-power solution is preferable.
Data rates are also variable. XBee and XBee Pro have a data rate of up to 250kbps, while the XBee Pro 900 XSC
has a maximum data rate of only 10kbps. Clearly, the latter module has sacrifificed data rate in addition to power
effificiency to achieve its long range. In a healthcare environment, it would be preferable to opt for a higher data
rate, as this will reduce the latency in the system and ensure critical health data is delivered timely.
ZigBee can operate at a range of frequencies, including 868MHz, 900MHz, and 2.4GHz bands, depending on
the module chosen. Each of these bands faces interference. The 2.4GHz band is shared by Bluetooth and WiFi,
while many long-range communications systems utilize the unlicensed 868MHz and 900MHz bands in Europe
and America respectively. ZigBee uses CSMA-CA to reduce collisions, and implements re-transmission if
messages sent are not acknowledged.
Several security features are provided by ZigBee, though most are optional and must be enabled by the network
developer.

ZigBee’s security model is largely based on 128-AES encryption, and offers types of security keys - a link key,
a network key, and a master key. The network key is mandatory. It is shared by all devices on the network, and
is a network-layer security mechanism that cyphers all transmissions within the network. The link key is
optional, and is used to secure communications at the application layer. Master keys are also optional, and are
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used to secure the creation and sharing of link keys.
Despite these security measures, a recent study found that it was relatively easy to exploit a ZigBee network
during a device join, by sniffifing the link key being exchanged. This compromises the network key and thus the
entire network. The researchers in this study did identify that the security flaws were not to do with ZigBee
itself, but rather with the way that manufacturers implemented key exchange and initialization. If ZigBee is to be
implemented in healthcare systems, only ZigBee modules with all optional security mechanisms and robust key
management should be used.
ZigBee has already been used in several works relating to healthcare. In, a system that detects wandering
Alzheimer’s patients and alerts their caregivers was developed using a ZigBee mesh network. a wearable
ECG sensor was developed using ZigBee to communicate with a central monitoring device. Improving ZigBee
for use in biomedical application was considered, where a low-power transceiver was developed with robustness
to interference.

Overall, ZigBee is reasonably well-suited to healthcare applications. It provides robustness to interference and
several security mechanisms. Several implementations are possible to optimize range, data rate and power
consumption for specifific applications. XBee modules were examined as a case study, and it was found that
low-power, high data rate modules existed with suitable range for healthcare applications.

The main drawback of using ZigBee is that key exchange can be compromised unless implemented extremely
well by the manufacturer. This could pose a risk to healthcare systems where sensitive patient data is being
exchanged regularly. Additionally, ZigBee is not commonly implemented in devices such as smartphones, while
BLE typically is.

This makes it less compatible with existing devices, and therefore it is suggested that it would be better suited to
fixed location, standalone purposes such as home automation than it is to wearable healthcare systems. It is
therefore recommended that system designers prefer BLE for wearable sensors over ZigBee, particularly in
applications where privacy is critical.

5.2: Long range communication:

Low-Power Wide-Area Networks (LPWANs) are a subset of long-range communications standards with high
suitability for IoT applications. The range of a LPWAN is generally several kilometers, even in an urban
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environment.
This is signifificantly longer than the range of traditional IoT communications types such as WiFi or Bluetooth,
whose ranges are in the order of meters and thus would require extensive and costly mesh networking or similar
to be plausible for healthcare.

LPWANs also have signifificant advantage over cellular networks such as 3G in that they are designed to
support short bursts of data infrequently. This is suitable for a large number of healthcare applications, including
monitoring general health and receiving hourly updates, monitoring critical health and receiving emergency
calls, and rehabilitation where updates may only be necessary once daily.

This design principle also allows for low-power device design, which in turn ensures that the designed healthcare
devices will operate for longer before human interaction is required to recharge or change batteries. This reduces
the risk of patients being offlfline, and provides more convenience to the wearer. Based on these advantages, it is
suggested that LPWANs are the best solution for transmitting data from the central node to the cloud for storage
or further processing.

The most prominent standards for LPWANs are Sigfox and LoRaWAN. While these standards are well-
established, they face competition from emerging standards including NB-IoT. In this section, existing LPWAN
standards are considered in terms of suitability for an IoT healthcare system, and recommendations are made. A
table summarizing the three main standards discussed is also included in Table 2 to provide a
snapshot of their features, enabling easy comparison between these standards.

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Table 2: comparison of long range communication standards

5.2.1:- Sigfox:

Perhaps the simplest of the LPWAN standards, Sigfox provides limited functionality but is widely deployed
compared to other standards listed. It is a protocol developed in the first four layers of the OSI model, and its
base stations bear similarity to those in cellular - antennas mounted on towers.
Sigfox uses a star topology, and nodes are designed to be uplink only to improve battery effificiency. It is
possible for a node to receive downlink, but it must explicitly request it.
As acknowledgement of receipt is important for health data, downlink would have to be requested.
Unfortunately, a limitation of Sigfox is that downlink can only be requested 4 times per day.
There is a trade-off in design between latency and [Link] a receiver has higher sensitivity, it can detect weaker
signals; thus, the distance a signal can travel is increased. Sigfox opted to maximize range to around 9.5km in
urban areas by using slow D-BPSK modulation and a low bit rate of 100 bits per second (bps).

In rural areas, Sigfox can reach a range of up to 50km . The high latency of Sigfox is a drawback for its use in
healthcare applications, as it is important for messages to be delivered quickly in this critical context.
Sigfox operates in the unlicensed bands of 868MHz in Europe and 915MHz in the US. As with other LPWAN
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technologies operating in the sub-GHz spectrum, no globally available band exists for Sigfox’s use. Operating in
an unlicensed band allows Sigfox to occupy a wider bandwidth, but comes with the disadvantage of increased
interference, which may be an issue in healthcare.
To increase resistance to interference, Sigfox sends payloads in three consecutive frames, each in different
pseudorandom sub-carriers and over different propagation paths.
This improves the likelihood that the message will be received intact, and thus reduces the disadvantages of
increased interference in the unlicensed bands.
Sigfox has a high network capacity and can support approximately 50,000 nodes with a single gateway. This
is comparable to NB-IoT’s 52,547 nodes, which has been shown to be able to support 40 devices per household
assuming a household density equivalent to London’s and an inter site distance of 1732m. In rural areas such as
Australia’s Burdekin Shire, which had a population of 17,784 people in 2011 and is 4880km in area, one well-
positioned base station would enable every resident of the region to be connected to healthcare providers via
Sigfox.

This is significant for healthcare applications, especially in regional areas. Security is implemented in Sigfox by
signing each message with the device’s private key. This reduces the risk of spoofing attacks or interception, but
does not eliminate it.
A sophisticated attack targeting the node hardware or service provider could still reveal the unique keys,
compromising a patient’s healthcare system.
The limit of 140 messages per day also minimizes the impact that a spoofifing attack could have. However, in a
healthcare environment, even a small number of fraudulent messages could have signifificant impacts on the
wellbeing of patients.
Encryption and scrambling methods are supported by Sigfox, but developers must implement these themselves
within the 12-byte payload. If implemented well, these methods could reduce the risk of sensitive patient data
being intercepted.

Overall, Sigfox is suitable for non-critical applications where speed of message delivery and acknowledgements
of receipt are non-essential, such as in smart parking and automated street lighting. In such an application, a
breach of security would cause annoyance rather than danger. However, in healthcare, successfully transmitting
messages with relative speed is essential.

Any compromise of security could be detrimental for an individual’s health, or could affect the integrity of
medical databases. For this reason, we recommend that Sigfox not be used for critical healthcare applications. It

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is therefore strongly recommended that system designers instead consider alternative LPWANs for critical
healthcare applications.

5.2.2:- LoRa & LoRaWAN

Technical information about the LoRa & LoRaWAN standards is presented in, written by the LoRa Alliance.
This subsection overviews the key components of the standard based on this source, and thus the interested
reader is referred to it for further information about LoRa & LoRaWAN.
LoRa is a physical layer protocol that utilizes chirp spread spectrum techniques over a wide bandwidth of at least
125kHz. This provides low-power, long-range communications with high resilience to intentional or
environmental interference.
LoRaWAN is built on top of the LoRa standard, in the network layer. It utilizes a star topology, and nodes are
asynchronous; they only communicate when they need to, such as after an event or scheduled measurement.
Scheduled messages from nodes would suit long-term monitoring applications, while event-driven messages
from nodes would suit emergency monitoring.

LoRaWAN also has a high network capacity, ensuring many messages can be passed over the network at
the same time. Each gateway can support approximately 40,000 nodes. While this is lower than the capacity of
Sigfox, it would still be suitable for use in urban and regional areas if optimal base station positioning was
considered thoroughly.

Already, LoRaWAN has been successfully deployed in several areas including parts of Europe, America, and
the Asia-Pacifific region. With a maximum link budget of 155 dBm, messages can travel over a range of around
7.2km in an urban area at a rate of 0.25-5.5 kbps. This is a significantly faster data rate than Sigfox, with about
2.3km less range. It is suggested that for healthcare, this trade-off is worthwhile as low latency is essential. More
range can be obtained by simply installing more base stations.
To allow consumers to choose a solution that suits them best, LoRaWAN specififies three classes of device that
can be used. Class A is the most battery effificient, providing downlink for only a small window after uplink.
This would be suitable for healthcare, as downlink would only be required to receive acknowledgement that the
health data was delivered.

Like Sigfox, LoRaWAN operates in the unlicensed bands of 868MHz in Europe and 915MHz in the US. This
carries the advantage of wider spectrum availability, but also the disadvantage of increased exposure to potential
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interference.
Security is provided by the LoRaWAN standard. A unique key is assigned to each node on the network; this key
is known only to the node and to the network provider. Theoretically, this would eliminate man-in-the-middle
attacks as intercepted data would be encoded and not decipherable.
Unfortunately, a node’s unique key could become a single point of failure for the whole system should the key
be discovered through sophisticated hardware hacking of the node, or through an attack on the network server. If
a key was illicitly obtained, then the attacker could use it to decipher all future messages from the node, or could
send false messages to the base station whilst pretending to be the node.

For the most part, LoRaWAN is reasonably well-suited to healthcare applications due to its range, latency, and
network capacity. Interference could potentially cause issues while operating in unlicensed bands, but a more
signifificant issue is that of key management. To be truly secure, proper key management must be implemented
by the developers and service providers so that sensitive healthcare data and important medical databases are
protected from malicious attacks, as LoRaWAN does not provide a complete security solution.

5.2.3: NB-IoT

Standardized in the recent 3GPP Release 13, NB-IoT operates in the licensed bands of GSM or LTE and
provides long range, low-power communications. As NB-IoT has been developed based on LTE, much of the
existing LTE hardware can be used to deploy it rapidly and effectively.

There are three different ways in which NB-IoT can be deployed, allowing easier coexistence with existing
networks. These deployment modes are in-band, guard-band, and stand alone. Using in-band mode involves
reserving LTE Physical Resource Blocks (PRBs) from the existing LTE network, for use by NB-IoT.

In guard-band mode, NB-IoT utilizes the bandwidth of an existing LTE carrier’s guard-band. Finally, in stand-
alone mode, GSM carriers can be re-farmed and used for NB-IoT, or NB-IoT can exist in entirely new
bandwidth. Operating within licensed bands has the signifificant advantage of reduced risk of interference. One
potential disadvantage is that there will likely be a higher cost to use NB-IoT than there is for unlicensed
standards.

Just as mobile phone users pay a fee to be able to use LTE, NB-IoT device users will likely have to pay a
connection fee for the use of NB-IoT.
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The exact magnitude of these costs is not yet known as NB-IoT is yet to be widely deployed. Nonetheless, a
decrease in interference is likely to be worth the additional cost when considering healthcare systems, as QoS in
these applications is critical.

Due to a high receiver sensitivity of 164dB, NB-IoT achieves a range of up to 15km. Despite the long range,
speed remains relatively high, with a maximum uplink data rate of 250kbps. The signifificant data rate and wide
range are ideal for healthcare applications, as messages can travel a reasonable distance within an acceptable
time frame for even the most critical health events.
Battery life was a fundamental consideration in the design of NB-IoT. The power effificiency has some
dependence on which mode NB-IoT operates. it was found that the life of 5Wh batteries were 2.6 and 2.4 years
in standalone and in-band modes respectively when a 50 byte message was being sent every 2 hours. When a 50-
byte message was only sent once per day, the battery lifetime increased to 18.0 and 16.8 years respectively.

Applications such as longterm monitoring would likely require several transmissions per day, while emergency
health monitoring system would transmit short ‘‘heartbeat’’ messages occasionally. Longer messages would
only be sent when an emergency condition is detected. For each of these applications, the energy consumption of
NB-IoT is suffificiently low, and allows for minimal interaction by the system wearer.
NB-IoT can also support a minimum of 52,547 nodes per base station. As mentioned in Section IV.B.1., this
would be suffificient to support 40 devices per home, assuming a household density equivalent to that of London
. With an average household population of 2.47 people and ideal positioning of cell sites, every resident of
London could wear over 15 healthcare sensors, each successfully communicating directly with the closest base
station.

The capacity of NB-IoT is clearly suffificient for providing wide-spread healthcare. State-of-the-art 3GPP S3
security is used by NB-IoT, with mechanisms on both the transport and application layers. There are several
mandatory mechanisms including entity authentication, device identifification, user identity confifidentiality, and
data integrity. Optional mechanisms are also available for ensuring application authentication, data
confifidentiality, and more. As eavesdropping is a real threat to radio communications, it is recommended that
the optional encryption mechanisms are also used to protect sensitive health data. With all mandatory and
optional mechanisms in place, NB-IoT will likely be suitably secure for healthcare applications.

Overall, NB-IoT is suitable for healthcare applications. It is secure, supports communications over a long range,
has high energy effificiency, and can support many devices.
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The most signifificant drawback is the current lack of deployment, though this is expected to occur rapidly due
to the reusability of existing LTE infrastructure. This lack of deployment limits the immediate usefulness of NB-
IoT, but the standard will likely be deployed rapidly on a large scale due to the ability to reuse existing 3G
hardware. When this happens, NB-IoT is highly recommended for use, as it offers many favourable
characteristics that make it the most suitable standard for use in healthcare systems.

5.2.4: Other communication standards

Several other LPWAN standards have been developed for operation within unlicensed, sub-GHz bands, but these
have been minimally deployed compared to SigFox and LoRaWAN. They also feature unique hardware, making
them harder to deploy on the same wide-scale that NB-IoT could be deployed on. These standards include
Symphony Link, nWave, Weightless, and NB-Fi. Outside of the sub GHz bands but still within ISM bands lies
Ingenu Random Phase Multiple Access (RMPA).
Meanwhile, in the licensed bands, two additional standards besides NB-IoT have been developed by 3GPP.
These standards are Extended Coverage GSM for IoT (EC-GSM) and Long-Term Evolution Machine Type
Communications Category M1 (LTE-M or eMTC). Each of these standards is brieflfly discussed in this
section.
Symphony Link [106], [107] is a synchronous protocol that uses LoRa as its physical layer, and serves as an
alternative to LoRaWAN. It is used in a star topology, but allows for the use of repeaters to provide more hops.
All messages sent using Symphony Link are acknowledged, and message length can be longer. It is robust and
secure standard, but is less energy effificient due to the need for nodes to frequently synchronize with the
network.
The increased power consumption and lack of deployment are the main limiting factors in using Symphony Link
for healthcare purposes. nWave is an ultra-narrow band technology using a star topology. It boasts high capacity
and a range of up to 10km. nWave has previously been used for smart farming and smart parking. Little further
information is made available by this company with regards to their technology.
Weightless offers three standards to give end users more choice - Weightless-N, Weightless-P, and
Weightless-W. Weightless-N was developed through a partnership with nWave, and offers uplink-only simplex
communications with low battery consumption and a range around 4.1km. Weightless-P offers two-way
communications, but with lower range and shortened battery life.

Weightless-W has the lowest battery life, but has similar range to Weightless-N whilst enabling two-way
communications. Of the Weightless standards, Weightless-P would likely be best suited to most healthcare
applications due to its two way communications and longer battery life. However, the short range of 2km is a
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limiting factor even in a dense urban environment.
NB-Fi by WAVIoT is another unlicensed UNB technology that operates in a star topology. It is full duplex, with
a range of 16.6km in an urban environment. The trade-off made is a high latency of 30 seconds on uplink and 60
seconds on downlink. This may be suitable for non-critical systems, but would not be suitable when an
emergency health alarm needs to be transmitted.
Ingenu RPMA is the only well-known LPWAN standard operating in the unlicensed 2.4GHz band. This design
choice allows for higher transmission power and antenna gain to be used, but this uses extra power. Additionally,
the popularity of the 2.4GHz band means that messages transmitted using Ingenu RPMA are likely to be
subjected to interference.
Ingenu’s range is short compared to its competitors, only reaching 4.6km in urban areas. High capacity and QoS
are provided by Ingenu, which would be advantageous in healthcare. However, the low range for high power
consumption is not ideal for a battery-powered wearable system. This standard would likely be better suited to
IoT applications where permanent power supplies are available for sensor nodes.
EC-GSM is a licensed band standard that was introduced to EC-GSM is a licensed band standard that was
introduced to improve GSM for IoT usage, as GSM has already been widely used for M2M communications due
to its high deployment and low cost devices. EC-GSM can be enabled by updating the software on existing GSM
gateways. This allows for extremely fast roll-out, and allows operators to extend the useful lifetime of legacy 2G
gateways.
EC-GSM provides coverage improvements of up to 20dB, and each gateway can support up to 50,000 devices.
The data rate offered by EC-GSM is less than 140kbps for both uplink and downlink, slower than NB-IoT.
Currently, EC-GSM has similar capabilities to that of NB-IoT and thus would be suitable for use in healthcare.
However, EC-GSM operates on legacy gateways while NB-IoT operates on modern LTE gateways.
It is therefore suggested that NB-IoT will outlast EC-GSM as a widely utilized standard, and thus it would be
preferable to develop healthcare systems based on NB-IoT rather than EC-GSM.

LTE-M is another licensed band standard that has been developed to utilize the full capacity of an LTE carrier
using multiplexing techniques, whilst improving battery life and coverage. The major difference between LTE-
M and classic LTE is that the former introduces new power-saving methods not implemented in the latter [. With
a data rate of up to 1Mbps, LTE-M allows for more advanced IoT applications, but has limited range and can
only support around 20,000 nodes per gateway. LTE-M is certainly an ideal solution for a system where high
speed, large amounts of data, and advanced features are required

CHAPTER-6

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CLOUD-BASED IoT HEALTHCARE SYSTEMS

Cloud technologies have been widely researched due to their usefulness in big data management, processing and
analytics. Several related works have surveyed the literature on using cloud technologies for IoT purposes such
as smart grid and mobile cloud computing for smartphones, where complex computations are
offloaded from low-resource mobile devices to the highpower environment of the cloud, before the result is
returned to the mobile device.
These works consider data storage and data processing as key advantages of cloud technologies. Further related
works have reviewed the state of cloud centric healthcare. The use of cloud technology for health record storage
is considered, which also overviews cloud technologies as a complete fifield. Storage is considered further and,
with particular focus on how a large database could be used for data analysis and trend determination.
While each of these related works provides valuable insight into the fifield of cloud technologies, there is no
known article that considers all advantages, disadvantages, challenges, and opportunities that cloud presents to
healthcare systems based on WSNs and the IoT.

Much research has been conducted in recent years regarding the benefifits of cloud for healthcare applications.
These benefits stem from the three primary services that can be provided by cloud technologies in healthcare
environments:
A) Software as a Service (SaaS) - provides applications to healthcare providers that will enable them to work
with health data or perform other relevant tasks.

B) Platform as a Service (PaaS) - provides tools for virtualization, networking, database management, and more.

C) Infrastructure as a Service (IaaS) - provides the physical infrastructure for storage, servers, and more.

These services can be used to achieve a variety of tasks, but two key uses are easily identifified in the literature;
big data management and data processing. These two different concepts are presented separately in this section.
However, it is also highlighted that both are essential for a state-of-the-art IoT healthcare system, and thus
should be included together.

ADVANTAGES:
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1. Simultaneous reporting and monitoring:

Real-time monitoring via connected devices can save lives in event of a medical emergency like heart failure,
diabetes, asthma attacks, etc.
With real-time monitoring of the condition in place by means of a smart medical device connected to a
smartphone app, connected devices can collect medical and other required health data and use the data
connection of the smartphone to transfer collected information to a physician.
Center of Connected Health Policy conducted a study that indicates that there was a 50% reduction in 30-day
readmission rate because of remote patient monitoring on heart failure patients.
The IoT device collects and transfers health data: blood pressure, oxygen and blood sugar levels, weight, and
ECGs.
These data are stored in the cloud and can be shared with an authorized person, who could be a physician, your
insurance company, a participating health firm or an external consultant, to allow them to look at the collected
data regardless of their place, time, or device.

2. End-to-end connectivity and affordability:

IoT can automate patient care workflow with the help healthcare mobility solution and other new technologies,
and next-gen healthcare facilities.
IoT in healthcare enables interoperability, machine-to-machine communication, information exchange, and data
movement that makes healthcare service delivery effective.
Connectivity protocols: Bluetooth LE, Wi-Fi, Z-wave, ZigBee, and other modern protocols, healthcare personnel
can change the way they spot illness and ailments in patients and can also innovate revolutionary ways of
treatment.
Consequently, technology-driven setup brings down the cost, by cutting down unnecessary visits, utilizing better
quality resources, and improving the allocation and planning.

3. Data assortment and analysis:

Vast amount of data that a healthcare device sends in a very short time owing to their real-time application is
hard to store and manage if the access to cloud is unavailable.
Even for healthcare providers to acquire data originating from multiple devices and sources and analyze it
manually is a tough bet.
IoT devices can collect, report and analyses the data in real-time and cut the need to store the raw data

4. Tracking and alerts:

On-time alert is critical in event of life-threatening circumstances. Medical IoT devices gather vital data and
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transfer that data to doctors for real-time tracking, while dropping notifications to people about critical parts via
mobile apps and other linked devices.
Reports and alerts give a firm opinion about a patient’s condition, irrespective of place and [Link] also helps
make well-versed decisions and provide on-time treatment.
Thus, IoT enables real-time alerting, tracking, and monitoring, which permits hands-on treatments, better
accuracy, apt intervention by doctors and improve complete patient care delivery results.

5. Remote medical assistance:

In event of an emergency, patients can contact a doctor who is many kilometers away with a smart mobile apps.
With mobility solutions in healthcare, the medics can instantly check the patients and identify the ailments on-
the-go.
Also, numerous healthcare delivery chains that are forecasting to build machines that can distribute drugs on the
basis of patient’s prescription and ailment-related data available via linked devices.
IoT will Improve the patient’s care In hospital. This in turn, will cut on people’s expanse on healthcare

6. Research:
IoT for healthcare can also be used for research purposes. It’s because IoT enables us to collect a massive
amount of data about the patient’s illness which would have taken many years if we collected it manually.
This data thus collected can be used for statistical study that would support the medical research. Thus, IoT don’t
only saves time but also our money which would go in the research.
Thus, IoT has a great impact in the field of medical research. It enables the introduction of bigger and better
medical treatments.
IoT is used in a variety of devices that enhance the quality of the healthcare services received by the patients.
Even the existing devices are now being updated by IoT by simply using embedding chips of a smart devices.
This chip enhances the assistance and care that a patient requires.

DISADVANTAGES & CHALLENGES:

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1. Data security and privacy:

One of the most significant threats that IoT poses is of data security & privacy. IoT devices capture and transmit
data in real-time. However, most of the IoT devices lack data protocols and standards.
In addition to that, there is significant ambiguity regarding data ownership regulation.
All these factors make the data highly susceptible to cybercriminals who can hack into the system and
compromise Personal Health Information (PHI) of both patients as well as doctors.
Cybercriminals can misuse patient’s data to create fake IDs to buy drugs and medical equipment which they can
sell later.
Hackers can also file a fraudulent Insurance claim in patient’s data.

2. Integration: multiple devices & protocols:

Integration of multiple devices also causes hindrance in the implementation of IoT in the healthcare sector.
The reason for this hindrance is that device manufacturers haven’t reached a consensus regarding
communication protocols and standard.
So, even if the variety of devices are connected; the difference in their communication protocol complicates and
hinders the process of data aggregation.
This non-uniformity of the connected device’s protocols slows down the whole process and reduces the scope of
scalability of IoT in healthcare.

3. Data overload & accuracy:

data aggregation is difficult due to the use of different communication protocols & standards.
However, IoT devices still record a ton of data. The data collected by IoT devices are utilized to gain vital
insights.
the amount of data is so tremendous that deriving insights from it are becoming extremely difficult for doctors
which, ultimately affects the quality of decision-making. Moreover, this concern is rising as more devices are
connected which record more and more data.

4. Cost:

IoT has not made the healthcare facilitates affordable to the common man yet.
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The boom in the Healthcare costs is a worrying sign for everybody especially the developed countries.
The situation is such that it gave rise to “Medical Tourism” in which patients with critical conditions access
healthcare facilities of the developing nations which costs them as less as one-tenth. IoT in healthcare as a
concept is a fascinating and promising idea.

IMPROVEMENTS FOR FUTURE WORKS:

In terms of sensors, much progress has been made but there are still no available devices that match the accuracy
of hospital-grade devices without compromising energy effificiency or wearability. This is especially true of
complex devices such as blood pressure and respiratory rate sensors, both of which would be invaluable to
the field of medicine.

As such, further research efforts should be made towards improving the quality of these sensors until they are
highly accurate, reliable, and comfortably wearable.
In future works, placing particular focus on developing a blood pressure monitor that is more wearable without
compromising accuracy. We will also look at reducing the impact of motion on sensors, particularly for
respiratory rate and pulse sensors.

In terms of communications standards, it would be worthwhile to develop wearable healthcare systems that are
reliant on the emerging NB-IoT standard. As this is an extremely new standard, no known work has
implemented it into a healthcare environment despite its obvious advantages for this field. In future works,
implementing NB-IoT into healthcare devices to confirm its suitability, before using it as the foundation
communications standard for a healthcare system that is being developed in accordance with the model proposed
by this paper.

Data storage using cloud technologies has been extensively considered, but data processing is an area in which
further research should be conducted. The development of cloudbased algorithms that are capable of processing
raw data from complex sensors and extract meaningful information about a person’s health should be continued.

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