Journal Pre-proof

IoT-based telemedicine for disease prevention and health promotion: State-of-the-Art

A.S. Albahri, Jwan K. Alwan, Zahraa K. Taha, Sura F. Ismail, Rula A. Hamid, A.A.
Zaidan, O.S. Albahri, B.B. Zaidan, A.H. Alamoodi, M.A. Alsalem

PII: S1084-8045(20)30337-4
DOI: https://doi.org/10.1016/j.jnca.2020.102873
Reference: YJNCA 102873

To appear in: Journal of Network and Computer Applications

Received Date: 20 January 2020

Revised Date: 27 July 2020
Accepted Date: 13 October 2020

Please cite this article as: Albahri, A.S., Alwan, J.K., Taha, Z.K., Ismail, S.F., Hamid, R.A., Zaidan,
A.A., Albahri, O.S., Zaidan, B.B., Alamoodi, A.H., Alsalem, M.A., IoT-based telemedicine for disease
prevention and health promotion: State-of-the-Art, Journal of Network and Computer Applications
(2020), doi: https://doi.org/10.1016/j.jnca.2020.102873.

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 IoT-based Telemedicine for Disease Prevention and Health Promotion: State-of-the-Art

A. S. Albahri, Jwan K. Alwan, Zahraa K. Taha, Sura F. Ismail, Rula A.Hamid, A. A. Zaidan, O. S. Albahri*, B. B.
Zaidan, A. H. Alamoodi, M. A. Alsalem

Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan,
Tanjung Malim, Malaysia

Abstract
Numerous studies have focused on making telemedicine smart through the Internet of Things (IoT) technology.
These works span a wide range of research areas to enhance telemedicine architecture such as network
communications, artificial intelligence methods and techniques, IoT wearable sensors and hardware devices,
smartphones and cloud computing. Accordingly, several telemedicine applications covering various human diseases
have presented their works from a specific perspective and resulted in confusion regarding the IoT characteristics.
Although such applications are useful and necessary for improving telemedicine contexts related to monitoring,

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detection and diagnostics, deriving an overall picture of how IoT characteristics are currently integrated with the
telemedicine architecture is difficult. Accordingly, this study complements the academic literature with a systematic
review covering all main aspects of advances in IoT-based telemedicine architecture. This study also provides a

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state-of-the-art telemedicine classification taxonomy under IoT and reviews works in different fields in relation to
that classification. To this end, this study checked the ScienceDirect, Institute of Electrical and Electronics
Engineers (IEEE) Xplore, and Web of Science databases. A total of 2,121 papers were collected from 2014 to July
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2020. The retrieved articles were filtered according to the defined inclusion criteria. A final set of 141 articles were
selected and classified into two categories, each followed by subcategories and sections. The first category includes
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an IoT-based telemedicine network that accounts for 24.11% (n = 34/141). The second category includes IoT-based
telemedicine healthcare services and applications that account for 75.89% (n = 107/141). This multi-field systematic
review has exposed new research opportunities, motivations, recommendations and challenges that need attention
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for the synergistic integration of interdisciplinary works. This extensive study also lists a set of open issues and
provides innovative key solutions along with a systematic review. The classification of diseases under IoT-based
telemedicine is divided into 14 groups. Furthermore, the crossover in our taxonomy is demonstrated. The lifecycle
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of the context of IoT-based telemedicine healthcare applications is mapped for the first time, including the procedure
sequencing and definition for each context. We believe that this study is a useful guide for researchers and
practitioners in providing direction and valuable information for future research. This study can also address the
ambiguity in the trends in IoT-based telemedicine.
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Keywords: telemedicine; remote monitoring; healthcare services; diseases; Internet of Things; network.
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1. Introduction
The World Health Organization (WHO) defines telemedicine as ‘the practice of medical care using interactive
audiovisual and data communications. This includes the delivery of medical care services, diagnosis, consultation,
treatment, as well as health education and the transfer of medical data’ [1]. Telemedicine architecture consists of
three tiers, namely, sensor-based (tier 1), gateway-based (tier 2) and medical centre institute (tier 3) [2]. The Internet
of Things (IoT) conceptualises a connected set of anyone, for anything, at any time, in any place, for any service and
for any network [3]. Many definitions of the IoT are available in the literature. According to [4], the rationale behind
this multiplicity of meanings is that IoT constitutes two words: ‘Internet’ and ‘Things,’ thereby creating two main
visions. The first is oriented for the ‘Internet’ or the component for network, whilst the second is oriented towards
the ‘things’ component. ‘Things’ concern the RFID tags, and later, more ‘Things’ appearing as sensors and actuators
generally involve mobile devices. Other definitions to understand IoT concepts and characteristics can be found in
the works of [5], [6] and [7]. The IoT is capable of boosting various medical applications such as remote health
monitoring, fitness programmes, rehabilitation, chronic diseases and elderly care [7]. Compliance with remote
monitoring for treatment and medication at home is an important potential for telemedicine application. Therefore,
various medical devices, sensors and imaging devices are essential as smart devices or objects constituting a core
part of the IoT for the telemedicine architecture [6]. Thus, the future worldwide healthcare industry should be
prepared for extensive remote healthcare monitoring through IoT and telemedicine [8].
The number of diseases has skyrocketed in the medical field and related areas [9]. Overall, various diseases have
become increasingly frequent, with several varied causes [10]. With the growth of the world population, increased
life expectancy and improvement of living standards, additional mortality causes are changing around the globe

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[11]. Figure 1 presents an overview of the global causes of death based on various diseases [12]. The chart presents
a comparison of people who had died due to special causes in 2016.

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Figure 1 Causes of Death According to Various Diseases in 2016 [12]
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Globally, majority of fatalities are due to non-communicable diseases (NCDs). These diseases are characterised by
being chronic and long-term similar to cardiovascular diseases (CVDs), in addition to others such as diabetes, cancer
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and respiratory disease. Overall, non-communicable diseases are responsible for more than 70% of global deaths.
Additionally, the numbers of patients have been continuously increasing, with an ageing population as the main
issue in healthcare services [13]. Figure 2 presents the National Institutes of Health (NIH)’s total ageing funding
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between fiscal year (FY) 2013 and FY 2020 (in million US dollars) [14]. In fiscal year 2017, neuroscience funding
by the NIH was approximately USD 3.57 billion. These figures display the actual ageing funding by the NIH from
FY 2013 to FY 2018 and estimates for FY 2019 and FY 2020. According to the National Institute on Aging (NIA),
the US recognised and supported continued research in the biomedical domain, particularly research on ageing and
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Alzheimer’s disease and related cognitive diseases [15]. Furthermore, anxiety occurs when the number of medical
specialists is not increasing at pace with the growing number of patients [16], consequently presenting challenges in
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healthcare accessibility and availability.

Figure 2 Total Ageing Funding by NIH from FY 2013 to FY 2020 [13]

The abovementioned context raises the question of whether future healthcare is prepared for extensive remote
medical care practice through IoT and telemedicine. The results of this systematic review are expected to allow for

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constructive reflection on future developments and identification of research priorities on IoT-based telemedicine for
networks, healthcare services and applications. Some reviews [17]–[24] have addressed different telemedicine
issues. Although such studies did not provide a systematic review and generalised analysis for similar topics, some
design issues are noteworthy in specific cases. To the best of our knowledge, no systematic analysis has been
conducted to grasp whether research on IoT and telemedicine exists. Moreover, no discussions exist on major issues
and future directions of IoT-based telemedicine architecture to provide suitable healthcare services by covering
different human diseases. Accordingly, the current study provides an improved understanding of how IoT
characteristics are included in telemedicine practices (the Discussion section presents an argument) to remove all
barriers in the way of both in global healthcare. IoT brings new opportunities for telemedicine; therefore,
approximately 4 million patients are estimated to vouch for remote health care monitoring by the year 2020
[25][26]. IoT is targeted to have continuous real-time communicability with the patient, with enhanced
interoperability of applications and a detailed case history enabling physicians to adopt judicious treatment
procedures [27]. This feature would enable improved healthcare delivery through accurate data compilation and
automated workflow, substantially reducing the cost and waiting time of patients [26]. Availability of real-time data
would help in better disease management, providing timely treatment and minimising the chances of error.

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According to a new report by Global Market Insights, the value of the US telemedicine sector is expected to cross
USD 64 billion by 2025 [28]. Increasing the prevalence of chronic diseases is one of the major factors that has
created the need to adopt telemedicine services and provide increased home supervision. The telemedicine market is

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expected to establish a large presence in pre- and post-treatment management and further utilisation of artificial
intelligence [29]. In IoT-based telemedicine, contexts would find extensive applications where most of the patients
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can be effectively and remotely monitored, with their critical diseases detected, diagnosed, prevented and treated
[17]. Furthermore, IoT is capable of correctly identifying optimum time supplies for various devices and replenished
for their smooth and continuous operation. Furthermore, IoT can efficiently schedule limited resources by ensuring
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their best utilisation and service for other patients [8].
The current study addresses IoT’s impact on telemedicine through an extensive literature review. Firstly, this review
covers important aspects of IoT in telemedicine, where the latter includes network topology, architecture and
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platform. The main sensors, devices and communications technology of the IoT wearables are presented. Secondly,
the IoT in telemedicine healthcare services is discussed with regard to patients and the elderly, and various figures
and statistics are presented. The IoT-based telemedicine application contexts are analysed and defined. The extant
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literature presents several distribution results, and each is analysed as well. This review shows that the IoT-based
telemedicine, which deals with several issues, and the efforts reported in the literature are limited. Most studies have
presented duplicate ideas and covered a number of diseases. Following the review, we identified open issues and
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discussed innovative key solutions to future IoT and telemedicine research that can support healthcare services for
different human diseases. In this regard, the current study contributes the following:
1. The classification of current IoT-based telemedicine papers are divided into two categories and form a
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distinct taxonomy in this trend.

2. The human diseases covered by the literature studies are classified into 14 groups and implicitly present a
crossover with IoT-based telemedicine taxonomy.
3. An IoT-based telemedicine healthcare app context lifecycle and sequencing procedure is mapped.
4. Various distribution results and statistics are provided to embrace IoT-compatible telemedicine apps and
prototypes, and a useful table is presented, which contains all disease datasets found in the literature.
5. Motivations, challenges, recommendations and open issues and key solutions that need attention are
provided to ensure that IoT-based telemedicine technologies are robust.
Figure 3 explains a new conceptual diagram of IoT-based ubiquitous telemedicine solutions based on the scope of
the studies presented in this paper.

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Figure 3 Conceptual Diagram of IoT-based Ubiquitous Telemedicine Solutions

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2. METHODS
This study was designed in accordance with preferred reporting items for systematic reviews and meta-analyses
guidelines illustrated in Figure 4 [30]. In the systematic review paper, the researchers should basically avoid relying
on searching a single database for the literature; no single database is likely to contain all relevant references; thus,
supplementary search is necessary [31]. According to previous studies [32][33][34], a solid systematic review
should be conducted on more than one database to cover most articles. Thus far, to improve the chances for best
search results, three major digital databases were selected and searched: (1) Science Direct (SD), which provides
access to a range of journals from various scientific domains, including medicine, science and technology; (2) IEEE
Xplore digital library, which provides various engineering- and technology-related publications; (3) Web of Science
(WoS), which enables access to different articles from various domains. These databases were selected on the basis
of their academic reliability and presentations from different academic disciplines.

Query:
(‘telemedicine’ OR ‘e-health’ OR ‘telecare’ OR ‘telehealth’ OR ‘remote monitoring’ OR

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‘mHealth’ OR ‘medical system’ OR ‘healthcare services’) AND ‘internet of things’
Identification

Records identified through database searching

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WoS = 550, IEEE = 634, SD = 937
(Total = 2121)

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(n = 281)
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Records excluded after

Screening

Records screened reviewing titles and

(n = 1840) abstracts
(n = 1066)
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Full-text studies
Studies judged ineligible
assessed for eligibility
Eligibility

(n = 633)
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(n = 774)
Included

Studies included in
qualitative synthesis
(n = 141)

Figure 4 Schematic Flowchart of Approach for Identification, Screening and Inclusion of Relevant Studies.

2.1 Search Strategy

A comprehensive search was conducted on SD, IEEE and WoS for English-language papers from 2014 to July 2020.
These indices were selected for their sufficient coverage. Most of the studies are related to our research, considering
that the trends of IoT utilisation are highly active in telemedicine applications and medical healthcare services

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during the said period [35][36]. This study utilised Boolean query search using various keywords associated with
pervasive ‘healthcare technologies’ (e.g., ‘telemedicine’ OR ‘e-health’ OR ‘telecare’ OR ‘telehealth’ OR ‘remote
monitoring’ OR ‘mHealth’ OR ‘medical system’ OR ‘healthcare services’) and a keyword that considered all these
terms developed under the concept of IoT. In other words, we used this query to strengthen the search for different
telemedicine and healthcare studies to recover various human diseases within all these terms based on IoT.

2.2 Inclusion criteria

1. The paper is written in the English language and is submitted to a journal or conference.
2. The main aim lies in the development of various health technologies, such as applications, systems,
algorithms, methods, and techniques.
3. The development technologies are only adaptive IoT perspectives such as IoT technologies (invasive/non-
invasive sensors and devices) and IoT network coverage.
4. The analysis of the case-control context of these studies includes monitoring, detection, diagnosis,
prediction, and treatment of different human diseases that involve telemedicine practice and clinical service
types such as

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o store-and-forward telemedicine,
o real-time telemedicine (interactive services) and
o remote patient monitoring.

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Figure 5 summarises a sequence of the presented inclusion criteria.

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Different
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Technologies
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Adaptive IoT
Perspectives
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Healthcare
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and Disease
Prevention
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Telemedicine
Types

Figure 5 Sequences of Inclusion Criteria

2.3 Exclusion Criteria

These sections highlights exclusion criteria for this review including studies in English and those on IoT perspective
but were not linked to healthcare or medicine domain and vice versa. Moreover, articles which included a
technology but did not present a clear scientific method for development were excluded. Notably, a symptom is a
phenomenon experienced by the individual affected by the disease. Therefore, studies presented only symptoms, and
the diseases behind the latter were not mentioned. That type was also excluded.

2.4 Study Selection

After duplicate articles were removed, the next phase involved scanning of papers’ titles and their abstracts by three
researchers according to the inclusion/exclusion criteria. Full-text readings for potentially related articles were
assessed individually by the researchers. Then, those researchers reviewed the entire process including the extracted
tables of data elements in the relevant papers. Disagreements were addressed through consultations with a senior

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researcher (corresponding author). The senior researcher additionally examined and confirmed the relevance of all
papers included in the study.

2.5 Data Extraction and Classification

The current study classified IoT enhancement of the telemedicine and healthcare domains to recover various
diseases and related health problems achieved by different telemedicine context such as monitoring, tracking, and
diagnosis and under IoT concept. Data attributes were extracted from academic literature. To discuss the concept of
IoT perspectives in telemedicine and provide deep analyses, the data extracted include IoT physiological and
environmental sensors; IoT hardware devices; subject fields of target diseases; datasets for different diseases and its
resource, purpose of study, method/technique used, targeted location of patient, and healthcare service types
(asynchronous or synchronous). Then, the extracted data were reviewed by an expert panel. The panel included two
medical informatics specialists and two health information management specialists. The panel compared similar IoT
telemedicine practices from various studies and initiated categories that grouped the relevant studies to a specific
concept (e.g., IoT telemedicine applications). Furthermore, disease classification under the IoT telemedicine
perspective was reviewed and recognised by the medical expert panel based on [37]. We analysed every category

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and attempted to find or create sub-categories and then sections and subsections within this category according to
various telemedicine contexts (e.g., monitoring, detection, and diagnostics) and cross with pure medical
classification for human diseases [37]. The telemedicine contexts were identified in every study of the included

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ones. Thereafter, the sections and subsections were incrementally listed as they were identified.

3. RESULTS
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The initial study selection phase started with around 2,121 articles from the three databases. Upon the completion of
duplication screening, a total of (n = 281) papers were removed which resulted in a total of (n = 1,840) articles. The
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second phase of screening was meant for title and abstract scanning, which resulted in a total of (n = 774) articles.
The following filtration phase was conducted through a full-text reading for identified articles from the previous
phase. A total of 141 articles were screened and determined as relevant to the review based on our criteria (see
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Figure 4). Selected articles were later categorised on the basis of purpose similarity. The first major category
contains (n = 107) articles belonging to (1) ‘IoT telemedicine healthcare services and applications’. Two
subcategories existed in the latter. For the second major category (2), a total of (n = 34) articles were presented
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under ‘IoT telemedicine network’ with the latter also containing three sub-categories. Based on the observed pattern
from these articles, they were grouped and formed into a coherent taxonomy (see Figure 6). Different sub-categories
were identified despite the overlapping. The following sections describe the categories with simple concomitant
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statistics in the figures.

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 ECG
Asynchronous (8)

Healthcare Services (5)

Movement
(9) Synchronous (3)
(4) Physiological
IoT Telemedicine Sleep
Parameter Monitoring
Healthcare Services (3)
and Applications (16)
(107) Pressure
Disease Monitoring
(1)
(21)

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Pulse
IoT-based Telemedicine

Disease Detecting
Single-Condition (1)
(8)

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(67)
(141)

Disease Diagnostics
Multi-Condition (14)

Applications
(98)
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Telemedicine
Disease Prediction
(7)
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Rehabilitation
Topology (10) Diseases Treatment
(6) (1)
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AAL
IoT Telemedicine
Network Architecture (15) (9)
(34)
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Platform
(13)
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Figure 6 Taxonomy of Research Literature on IoT-based Telemedicine

3.1 IoT-based Telemedicine Network

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The IoT-based telemedicine network is one of the vital elements for helping society towards disease prevention and
providing accurate healthcare services [38]. This network supports the IoT applications to access the network
backbone, facilitates the transmission and reception of medical information and data among three tiers and enables
the utilisation of healthcare services for various diseases by utilising tailored communication. Figure 6 presents IoT
medicine topology along with its platform and architecture. Nevertheless, proposed architectures in the work of [2]
can be deemed a suitable anchor towards developing IoT telemedicine network insights. Amongst all of the articles
screened, a total of (n = 34/141) are included in the category. Moreover, despite the absence of a comprehensive and
generalised model analysis, some design issues arise. The following summary is aimed at classifying current studies
related to IoT-based telemedicine network to three trends presenting them.

3.1.1 Topology
Various IoT telemedicine network elements are arranged, with representative scenarios of seamless healthcare
environments. The topology of the IoT telemedicine network demonstrates the compatibility of different tiers in the
telemedicine architecture and enables seamless workflow among all components represented by tiers 1, 2 and 3
under the IoT healthcare network. This sub-category contains (n = 6/34) articles.
A framework aims to set up a service architecture topology using an open telemedicine interoperability hub (OTI-
Hub), which enables bidirectional semantic and syntactic interoperability among healthcare information systems
(HIS), telemedicine instruments (TI) and eHealth smart devices (eHSD) by establishing a cloud-based system
landscape based on the OTI-Hub and the HL7 interoperability standard [39]. An intelligent hybrid context-aware
model called IHCAM-PUSH for elderly patients based on the local components in the event of Internet
disconnections and cloud-based components is used to facilitate the storage and processing of big data generated by

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ambient assisted living (AAL) systems, which are utilised to monitor chronic diseases of the elderly at home [40].
For example, [38], discussed autonomic healthcare management system using technology of fog computing, where
the system is meant for autonomic fall detection leverage wearable IoT technologies; the collected information is
stored in the local database under the personal health record with timestamp enabled for continuous false detection
events; then, the data are uploaded to the cloud server. The following study discussed applying remote monitoring
and management architecture on Parkinson’s disease patients who suffer from freezing of gait (FoG). Their
architecture comprises certain aspects, which include a database, a smartphone app and a web app; the collected
information is stored through the app within the local database, which is later transferred to the central database
when an Internet connection is available [41]. [42] proposed an IoT-based system with four layers for lightweight
transmission algorithm on the basis of big data visualization in telemedicine. The purpose was to enhance the
efficiency of transmission and acquire lossless transmission of the original data workflow. [43] presented a
distributed and scalable computing framework, the purpose of which was to enhance the reliability of
communication for end users of wearable IoT-assisted medical sensors.

3.1.2 Architecture

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Telemedicine architecture highlights the specification of physical elements for IoT telemedicine network, along with
its functional organisation and working techniques and principles. In this section, the IoT telemedicine network
architecture refers to the IoT physical components, devices and wearables as well as their functionality or working

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procedure within the three tiers of the telemedicine architecture network. This sub-category contains (n = 15/34)
articles. A three-layer architecture is presented, which consists of community monitoring centre, home monitoring
nodes and hospital monitoring centre with the IoT technology serving as a core towards combining the concept of
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IoT technology with mobile agent technology to design a remote medical monitoring system [44]. [45] proposed an
architecture for an IoT device based on WBAN application to provide suitability for e-health services through (1)
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network caching and (2) name-based routing instead of IP addresses. The proposed protocol is for 5G-CCN WBAN
to ensure reliable, efficient and secure application of e-health services, which meet the needs of existing IoT devices
and IP protocol stack. The architecture of an IoT-based health-care monitoring system called IoT4HC consists of
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four main components, namely, data collector, analysis, treatment plan generator and treatment plan executor, which
gather health parameters transferred using a LoRaWAN network to a data analysis module [46]. In the work of [47],
an intelligent e-health system was proposed for chronic care through basic building blocks during the design of
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wireless interconnection between Android application and ECG block. Furthermore, [48] presented SmartFog
architecture to enhance analytics in the wearable Internet of medical things; the authors relied on unsupervised
machine learning (ML) for big data analysis to discover patterns in physiological data from telemonitoring of
patients whilst addressing the issues of network bandwidth and resource constraints for IoT devices that
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communicate with the fog node. In [49], an IoT-based architecture was used for the early detection of CVDs based
on wearable 12-lead ECG SmartVest. Four components existed. The first component is a sensing layer by textile dry
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ECG electrode, followed by the second component which is a network layer that utilises Bluetooth, WiFi and others.
The next components include a cloud-saving platform and server calculation. The last one is the application layer
responsible for signal analysis and decision making. For [50], an architecture based on tracking and monitoring
patients suffering from mental disorder was proposed. Based on IoT LoRa, the architecture functions consist of two
elements: first, a client device for tracking is attached to the patient. Then, LoRa gateways which are local servers
and cloud servers connected through mobile cellular or WiFi are installed in hospitals and other public locations
[51]; a LOMB algorithm was discussed for the analysis of heart rate variability (HRV) using PPG sensor on DSP
processor at node device with LoRaWAN IoT eco system. In addition, the analysis of HRV is capable of reflecting
sympathetic and parasympathetic activities on a person’s health condition, and it enables the medical centre to
monitor the patient within the metropolitan area. To monitor patients’ heart condition with ECG collected and data
provided, [52] designed a device which provides a QoS framework for the assessment of wireless services in the
healthcare system. These services can be easily extended to support various networks, which can also determine
jitter size needed to avoid dropout of service to buffer underrun towards ensuring an increased reliability in ECG
monitoring. The architecture of ‘ECG Android App’ in the work of [53] allows the end user to visualise ECG waves
with the functionality of data logging in the background. The infrastructure comprises different technologies
including OIO microcontroller, communication protocols, signal processing, efficient and secure mechanisms for
transferring large files, database management system and centralised cloud. A scalable supported healthcare
architecture with fault tolerance aimed at healthcare covers various fault scenarios, such as malfunction of sink node
hardware, including the traffic bottleneck on a node resulting from the large data receiving rate [54]. The next work
discusses the exploitation of the fog computing concept in start gateways, which supply sophisticated technologies
and services. Some of these services include distributed storage, data mining and notification service on the edge of

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network guaranteed QoS and minimising the number of transmitted data over the network [55]. [56] proposed a
heart rate sensor node for embedded telemedicine system using body-area network and multi-hopping structure.
Overall, MICS band can be utilised to gather signals from sensors and WMTS and transmit these data to a remote
station. Such a procedure allows simultaneous long-range monitoring for several patients. Ultimately, a cyber-
healthcare framework was established around the architecture of multi-layer IoT. Furthermore, implementing the
framework as fog-based CPHS infrastructure with lightweight low-cost devices towards recognising the patient’s
condition is the first step in implementing digital healthcare support systems in the developing world [57]. [58]
designed medical IoT sensor nodes while considering the low cost, power consumption and increased data accuracy,
which is all based on open-access platforms capable of performing medical checks. A communication protocol was
developed among sensors local gateways, smartphone devices.

3.1.3 Platform
This section discusses the platform in IoT telemedicine domain, which is referred to as network platform model and
the computing platform. The sub-section contains (n = 13/34) publications.
In [59], the studies discuss a smart home platform called iHome Health-IoT, which enables a seamless fusion

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between IoT devices and in-home telemedicine towards improving patient experience and service efficiency.
Furthermore, it would include an open-platform-based intelligent iMedBox with improved connectivity and
interchangeability for integrating devices and services, iMedPack and Bio-Patch device [59]. A distributed

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coexistence IoT-based smart medical system in WBANs is proposed in [60]. The system comprises two phases: the
channel planning phase and medium access adjustment phase, which can dynamically avoid interference in a
coexistence situation. In addition, the system would guarantee a reliable distributed communication. A study is
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proposed to infer sensed data by applying beacon data points after the data processing inference using variance rates
used cloud servers in the production network provided by Intel and Fitbit. It gathers the sensed data using the
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smartphone and provides export to the PC upon request for data processing [61]. In [62], an asset called locate was
designed. It is a tracking system which incorporates different technologies including (1) cloud, (2) IoT and (3)
802.11 wireless technologies. It aims to provide a cheaper alternative to traditional real-time monitoring systems. It
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integrates WiFi signals (802.11), with others including embedded systems, cloud computing platforms and wireless
networking towards implementing IoT-centric solution for an RTLS in a health care environment. A design of
common recognition and identification platform (CRIP) is a part of the CareStore project. This project offers sensor-
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based assistance for seamless user identification other than health devices. It is also implemented with the use of
various technologies. The latter enables seamless integration and interaction of sensors and patients [63]. An
optimisation scheme is developed for a large-scale network of patients in a parallel, distributed manner to improve
computation efficiency in the Internet of Hearts (IoH), which enables the network optimisation into multiple
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processors for parallel computing [64]. Incorporating compressive sensing in monitoring platforms, which are IoT
based, and comprises a CS-based compression and recovery, whilst supplying abnormality detection for every single
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heartbeat in which the random sensing matrix with entries drawn from normal distribution is utilised for the
compression of data where the algorithm of SP recovery is meant for an efficient ECG signal reconstruction [65]. A
similar study quantifies the performance of CS-based scheme for vital sign acquisition for a connected health
application over an IoT platform taking multichannel EEG signals as well as a designed sparsifying basis to increase
the sparsity of the EEG signal towards improvement of the quality reconstruction and system efficiency [66]. [67]
discusses a monitoring system for wireless and wearable ECG. The monitoring system is embedded in IoT platforms
and integrates heterogeneous nodes and applications. The system has a long battery life whilst providing a high-
quality ECG signal. That scheme enables the monitoring of several patients on a large indoor area. [68] discussed a
conceptual framework for modelling purposes to execute a flexible and arbitrary clinical knowledge for complex
networks of processes, including analysis, monitoring, decision and effectuation. Accordingly, the designated
functionality of decision support can be distributed at runtime by mapping various knowledge portions across the
devices, which in turn constitute the system. In [69], Amrita IoT Medical (AIM), which is an IoT-based smart edge
system for health tele-monitoring, was proposed. The system contains wearable sensors which transmit vital data
into the following two novel software engines: (1) rapid active summarization, which is in charge of effective
prognosis (RASPRO) and (2) criticality measure index (CMI) alerts, which are implemented for cardiac diseases
and acute hypotensive episodes. An IoT platform was established in [70] for the e-health system in which it supplies
enriched tele-health data with context information done through aggregation and the pre-processing of cross-domain
inputs from several sources. The next work of [71] sheds light on the dynamic network algorithm development for
mobile and e-network smart health (MESH). Such development aims to advance IoH with wireless sensors, with
smart mobile devices and big data analytics, enabling the doctors to have remote access to their patients’ ECG

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signals in real time, anytime and anywhere. This process enables them to interact with patients and rapidly respond
to life-threatening cardiac disorders.

3.2 IoT in Telemedicine Healthcare Services and Application

This category contains 107 out of 141 articles and is divided into two sub-categories as detailed below. Studies in
this category achieved various telemedicine aspects by either healthcare service models or applications.

3.2.1 IoT Telemedicine Healthcare Services

Within the healthcare settings, no standardised definition exists for healthcare services based on IoT. Nevertheless,
some cases existed where a service cannot be differentiated objectively from a specific application or solution. This
study suggests that healthcare services in telemedicine technologies have two general types that most ‘sharing’
technologies tend to fall into, namely, asynchronous (store-and-forward) and synchronous healthcare service (live
real-time) technologies [72][73]. In addition, although studies in the next sub-category ‘IoT Telemedicine
Applications’ provided or mentioned the healthcare service types, the main contribution and enhancement of the
studies in this sub-category are precise towards the development of intelligent IoT telemedicine healthcare services
for treatment of various diseases. This sub-category contains 9 out of 107 articles as detailed below.

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3.2.1.1 Asynchronous Healthcare Services

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Although the store-and-forward healthcare services are based on IoT perspectives, the concept for this type does not
involve live interaction with patient data as they are being collected [72]. Instead, the patients’ data such as records,
scans, and images, are collected and sent to the medical institutes or professionals. Then, they can analyse them as
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though they were in the clinic when such information was collected. This section contains (n = 5/9) articles.
In an edge and cloud architecture leveraging wearable IoT for providing cloud-based clinical services, such as
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alarm, phone call or text messages using human activity data transfer for storage and retrospective analysis, the
services are triggered when prescribed activities are not performed by patients [72]. A micro services model in a
web of objects platform enabling IoT services supplies a development base of interoperable micro services which
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support dynamic features by utilising streams of sensory data [74]. The development of a class of intelligent
mHealth services in telemedicine aimed at introducing reference scenarios of personalised assistance focuses on
emergency cases. It functions by operating within a common networked computing environment. Moreover, it
interacts by sharing information and its semantics [75]. [76] presents a home healthcare matching service system
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that enables patients to feel that the system is in charge of their healthcare while licensing requirements, legal
requirements and travel schedule restrictions of the healthcare professionals are met. [77] developed an IoT-based
smart e-health care system that includes sensors, mobile apps, Bluetooth, and cloud. The system introduced offline
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accumulation of sensory data which is automatically uploaded to the cloud on availability.

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3.2.1.2 Synchronous Healthcare Services

Real-time services in the healthcare domain are supposed to possess characteristics including immediacy and ability
to remotely supply healthcare providers with live access through video conferencing or live streaming medical
images and videos, among others [78]. This feature enables a true interactive experience in which patients and
physicians can make clinical assessments similar to those conducted in face-to-face appointments. This section
contains (n = 4/9) articles.
In Sweden, a simulation study in the context of BoIT projects investigates the utilisation of various IoT devices such
as a care phone device, with the aim to start a voice over IP (VOIP) connection with caregivers or relatives [73].
Aspects linked to IoT and decision support systems (DSSs) are intended to offer healthcare which is both preventive
and intelligent in designing IoT healthcare platform and DSS components [78]. [79] proposed medical IoT
architectures based on LoRa dedicated to homecare and hospital services. The study analyses and improves every
component of the IoT architecture to develop reliable platforms to improve real-time e-health services. [35]
proposes a remote healthcare system between the patient and the doctor, which is called telemedicine and is
classified under IoMT by multiple medical sensors to connect to a server using multiple communication
technologies.

3.2.2 IoT-based Telemedicine Application

Aside from IoT telemedicine healthcare services, the IoT telemedicine applications have attracted close attention
[80]. Healthcare services in telemedicine are utilised towards developing telemedicine applications that can be
directly used by patients. Therefore, healthcare services and applications are closely associated, and separating them
in terms of workflow is difficult. The application presented in this category leads to various healthcare solutions in
the monitoring context, detection and diagnostics for various diseases. This sub-category contains (n = 98/107)

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articles and is also divided into four sections addressing various IoT-based telemedicine applications, including
single-condition, general-condition, telemedicine rehabilitation and AAL applications.

3.2.2.1 Single-Condition Application

This section discusses a single condition or a disease. IoT telemedicine applications in this section are divided into
six sub-sections and designed to help patients meet specific requirements for form, fit and function based on only
one disease. This section contains (n = 67/98) articles as detailed in the following.

3.2.2.1.1 Physiological Parameter Monitoring

Studies in this sub-section enable human physiological parameters to continuously monitor the patients during life
activities. IoT technologies adapting those parameters provide medical institutes immediate knowledge about sudden
health state changes and can be integrated with other contributions such as disease monitoring, detection and
prevention [81]. The concept is established for home use by patients to eliminate life-threatening situations and
support their surveillance by the family or remote doctors. The concept of these studies can effortlessly protect many
patients’ lives against human diseases. This sub-section contains (n = 16/67) articles including four parameters as
discussed in the following.

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3.2.2.1.1.1 Electrocardiogram (ECG)

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A revolutionary IoT-based ECG monitoring system was discussed by [82]; the system called Tele-ECG assists in
monitoring cardiac health within a telemedicine environment. Although the system is as competitive as an ECG
from a specialist’s office, the system enables basic monitoring by which analysing the patient’s evolution over time
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is possible. ECG is considered amongst the most characteristic representatives of heart work whilst representing
recorded electrical activity of the heart from electrodes on the body surface [82]. The ECG physiological parameters
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measure the electrical heart vector variation and heart work rate [83]. ECG parameter contains (n = 8/16) articles.
[84] discussed a monitoring framework for enabling health IoT. Their framework was meant for collecting ECG
data along with other health care data through mobile devices and sensors. The authors also discussed the secure
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transmission of these data to the cloud, thereby enabling health professionals to obtain seamless access. Other
researchers [83] proposed a system for 12-Lead ECG; they discussed that previous systems were costly and required
a large setup size, which is why their proposed system is portable and demonstrates effective results in ambulatory
systems; it can also transfer the ECG to medical professionals from a remote location to any location around the
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globe. A low-cost IoT-based ECG health monitoring system with automatic analysis and notification comprises
energy-efficient wearable sensor devices and a fog layer; the sensor nodes transmit the vital signs to a smart gateway
accessed by caregivers specialising in cardiovascular diseases [81]. An IoT architecture was proposed by [82] to
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monitor ECG signals of a patient using his/her mobile tele-ECG, where the monitoring of health is possible without
requiring a doctor’s involvement. A health care system implementation scheme using hidden Markov model (HMM)
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chain and ECG sensors was discussed by [85] with the aim to provide an enhanced monitoring along with timely
intervention for patients suffering from CVD. Then, the development of an ECG monitoring system was discussed
by [86] where the system is simultaneously accessible to various users for ECG signal media and data transmission.
Finally, a design, implementation and development of research on monitoring via ECG were proposed by [87]; they
discussed their connection to the cloud server through an Android mobile phone. [88] designed Tele-ECG and heart
rate monitoring system for several telemedicine benefits such as emergency request, both manually and
automatically, and the ability to follow multiple patients through smartphone, server side and webpage.

3.2.2.1.1.2 Movement
In the domain of telemedicine applications, the recognition of human actions along with the falling risk access of
patients is considered vital and helpful to alarm patients to do exercises or have a rest [89]. Subsequently, a large
number of medical applications or frameworks based on IoT have been proposed to monitor health or human
physiological diseases. Movement subsection contains (n = 3/16) articles.
The work of [90] discussed fabricating an e-textile device as some glove-woven components including Arduino, flex
sensors and laptop to collect data from the gloves and have them transmitted to a patient app. The purpose was to
monitor some of the motor symptoms of Parkinson’s disease. Subsequently, [89] introduced a sensing system based
on Wi-Fi signal; the system is capable of detecting human movements indoors from the whole motions of the body.
The system uses Dopple which enables the underpinning of on-intrusive and full-coverage healthcare IoT platform
in-home. A motor condition system for assessment was developed by [91] for patients suffering from progressive
neurodegenerative disease. The system components included an Android mobile phone that functions as a
communication gateway as well as a Linux-based server.

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3.2.2.1.1.3 Sleep
Among sleep disorders, obstructive sleep apnea is the most common type with breathing. The term ‘sleep disordered
breathing’ is widely utilised in countries such as the US to describe breathing issues during sleep where insufficient
air can reach the lungs (e.g., hypopnea and apnea) [92]. Sleep-disordered breathing can increase the cardiovascular
disease risk, including other diseases such as high blood pressure, stroke, arrhythmias, diabetes and accidents [92].
Sleep parameter is contained in (n = 3/16) articles.
[92] discussed the implementation of a sleep monitoring system through wireless polysomnography based on IoT.
The system uses a battery-powered and a unit for ambulatory biopotential acquisition, as well as a friendly interface
for monitoring and recording. [93] utilised IoT sensors for the accurate classification of sleep patterns through
precise and sufficient data collection, as well as a hybrid of deep belief network (DBN) and long short-term memory
(LSTM). An ubiquitous central monitoring system of remote IoT bio-signal technology was patented in [94]. The
system is attached to a bed using a thin strip sensor, and then the user’s sleep efficiency and respiration rate can be
measured.

3.2.2.1.1.4 Pressure

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The second physiological parameter for describing the heart’s work is blood pressure. The pressure physiological
parameters measure the systolic and diastolic blood pressure and heart rate [95]. Pressure parameter is contained in
(n=1/16) article. A non-invasive optical fibre sensor architecture adaptable to a shoe sole for plantar pressure remote

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monitoring integrated with IoT e-Health solution to monitor the individuals’ well-being was developed by [95].

3.2.2.1.1.5 Pulse
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Pulse is one of the most significant physiological parameters. It is defined by arterial blood oxygenate measuring
light absorption by blood [96]. The pulse physiological parameters measure the heart work rate [95]. The pulse
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parameter is contained in (n=1/16) article. An IoT monitoring system adapted into lateral rotation mattress is utilised
for bed-bound patients through a pulse sensor to recognise discomfort in patients and alleviate it via an intelligent
IoT system [96].
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3.2.2.1.2 Disease Monitoring

Certain medical conditions require monitoring patients in the long term, especially chronic disease cases [97].
Therefore, continuous monitoring for such cases is essential. This sub-section contains (n = 21/67) articles; IoT
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applied to the monitoring of patients throughout several sensors, parameters and IoT devices only provides limited
and specific recommendations in the case of changing patient’s health condition focusing on endocrine and
metabolic disorder and diabetes (7 articles), cardiac disease (7 articles), psychiatric disease such as Alzheimer’s (3
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articles), neurological disease such as abnormal movement and gait disorder (1 article), epilepsy (1 article)
autonomic nervous system (ANS) (1 article) and respiratory disease (1 article).
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The monitoring of blood glucose reveals changes in the different patterns for individuals, and the latter assists in
meal planning, medication times and activities. In the work of [98], a system architecture was designed from a
sensor device. The system was targeted to present real-time data for body temperature and glucose plus contextual
data (i.e. environmental temperature). Such data would be in graphical and human-readable forms for end users such
as medical specialists and patients. A novel distributed software was presented by [97], who discussed remote
monitoring infrastructure for patients who suffer from chronic metabolic disorders. Some of the system activities
included activity tracking, smart scales, pulse oximeters, BP and glucometers. The system was also equipped to
perform analysis, which would assist the medical diagnosing procedure. The system is also capable of promoting
bidirectional communication between patients and doctors. [36] offered a platform based on telemedicine for
diabetes management and control to assist patients in recording and monitoring their vital signs and diabetes and
supplying them with feedback. [80] discussed the digital innovations deployed in the IoT test bed and described the
architectural solution underpinning the diabetes digital coach platform. In the work of [99], a management
intervention approach based on IoT was proposed for Type 1 diabetes (T1D), which focused on different aspects
including functionality, structure and process of MyDay development. It is a solving tool for multi-faceted self-
management issues for paediatric T1D patients. Another approach for mHealth based on the IoT platform aims to
support diabetes self-management to allow for other diabetes care dimensions. This goal is accomplished through
information collection and patients’ remote monitoring, and provision of customised and personalised feedback on a
smartphone platform [100]. A tele-care system is set up for diabetic patients and caregivers. The system is
interactive and can increase the quality of self-care. This feature is accomplished through the adoption of IoT
technology, whilst enabling a direct patients’ medical device communication with their caregivers using
smartphones [101].

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A human activity recognition (HAR) system based on IoT is aimed at remotely monitoring the vital signs of chronic
heart disease patients; the system is composed of two modules working independently: a traditional HAR system
and an e-health application of any recognition or surveillance system [102]. IoT-based heart monitoring system
composed of data collection and data transmission makes use of patients’ physical signs (BP, ECG, SpO2, HR, pulse
rate, blood glucose, blood fat) and patients’ location connected with real-time remote medical applications; it is also
designed to be sampled at different rates, continuously taking patients’ risk conditions [103]. [104] proposed a new
approach called heart monitoring through perceptual computing (HMT Per-C), where a patient’s medical condition
is assessed to determine the risk of heart failure. This approach works by having the user feedback processed in
terms of ‘words’ and providing recommendation for needed medical attention. Then, [105] presented a system
infrastructure for pervasive patient health monitoring (PPHM). The infrastructure was based on IoT technologies
along with integrated cloud computing for monitoring patients in real time, specifically those who suffer from
congestive heart failure monitored through ECG; the rationale for ECG was the need to demonstrate the suitability
of the proposed PPHM. An efficient, low-cost, low-power IoT medical system for ECG monitoring based on IoT
techniques of cardiac patients but with greater memory autonomy was implemented, and the paper presents a
qualitative and embedded application [106]. In [107], a methodology is presented for real-time monitoring of ECG

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signals implemented on an IoT-based microcontroller platform to continuously monitor the cardiac condition. [108]
proposed a novel healthcare-based fog cloud system and IoMT to collect, analyse, and determine the process of
critical tasks of the heartbeat medical application for cardiovascular disease.

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A mobile tele-health infrastructure based on IoT for monitoring patients staying at home and suffering from
Alzheimer’s through ECG and RFID for KFUPM Medical Centre in Saudi Arabia was proposed by [109]. A
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cognitive stimulation therapy novel system was proposed by [110]; this study discussed from the social care
perspective how the cognitive impairment and emotional well-being of dementia patients is assessed. In addition, the
study discussed providing a therapy which is adaptive and computer-assisted to minimise therapist input on
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assessment and plan formulation. [111] discussed an assistive technology for patients suffering from dementia; they
came up with a framework monitoring assistive IoT along with wearable devices to address some of the barriers
faced by the patients in completing their everyday activities, whilst using data analytics such as real-time complex
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event processing which in turn enables better monitoring.

An IoT-based system for remote monitoring patients utilised wireless inertial sensors with movement disorders
applied for dystonic tremor monitoring for patients with spasmodic torticollis [112]. An efficient algorithm was
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developed by [113] to successfully maintain high scalability of the proposed solution with respect to memory usage,
processing time and energy consumption. The approach can efficiently support data portioning and parallelism by
relying on the MapReduce platform that can analyse real-time series big EEG data. This platform can assist in
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monitoring epileptic seizures. [114] presented a novel wearable ring sensor for the continuous measurement of ANS
using wearable biosensors in mobile healthcare applications. In the work of [115], electronic monitoring devices
were given to seven adolescents to monitor their inhaler usage for a month; such SmartTrack device for asthma is
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amongst the emerging devices and technologies within IoT.

3.2.2.1.3 Disease Detection

In clinical settings, the term ‘detection’ often refers to detecting a problem or an issue (i.e. symptoms) objectively
[116]. Such a problem can also be subjective but credible at the same time, such as a patient complaining about a
sickness whose symptoms are not visibly apparent (i.e. back pain). It is an art or skill of identifying some
abnormalities, which are below or higher than the normal permissible range/threshold.
Studies in this section refer to ‘detection’ with implicit medical direction and are integrated with few other contexts
such as recognition, prediction and prevention. However, a brief description of the ‘detection’ process for each study
described below explains how it is integrated with other medical contexts. This sub-section contains (n=8/67)
articles. Studies in this section focus on cardiac disease (4 articles), infectious diseases such as nondemic influenza
(H1N1), Ebola, and mosquito-borne (3 article) and neurological diseases such as cerebral stroke (1 article).
[117] discusses live video streams which aim to measure multiple people’s heart rate (HR) simultaneously by
utilising face detection in combination with object tracking to produce a set of face rectangles based on ML. [118]
presented an early warning of cardiovascular disease framework based on IoT; its main functions include context
recognition, abnormality detection and risk predetermination by utilising knowledge engineering and data mining
methods and discovering and refining personal situation knowledge through the service centre. An IoT system was
developed by [119]; it discussed remotely acquiring patient reading from ECG sensor other than the human body
and having it processed to intelligently predict arrhythmia and immediately sending an indication alarm to the
doctor. [120] constructed a triage algorithm called RLLT within a new framework (FTF-mHealth-IoT) in mHealth
(Tier 2) for detecting patients’ emergency case for chronic heart disease and then identifying the healthcare service

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package of the risk level. An architecture for smart monitoring, predicting, preventing and detecting an airborne
H1N1 flu using random decision tree, cloud computing and social network analysis is proposed in [121]. A novel
architecture presented for detecting Ebola in real time was proposed by [116], the IoT-based system along with
mobile phone, RFID and cloud computing were used for early stage prevention of the spreading infection. For
evaluation purposes, a J48 decision tree was used to assess the level of infection depending on the symptoms of the
user. In the work of [122], an intelligent healthcare system based wearable, IoT sensors and fog computing are used
to analyse, categorise and share medical information among the user and healthcare service providers to differentiate
the various mosquito-borne diseases (MBDs) based on the patient’s symptoms. A detection solution was proposed
by [123] for the detection of cerebral stroke. The detection solution uses cloud services for data analysis and storage
to provide statistics to public institutions.

3.2.2.1.4 Disease Diagnostics

To ‘diagnose’ a problem is to ensure that the specific medical condition is causing the problem [124]. The diagnosis
application process aims to determine which disease or condition explains a patient’s symptoms and signs [125].
Studies in this section refer to ‘diagnostics’ with implicit medical direction and are integrated with other contexts

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such as detection, recognition, prediction, prevention and treatment. However, a brief description of the
‘diagnostics’ process for each study described in the following explains how it is integrated with other medical
contexts. This sub-section contains (n=14/67) articles. Studies in this section focus on infectious diseases such as

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transmitted diseases (3 articles), oncological diseases such as lung cancer (3 articles), ophthalmological disease (1
article), dermatological disease (1 article), psychiatric diseases such as mental illness (1 article), cardiac disease (1
article), community medicine and general practice (1 article), renal disease (1 article), gastrointestinal diseases such
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as ulcerative colitis (1 article), and rheumatological disorder and rehabilitation (1 article).
[126] proposed a novel system based on IoT sensors to monitor, classify and distinguish patients infected by MBDs
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at an early stage. The system aims to control the MBD outbreak by calculating the similarity factor to differentiate
between MBDs and then using J48 decision tree classifier for the classification of infectious categories for every
user. The detection, diagnosis and prevention of users infected by Chikungunya virus (CHV) was also discussed,
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where fog-based IoT system consists of three layers, namely, (1) IoT sensor layer, (2) fog layer and (3) cloud layer
with the decision tree utilised for the classification of user’s category infection depending on health symptoms [124].
In addition, a wearable IoT sensor-based healthcare system is proposed to identify and control a CHV outbreak.
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Fuzzy C-means is utilised for diagnosing potential users who might be infected and immediately providing diagnosis
emergency alerts to them from fog layer [127].
[128] searched the construction of segmentation regions within a small area to improve the results of the
segmentation with the use of numerical modelling of IoT and computer-assisted image analysis. Segmentations of
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slices were generated by using volume data with linear equation for chest CT images. An IoT decision support
system with computer-assisted diagnosis was proposed by [129]; the system uses a novel deep learning-based model
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for early classification and detection of pulmonary cancer, and it diagnoses four stages of lung cancer. Metastasis
information was acquired from Medical Body Area Network. A wrist pulse signal processing method for diagnostic
and treatment with an insight from Jin’s pulse diagnosis (JPD) and enabled IoT cloud is proposed and an iterative
slide window algorithm was developed to segment the de-noised signal into single periods for people with lung
cancer [130].
[131] proposed an IoT healthcare hybrid architecture, where retinal images captured with smartphone fundoscopy
are processed with super-resolution (SR) algorithm and using multi-kernel support vector regression (SVR) for
quality improvements of the images. A deep neural network system named dermatosis discrimination assistant
(DDA) was proposed to classify images of dermatosis generated using confocal laser scanning microscopes; in this
system, diagnosing seborrheic keratosis (SK) and flat wart (FW) were used as examples [132]. A multi-agent system
run on commodity hardware such as Raspberry PI, smart phones or Arduino for the remote monitoring and detection
of elderly patients with mental disorder diseases based on ontology-based diagnosis between sensors, symptoms and
diseases in the IoT paradigm is presented by [133]. A telemedicine auto-diagnosis application called My Kardio,
which is based on M2M and kNN algorithm for cardiovascular patients to assist the doctor in conducting a
diagnosis, uses a sphygmomanometer, heart rate, diagnosis and ECG and others where the data along with the auto-
diagnosis are sent to the server through the Internet [125]. A cloud and IoT-based mobile healthcare application has
been developed and implemented for predicting and diagnosing the severity of diabetes; fuzzy rule-based neural
classifier and IoT devices are used, which function on the basis of sensors [134]. A field programmable gate array-
based computer-aided diagnosis (CAD) algorithm was used for abnormality detection of the kidney in an ultrasound
image-based IoT-enabled ultrasound system based on look-up table approach and support vector machine (SVM)
with multi-layer perceptron classifier [135]. [136] presented a novel IoT-fog-cloud assisted cyber-physical system

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for diagnosis and stage classification of ulcerative colitis. A vital point of this study is real-time alert generation
from the fog layer in case the user needs emergency treatment if he/she has been diagnosed with UC. [137] studies
the application of IoT technology in sports injury medical system, and expounds on the application of telemedicine,
mobile diagnosis and user data management supported by IoT technology.

3.2.2.1.5 Disease Prediction

Predicting the disease probability and intuition preventive schemes are derived from the field of predictive to either
prevent diseases or largely minimise their effect on the patient (e.g. by preventing mortality or limiting morbidity).
Concurrently, developed applications for services, such as diagnosis and therapy, can potentially aid the prediction
of support conditions of diseases [138]. Furthermore, prediction within the system can assist in delay avoidance for
timely medical treatment even before the individual reaches a critical condition [139]. This sub-section contains
(n=7/67) articles. Studies in this section focus on cardiac disease (3 articles), psychiatric disease such as emotional
disorder (1 article), renal disease (1 article), endocrine and metabolic disorder and diabetes (1 article), and
community medicine and general practice (1 articles).
In the work of [139], a prediction approach based on ML was proposed; this approach utilises heart rate variability

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(HRV) analysis along with ML based on monitoring through IoT. The approach also utilises a wearable 3-lead ECG
kit and concentrates on performing real-time analysis for the detection of arrhythmia, thereby predicting and
identifying heart risk. A stroke disease diagnostic and prediction system is proposed based on IoT and ML with the

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use of a connected microcontroller for various wearable sensors and cloud; the critical data are sent to the prediction
system to test and predict whether the patient has a high risk of stroke or not, and the system subsequently alarms
the doctor [140]. [141] proposed a healthcare system which is IoT-fog-based to continually monitor and analyse
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blood pressure statistics to predict the risk level of hypertension attack in users at remote sites. [138] discussed an
emotion-aware smart systems algorithm which is capable of starting prediction for women with hypertensive
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disorders during their pregnancy or postpartum depression. IoT sensors enable the collection of real-time data and
ML algorithms are used in analysis; this procedure occurs in the healthcare cloud service provider to evaluate a
pregnant woman’s current condition. For effective medical services, [142] introduced an online medical decision
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support system for chronic kidney disease prediction based on IoT and cloud platforms. [143] proposed a Freestyle
Free sensor that allows continuous monitoring of the blood glucose rate by integration between the patient and the
near-field communication sensor over an IoT card, which sends the data collected for the LibreMonitor mobile
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application. [144] proposed an mHealth approach encouraged in the concept of IoT for daily human activity
recognition recorded through accelerometer sensor using S transform and a supervised regularization-based robust
subspace learning method.
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3.2.2.1.6 Disease Treatment

Medical treatment excludes diagnostic procedures and focuses on caring for a patient to combat disease or disorder
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[145]. In telemedicine applications, the treatment can include the use of any device or system designed to remotely
treat parts of the body. This sub-section contains (n=1/67) article focusing on ophthalmological disease. An
optoelectronic controller chip is designed and can be mounted on a patient’s head to control the micro light-emitting
diode (LED) matrix which can help in treating patients who suffer from retinal prosthesis and stimulate retinal
ganglion cells which have been genetically modified to restore partial vision; an individually addressable low-power
micro LED array is designed, and the results are reported [145].

3.2.2.2 Multi-Condition Application

General-condition applications address a number of diseases or conditions as a whole [146]. IoT telemedicine
applications in this category are designed to help patients meet general requirements for form, fit and function based
on various diseases. This section contains (n=12/98) articles. Most of these applications are conducted in community
medicine and general practice (7 articles), psychiatric diseases such as emotional disorder and mental illness (3
articles), geriatric medicine (1 article) and neurological disease such as abnormal movement and gait disorder (1
article).
A system is developed in [147] for remotely monitoring incorporated application in patients by using a sensor-
integrated shoe and waist belt for different purposes such as measuring, transmitting and storing foot sole vital
pressure points to an IoT cloud. The system can also track location and detect a fall. It is capable of detecting
diabetic foot ulcer aggravations and remotely monitoring patients with Parkinson’s disease and neuropathic
recovery. [148] developed an ontology-based architecture for IoT, monitoring the routine of workout and health
recommendations aimed for patients suffering from chronic diseases. A mobile phone-based IoT approach was
proposed for recognising human actions; in the work of [149], data collection is initiated using a smartphone. The

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latter is worn on the waist to transmit data into the application server to cut these data into different segments. Then,
a geometric template matching algorithm is used to classify these segments into different actions. In [146], an IoT
intelligent m-healthcare system was proposed to recognise human activity with the use of user-dependent data
mining techniques, which would examine human behaviour. An activity recognition technique and a dataset from
two sensing modalities, namely, Kinect Skeleton pipeline and Smartwatch inertial measurement unit (IMU) are used
to improve assistive functions related to sitting posture detection in an intelligent IoT environment and two-level
security scheme. The security scheme comprises key establishment and two-factor authentication [150]. [151]
discussed a module prototype for recognising activity and collecting data. The aim was to assist the data collection
process to help train personnel responsible for patient diagnosis, especially patients with disabilities, through the use
of IoT technologies. [152] designed an IoT-based wearable sport health monitoring system in real time in addition to
body sensor network (BSN). That system was utilised in sports training, biomedical, monitoring of daily activities
and other fields to establish a new way of thinking about telemedicine and home health care. [153] discusses
assisting elderly patients in a smart home environment through a system that uses camera and image processing on
IoT automatically along with features for recognising and detecting emotions. The patient state is considered for the
system because it is a main factor in their disease recovery. A powerful system based on 5G was proposed by [154];

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it is meant for recognising emotions and linked to a large big-data system in healthcare institution. The system also
has a superior detection module for emotion and it uses IoT-connected devices to capture speech signals and images
in a smart home environment. The development of mobile application as a tool can remember activities and possible

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lost objects based on IoT to help adults with attention deficit and hyperactivity disorder (ADHD), which causes
perceptive in behaviour and usually affects sleep and activities [155].
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A context-aware IoT mobile application uses built-in sensors, and other external sensors that gather the context of
multidimensional health assessments are performed by the sick person, enabling him/her to monitor the activities
and analyse the data to assess their functional status [156]. A new approach for the recognition and monitoring of
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real-time activity called basket-based sorting structure identifies the correlation between sensor events to identify the
events of sensor (SEs) in concurrent activities and have the correlated SEs stored into the SE container instance
(basket) for further prediction purposes [157].
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3.2.2.3 Telemedicine Rehabilitation

Telerehabilitation is identified as a means of virtually delivering services of rehabilitation to the patient’s home;
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such methodology has demonstrated benefits when it was utilised to enhance and replace traditional means of
therapy to overcome geographic, physical and cognitive barriers [158]. Rehabilitation systems can be improved by
the IoT with respect to addressing problems associated with the ageing population and health expert’s shortage
within telemedicine applications [159],[160]. This section contains (n=10/98) articles. Studies in this section focus
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on rheumatological disorder and rehabilitation (8 articles), community medicine and general practice (1 article) and
neurological diseases such as abnormal movement and gait disorder (1 article).
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The system discussed by [161] is for telerehabilitation that utilises wearable muscle sensor and Kinect. Both are
used to conduct interactive personalised physical therapy, which can be done at home and allows for faster recovery
for stroke patients using serious games. An application of wearable devices, video games and IoT aims to facilitate
the rehabilitation process of patients, whilst remote monitoring is enabled to allow the process of rehabilitation of
patients who suffer from disability in their upper limb as a result of stroke [159]. A sensor device and real-time
therapist application are proposed on the basis of three feedback systems. The latter employs IoT, wearables, big
data analytics, cloud and various cutting-edge technologies which are involved in the rehabilitation therapy
evaluation of swimming exercises such as stroke time and stroke rotation angle symmetry [160]. A rehabilitation
assessment system was proposed by [162] based on IoT for stroke survivors based on different aspects including a
sub-system for sensing, data cloud, cloud computing and Android-based software. A wearable IoT-based system for
monitoring physical rehabilitation and characterisation of the elbow can record movement data with tri-axial
accelerometer and gyroscope using sensors for movement characterisation, which will in turn allow patients’ state
monitoring and estimation at all times [163]. [164] discusses a system for the rehabilitation of remote upper limb
aimed for post-stroke patients. The system uses interactive digital media (IDM) and BSN for acquiring patterns of
body motion. In addition, the system would be reconstructed in 3D activity recognition (AR) with gaming
technologies which are interactive and immersive. To assist people’s progress in physical rehabilitation tasks, [158]
proposed a designed system which can enable the remote monitoring of telemedicine track movements. System
components include modular electronics to act as matrix interface for 32 bendable force sensors assembled on a
flexible PCB. In [165], produced an intelligent sports health vital sign acquisition system explores the effects of
wearable medical devices in vital sign monitoring namely, ear temperature, pulse, blood oxygen saturation, and
blood pressure, which is the key to telemedicine rehabilitation. A processing function for treatments, namely, AR

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and movement recognition, can use smartphones equipped with sensors, such as accelerometer and IoT elements,
which are advantageous in detecting specialised movements needed in rehabilitation protocols for lower and upper
limbs [166]. Lastly, a system for the long-term monitoring of children with movement disorders is proposed by
[167]; the authors discussed that the movement disorder system comprises some sub-systems in Malaysia. Those
subsystems will be responsible for collection, detection analysis, transmission and storage of the different
parameters of gait.

3.2.2.4 AAL
In general, traditional IoT-based medical service and smart home should by default provide the elderly with
specialised services. That is, a separate IoT service is mandatory. AAL is ‘an IoT platform which is enabled by
artificial intelligence to address [the] healthcare of the elderly and incapacitated individuals’ [168]. The goal of AAL
is to conveniently and safely extend elderly individuals’ independent life in their homes [169]. AAL services are
able to meet the expectations of individual elders, which ensures greater autonomy, in addition to providing
assistance similar to what is provided by a human caregiver when a problem arises [170]. Several studies combine
ambient intelligence with telemedicine solutions based on the IoT, thereby improving the quality of life amongst the

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elderly. This section contains (n = 9/98) articles. Studies in this section focus on psychiatric diseases such as sleep
disorder and depressive disorder (3 articles), geriatric medicine (3 articles), community medicine and general
practice (2 articles) and neurological diseases such as abnormal movement and gait disorder (1 article).

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IoT-based unobtrusive sleep monitoring pillow is capable of monitoring patterns of breathing and overall sleep
quality of AAL, quantifying five variables whose thresholds can be varied among medical staff. An intelligent
algorithm enabled by the system employs and processes decisions to enhance the AAL system [169]. A system for
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the detection and treatment of elderly depression based on IoT, context awareness and the concept of e-health is
proposed to determine the activities of daily living (ADL) through gesture recognition log events towards
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determining abnormality as a means to conclude the variations in the ADL [171]. [172] proposed a hybrid real-time
remote monitoring framework based on IoT which monitors the condition of elderly patients suffering from chronic
disease and addresses the disadvantages of local and cloud AAL architecture to develop smart healthcare services
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that have great prediction capabilities.

[173] discussed an enhancement method for elderly assisted living. This process is done by incorporating indoor
positioning system (IPS) and non-vision-based motion tracking assisted living services including emergency panic
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button and medical adherence system into the IoT platform. [174] proposed a real-time health monitoring system of
older adults living in geriatric residences to help caregivers monitoring their patients and have closer communication
with their patients’ family members. [175] proposed a scalable telemedicine system based on mobile IoT devices
that can monitor thousands of older adults, detect falls and notify caregivers through the cloud and on the edge.
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A multimodal sensing to detect existing situations and predict future situations is proposed with the use of decision-
tree and association analysis algorithms for activity recognition of the elderly in IoT–AAL smart homes
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environment; it allows for responses to accidents and emergency situations [168]. [176] an e-health system for
monitoring elderly general health periodically in their homes and sends it in real time to the cloud based on IoT and
Fog computing using MySignals HW V2 platform and an Android app.
An IoT CPS system integrates wireless, non-invasive devices in real-time algorithms to discern the voluntariness of
human movement through direct sensing of brain potentials combined with muscular action signal monitoring and to
prevent falls for AAL affected by neurodegenerative diseases; thus, the system opens possibilities for mild cognitive
impairment, Alzheimer’s and neurodegenerative disorders such as Parkinson’s and Huntington’s disease and
multisystem atrophy [170].
Following the taxonomy results, telemedicine contexts such as monitoring, detection, diagnostics, prediction and
treatment were proposed to support various human diseases. Figure 7 illustrates the crossover between telemedicine
studies in this category and different human diseases under IoT technologies. These contexts were considered
sensitive and as such, were hidden with the use of various techniques. Therefore, during the classification conducted
in this study, we extracted the frequency numbers for each context used for each disease. The data are presented in
Table 1.

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Figure 7 Crossover amongst Telemedicine Healthcare Services/Applications and Human Diseases under IoT

Table 1 Frequency of Telemedicine Contexts towards Classification of Diseases under IoT

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Diseases Type/Context Type Monitoring Detection Diagnostics Prediction Treatment Recognition

Alzheimer’s 3 χ χ χ χ χ
Depressive disorder χ 1 χ χ 1 1
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1 Psychiatric disease Emotional disorder 1 1 χ 1 χ 1

Mental illness 2 1 1 χ χ 1
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Sleep disorder 1 χ χ χ χ χ
Cerebral stroke χ 1 χ χ χ 1
Epilepsy 1 χ χ χ χ χ
Abnormal movement and
4 χ χ χ χ 1
2 Neurological disease gait disorder
Autonomic nervous system 1 χ χ χ χ χ
Demyelinating disease χ χ χ χ χ χ
Parkinson’s 2 1 χ χ χ χ
3 Geriatric medicine 3 χ χ χ χ χ
Community medicine
4 4 3 2 1 1 6
and general practice
5 Renal disease χ 1 1 1 χ χ
Ebola 1 1 χ 1 χ χ
6 Infectious disease Nondemic influenza (H1N1) 1 1 χ 1 χ χ
Transmitted χ 1 3 χ χ 1
7 Oncological disease Lung cancer χ 2 3 1 1 χ
8 Dermatological disease χ χ 1 χ χ χ
Ophthalmological
9 χ χ 1 χ 1 χ
disease

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 Rheumatological
10 disorder and 4 χ 1 χ 1 1
rehabilitation
11 Respiratory disease 1 χ χ χ χ χ
Endocrine and
12 metabolic disorder and 4 χ χ 1 χ χ
diabetic
13 Cardiological disease 8 5 2 3 χ χ
14 Gastrointestinal disease Ulcerative colitis χ χ 1 χ χ χ
Total frequency of a context 41 19 16 10 5 13

Although the recognition context is excluded from the classification taxonomy (Figure 6), this context has been
implicitly analysed in some studies as a support to other contexts. Accordingly, we included it in the table. The
presented table provides valuable information about the contexts and some points of interest that researchers can
engage in (will be analysed later in the section ‘Open issues and innovative key solutions’).

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4. Distribution results
As shown in Figure 6, the academic literature of this work consisted of two major categories. The first category, IoT

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telemedicine network, consisted of three sub-categories: topology, architecture and platform. The second category,
IoT in telemedicine healthcare services and application, consisted of two sub-categories: IoT healthcare services,
which consisted of two sections, namely, asynchronous and synchronous healthcare services, and IoT telemedicine
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application, which consisted of four sections: single-condition application, multi-condition application, telemedicine
rehabilitation and ambient assisted living. This paper presents new distribution results according to the classification
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of human diseases. Classifying diseases is significant due to its role of establishing a mutual reporting and
monitoring language for diseases [49][147]. Consequently, data can be shared and compared consistently and
facilitated for storage and analysis which in turn allow for evidence-based decision making. The findings from our
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academic literature showed that various human diseases were used by previous researchers. As shown in Error!
Reference source not found., we have found 14 types, and cardiovascular disease is the most commonly used.
Table A1 (Appendix) provides the definitions of these diseases.
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Figure 8 Disease Classification Under IoT-based Telemedicine

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Error! Reference source not found. displays the taxonomy classification and numbers of human diseases used by
the literature within IoT-based telemedicine. These diseases are either used as a case study to prove the concept of
the study, whilst other studies presented real contributions and enhancements dedicated to a specific disease. For
example, a study presented by [49] developed a novel IoT-based wearable 12-lead ECG SmartVest system
specialised for early detection of CVD diseases which cannot be used for other diseases; conversely, the study by
[147] developed an Android application which can be used extensively for different diseases.
In addition, the literature enveloped and summarised various statistical information of interest for researchers can
also be analysed later as follows. (Figure 9.a) provides the frequency of healthcare service types in which the
literature mostly considered the asynchronous healthcare services type (46%). (Figure 9.b) provides the frequency of
the healthcare services considered for the elderly were (56%) of the most literature considered their works for
elderly people. Figure 10 provides the frequency of indoor and outdoor targeted location of patients’ mobility (55%
of the studies were considered both). Figure 11 summarises some existing algorithms and methods. Overviews of
some existing environmental and physiological sensors are provided in Figure 12. Figure 13 summarises some of the
short- and long-range wireless networking technologies used in the literature.

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(a) Frequency of Healthcare Services Types (b) IoT AAL Healthcare Services

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Both
(Asyn&Synch)
2%

Not Mentioned
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Mentioned
11%
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16%

Asynchronous Not Consider Consider AAL

Healthcare AAL
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Healthcare
46% Healthcare Services
Synchronous Services 56%
Healthcare 33%
36%
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Figure 9 Frequency of Healthcare Service Types and Elderly in Literature Review

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Indoor Environments
45%
55%
Indoor/Oudoor
Environments

Figure 10 Frequency of Indoor and Outdoor Targeted Location of Patients’ Mobility in Literature Review

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 10

15

20
0

12
SVM

Figure 13 Summary of Short- and Long-Range Wireless Networking Technologies Used in Literature Review
KNN

6 6
Decision Tree

Figure 12 Summary of IoT-based Environmental and Physiological Sensors Used in Literature Review
Artificial Neural Network

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(a) IoT based Environmental Sensors
CNN based Deep Learning

3 3
Random Forest
Genetic

2 2
Principal Component Analysis

Figure 11 Summary of Some Algorithms and Methods Used in Literature Review

Multilayer Perceptron

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
AdaBoost
Extended Nearest Neighbor

(a) Algorithms
Dynamic SpatiotempOral Warping

10
20
30
40
50
60
Fuzzy k-Nearest

0
Deep Belief Networks

f
Dimensionality Reduction

o
Adaptive Learning Rate Optimization
HCCETS

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Edge Computing and Compression
Boosted Decisions Trees
Naïve Bayes

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Whale Optimization
Dynamic Time Warping
LOMB
Moving Window Average filtering

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Kalman Filtering
Wavelet Packet Transform
Median Filtering

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Low-pass Filtering

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10
15
20
25
30
0
5
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5
(b) IoT based Physiological Sensors

2
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2
2
2
1

(b) Methods
1
1
1
1
1
1
1
1
1
1
1
1
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Ultimately, IoT presented a capability which makes it stand unique compared with other technologies. It enables the
extension of the internet connection far more than in standard devices such as laptops, desktops computers, tablets
and smartphones to any dumb or non-internet-enabled physical devices and everyday objects. By embedding such
devices with technology, they would be able to communicate and interact over the Internet and thus be remotely
controlled or even monitored [177]. IoT devices can be presented as any devise loaded with sensors obtaining
targeted information from their environments, and then analysing and transmitting the information to remote
locations for further processing [178]. Figure 14 lists the studies which used hardware devices utilizing the IoT
technologies in the literature.

50
45
40
35
30
25
20
15

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5
0

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Figure 14 Summary of Hardware Devices Utilizing IoT technologies in Literature Review

5. Discussion
This study aims to update the concept of telemedicine continuously on the basis of IoT characteristics for both
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networks and applications to enhance healthcare service provisions against different human diseases. This study
inevitably provides the taxonomy based on the principle of IoT-based telemedicine. The development of the IoT-
based telemedicine taxonomy based on the literature can offer certainadvantages. Various publications related to the
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topic may be dominated by a new researcher who is interested in IoT-based telemedicine without a clear view of the
classification of the diseases used with different telemedicine contexts and fails to acquire a proper sense of the
actual activities in this field [118][140]. In addition, different articles consider the network of telemedicine from an
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introductory perspective [40][65]. By contrast, other articles examine a selected number of existing IoT sensors,
devices, fog concepts and actual IoT trends involved in the development of the three-tier telemedicine network
topology, architecture and platform [38][49][65].
Most telemedicine applications consider their work under the IoT perspective without proof. This claim lacks
justification, which raises confusion among researchers. The question is as follows: are all telemedicine practices
included in the IoT characteristics? This study attempts to remove obstacles around this ambiguity. On the one hand,
telemedicine is identified as remote delivery of services for healthcare over the telecommunications infrastructure by
using common technologies such as smartphones and video conferencing [1]. On the other hand, IoT is about sensor
automation and Internet platform, support cloud communication and is both hardware- and software-based
technology [72][147]. Thus, the telemedicine application that does not rely on the sensor automation does not
support the cloud communication nor consider other IoT trends and characteristics. Consequently, we cannot
consider it as an IoT-based telemedicine application. For example, an application that facilitates typical healthcare
services such as discussion involving calling a telemedicine number, video conferencing and sending medical
images without a system of interrelated computing devices, mechanical and digital machines and objects, is not
considered IoT-based telemedicine application. In this context, through the intersection of both principles, the
answer to our question is as follows: not all telemedicine applications are based on IoT characteristics. Taxonomy is
provided to set guidelines for various telemedicine aspects and provide a meaningful, coherent and manageable
framework based on the literature.

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5.1 IoT-based Telemedicine Motivations
IoT in telemedicine has shown considerable development due to the benefits provided by the latter. This section
discuses telemedicine advantages from the literature. Eight classes are identified for the benefits. The following
references are displayed for further discussion (Figure 15).
Health Institutes and Organization
• Cerebral stroke detection solution
• IoT-based Decision Support System for
Intelligent Healthcare
Telemedicine Network
• Handling heterogeneous traffic from embedded
devices/sensors
• Avoid interference in coexistence WBAN
• 5G-CCN framework
• Reducing the burden of long trips in rural areas
• Reducing the data volume affect the bandwidth
and battery power reduction
• LoRaWAN network
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Smart Health Home Monitoring
• Analysis of real-time series EEG
• Basket-based sorting method
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• Rehabilitation-based IoT
• Modelling and executing clinical knowledge
• Optimizing a Large-scale Dynamic Network
• 12-Lead ECG system
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• Monitoring of medical parameters
• Multisensor dataset on fall detection
• Optical fibre sensor networks integrated with
wireless transceiver
• Fog architecture relying on unsupervised ML big
data
• Intelligent hybrid context-aware model
• IoH
• Intelligence attributes
• IoT-based monitoring with mobile
• Providing doctors and caregivers information
remotely
Figure 15 Benefit Categories for IoT-based Telemedicine
5.1.1 Benefits to Patient Quality of Life (PQoL)
PQoL is the perceived quality of patients’ daily life, that is, it assesses how the patients’ well-being may be affected
over time by a disease, disability or disorder. Throughout the utilisation of patient images and emotional detection,
Patient Quality of Life
• Emotional detection/early diagnosis
• Attention deficit disorder and hyperactivity
• LoRa-based IoT application
• Cyber-physical health system
• IoT-based wireless polysomnography
• 12- ECG Lead configuration/ ECG Android of IoT
• m-GreenCARDIO
• IoT as media data transmission application
• Heart monitoring computing Per-C
• Android-based cloud ECG monitoring
• Smart rehabilitation
• Electronic monitoring devices Elderly Quality of Life
• IoT-based Smart Pillow
• Voice connection via IP
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• Tele-caring utilise plantar pressure data
• Multimodal data analysis
• IoT-based glucose monitoring
• Early detection and treatment
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• UHF passive wearable RFID wristband
• Rehabilitation monitoring
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Medical Data and Information
Benefits of IoT- • Early warning system
• Cloud computing/ sharing mechanism
based •
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Context information to health data
•
Telemedicine Complex Event Processing
• IoH and big data analytics
Therapies
• Artificial intelligence techniques
• Using ontology as knowledge representation
• IoT utilize cyber-physical system
• Multiple sclerosis
• Healthcare, AAL devices and app in home
• Self-regulated Lateral Rotation Mattress based on
IoT
• Medical amenities in rural areas
• IoT wearable inertial sensor devices
• Telerehabilitation based on IoT
• ECG SmartVest system
• Machine-to-Machine Technology
• System graphics correlation features
Quality of Healthcare Services • Hybrid multi-kernel SVR IoT
• Hybrid deep learning architecture • Cognitive system based on a deep CNN
• Home-based healthcare service architecture • Decentralised healthcare services
• Fall detection management systems
• Examination of human behaviour
• Monitoring/management uses sensors on
smartphone
• Fog-cloud-assisted cyber-physical system
• Healthcare-IoT
• Interactive telecare system based IoT
• Spreading cardiac care to urban and rural areas
• Fog computing and energy-efficient wearable
sensor
• Monitoring vital functions using IoT
• IoT-based healthcare using hidden Markov model
• Web of Objects platform enables IoT
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patients will be assisted in the home healthcare context [153]. Early diagnosis of mental disorders can assist patients
to live a better life [133]. Adults with ADHD can afford a better quality of life when using the IoT [155]. [50]
utilised LoRa-based IoT as the prime platform for device communication to show an exact patient location in case
they were away from the supervision zone. By doing so, the potential risks are to be reduced, which include risks
such as accidents, which can be the result of their inability to recognise road conditions or other public facilities.
Also, the possibility of suicidal behaviour was considered. Such advantages were argued upon with the aim of
assisting the tracking and monitoring of the health context of patients with mental disorder [50]. [57] discuss a
cyber-physical health system that collects and disseminates patients’ vital signs to achieve patient treatment
prioritisation or triage. Quantified measurements in movement disorders pave the way for accurate patient data
collection for Parkinson’s disease and make the process personal and comfortable without requiring regular doctors’
visits [90]. [92] proposed a based wireless IoT polysomnography intelligent system, which can simplify the tracing
of long-term patients and investigate personal sleep monitoring at home. The test bed will empower the mobile
health infrastructure with self-management tools, which include patient education, wearable sensors and supporting
services and applications; thus, either type 1 or 2 diabetes patients would ‘take the proper action at the right time’ to
self-manage their condition [80]. A 12-ECG lead configuration provides increasing detection and diagnosis for the

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heart conditions of patients, making good healthcare facilities available to remote and underprivileged locations
[83]. Implementation of the m-GreenCARDIO embedded system assists in making efficient medical
instrumentation, making the system accessible to a wider social range of patients using IoT [52]. The ECG Android

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application of IoT would reduce the cost of medical equipment for senior citizens, athletes and common patients
[53]. Self-management of diabetes through existing and historical patient data enables real-time clinical interaction
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and feedback tailored to the patients’ personal needs [100]. IoT as media data transmission application is useful for
patients with heart disease because they can interact and consult with a cardiologist anytime and anywhere [86].
Android-based cloud ECG monitoring provides patients with a portable medical instrument to record their ECG
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signal activities wherever they are and store the latter in the cloud [87]. Heart monitoring through perceptual
computing Per-C for health monitoring is suitable for patients whose condition is relatively stable [104]. Accurate
detection technique in a secure IoT-based assistive living environment improves patients’ daily life assistive
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activities [150]. Smart rehabilitation techniques combined with gaming, IoT wearable technology can assist in
alleviating or even boosting the recovery process of various disabilities in patients [159]. The J48 decision tree is
used to evaluate the level of infection in a control Ebola virus outbreak depending on patients’ symptoms [116].
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Wrist pulse signal and standardisation of the pulse diagnosis method of JPD theory can help in diagnosing lung
cancer patients [130]. Electronic monitoring devices have shown the potential to enhance the patients’ use of
inhalers [115]. After the integration process for Bluetooth BG meter data, MyDay performs an overall monitoring of
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BG, in addition to activating weekly BG value comparisons that help motivate problem-solving skills in adolescents
with type 1 diabetes [99]. [68] created a MADE framework model which executes clinical knowledge in a flexible
manner as sophisticated monitoring network, analysis, decision and effectuation processes in IoT; this model would
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empower telemedicine systems to establish patient knowledge-based decision support in addition to quality
awareness properties.

5.1.2 Benefits to Elderly Quality of Life (EQoL)

The elderly can use the application in rural areas to monitor their activities and assess their health status which in
turn minimise the burden of health and social services in improving the EQoL at a minimal cost [156]. [169]
discussed an architecture for the IoT-based Smart Pillow system list circumstances; the latter can assist in reducing
quality of sleep and takes actions using intelligent devices which enhance the sleep quality of the user. A voice
connection is established using the IP to empower the elderly to live independently as far as possible, whilst
avoiding unnecessary hospitalisations in the future [73]. Implementing real-time tele-care systems which use plantar
pressure data aided by an identification of the elderly’s conditions and help determine the impairments in
neurological disorders, will be extremely useful [147]. In AAL environment, A multimodal data analysis is capable
of enhancing the living environment for the elderly people and of attempting to provide efficiency in the processing
of complex event for real-time situational awareness [168]. IoT capabilities can benefit rehabilitation and elderly
monitoring for active ageing, particularly for in-home treatments [166]. IoT-based continuous glucose monitoring
offers possible advantages to an ageing population, where the elderly can be monitored and treated at home [98].
Early detection and treatment of the older adults’ state of depression benefit the growing population; majority of the
elderly would need special care which involves wear deterioration and financial strain on the family [171]. To
monitor the whereabouts of the elderly, a UHF passive wearable RFID wristband is utilised [109].

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5.1.3 Benefits to Quality of Healthcare Services (QoHS)
IoT introduction in applications for healthcare promises several benefits, which are related to financial savings
through reduced cost of hospital visits, including costs of health care provision, human resources, transportation and
insurance [81]. An added advantage could be the result of improved quality of health care services. A hybrid
architecture based on deep learning can meet the growing demand for sleep management services towards the
development of sleep monitoring services for individuals [93]. Extending home-based healthcare service
architecture is easy for a provider of community healthcare service. It can also be appropriate for community
rehabilitation centres [72]. Fall detection management systems are aimed towards enhancing life-saving capabilities
and will reduce the overall costs of medical services and healthcare [38]. One of the most promising m-healthcare
areas is human behaviour [146]. Sensors utilised by the remote health monitoring and management system on board
a smartphone are flexible, affordable and less intrusive than other types [41]. Fog-cloud healthcare services based on
assisted cyber-physical system are emerging as a proactive and efficacious solution. This solution aims to provide
services to the early detection and remote health monitoring of infected users who suffer from MBDs [126]. Fog
computing can offer various services for real-time applications including low latency, location awareness, quality of
service (QoS) assurance and immediate notification services [124]. Successfully using IoT in healthcare IoT can

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enable efficient and reliable preventive care, including other benefits such as low-cost, enhanced patient-related
practice and improved sustainability [129]. Improving interactive telecare system-based IoT can assist in chronic-
disease patients maintaining healthy behaviours without incurring high medical costs [101]. The spread of cardiac

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care to rural and urban areas will enable the remote monitoring of ECG signals, which in turn can help reduce the
expenses of cardiac patients, especially those with high expenses in large hospitals [119]. A low-cost IoT-based
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system for remote health monitoring with Fog computing and energy-efficient wearable sensor devices can
minimise the healthcare costs whilst improving the quality of healthcare service [81]. Utilising IoT to monitor vital
functions can improve healthcare performance in cases such as heart disease, and can reduce the death rate which in
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turn results in a pervasive passive healthcare mode [103]. IoT-based healthcare system using hidden Markov model
can potentially improve medical services for patients with cardiovascular disease [85]. The predictive aspect
embedded in the system can assist in avoiding delays whilst providing timely medical health treatment even before
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the individual reaches a critical condition [139]. IoT services are enabled through Web of Objects platform by
virtualising real-world objects using semantic ontology, where the latter provides a development base for
interoperable micro services [74]. Big data-oriented wireless technologies, edge computing, interconnected devices
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of IoT and data analytics can remarkably contribute to personalised and seamless emotion-aware healthcare services
towards 5G-ready healthcare services [154]. Fog computing along with cloud computing services can achieve
efficient network bandwidth whilst providing high care service quality and low response time in generating real-time
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notification than a cloud-only model [127]. For smart home environments, the extension of IoT-based cloud
framework would allow other new applications and development services [134]. Remotely monitoring patient
system is important in determining healthcare services on a large scale by using advanced technologies such as
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wearables, wireless sensors, IoT, fog and cloud computing [122]. Utilizing fog as a service empowers the modern
IoT models based on healthcare to deliver computing, storage and control services in various volumes to meet the
expectations of various end users [141].

5.1.4 Benefits for Therapies

Utilising numerous AI approaches enables specialists in the medical domain and therapists with a significant
guidance to identify critical marks, such as in the support decision-making process for monitoring the emotional
states of pregnant women during and after pregnancy [138]. Oncology is an example to represent the main
symptoms for a designated disease, and facilitates the diagnosis process for physicians [133]. The cognitive burden
is minimised on care workers through an intelligent system, which also aids therapists with supervision capabilities
and others, including assessments, observation and therapy plan adaptation. This feature will empower the therapy
to be performed at home using mobile health computing infrastructure [110]. A system built upon an IoT utilises
cyber-physical aids in clinical procedures, including strategies for postural correcting, enhancing, and blocking
muscle action which could be accidental and eventually dangerous. In addition, the system is capable of identifying
potential targets of rehabilitation [170]. Based on the literature, instrumented solutions must be developed for
motion assessments of multiple sclerosis patients so that the workload of clinicians and assessment subjectivity can
be minimised [91]. The deployment of AAL devices for healthcare and applications in the citizens’ homes would
require the support of caregivers, along with the citizens, to seamlessly manage health routines [63]. An IoT-based
self-regulated lateral rotation mattress would provide excellent caregivers’ assistance [96]. [135] discussed
supplying medical amenities for patients living in rural areas. The mechanism starts with an ultrasound data
transmission to the cloud. Subsequently, doctors would access such data from any location around the globe for

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diagnosis purposes. Wearable IoT devices are recognised for helping people such as therapists in monitoring and
evaluating parameters, along with significant indicators for rehabilitation activities [160]. An IoT system for
telerehabilitation can remotely empower effective physical therapy implementation, along with ensuring insights
into the recovery process for capable medical specialists from a remote location and enabling therapists to interact
with patients through communication technologies [161]. An IoT-monitoring mode called ECG SmartVest system
saves medical resources with respect to the time of physicians [49]. Technologies based on real-time health
parameters such as decision making and data analytics for sick people would assist medical specialists in performing
systematic diagnosis and tailoring a restorative treatment for stroke [140]. Machine-to-machine technology helps
doctors diagnose cardiovascular patients in rural areas [125]. The advanced graphics in the system correlation
features are expected to assist physicians in identifying the actual roots of health problems [70]. The hybrid
architecture of multi-kernel SVR for applications of IoT healthcare assists ophthalmologists in achieving an efficient
diagnosis. The latter is accomplished by providing high-resolution retinal images [131]. A cognitive system based
on a deep convolutional neural network is capable of providing diagnostic advice to medical specialists [132].
Decentralised services in the domain of healthcare can minimise access to emergency rooms for erroneous therapies
or for therapies not adapted to changes in patients’ medical records [97].

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5.1.5 Benefits of Smart Health Home Monitoring
Utilising smart health monitoring is extremely important. The concept has been introduced through a combination of

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various products in telemedicine and information systems. It is defined as smart monitoring of health at home with
specialised devices for remote healthcare [153]. Such devices are mostly actuators and sensors. The latter devices
should perform actions when a critical situation is identified [153]. Analysing and processing real-time series EEG
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terms support parallelism and data portioning where they can assist in automatically monitoring and detecting
systems of indoor epileptic seizures [113]. A basket-based sorting method-based smart environment can notably
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enhance the accuracy of activity recognition in the home area of real-time monitoring through simple ML models
[157]. Monitoring patients’ status in real time is possible by IoT technologies to acquire important data and
subsequently analysed for the system of remotely medical diagnosis [151]. Remote rehabilitation based on IoT
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enables telemedicine and remote health monitoring progresses during physical rehabilitation tasks and assists people
to pursue healthier lifestyles, physical activity and correct posture [158]. IoH can handle a large number of remote
patients in their home due to the optimisation of large-scale dynamic network whilst promptly recognising disease
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patterns in early stages [64]. The motivation of 12-lead ECG system was presented with an aim to make an accurate
ECG monitoring system whilst covering a wide indoor range of cardiac diseases [83]. Both IoT technologies with
integrated cloud computing clearly enable the pervasive monitoring of patients’ health and remote supply of high-
quality and efficient patient health status monitoring information [105]. Introducing the concept of context
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awareness in the healthcare domain with respect to specific smarts into the IoT gateways creates relevance to remote
health monitoring systems based on IoT for global health deployment, specifically in sparsely connected remote and
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rural regions [69]. Minimising the healthcare cost is possible via remote health monitoring for medical parameters.
In addition, the medical personnel will always have medical data for patients without necessitating their physical
presence in the office [82]. A multi-sensor dataset for the research on automatic fall detection enables studying the
importance of sensor placement to ensure the effectiveness of fall detection algorithms [179]. To guarantee the
mobility of patients, optical fibre sensor networks integrated along with a wireless transceiver can enable efficiently
ubiquitous patient monitoring [95]. Fog architecture based on unsupervised ML big data analysis can be beneficial
in other applications when it comes to wearable IoT targeted for smart telemedicine scenarios for patients at home.
This process is possible by translating ML approaches from the cloud backend to edge computing devices [48].
Intelligent hybrid context-aware model facilitates the storage and processing of big data generated through systems
of ambient-assisted living. Those systems help produce an accurate, fast and fault-tolerant model for the monitoring
of remote patients [5]. IoH enables the acquisition of ECG signals pertinent to space–time cardiac dynamics anytime
and anywhere [71]. Smart home space enables serving such intelligence attributes service ubiquity, whilst using
multisource data, knowledge reasoning, context awareness and flexible service construction [75]. For those who live
in different communities in the long term, an IoT-based monitoring system combined with mobile agent technology
can assist in monitoring the patients’ health conditions [44].

5.1.6 Benefits to Health Institutes and Organisation

From a healthcare provider’s perspective, IoT can aid in healthcare organisation through a remote provision.
Employing cloud for data storage and analysis on a cerebral stroke detection solution can potentially supply
statistics for public health institutions [123]. A decision support system based on IoT for intelligent healthcare can

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supply a platform which is common for all healthcare stakeholders whilst efficiently operating in disease prediction
[78].

5.1.7 Benefits to Medical Data and Information

Whilst considering the benefits of IoT technologies, early warning systems are capable of auto monitoring whilst
storing large data volume where the latter can be analysed in real time [118]. Feedback can be supplied by cloud
computing architecture for feedback associated with an individual’s health condition, along with effective design
and representation of the information sharing mechanism in real time for the epidemic status of H1N1 disease
patients [121]. Through the aggregation and processing of cross-domain inputs across many sources, the context
information along with complementary health data can enrich telehealth data with context information [70]. A
framework for real-time accurate analysis of data from assistive technology and wearable devices can be provided
through complex event processing (CEP) for remote healthcare, especially the monitoring of early dementia patients
[111]. IoH technology can potentially empower and aid in big data analytics in large-scale IoT contexts [71].

5.1.8 Benefits to Telemedicine Network

By handling heterogeneous traffic from embedded devices/sensors in the IoT, multiple M2M applications are

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enabled to utilise network resources efficiently on the basis of factors such as application needs, network overload
level and the device resources [59]. Interference avoidance in coexistence WBAN situation ensures a reliable

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distributed communication [60]. 5G-CCN framework is capable of enabling suitability for network communication
in view of how low-power and low-cost devices can boost the QoL of people who suffer from chronic diseases or
emergency problems [45]. Monitoring patients, especially those with chronic diseases, is beneficial because it
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reduces the burden of long trips for those residing in rural areas and visiting healthcare facilities, whilst also
reducing the cost of network communication [46]. Bandwidth is affected by data reduction and battery power in
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telemedicine network and sensor devices [61]. Medical centres are enabled to monitor the patient status immediately
in metropolitan areas via LoRaWAN network [51]. LoRaWAN is the most important network in long-range low-
power networks, the current progress of medical IoT and LoRaWAN is more demanding in terms of node and link
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constraint [46] because this new-generation communication technology has low-cost, low-power, secure, efficient
long-distance transmission features [51], which reduces telemedicine network costs by improving the QoS.
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5.2 IoT-based Telemedicine Challenges

The design and implementation of numerous IoT-based telemedicine applications, services and network have been
pursued by researchers who have been actively working towards addressing different technological and architectural
issues associated with these topics. Despite the research concerns identified in academic literature, many existing
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challenges persist and require cautious attention. Figure 16 presents the classifications of the challenges.
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 Healthcare Affordability Ageing Population Security and Privacy
• Rising cost of health care • Alzheimer’s disease
• Cost associated with dementia car • Depression diseases afflict the elderly • Security attacks
• Monitor Ebola virus diseases • Problems related with hospitalization, cost • Connecting wearable devices directly to cloud
• Increase of incidences of stroke efficiency, and elderly independence computing
• 12-Lead ECG systems • Modern busy urban lifestyle • Data security
• Healthcare costs into a sustainable range • Hospitals insufficiency of infrastructure • IIoT based healthcare system
• Usability, research accuracy, coverage, and cost • Hospitals natural workflow, and circumstances

Patients’ Mobility Telemedicine Data Transmission and

• Monitor the exact position of the patient move
• Determine the degree of mobility in Parkinson's
Processing
diseases • Medical information exchanged regarding latency-
sensitive
• Cost embedding sensors and wireless connection
• Location awareness and large data transmission
• Sensors flexibility
• Absence of reliability and lack of standardization
• Unfamiliar environment and restricted mobility
with polysomnogram (PSG) • Lack of a public repository of movement datasets
• Accurately, reliably, and securely monitor • Anytime anywhere data acquisition and access
• Out-of-hospital cardiac tools in the IoT context • Physical signs sampling
• Active participation in measurements or data
• Real-time monitoring of patients from different
locations collection
• Collected/analysed real-time large amount of data

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• ECG implemented on hardware
• Uuman-mobile device's interaction, safety, privacy, • Resource constraints of mobile device
size/weight and power consumption • Real-time signal analysis
• Fast monitoring a single patient at a time • Signal Quality Assessment (SQA)

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Healthcare Accessibility and Availability Telemedicine Big Data
• IoT clinical services delivery • Transformation, compression, storage, and
•
•
•
•
Lack of proper medical equipment
Untrained medical staff and medical facilities
Delayed response in emergency services
Unreliable and error-prone laboratory diagnostics
IoT-based
Telemedicine
-p visualization of big data
• Real-time big data analytics in large-scale context
of IoH
• Unstructured, diverse and growing large amount of
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• Shortage of doctors/ lack of physicians data at an exponential rate
• unfeasible cares for MCD
Concerns • analysis of big emotional data
• Storage and fast computational power • Continuous monitoring of patients
• Delivering care to patients in remote regions • Processing, machine learning and cloud computing
•
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service of after-stroke care for the elderly for long-term ECG big data
• availability of online radiographers • Complexity, dynamicity, and multi-dimensionality
• quality of service for life-critical applications of connected healthcare services and data

Telemedicine Network Communication Patients’ Safely

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• Real-time recognition of disease patterns in the IoH • Identifying the optimal interval to reposition the
• Network reliability and stability patient
• Large amount of data communication • Exponential spread of MBDs/Chikungunya
• Lack of real-time monitoring, and adaptability of • Pulmonary cancer difficulty
heterogeneous system • Determine and segment the lung region
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• Connectivity aware M2M node • Lung cancer recognition

• Interference occurring in situation in coexistence • Observation of the identification and classification
problem of common skin diseases
• IP address for data transmission • Clinical classification for stroke patient
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• Transfer sensor data to external networks • Diagnosis constitutes

• High cost communication links • Combination symptoms of cerebral stroke
• Acquisition and processing of sensor data • Implement optogenetics based implants in the
human eye
• Treatment in asthma
• Lost connection with cloud system/network failure
• Threatening the condition of ischemic heart
disease, and hypertensive crisis

High Battery Power Consumption Interoperability of IoT Devices

• Radio link • Hardware layer miniaturization
• Reduce the power consumption of sensor devices • Huge of connected heterogeneous devices
• High-resolution signals • Integrates sensibly/seamlessly with IoT device
• Continuous monitoring • Design/implementation PCB m-GreenCARDIO
• Low adaptability, low scalability, and non-IP based • Optimize accuracy of Health Smart Homes system
Connection problems • Integration/unification different IoT technologies
• Glucose monitoring communication between • Design time which exact combination of physical
sensor devices and a gateway devices
• Sensors measurement are not very precise and its • Physical implementation (hardware) of the
size is very large wearable smart ECG

Figure 16 Challenge Categories for IoT-based Telemedicine

5.2.1 Concerns in Telemedicine Data Transmission and Processing

These telemedicine systems are filled with challenges, more specifically related to the utilisation of medical
information exchanged in latency-sensitive issues, along with large data transmission and location awareness. Large

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data volume is transmitted over network; increased chances of error occur due to some factors including data
transmission latency, bit error and the possibility of packet dropping which are proportional to the transmitted data
volume [55]. More precisely, in emergency cases, a single analysed-data error can lead to inaccurate treatment
decisions, thereby posing a crucial effect on human life. Therefore, minimising the transmitted data volume over a
network is essential whilst guaranteeing the QoS [55].
The number of existing services for sleep monitoring is void due to technical reliability with respect to factors
including collection of data, processing and analytic methodologies [93]. Using data acquired from tracking devices
of human activity for clinical purposes is impossible for two reasons. The first is related to the absence of reliability,
whilst the second is lack of standardisation. Wearable devices aimed at activity tracking only supply the data for
individual analysis, and their data are not integrated into clinical practice [72]. Public repository lacks movement
datasets in FDSs that allow a methodical and agreed evaluation of fall detection policies [179]. The development of
next generation technology for IoH has numerous challenges including the anytime–anywhere data acquisition and
access [71]. Various physical signs must be labelled with various frequencies to meet the medical requirements,
whilst simultaneously transmitting such signs separately based on their individual sample frequencies.
Consequently, a large amount of data and a heavy burden to the remote server are anticipated [103]. With an

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increasing amount of data to be transmitted in the reconstructed model and the small storage capacity, data need to
be compressed progressively before transmission [42]. In telehealth, technological solutions can supply a regular
collection of medical data. However, this process is not frequently seamless for users, including the need for active

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participation in measuring or collecting data. More importantly, this observation applies in the provision of context-
related information [70]. Under the mobile IoT early warning system, large data volume is to be gathered and
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analysed in real time. Nevertheless, constraints of resources for mobile devices can limit data storage and processing
function [118]. Efficient EEG compression schemes with the use of CS could still not reach the expected
performance due to the non-sparse signal nature of EEG [66]. Nevertheless, for wearable ECG monitoring based on
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IoT, challenges related to technology are associated with the accurate and real-time signal analysis of the embedded
processor in smartphones [49].
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5.2.2 Concerns in Telemedicine Big Data

Big data challenges in the medical domain are some of the results of the increased utilisation of wearables in a smart
telehealth system [48]. Three major challenges are apparent in monitoring epileptic seizures: compression,
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transformation, storage and visualisation of big data. These issues result from the continuous epileptic seizures
recording with the use of mobile devices [113]. In the context of IoH, real-time big data analytics is considered a
challenge [71]. Currently, healthcare faces challenges associated with unstructured, diverse large volume of data
growing at an exponential rate [53]. For example, approximately 16,000 hospitals exist worldwide. All of them
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gather data from their patients, and 80% of the data are unstructured. In computing research regarding emotion
awareness, the analysis of big emotional data needs equipment with high processing capacities and an exceptional
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analytical capability [138]. Big data are to be generated from the continuous monitoring of patients, and this process
provides excellent opportunities to promote personalised care for patients. In addition, this process constitutes
remarkable challenges for analysis and management [64]. For long-term ECG big data analysis, the big data
processing, ML and cloud computing are a challenge, especially when considering the IoT-driven wearable ECG
monitoring [49]. Connected healthcare services and data, owing to challenging factors such as multi-dimensionality,
dynamicity and complexity of computational models, are capable of discovering, collecting, analysing, mining and
effectively processing data, including healthcare big data, with high accuracy and timeliness [154].

5.2.3 Concerns in Healthcare Accessibility and Availability

IoT-based remote health monitoring is one of the most promising technological interventions; it deals with global
health access in remote-rural-developing regions, which can face challenges of affordability, accessibility and
availability [167][69]. IoT innovations have not rapidly defused nor have an effect in the healthcare sector than the
observed ones from other industries. Especially, IoT technologies still have to reshape the delivery of clinical
services [80]. The benefits of telemedicine include a vast bibliography, but practical challenges remain in organising
risk management in the context of the continuous improvement of remote healthcare services [120]. Several
countries suffer from public health sector issues, which require solutions to avoid poor service delivery in public
hospitals and health centres. Some of the issues include (1) lack of medical equipment, (2) overcrowded medical
facilities and untrained medical staff, (3) delayed responses in emergency services and (4) unreliable and error-prone
laboratory diagnostics resulting from capture processes of manual clinical data [57]. Healthcare services degrade in
some growing countries, such as Indonesia, because of the lack of physicians, particularly in rural areas [125]. In
addition, ‘numerous reports by different developing countries revealed a shortage of doctors, characterised by the

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number of doctors per citizen percentage being less or close to the minimum ratio of 1:1,000 as stipulated by the
WHO‘ [57].
Patients with MCD need costly care in densely populated areas, which is usually unfeasible [156]. For national
health support worldwide, a significant challenge resides in the large amounts of storage requirement, including the
fast computational power with daily maintenance issues [121]. Delivering patient care in remote areas is a challenge,
including specialised clinics’ access with respect to critical care and rehabilitation [163]. Providing the elderly with
after-stroke care service, which requires long-term commitment, remains an emerging challenge for medical and
human resources [140]. In tele-radiology, the availability of online radiographers, along with having a
communication facility for portable ultrasound, are challenges for utilising ultrasound scanning in remote healthcare
[135]. Usually, medical and rehabilitation institutions are limited with respect to space and personnel, consequently
compelling the patients to continue practicing physical therapy at home [161]. Despite the widespread availability of
healthcare services, ensuring their reach to the remote and virtual care parts remains a challenge [78]. A need arises
to improve some challenges including how the service quality essential for life is guaranteed [87].

5.2.4 Concerns in Healthcare Affordability

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With the trend of an ageing population, several consequences have been addressed, such as the increasing cost of
healthcare amongst all [158]. Some of the major factors behind the remarkable cost linked with dementia care
include care and support assigned to those suffering from dementia by NHS in personal attendant forms such as

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nurses and social workers [111]. Current systems for healthcare cannot efficiently monitor and control Ebola virus
diseases with minimal cost [116]. As a result of the rising incidences of stroke and cost of rehabilitation, the health
services, particularly the National Health Services (NHS) in the UK would be obligated to minimise the
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rehabilitation support duration [159]. Current 12-Lead ECG systems are expensive whilst requiring a big setup size.
In addition, they are not user-friendly in locations such as rural areas [83]. Requiring a minimised healthcare is an
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urgent issue and warrants attention [105]. Despite the high popularity and various benefits for usability and research
in vision-assisted HAR, they continue presenting numerous drawbacks in coverage, cost and accuracy [102].
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5.2.5 Concerns Regarding Interoperability of IoT Devices

Different challenges still hamper the IoT. In the hardware layer, these issues are associated with physical objects’
interconnection with the use of sensors and related technologies. Layer-associated challenges are miniaturisation
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related, although today’s devices exist with processing, storage and internal parts which should be small and must
improve efficiency [148]. Managing a large number of connected heterogeneous devices is difficult, apart from
handling enormous amounts of data generated, and providing services with them in a dynamic IoT environment
requires major efforts [74]. The integration of real-time physiological data (e.g., blood glucose) remains a challenge,
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especially with behaviour data and communicating behavioural patterns for young diabetes patients. This situation is
an issue which integrates sensibly and seamlessly with their utilisation of IoT-based devices [99]. In this field,
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designing and implementing PCB for m-GreenCARDIO as part of the medical equipment segment is challenging
[106]. Using camera and image processing on IoT is still an application which has not been fully explored with
respect to health smart homes. Identifying the most suitable method of positioning cameras and motion sensors is a
challenge which can be exploited to optimise the system accuracy [153]. Healthcare organisations face challenges
including integration and unification of various IoT technologies used in healthcare [63]. Device independence is
considered an equally important property for application in telemedicine to achieve genericity resulting from the
different clinical requirements and patient preferences. This might not be identified at the time of the design in
which physical devices’ exact combination is most suitable for each patient [68]. IoT-driven challenges for wearable
ECG monitoring technology come from the physical implementation (i.e. hardware) of the wearable smart ECG
garment system [49][148][153][63].

5.2.6 Concerns Regarding Ageing Population

Notable social and economic implications have been observed due to population ageing and chronic health
conditions raised in the public sectors, families and individuals. This observation caused an understanding shift for
daily activities, including the well-being at home to make lifestyle changes aimed at managing and even preventing
chronic health conditions [89]. Population ageing exerts enormous pressure on the healthcare and social services
systems [111]. The ageing citizens are considered social and major issues that warrant attention by government
because the number of people over 60 years old are increasing; at the same time, this population is more prone to
dependency, disability and chronic diseases [176]. Alzheimer’s disease is considered amongst the most public health
issues in which IoT and smart medical systems can assist, which in turn poses an effect on the predominantly ageing
population [110]. In Mexico, depression afflicts the elderly, and common issues include the ageing population, rise

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in diseases, specific ailments for the disabled and elderly, where ageing further results in additional financial
burdens on families [171]. AAL is considered a paradigm that addresses hospitalisation-linked problems, including
cost efficiency and elderly independence which are results of the ageing population [73][168]. Nevertheless, owing
to the busy urban lifestyle, leaving the elderly at home might cause anxiety among caretakers who are away or at
their workplaces [173]. Admitting the elderly is considered a challenge for hospitals due to the insufficiency of
infrastructure [119].Visiting physicians might not be possible for the elderly in crucial times due to their inability to
go to hospitals or clinics caused by difficulties including natural workflow and circumstances related to these
hospitals [109].

5.2.7 Concerns Regarding Mobility of Patients

Monitoring patients’ exact positions and movements is considered a crucial issue when dealing with patients with
mental disorder [50]. Currently, no existing approach objectively determines the mobility degree in Parkinson’s
diseases or the effectiveness of the symptom-easing prescription medication [90]. Sensors embedded at home are
considered expensive and intrusive; moreover, wireless connection with a server at home is not flexibly sufficient to
support patient mobility when the patient is not at home [41]. When a patient is being tested with a polysomnogram

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(PSG), the unfamiliar environment and restricted mobility can disturb their sleep, resulting in incomplete or
corrupted test [92]. However, the issue is linked to how accurate, reliable and secure healthcare professionals
monitor the health patient’s status without their physical presence at their residences to facilitate patient mobility

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whilst simultaneously improving their safety and increasing their autonomy [105]. In the IoT context, designing
remote and real-time monitoring tools for out-of-hospital cardiac patients is a genuine challenge [52]. Monitoring
patients in real-time from different locations remains critically challenging for IoT-based health care systems [85].
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In addition, some ECGs have been implemented on hardware where mobility is restricted and therefore cannot be
utilised by patients when they are engaged in daily activities, that is, when patients are close to suffering a cardiac
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arrest or a heart attack [139]. Size/weight, safety, privacy and power consumption of devices are considered the
major challenges in human–mobile device interaction to the mobility of elder citizens with incapacitating diseases
[95]. Furthermore, for contact devices, only one patient can be monitored at a time; the cannot assist when no need
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arises for a fast or a permanent examination of people from a specific location, such as an office or a metro station
[117].
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5.2.8 Concerns Regarding Safety of Patients

Although the number of symptoms decreases as life proceeds, for the safety of adults, majority of the issues are
linked to organising difficulties, along with managing time, planning, as well as remembering dates, objects and
appointments [155]. Optimal interval reposition identification for patients is considered a challenge with their
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different physical conditions and individual references [96]; notably, the set-up of short duration would indicate
repositioning or turning the patient too frequently and thus causing discomfort, whilst a large interval might lead to
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numbness in a portion of the patient’s body. Considering the high mortality rate and exponential spread of MBDs,
preventing its rapid transmission is largely challenging for agencies in the healthcare domain [126]. Given the fast
spread of Chikungunya, reducing the rate of mortality through early diagnosis is considered a serious challenge for
government-aided and healthcare agencies [124][127]. Finding a cure for pulmonary cancer is difficult because early
diagnosis is crucial to saving the patient [129]; in addition, determining and segmenting the lung region is also
difficult because the small region at the top and bottom of the lungs does not have many lung features [128]. In this
regard, no accepted results were achieved for lung cancer recognition with the use of JPD in the field of biomedical
signal processing. Moreover, no JPD standard pulse feature was defined with respect to pulse signals [130].
Observation of the identification and classification of common skin diseases (SK and FW) is difficult because the
medical data isolation, which is a bottleneck in data usage, and accurate labelling of medical data, are also
cumbersome and require professional experience [132]. Current clinical classification for stroke patient assessment
is time demanding, whereas the results are inaccurate and vary across physicians [162]. In decision making, the
diagnosis is considered a difficult process performed by medical specialists in disease identification [133]. Although
many of the said symptoms exist for patients suffering from cerebral strokes, the three symptoms combined below
are clear cerebral stroke indicators, namely, inability to smile, inability to raise both arms at the same level, and lack
of coherence in speech [123]. Implementing an optogenetic-based implants in the human eye remains a challenge,
although techniques which are optogenetic-based relatively have higher resolution [145]. Typically, treatment
adherence for asthma is poor, especially amongst children and adolescents [115]. Connections to the cloud system
on the Internet is sometimes intercepted, which prevents the monitoring of the elderly patients who suffer from
various diseases [40]. The most considerable complications of smart m-Health services for CVDs are acute coronary

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syndrome, which poses a threat of ischemic heart disease, and hypertensive crisis, which potentially causes life-
threatening complications of hypertension [75].

5.2.9 Concerns Regarding Security and Privacy

Various IoT security and privacy issues exist in telemedicine environment. These issues warrant considerable
attention. Various attack types can be executed to harm IoT-based telemedicine infrastructure. The latter can result
in large system damage [150]. Many challenges related to wearable device connections to cloud computing systems
are prone to occur. These challenges include issues such as performance, reliability, privacy and security [38]. A
large and remarkable challenge involves cloud environment roaming around data [134]. By contrast, privacy
protection is amongst the major concerns in the industrial Internet of Things (IIoT)-based healthcare system [84].

5.2.10 Concerns Regarding High Battery Power Consumption

Mostly, power consumption depends on a majority of sensors because of the radio link. Thus, acquired optimisation
using a dedicated front-end can cause a short power performance impact for the complete sensor [67]. Reducing the
power consumption is deemed a challenge for sensor devices, especially in maintaining high-quality signals. In
addition, when a need arises for high-resolution signals, high power consumption would be costly as a result of data

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acquisition and wireless transmission [81]. Large amounts of data are generated due to the continuous monitoring of
every individual record. Realising such approach is considered a challenge to minimise the cost of energy linked to

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wireless transmission [106]. Different IEEE 802.15.4 protocols cannot be deemed as most prominent with regard to
telehealth monitoring applications due to the high consumption of power, along with other factors including, low
scalability, low adaptability and non-IP-based connection [54]. Application to monitor glucose does not carefully
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consider sensor nodes, sensor devices and a gateway communication [98]. This sensor, which is utilised to monitor
diabetes, blood pressure, EKG and others is not highly accurate, and it is burdened by large size and high power
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consumption [148].

5.2.11 Concerns Regarding Telemedicine Network Communication

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Network dynamics reveals the change in the patient’s clinical status. Nevertheless, ‘a huge challenge is posed for the
recognition of disease patterns in real time when a large number of patients are involved in the IoH’ [64]. Network
mobile health subject-based IoT faces several challenges such as remote monitoring systems’ dependence on
network reliability and stability, large amount of data communication, lack of real-time monitoring and adaptability
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of heterogeneous systems [44]. The openness in communication, level of management and heterogeneity support for
distributed users is still a challenging demand in pervasive computing systems [43]. Building a connectivity-aware
M2M node capable of secure and proper communication interweaving is challenging [59]. WBANs are susceptible
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to interference occurring in situation in coexistence problem; the latter, in smart medical systems, can cause a
remarkable degradation of performance and can be fatal to the user’s life [60]. Using IP address for data
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transmission has many drawbacks such as loss of communication between hosts where the latter cannot supply
sufficient security due to exclusive securing of the connection in which data travel between hosts [45]. Other
powerful resources are accessible due to the interaction between smartphones and wearable devices, which can in
turn result in a large capacity to provide health information needed by well-being requests to transfer sensor data
efficiently to external networks [61]. Existing monitoring systems for IoT are prone to issues such as the utilisation
of costly communication links, including 3G/4G. They do not address data privacy issues, and do not analyse
monitored health parameters to prevent dangerous situations [46]. WSN design faces profound challenges in the
processing and acquisition of sensor data due to the strict resource constraints. Moreover, acquiring ECC signals is
challenging because of the large DC offset presence, along with numerous interference signals [47].

5.3 IoT-based Telemedicine Recommendations

This section aims to discuss recommendations linked to IoT-based telemedicine. The recommendations are grouped
on the basis of their characteristics (Figure 17).

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 Managing Complex Diseases

• Combining cloud computing and big data analytics

• Cyber-physical system for AAL
• Inertial sensors
• Affordable wearable devices
• Developing system for acquiring medical data
• Consolidation of EHR

Increase Performance
• Automated and consistent selection of cognitive Identification and Analysis Diseases
assessments
• More machine learning techniques IoT-based
• multimodal sensing approach • Interactive mobile visualization
• IoT-based cloud framework needs to estimate Telemedicine • Methods used in human activity recognition by
missing data
• Combine processing algorithms with other
Benefits using data mining
• Artificial neural network is needed for better
machine learning techniques health status recognition

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• Additional sensors on board attached to IOIO- • Smart monitoring and controlling of H1N1
OTG architecture could extend to more generic
• Reduction of energy consumption diseases
• Combining transducers, sensors and correlation

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techniques

•
•
•
Indoor location and motion tracking system -p
Researchers

CRIP platforms can be transformed into a valuable enabling technology

Computer-assisted decision support system should be used to detect other types of cancer
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• More skin diseases should be identified and classified using DDA
• Eye care system based IOT must by developed
• LOMB HRV analysis using PPG sensor based on LoRaWAN IOT must extend to house caring applications
• Implementation of multicore system on chip (SoC) to empower connected health apps
•
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Passive wireless sensing can be used to understand a range of health conditions

• Signal processing algorithm is necessary to enhance track movements
• Analysis of collected data may enhance the provision of diabetes care
• Multicore system can be integrated with the IoT platform
• Developed dialogue structure
• Integration of data stream management system technologies
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Figure 17 Recommendation Categories for IoT-based Telemedicine

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5.3.1 Recommendations to Manage Complex Diseases

Multiple morbidities are considered a complex disease, requiring the attention of various health care providers or
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facilities or even communities. These diseases include cardiovascular diseases, asthma, diabetes, epilepsy and
others. The combination of big data analytics and cloud computing presents a notable advancement in complex
disease monitoring for emotion-aware computing such as postpartum depression [138]. New possibilities will be
opened resulting from the development of the cyber-physical system for AAL for several important applications,
such as normal elderly care and monitoring as well as management of mild cognitive impairment, early Alzheimer’s
disease and further neurodegenerative disorders [170]. Inertial sensors can enhance the monitoring of patients with
spasmodic torticollis [112]. Affordable wearable devices are designed to manage stroke patients’ rehabilitation
through serious games [159]. Developing the system is accomplished through device introduction which can acquire
medical data for use at home by sick people without needing doctors’ assistance [82]. Other HER consolidations and
ubiquitous platforms will enable emergency monitoring of individuals’ health [139].

5.3.2 Recommendations to Identify and Analyse Diseases

Studies have demonstrated the probability of enhancing the identification and analysis of diseases through a
substantial amount of advice. The recommendations related to disease identification are focused on material or
methods and models. Visualisations through mobile devices, especially interactive methods, can enhance the
identification and analysis of epileptic seizures [113]. Approaches are utilised in recognising human activity through
data mining techniques, which are good in projecting tangible results [146]. Other types of artificial neural network
(ANN) are needed for better health status recognition [151]. IoT-based intelligent support system can enhance the
prediction of cardiovascular diseases through predictive analytics [78]. H1N1’s smart monitoring and architecture
controlling should be extended for other generic diseases. These diseases include examples such as diabetes,
hypertension and cancer with the use of social network analysis and cloud computing [102].

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5.3.3 Recommendations to Increase Performance
Expressing performance criteria can be achieved either as optimisation objectives or constraints. Performance of
system design focuses on satisfying (often conflicting) extra-functional requirements. It is determined by
coordination’s which is the complex and balancing of interrelated events in subsystems and components. Trade-offs
among all design disciplines would be necessary to achieve the target performance of system. We recommend
determining how to achieve high performance for suggesting system whilst maintaining other parameters such as
cost, complexity, and others; a consistent and automated selection of cognitive assessments can provide extra
accurate performance [110]. Other ML techniques should be tested to provide good activity recognition performance
[157]. A multimodal sensing approach is necessary to enhance identification performance [168]. Moreover, FoG
detection in daily living is used to increase performance [41]. The IoT-based cloud framework must estimate the
missing data for similar users towards improving the system efficiency [116]. The combined processing algorithms
with other ML techniques can improve recognition accuracy [130]. Other sensors on the board attached to the IOIO-
OTG are crucial to boost the system performance [53]. The m-Green CARDIO project seems effective with the
Remote Cardiac Monitoring System, but the reduction of the energy consumption, improvement of real-time system

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performances and study of mass production possibility should be considered [106]. Combining transducers, sensors
and correlation techniques can improve the robustness and reliability of the system for movement of patients and
connectivity losses [67]. Using the capacitive electrodes instead of sticking the electrodes to the body using gel

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enables low power wireless protocol, which can save power and extend battery life of wearable wireless tele-ECG
monitoring system [88].

5.3.4 Recommendations for Researchers

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Academic researchers are possibly able to provide a design for efficient healthcare services to individuals in low-
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and medium-income countries [72]. A platform which is capable of other applications and research in assisted living
is possible due to monitoring and tracking systems in indoor and outdoor locations [173]. Platforms demonstrating
similarities with CRIP could become a technology which is valuable and capable of ensuring reliable and secure
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deployments of IoT in the healthcare sector [63]. Computer-assisted decision support system should be capable of
detecting other types of cancer as DFCNet [129]. Other skin diseases should undergo identification and
classification using DDA [132]. In developing an entire system based on IoT for eye care, such a system would need
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minimal human intervention [131]. LOMB HRV analysis with the use of PPG sensor based on LoRaWAN IoT must
extend to home-care applications [51]. A multicore system on chip is implemented for empowering connected health
applications [65]. Passive wireless sensing could be utilised to understand health conditions’ range, not to mention
detecting accident and mishap events [89]. A signal processing algorithm is necessary to enhance track movements
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and provide other useful information to physicians [158]. Analysis of collected data may enhance the provision of
diabetes care [80]. The multicore system can be integrated with the IoT platform to empower connected health
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applications [65]. The developed dialogue structure is particularly crucial to improve the patients’ QoL [100].
Integrating a management system for data streaming is capable of supplying improved services in the health care
domain [103]. The combination of IoT and deep learning algorithms for clinical testing provides better means of
detection and research direction [137].

5.4 Open Issues and Innovative Key Solutions

This section briefly presents explored and unexplored issues surrounding IoT-based telemedicine.

5.4.1 IoT Telemedicine Network

The design of network type for IoT-based telemedicine is a new and open issue. The telemedicine network should
provide access to care for a large number of patients [38]. The patient’s location is a burden on the network when
service is required in every hospital and hundreds of other health care locations across the province [111]. Although
telehealth network is different from the telemedicine network in that it refers to a broader scope of remote health
care services than telemedicine [49], the telemedicine network in its practice is crucial due to its strong impact on
the lives of patients when providing them with clinical services and meetings for health care professionals and
patients [59][47]. As explained in the section ‘Concerns on patients’ safety’, the interrupted Internet connection to
the cloud system is causes the inability to monitor elderly patients suffering from various diseases. Constructing an
effective IoT telemedicine network (e.g. Ohio State University Telemedicine Network and Ontario Telemedicine
Network) necessitates the efforts of organisations and the government because of its high cost. Several approaches
have been developed to conduct IoT on a broader array of three-tier telemedicine architecture to improve network
performance [110][67]. The topology of the telemedicine network is considered a subset of the overall healthcare

35
network topology; thus, telemedicine belongs to e-healthcare, with the latter as the big picture. Topology also
includes a required network structure to support the streaming of vital signs from tier 1 until it reaches the final
destination at tier 3 and vice versa [38]. Several studies adapted a new enhancement in telemedicine architecture by
adding a local server between tiers 2 and 3 in case of connection or server failure at tier 3 [51]. In turn, this factor
changes the fundamental topology design of the telemedicine architecture for better activities in the continued
provision of healthcare services. Figure 12, Figure 13, Figure 14 respectively display the existing
environmental/physiological sensors, short- and long-range wireless networking technologies, and IoT hardware
devices used in the literature. The information constructed from Figure 13 represents the link-layer technologies for
the IoT-based telemedicine. Examples of such technologies include resource-constrained devices (i.e. Bluetooth,
IEEE 802.15.4, 6LowPan and BLE) [54][99]. In addition, other technologies for non-constrained devices (i.e.
cellular networks and WiFi) are available [62]. Indicators, requirements and conditions should obtain the benefits of
the following issues when designing IoT telemedicine network topology, architecture and platform.

• Solutions for Network Topology

Including the required network structure to support the streaming of medical vital signs,

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Including cloud computing for pervasive healthcare services as a conventional complete-mesh
networking system with the omnipresence of Internet connectivity,
Including a medical rule system in the case of a semantic medical monitoring system,

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Integration and unification of different network topologies and standards at the network level,
Integration of medical devices with the IoT telemedicine enterprise infrastructure, and
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Identifying associated activities and roles in medical healthcare services

• Solutions for Network Architecture

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Including IoT interoperability between Tier 2 and WLAN/WPAN networks;
Addressing the mobility based on four procedures such as including soliciting routers, waiting for
a new directed acyclic graph (DAG) information object (DIO), attachment to other available
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parent nodes and sending DAG information solicitation (DIS) messages;

Healthcare service delivery including composition, signalisation and data transmission; and
Data distribution architecture in the case of cloud computing integration
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• Solutions for Network Platform

Service platform framework includes a systematic hierarchical model of how caregivers or agents
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can access various databases from the application layer with the help of a support layer.
Data centre platforms function as the middleware between smart objects and the business layer.
Interfaces across stakeholders of the IoT telemedicine network are standardised to design an open
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platform.
Semantic platform architecture offers semantic interoperability across heterogeneous systems and
devices.
An IoT gateway is enabled to handle multiple users with multiple sensors.
Scalability and accessibility of cloud data are ensured, which requires coordination of data sharing
and interoperation.

5.4.2 IoT-based Telemedicine Application Assessment

The quality of telemedicine applications of IoT technologies is still not optimal. Even when the possibility of IoT
technologies applied to the telemedicine application is assessed [80], properly shedding light on the subject cannot
be guaranteed in several publications from the literature. The lack of reports on similar assessments does not
precisely mean it was done. Assessment reporting of different IoT technologies (especially sensors and hardware
devices) is likely to be a marker of the development of the telemedicine application [84][149]. Still, no guideline
direction exists to assess the quality of IoT-based telemedicine applications whilst considering factors and criteria
essential for such assessment. Alternately, diffusion, development and performance for IoT-based telemedicine
application as service of technological product strongly depends on market factors [28], with the regulatory
environment and the technology itself as well as their interaction. Designated criteria factors under the umbrella of
the three forces require consideration. Such an assessment framework can be used for real-time prioritisation and
ranking can be conducted in terms of best–worst scaling applications.

36
5.4.3 IoT-based Telemedicine Contexts
The fundamental of telemedicine essentially depends on medical contexts. According to several medical books and
guidelines [37], the procedures in the medial contexts should follow one another. For example (detection context
should be followed by diagnostics context and not vice versa). This interdisciplinary field includes ambiguities when
dealing with the telemedicine contexts. Therefore, when developing their studies, researchers should follow the
correct sequence of medical contexts. In the academic literature of our systematic reviews, few authors have
considered the context sequences, although an overwhelming evidence exists for its existence and impact on the
results of systematic reviews. To address this issue, the present study has presented the lifecycle of IoT-based
telemedicine context applications containing the sequencing procedures to be followed by healthcare organisations
and other studies. As shown in Table 1, the monitoring context has been conducted at the highest frequency, whilst
the treatment context reflects the lowest efforts. The presented lifecycle is reorganised by a medical expert panel
based on reliable references [37] as illustrated in Figure 18.

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Figure 18 Lifecycle and Sequencing Procedure of IoT-based Telemedicine Context Healthcare Applications
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Furthermore, diagnosis and detection are two terms that are similar but distinct in their meaning and unfortunately
often used interchangeably by the literature when presenting their studies [116][125]. Discussing this part primarily
aims to sensitise researchers to the fact that several studies in the literature can be misleading when authors are
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careless in selecting between them. Few studies have considered the differences based on medical practice. Here is
an example from medical practice where telemedicine applications should follow this concept. A memory loss
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would be detected by a physician by objectively establishing the recall ability of the patient not in the normal range
for patient age and educational peer group [37]. A physician must know the cause of the problem to detect it. Once
the problem is detected, the loss of memory would be highlighted as ‘diagnosed’, such as a thyroid disorder or
Alzheimer’s disease or any other memory-impairing medical conditions. The treatment decision would be informed
through the diagnosis. The initial task is the detection of medical clues to execute the diagnostic procedure.

5.4.4 IoT-based Telemedicine Demonstrations

According to [180], the French government had characterised the important demonstrations of telemedicine as
follows:
• Remote advisement: a medical practitioner provides a remote recommendation for sick people who might be
assisted by health specialists
• Remote proficiency: a doctor can remotely request various doctors to check conditions and manage them
• Medicinal telemonitoring: caregivers can monitor and decode the patient therapeutic indications
• Medicinal teleassistance: a doctor can remotely assist another doctor to perform a therapeutic demonstration
• Medical coordination of emergency
These demonstrations have attracted much attention but are normally less developed. No explicit enhancements
exist, and developing methods in the context of IoT governing these demonstrations, in turn, can provide a powerful
guide to best practices.

37
5.4.5 IoT-based Telemedicine Mobility
The IoT-based telemedicine applications and networks must be capable of supporting patients’ mobility to ensure
continuous provision of both healthcare services anywhere and anytime [158][69]. This mobility factor enables
patients to connect patient’s indoor and outdoor environments, and each of which has significance to patients/elderly
QoL [75]. Patients with critical diseases such as CVDs, endocrine and metabolic disorder and diabetes should
acquire the significance of both indoor and outdoor environments. Other patients with psychiatric diseases such as
Alzheimer’s, depressive disorder and emotional disorder are mostly confined to indoor environments. We
considered the importance of measuring indoor/outdoor activities by collecting both features from the literature as
mentioned in Figure 10. Researchers should consider this issue to improve PQoL, EQoL and QoHS in high-quality
outdoor environments.

5.4.6 IoT-based Telemedicine for New Diseases

IoT is considered an ultimate building block of new telemedicine applications [6]. Although many telemedicine
applications and new apps are consistently added to the list, the direction has been restricted to a few categories of
diseases (as shown in Error! Reference source not found.) [49][147]. Furthermore, studies based on the literature

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presented several duplicated ideas in terms of their enhancement in each disease category. Figure 11 summarises
these enhancements through a few and repeating algorithms and methods used in the literature on the diseases under
IoT. New methods should be considered to analyse massive amounts of complex data (e.g. deep learning) capable of

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learning unsupervised from disease dataset that is unstructured or unlabelled and can provide highly accurate results.
In addition, a study on the reporting of unfounded symptoms and illnesses for new diseases to be adaptive in
telemedicine apps is essential. This effort should be achieved under a medical expert’s supervision. Then, sensors,
devices and methods can be utilised to present new apps.
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5.4.7 IoT-based Telemedicine Healthcare Services
Clinical services in telemedicine include asynchronous and synchronous healthcare services [73][74]. Remote
patient monitoring is also considered a type of service due to continually monitoring the patients’ health conditions
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[36][101]. Many papers on research practices in the literature did not mention the type of healthcare services as
shown in Figure 9.a, whereas synchronous healthcare service for critical diseases has attracted less attention and
effort. IoT-based telemedicine apps require a real-time operating system with further stringent requirements. Figure
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9.b also provides unsatisfactory frequencies of the healthcare services considered by the literature on the elderly.

5.4.8 Internet of Wearables and Device-based Telemedicine

Several IoT wearables and hardware devices were not utilised in the literature as presented in Figure 14. We
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extended our research to collect sensors and devices as much as possible, and we presented these elements in a
conceptual diagram of IoT-based ubiquitous telemedicine solutions in Figure 3. Further efforts are needed to adapt
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other sensing technology and hardware devices in telemedicine architecture due to the increasing demand for
telemedicine projects in different countries [28]. Figure 19 shows the statistics for the market share of telemedicine
in the United States between 2014 and 2025. The type of product is the main aspect of distributing the shares, and
such market is expected to reach USD 22 billion by 2020. Telemedicine hardware products are expected to account
for 42% of the market [28].

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Figure 19 Forecast for US Telemedicine Market Share by Product, 2014–2025 [28]
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5.5.9 IoT-based Triage and Priority
Researchers may perceive triage and priority of patients as a method, algorithm or even technique [8][57]. However,
to the best of our knowledge, no study has offered any evidence in making triage and priority process under IoT
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workflow. In this regard, IoT sensor and device analysis of a typical triage and priority platforms may be useful as
an important variable that affects chronic diseases. Statistics presented in Figure 11, 12, 13 and 14 are useful to
achieve such a goal.
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5.4.10 Standardisation
IoT-based telemedicine solutions remain in the early development stages, and existing solutions do not conform to
specific rules and regulations [148][153][63]. Issues include interoperability (as presented in the section ‘Concerns
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on Interoperability of IoT Devices,’ which necessitates collaboration amongst researchers, such as the formation of a
task force in IoT telemedicine).
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5.4.11 Implementing Telemedicine Programmes

Additionally, several issues outlined by [181] presented another challenge for implementing telemedicine
programmes. The statistics presented in Figure 20 shows the percentage of the US health care organisations that
selected challenges in implementing telemedicine practices as of 2017. These challenges are different from one
organisation to another depending on the country’s property. We believe that the benefits identified in this study
(PQoL, EQoL, QoHS and smart health monitoring) should gain extra attention to overcome some of the challenges
presented in Figure 20 such as monitoring the quality of telemedicine technology, which presented 11% of the
overall challenges by integrating IoT characteristics in different telemedicine contexts. Consequently, telemedicine
architecture can be improved in terms of monitoring aspects.

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Figure 20 Challenges in Implementation of Telemedicine Practices in the US in 2017 [181]

5.4.12 IoT-based ML Techniques

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Most IoT devices generate big data and raise IoT concerns [138] called 3Vs (volume, velocity and variety) of
generated data. Besides an increase in data volume, big data generated from IoT are characterised by velocity in
terms of time and area reliance, with a variety of compound forms and data quality [27]. Outlining the 3Vs means
applying the most suitable algorithms for the type of data being used and the nature of the problems to be solved
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[154]. Table 2 shows the information related to disease datasets established and extracted in the literature such as
resource description, size and sample of dataset, algorithms and techniques used. This information can provide
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valuable information especially in developing new methodologies and selecting one of the case studies in this table.
In addition, two types of ML tasks used in reviewed studies, namely, classification and clustering to deal with the
3Vs concerns and evaluate the works with real or existing datasets from patients. The majority of ML methods in
these studies were generally based on classification tasks; by contrast, fewer studies depend on clustering [93][110].
Variety in the use of ML algorithms was observed in the studies reviewed, and the most common algorithms used
were support vector machine and decision trees. However, none of the studies mentioned the motives behind the
use of ways to learn the machine from others, and whether using one of the methods of ML would achieve better
results than others. Most of the reviewed studies expected results with high accuracy and performance, although the
results obtained from these techniques varied from one study to another. The question that is worthwhile to discuss
is how we can select the suitable ML techniques that provide the best performance results for a specific case.

40
 Table 2 Disease Dataset Information Extracted from Systematic Literature Review

Labelled/
Seq. Ref. Disease Type Resource description Dataset size Algorithms used Techniques used
Unlabelled
Sociological pattern infrastructure real dataset collected
Infectious disease/Mosquito-
1 [126] in December 2015 within seven days and include 188,509 records J48 Decision Tree - L
borne diseases
students’ contact information.
- DNN: deep neural network.
- SNN: Single hidden layer
Neural Network.
Neurological disease/ Patients’ vital signs recorded dataset (unlabelled) which
2 [57] 531 files (322 ADLs and 209 falls) - MLiR: Multi-variant Linear - L
Movement is collected by biosensor devices

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Regression.

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- MLoR: Multi-variate
Logistic Regression.

Dermatology disease/
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Comprises labelled/unlabelled data. Labelled data
755 SK images, 545 FW images,
consists of feature data (comprise images for obvious
include 43 labelled feature images CNN: deep Convolution

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3 [132] Dermatosis Discrimination and clear lesion characteristics) and non-feature data - L
and 48 labelled non-feature images Neural Network.
Assistant (comprise images for no obvious lesion features and
of SK
noise information)

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The first set of information is concerning:
The dataset consists of two sets
- resting sitting
measurements:

Neurological disease/
4 [170]
General Neurological
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- resting standing STFT: Short
- 10 healthy subjects (aged
- walking naturally - time Fourier N/A
between 23 and 29).
- walking with obstacles performing a second cognitive Transform
- 10 healthy subjects (aged
task obtained with EMG/EEG wireless recording

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between 24 and 28).
system.
MIT-BIH repository, MITDB database which is an ECG
5 [139] ECG case study waveform samples database for 47 subjects of different N/A Neural Network - L

Cardiovascular/ blood- ur
ages includes males and females.
Physionet MIMIC-II database, real vital signs synthetic
MapReduce with ML
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6 [40] datasets generated from eMedical internet of things kits 3 patients - L
pressure classification algorithms
(MySignals) in AAL.
-ECG recording from PhysioNet -200 ECG recording
7 [49] Cardiovascular SVM - L
- ECGs telehealth from Telehealth -250 telehealth ECGs
- Medical data collected from patients by using IoT
devices.
Fuzzy Rule
- UCI repository dataset (Murphy & Aha 1995).
8 [134] Diabetes N/A - based L
- Diabetics patients attached to sensors for predicting
Neural Classifier
the disease including the patients' history data collected
from hospitals.
Neurological disease/ Thirty volunteers (19- 48 years - k-NN: k-nearest-neighbours
9 [149] HAR datasets from the UC Irvine ML repository - L
Movement old) - SVM
polygraphic' signals for the patient with the technical
10 [92] Respiratory disease characteristics of the recorded signals for sleep analysis: - - - N/A
ECG x1/EMG x 1/EOG x2/EEG x 2/airflow.
Infectious disease/ Pandemic
11 [121] synthetic dataset generation for H1N1 5000 cases of H1N1 virus DTs - L
Influenza (H1N1)
42 LBBB patient:
12 [71] Cardiovascular/ Heart -Left Bundle Branch Blocks (LBBB) patient - t-test and KS test N/A
- 29 type 1

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 - 13 patients type 2
Neuropsychiatric disease/ Person’s profile information includes situations,
13 [74] N/A - Web of objects N/A
Depressive Disorder activities, and emotions.
- A new motion tracking dataset used BLE beacon. - SVM
Neurological disease/ - A new location tracking dataset. - k-NN
14 [173] 4883 samples for both activities - L
Movement - The Digital Home laboratory consists of giving rooms - DTs: Decision Trees
includes SOHO/bedroom/kitchen/living room/foyer. - Random Forests
123 Adult actors with 593 facial
expressions (31% male, 69%
- Fuzzy Logic
female). The population samples - KNN
Free access database. Emotional-facial-expressions- - Bayesian
15 [153] Emotion/Healthcare have the following characteristics: - DTs or Logistic Regression L
pictures from the Extended Cohn Kanade (CK+). Networks
- 6% belong to other ethnic groups -SVM
-

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- 13% are African-American

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- 81% are European or American
(1) Daily sleep records data composed by using IoT

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sensors
- LSTM: Long Short-Term
Neuropsychiatric disease / (2) Mobile web diary from self- reported lifestyle 333 adult participants aged
16 [93] Memory - UnL/L

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Sleep disorder behaviour between 20 and 64 years
- DBN: Deep Belief Network
(3) Demographic profile collected using pre/post-survey
questionnaires.

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Using iExaminer system to capture images for normal - Multikernel
17 [131] Ophthalmological disease 100 images SVR L
retinal atlas

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- BDT: Binary decision tree
Cardiovascular diseases, MIT-Arrhythmia database. ECG signals record - KNN
18 [65] N/A - L
(ECG) 106/119/223/201. - ENN: extended nearest
neighbour

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- Physiological dataset: includes mandatory symptoms
of patients’ health.
- Environmental dataset: comprises information about - TNA:
19 [124]
Infectious disease /Mosquito
Borne disease
(Chikungunya)
breeding ur
mosquito-dense locations and patients’ nearby mosquito
2,367 volunteers
- J48 decision tree Temporal
Network
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- Location dataset: comprises infected location, Analysis
susceptible and exposed patients and mosquito dense
location as well as breeding sites
- Fuzzy logic
using Mamdani
inference
- Computer-
Using software and IBM servers to collect patients’
Neuropsychiatric disease/ Assisted
20 [110] interactions recorded over three months in the IM 39 patients - K-means clustering L
Dementia Cognitive
information.
Therapy (CACT)
software called
Mente Activa,

Neuropsychiatric disease/ Using KFUPM clinic and the University laboratory to 30 ECG sample data from young
21 [109] - - N/A
Alzheimer’s collect data from 2010 to 2013. and elderly volunteers
AHE patient data MIMIC II sensor datasets include
30 patients of P group and 29
22 [69] Cardiovascular/ Cardiac mean arterial patient’s group blood pressure values SVM L
patients of H
mentioned as P and control group mentioned as H.

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 1- Skeleton-based open access Kinect activity dataset
(CAD 60) founded at Cornell University having activity
classes concerning full-body actions.
- 60 RGB-D videos of 12 activities - HMM: Hidden
2- Berkeley Multimodal Human Action Database
performed by four subjects. Markov Model
Neurological disease/ (MHAD) includes data from:
23 [150] - 11 activities performed 5 times - - Activity L
Movement - microphones
by 12 subjects (7 male and 5 Recognition
- Kinect depth cameras.
female) Techniques
- Stereo cameras.
- Motion captures system.
- Wearable’s accelerometers.
198 recorded seizures from 22
CVA: credit valuation
Neurological disease/ CHB-MIT database collected by Boston Children’s subjects (5 males,
24 [113] adjustment - N/A
Epileptic Hospital. ages 3 to 22 years and 17 females)

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compression algorithm
with ages 1.5 to 19 years

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Sensed data include heart rate, body temperature and 168 sensed coarse inference
25 [61] - N/A

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respiration rate data (4 sensors × 42 captures) method
kNN
26 [125] Cardiovascular Medical records collected from Harapan Kita Hospital 450 medical records L

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The database at the clinical server stores the
information:

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- Rehabilitation therapies and pharmacological assigned
Neurological
27 [41] by a clinician to the patient. N/A - Fuzzy logic L
disease/Parkinson’s disease
- Patients’ monitoring data from the smartphone

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application.
- Web application patients’ personal details.
- Sorting method
CASAS at WSU. Daily Life Spring 2009 Dataset

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Neurological disease/ containers
28 [157] comprises all the sensor events generated by two 1,719,558 sensor events SVM L
Movement (baskets).
participants in a smart home for 2 months.
-

Infectious disease / Ebola ur

- Using SocioPatterns infrastructure 2016 to measure
real dataset comprising the students’ contact details for
five days in December 2013.
188,508 entries and each entry
describes close proximity
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29 [116] interaction (CPI) between different J48 decision tree - L
virus - Synthetic data generation: mapping the CPI data
students during 20-s intervals - 2
between students at different time intervals with
million users
generated 5,000 cases of Ebola.
CHFD dataset includes ECG
recordings (15 subject’s severe
congestive heart failure). The
- Using BIDMC Congestive Heart Failure Database - (Cobweb, Expectation - RCC: Rank
individual recordings are
Cardiovascular /Congestive (CHFD) to generate real ECG signals. Maximization, Farthest First, Correlation
30 [105] approximately 20 hours in N/A
heart failure - MIT-BIH database. ECG recordings from 15 severe and Simple K-Means) Coefficient
duration. They contain two main
congestive heart failure subjects. - Naive Bayes
ECG signals, each sampled at 250
samples/s with 12-bit resolution
over a range of ±10 mV.
ML/ Ensemble algorithms
Patient’s records include being affected with stroke and - Random Forest scheme -
31 [140] Cardiovascular/Stroke having attributes of 191 patients’ records - Naïve Bayesian L
age/sex/systolic/diastolic/heartbeat/sugar - KNN
- DTs

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 ensemble classifiers
Performance assessment of
Using the Maternity School Assis Chateaubriand dataset
205 parturient women diagnosed DTs
32 [138] Emotion/pregnancy of pregnant women, their medical history, and L
with related pregnancy problems - SVM
sociodemographic information.
- NN: nearest neighbour and
ensemble classifiers.
Fourier
transform
33 [154] Emotion/healthcare eNTERFACE’05 emotion database N/A SVM band-pass filters L
(BPFs)

Neuropsychiatric disease/ Collected information about patient’s location and CEP: Complex
34 [111] N/A - N/A
Dementia behaviour from mobile and wearable devices Event Processing

f
Using CA to collect the data, the proposed e-health

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Neuropsychiatric disease/
35 [171] system acquires an environment’s colour, lighting data, N/A - decision theory N/A
Depressive disorder

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humidity and temperature.
Two datasets are used:
1) dataset of patients with CHD and their triage level

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- 572 patients AHP
36 [120] chronic heart disease and - N/A
- 12 hospitals 3LLT
2) dataset of healthcare

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services provided by hospitals
chronic kidney disease
(CKD)

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benchmark CKD (UCI source) 400 instances under the
37 [142] https://archive.ics.uci.edu/ml logistic regression - L
presence of 24 features
/datasets/Chronic_Kidney_D
isease

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Random Forest (RF),
_ Artificial Neural Network
(ANN),
data collected from sensors on smart phone about fall
38 [175] lack of balance
event
ur - _ Support Vector Machine
(SVM),
_ Boosted Decision Tree
- L
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(BDT).
clinical data of the elderly patients suffering from blood Naïve Bayes (NB) and
39 [172] chronic disease pressure disorders from PhysioNet MIMIC-II 3 patients with 11 features Whale Optimization - L
Algorithm (WOA)

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6. Conclusion
Humans need efficient telemedicine efforts, which can serve the demand of larger and older populations at an
affordable cost. In presenting the results, researchers across the world have begun to examine solutions to medical
practice in a manner that reforms telemedicine services by focusing on the potential of the IoT. The growing demand
of the patient and elderly populations for remote healthcare services will drive the telemedicine industry in the
coming years by working with various IoT technologies to overcome the effect of various diseases. This study
discussed diverse aspects of IoT-based telemedicine for the network, healthcare services and applications and
reshaped the new telemedicine architecture backbone in the context of IoT. In addition, this study provided detailed
descriptive information concerning the IoT-based telemedicine contexts that interact with the disease classification
covered in the literature. We comprehensively analysed some studies to highlight the benefits, challenges and
recommendations related to IoT-based telemedicine and found certain gaps. Thus, we presented solutions for the
challenges and issues highlighted in this study. To gain deeper insights into the investigated field, this study
provides a broader foundation to the industry trends by exploring the impact of IoT sensors, devices, methods and
other technologies to encourage telemedicine developments for the treatment of various diseases. That is, salient
relationships exist between IoT characteristics and telemedicine architecture requiring the use of patients, health care

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providers and policymakers leading to the improvement of existing applications and development of high standards
of medical and healthcare practice.

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Acknowledgment
The authors are grateful to the Universiti Pendidikan Sultan Idris, Malaysia for funding this study under UPSI
Rising Star Grant No. 2019–0125–109–01.

References
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[1] J. Craig and V. Patterson, “Introduction to the practice of telemedicine,” J. Telemed. Telecare, vol. 11, no. 1, pp. 3–9,
2005, doi: 10.1258/1357633053430494.
[2] G. Acampora, D. J. Cook, P. Rashidi, and A. V. Vasilakos, “A survey on ambient intelligence in healthcare,” Proc.
lP

IEEE, vol. 101, no. 12, pp. 2470–2494, 2013, doi: 10.1109/JPROC.2013.2262913.
[3] A. A. Zaidan et al., “A survey on communication components for IoT-based technologies in smart homes,”
Telecommun. Syst., vol. 69, no. 1, pp. 1–25, Sep. 2018, doi: 10.1007/s11235-018-0430-8.
[4] A. Luigi, I. Antonio, and M. Giacomo, “The internet of things: a survey,” Comput. Networks, vol. 54, no. 15, pp. 2787–
na

2805, 2010.
[5] J. Holler, V. Tsiatsis, C. Mulligan, S. Avesand, S. Karnouskos, and D. Boyle, From Machine-To-Machine to the Internet
of Things. Elsevier, 2014.
ur

[6] G. Kortuem, F. Kawsar, V. Sundramoorthy, and D. Fitton, “Smart objects as building blocks for the internet of things,”
IEEE Internet Comput., vol. 14, no. 1, pp. 44–51, 2010, doi: 10.1109/MIC.2009.143.
[7] S. Adibi, “A mobile health network disaster management system,” in International Conference on Ubiquitous and
Jo

Future Networks, ICUFN, Jul. 2015, vol. 2015-Augus, pp. 424–428, doi: 10.1109/ICUFN.2015.7182579.
[8] M. Talal et al., “Smart Home-based IoT for Real-time and Secure Remote Health Monitoring of Triage and Priority
System using Body Sensors : Multi-driven Systematic Review,” J. Med. Syst., vol. 43, no. 3, p. 42, Mar. 2019, doi:
10.1007/s10916-019-1158-z.
[9] B. G. DeRubertis, M. Pierce, E. J. Ryer, S. Trocciola, K. C. Kent, and P. L. Faries, “Reduced primary patency rate in
diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening
ischemia,” J. Vasc. Surg., vol. 47, no. 1, pp. 101–108, 2008, doi: 10.1016/j.jvs.2007.09.018.
[10] N. D. Wolfe, C. P. Dunavan, and J. Diamond, “Origins of major human infectious diseases,” Nature, vol. 447, no. 7142,
pp. 279–283, 2007, doi: 10.1038/nature05775.
[11] C. J. L. Murray and A. D. Lopez, “Measuring the global burden of disease,” N. Engl. J. Med., vol. 369, no. 5, pp. 448–
457, 2013, doi: 10.1056/NEJMra1201534.
[12] C. Karimkhani et al., “Global skin disease morbidity and mortality: an update from the global burden of disease study
2013,” JAMA dermatology, vol. 153, no. 5, pp. 406–412, 2017.
[13] R. Seising and M. Elio, “Fuzziness and Medicine: Philosophical Reflections and Application Systems in Health Care,”
vol. 302, 2013, doi: 10.1007/978-3-642-36527-0.
[14] Statista, “Total aging funding by the National Institutes for Health (NIH),” 2019.
https://www.statista.com/statistics/716570/aging-funding-by-the-national-institutes-for-health/ (accessed Nov. 02,
2019).
[15] R. HODES, Director, and O. of the D. (OD)., “We have a budget for FY 2019!,” 2018.
https://www.nia.nih.gov/research/blog/2018/10/we-have-budget-fy-2019 (accessed Nov. 02, 2019).
[16] C. JM, C. JM, and K. RL, “Will generalist physician supply meet demands of an increasing and aging population?:
projected shortages could be alleviated in the United States produced four additional generalist graduates in each family
and internal medicine residency program each ye,” Health Aff., vol. 27, no. Suppl1, pp. w232-41, 2008, [Online].

45
 Available: http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105707257&site=ehost-live.
[17] E. Gonzalez, R. Peña, A. Avila, C. Vargas-Rosales, and D. Munoz-Rodriguez, “A Systematic Review on Recent
Advances in mHealth Systems: Deployment Architecture for Emergency Response,” J. Healthc. Eng., vol. 2017, pp. 1–
13, 2017, doi: 10.1155/2017/9186270.
[18] C. F. Pasluosta, H. Gassner, J. Winkler, J. Klucken, and B. M. Eskofier, “An emerging era in the management of
Parkinson’s disease: Wearable technologies and the internet of things,” IEEE J. Biomed. Heal. Informatics, vol. 19, no.
6, pp. 1873–1881, 2015, doi: 10.1109/JBHI.2015.2461555.
[19] S. Amendola, R. Lodato, S. Manzari, C. Occhiuzzi, and G. Marrocco, “RFID technology for IoT-based personal
healthcare in smart spaces,” IEEE Internet Things J., vol. 1, no. 2, pp. 144–152, 2014, doi: 10.1109/JIOT.2014.2313981.
[20] M. Kang, E. Park, B. H. Cho, and K. S. Lee, “Recent patient health monitoring platforms incorporating Internet of
Things-enabled smart devices,” Int. Neurourol. J., vol. 22, no. 2, pp. S76–S82, 2018, doi: 10.5213/inj.1836144.072.
[21] M. Haghi, K. Thurow, and R. Stoll, “Wearable devices in medical internet of things: Scientific research and
commercially available devices,” Healthc. Inform. Res., vol. 23, no. 1, pp. 4–15, 2017, doi: 10.4258/hir.2017.23.1.4.
[22] M. Irfan and N. Ahmad, “Internet of medical things: Architectural model, motivational factors and impediments,” in
2018 15th Learning and Technology Conference, L and T 2018, 2018, pp. 6–13, doi: 10.1109/LT.2018.8368495.
[23] H. H. Nguyen, F. Mirza, M. A. Naeem, and M. Nguyen, “A review on IoT healthcare monitoring applications and a
vision for transforming sensor data into real-time clinical feedback,” in Proceedings of the 2017 IEEE 21st International

of
Conference on Computer Supported Cooperative Work in Design, CSCWD 2017, 2017, pp. 257–262, doi:
10.1109/CSCWD.2017.8066704.
[24] J. Wan, X. Gu, L. Chen, and J. Wang, “Internet of Things for Ambient Assisted Living: Challenges and Future

ro
Opportunities,” in Proceedings - 2017 International Conference on Cyber-Enabled Distributed Computing and
Knowledge Discovery, CyberC 2017, 2018, vol. 2018-Janua, pp. 354–357, doi: 10.1109/CyberC.2017.83.
[25] R. V. Milani and C. J. Lavie, “Health care 2020: Reengineering health care delivery to combat chronic disease,” Am. J.

[26]
-p
Med., vol. 128, no. 4, pp. 337–343, 2015, doi: 10.1016/j.amjmed.2014.10.047.
M. Mohammadpour, Z. Heidari, M. Mirghorbani, and H. Hashemi, “Smartphones, tele-ophthalmology, and VISION
2020,” Int. J. Ophthalmol., vol. 10, no. 12, pp. 1909–1918, 2017, doi: 10.18240/ijo.2017.12.19.
re
[27] A. Panesar, “Future of Healthcare BT - Machine Learning and AI for Healthcare : Big Data for Improved
Health Outcomes,” A. Panesar, Ed. Berkeley, CA: Apress, 2019, pp. 255–304.
lP

[28] Www.statista.com/statistics, “U.S. telemedicine market share by product forecast 2014-2025,” 2019.
https://www.statista.com/statistics/938578/telemedicine-market-share-forecast-united-states-by-product-type/ (accessed
Nov. 03, 2019).
[29] M. Stefanelli, “The socio-organizational age of artificial intelligence in medicine,” Artif. Intell. Med., vol. 23, no. 1, pp.
na

25–47, 2001, doi: 10.1016/S0933-3657(01)00074-4.

[30] D. Moher, A. Liberati, J. Tetzlaff, and D. G. Altman, “Preferred reporting items for systematic reviews and meta-
analyses: The PRISMA statement,” Int. J. Surg., vol. 8, no. 5, pp. 336–341, 2010, doi: 10.1016/j.ijsu.2010.02.007.
[31] C. Cooper, A. Booth, J. Varley-Campbell, N. Britten, and R. Garside, “Defining the process to literature searching in
ur

systematic reviews: A literature review of guidance and supporting studies,” BMC Med. Res. Methodol., vol. 18, no. 1,
p. 85, 2018, doi: 10.1186/s12874-018-0545-3.
[32] W. M. Bramer, M. L. Rethlefsen, J. Kleijnen, and O. H. Franco, “Optimal database combinations for literature searches
Jo

in systematic reviews: A prospective exploratory study,” Syst. Rev., vol. 6, no. 1, p. 245, 2017, doi: 10.1186/s13643-
017-0644-y.
[33] M. Gusenbauer and N. R. Haddaway, “Which academic search systems are suitable for systematic reviews or meta-
analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources,” Res. Synth. Methods, vol.
11, no. 2, pp. 181–217, 2020, doi: 10.1002/jrsm.1378.
[34] S. Kraus, M. Breier, and S. Dasí-Rodríguez, “The art of crafting a systematic literature review in entrepreneurship
research,” Int. Entrep. Manag. J., pp. 1–20, 2020, doi: 10.1007/s11365-020-00635-4.
[35] M. M. Abdellatif and W. Mohamed, “Telemedicine: An IoT based Remote Healthcare System,” Int. J. Online Biomed.
Eng., vol. 16, no. 06, p. 72, 2020, doi: 10.3991/ijoe.v16i06.13651.
[36] S. Alelyani and A. Ibrahim, “Internet-of-Things in telemedicine for diabetes management,” in 2018 15th Learning and
Technology Conference, L and T 2018, 2018, pp. 20–23, doi: 10.1109/LT.2018.8368505.
[37] A. K. Mohanakrishnan, C. Prakash, and N. Ramesh, “A simple iodination protocol via in situ generated ICl using
NaI/FeCl3,” Tetrahedron, vol. 62, no. 14, pp. 3242–3247, Apr. 2006, doi: 10.1016/j.tet.2006.01.067.
[38] A. T. Ozdemir, C. Tunc, and S. Hariri, “Autonomic fall detection system,” in Proceedings - 2017 IEEE 2nd
International Workshops on Foundations and Applications of Self* Systems, FAS*W 2017, 2017, pp. 166–170, doi:
10.1109/FAS-W.2017.142.
[39] A. Garai, I. Pentek, A. Adamko, and A. Nemeth, “A clinical system integration methodology for bio-sensory technology
with cloud architecture,” Acta Cybern., vol. 23, no. 2, pp. 513–536, 2017, doi: 10.14232/actacyb.23.2.2017.6.
[40] M. K. Hassan, A. I. El Desouky, S. M. Elghamrawy, and A. M. Sarhan, “Intelligent hybrid remote patient-monitoring
model with cloud-based framework for knowledge discovery,” Comput. Electr. Eng., vol. 70, pp. 1034–1048, 2018, doi:
10.1016/j.compeleceng.2018.02.032.
[41] L. Pepa, M. Capecci, F. Verdini, M. G. Ceravolo, and L. Spalazzi, “An architecture to manage motor disorders in
Parkinson’s disease,” in 2015 IEEE 2nd World Forum on Internet of Things (WF-IoT), 2015, pp. 615–620, doi:

46
 10.1109/WF-IoT.2015.7389124.
[42] G. Xu et al., “An IoT-Based Framework of Webvr Visualization for Medical Big Data in Connected Health,” IEEE
Access, vol. 7, pp. 173866–173874, 2019, doi: 10.1109/ACCESS.2019.2957149.
[43] H. Fouad, N. M. Mahmoud, M. S. El Issawi, and H. Al-Feel, “Distributed and scalable computing framework for
improving request processing of wearable IoT assisted medical sensors on pervasive computing system,” Comput.
Commun., vol. 151, pp. 257–265, 2020, doi: 10.1016/j.comcom.2020.01.020.
[44] X. M. Zou, “Prototype design of a remote medical monitoring system based on the internet of things,” Int. J. Online
Eng., vol. 12, no. 1, pp. 50–57, 2016, doi: 10.3991/iioe.vl2il.5227.
[45] K. N. Lal and A. Kumar, “E-health application over 5G using Content-Centric networking (CCN),” in IEEE
International Conference on IoT and its Applications, ICIOT 2017, 2017, doi: 10.1109/ICIOTA.2017.8073614.
[46] A. Mdhaffar, T. Chaari, K. Larbi, M. Jmaiel, and B. Freisleben, “IoT-based health monitoring via LoRaWAN,” in 17th
IEEE International Conference on Smart Technologies, EUROCON 2017 - Conference Proceedings, 2017, pp. 519–524,
doi: 10.1109/EUROCON.2017.8011165.
[47] F. Nasri, N. Moussa, and A. Mtibaa, “Internet of Things: Intelligent system for healthcare based on WSN and android,”
in 2014 World Congress on Computer Applications and Information Systems, WCCAIS 2014, 2014, doi:
10.1109/WCCAIS.2014.6916635.
[48] D. Borthakur, H. Dubey, N. Constant, L. Mahler, and K. Mankodiya, “Smart fog: Fog computing framework for

of
unsupervised clustering analytics in wearable Internet of Things,” in 2017 IEEE Global Conference on Signal and
Information Processing, GlobalSIP 2017 - Proceedings, 2018, vol. 2018-Janua, pp. 472–479, doi:
10.1109/GlobalSIP.2017.8308687.

ro
[49] C. Liu et al., “Signal quality assessment and lightweight qrs detection for wearable ECG smartvest system,” IEEE
Internet Things J., vol. 6, no. 2, pp. 1363–1374, 2019, doi: 10.1109/JIOT.2018.2844090.
[50] N. Hayati and M. Suryanegara, “The IoT LoRa system design for tracking and monitoring patient with mental disorder,”

[51]
-p
in 2017 IEEE International Conference on Communication, Networks and Satellite, COMNETSAT 2017 - Proceedings,
2018, vol. 2018-Janua, pp. 135–139, doi: 10.1109/COMNETSAT.2017.8263587.
D. Z. Wu, C. C. Sun, K. W. Chun, Y. X. Lin, and Y. H. Lin, “System integration of LOMB HRV analysis using PPG
re
sensor based on LoRaWAN IOT,” in SII 2017 - 2017 IEEE/SICE International Symposium on System Integration, 2018,
vol. 2018-Janua, pp. 493–498, doi: 10.1109/SII.2017.8279269.
lP

[52] I. Zagan, V. G. Gaitan, N. Iuga, and A. Brezulianu, “M-GreenCARDIO embedded system designed for out-of-hospital
cardiac patients,” in 2018 14th International Conference on Development and Application Systems, DAS 2018 -
Proceedings, 2018, pp. 11–17, doi: 10.1109/DAAS.2018.8396063.
[53] J. Mohammed, C. H. Lung, A. Ocneanu, A. Thakral, C. Jones, and A. Adler, “Internet of things: Remote patient
na

monitoring using web services and cloud computing,” in Proceedings - 2014 IEEE International Conference on Internet
of Things, iThings 2014, 2014 IEEE International Conference on Green Computing and Communications, GreenCom
2014 and 2014 IEEE International Conference on Cyber-Physical-Social Computing, CPS 20, 2014, pp. 256–263, doi:
10.1109/iThings.2014.45.
ur

[54] T. N. Gia, A. M. Rahmani, T. Westerlund, P. Liljeberg, and H. Tenhunen, “Fault tolerant and scalable IoT-based
architecture for health monitoring,” in SAS 2015 - 2015 IEEE Sensors Applications Symposium, Proceedings, 2015, pp.
334–339, doi: 10.1109/SAS.2015.7133626.
Jo

[55] T. N. Gia, M. Jiang, A. M. Rahmani, T. Westerlund, P. Liljeberg, and H. Tenhunen, “Fog computing in healthcare
Internet of Things: A case study on ECG feature extraction,” in Proceedings - 15th IEEE International Conference on
Computer and Information Technology, CIT 2015, 14th IEEE International Conference on Ubiquitous Computing and
Communications, IUCC 2015, 13th IEEE International Conference on Dependable, Autonomic and Se, 2015, pp. 356–
363, doi: 10.1109/CIT/IUCC/DASC/PICOM.2015.51.
[56] H. Fouad and H. Farouk, “Heart rate sensor node analysis for designing internet of things telemedicine embedded
system,” Cogent Eng., vol. 4, no. 1, 2017, doi: 10.1080/23311916.2017.1306152.
[57] A. Bagula, M. Mandava, and H. Bagula, “A framework for healthcare support in the rural and low income areas of the
developing world,” J. Netw. Comput. Appl., vol. 120, pp. 17–29, 2018, doi: 10.1016/j.jnca.2018.06.010.
[58] N. Petrellis, M. Birbas, and F. Gioulekas, “On the design of low-cost IoT sensor node for e-health environments,”
Electronics, vol. 8, no. 2, p. 178, 2019.
[59] G. Yang et al., “A Health-IoT platform based on the integration of intelligent packaging, unobtrusive bio-sensor, and
intelligent medicine box,” IEEE Trans. Ind. Informatics, vol. 10, no. 4, pp. 2180–2191, 2014, doi:
10.1109/TII.2014.2307795.
[60] B. S. Kim, “A distributed coexistence mitigation scheme for IoT-based smart medical systems,” J. Inf. Process. Syst.,
vol. 13, no. 6, pp. 1602–1612, 2017, doi: 10.3745/JIPS.03.0087.
[61] J. J. Kang, T. H. Luan, and H. Larkin, “Enhancement of sensor data transmission by inference and efficient data
processing,” in Communications in Computer and Information Science, 2016, vol. 651, pp. 81–92, doi: 10.1007/978-
981-10-2741-3_7.
[62] T. D. McAllister, S. El-Tawab, and M. H. Heydari, “Localization of Health Center Assets Through an IoT Environment
(LoCATE),” in 2017 Systems and Information Engineering Design Symposium, SIEDS 2017, 2017, pp. 132–137, doi:
10.1109/SIEDS.2017.7937703.
[63] J. Miranda et al., “An open platform for seamless sensor support in healthcare for the internet of things,” Sensors

47
 (Switzerland), vol. 16, no. 12, 2016, doi: 10.3390/s16122089.
[64] C. Kan, F. M. Leonelli, and H. Yang, “Map reduce for optimizing a large-scale dynamic network - The Internet of
hearts,” in Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology
Society, EMBS, 2016, vol. 2016-Octob, pp. 2962–2965, doi: 10.1109/EMBC.2016.7591351.
[65] H. Djelouat, H. Baali, A. Amira, and F. Bensaali, “IoT Based Compressive Sensing for ECG Monitoring,” in
Proceedings - 2017 IEEE International Conference on Internet of Things, IEEE Green Computing and Communications,
IEEE Cyber, Physical and Social Computing, IEEE Smart Data, iThings-GreenCom-CPSCom-SmartData 2017, 2018,
vol. 2018-Janua, pp. 183–189, doi: 10.1109/iThings-GreenCom-CPSCom-SmartData.2017.32.
[66] H. Djelouat, H. Baali, A. Amira, and F. Bensaali, “Joint sparsity recovery for compressive sensing based EEG system,”
in 2017 IEEE 17th International Conference on Ubiquitous Wireless Broadband, ICUWB 2017 - Proceedings, 2018,
vol. 2018-Janua, pp. 1–5, doi: 10.1109/ICUWB.2017.8251001.
[67] E. Spanò, S. Di Pascoli, and G. Iannaccone, “Low-Power Wearable ECG Monitoring System for Multiple-Patient
Remote Monitoring,” IEEE Sens. J., vol. 16, no. 13, pp. 5452–5462, 2016, doi: 10.1109/JSEN.2016.2564995.
[68] N. L. S. Fung et al., “The Conceptual MADE Framework for Pervasive and Knowledge-Based Decision Support in
Telemedicine,” Int. J. Knowl. Syst. Sci., vol. 7, no. 1, pp. 25–39, 2016, doi: 10.4018/ijkss.2016010102.
[69] R. K. Pathinarupothi, P. Durga, and E. S. Rangan, “IoT Based Smart Edge for Global Health: Remote Monitoring with
Severity Detection and Alerts Transmission,” IEEE Internet Things J., pp. 2327–4662, 2018, doi:

of
10.1109/JIOT.2018.2870068.
[70] M. Pustišek, “A System for Multi-Domain Contextualization of Personal Health Data,” J. Med. Syst., vol. 41, no. 1,
2017, doi: 10.1007/s10916-016-0663-6.

ro
[71] C. Kan, Y. Chen, F. Leonelli, and H. Yang, “Mobile sensing and network analytics for realizing smart automated
systems towards health Internet of Things,” in IEEE International Conference on Automation Science and Engineering,
2015, vol. 2015-Octob, pp. 1072–1077, doi: 10.1109/CoASE.2015.7294241.
[72] -p
P. Kumari, M. Lopez-Benitez, G. M. Lee, T. S. Kim, and A. S. Minhas, “Wearable Internet of Things - From human
activity tracking to clinical integration,” in Proceedings of the Annual International Conference of the IEEE Engineering
in Medicine and Biology Society, EMBS, 2017, pp. 2361–2364, doi: 10.1109/EMBC.2017.8037330.
re
[73] D. Perez, S. Memeti, and S. Pllana, “A simulation study of a smart living IoT solution for remote elderly care,” in 2018
3rd International Conference on Fog and Mobile Edge Computing, FMEC 2018, 2018, pp. 227–232, doi:
lP

10.1109/FMEC.2018.8364069.
[74] S. Ali, M. G. Kibria, M. A. Jarwar, S. Kumar, and I. Chong, “Microservices model in WoO based IoT platform for
depressive disorder assistance,” in International Conference on Information and Communication Technology
Convergence: ICT Convergence Technologies Leading the Fourth Industrial Revolution, ICTC 2017, 2017, vol. 2017-
na

Decem, pp. 864–866, doi: 10.1109/ICTC.2017.8190800.

[75] D. G. Korzun, A. V. Borodin, I. A. Timofeev, I. V. Paramonov, and S. I. Balandin, “Digital assistance services for
emergency situations in personalized mobile healthcare: Smart space based approach,” in Proceedings - 2015
International Conference on Biomedical Engineering and Computational Technologies, SIBIRCON 2015, 2015, pp. 62–
ur

67, doi: 10.1109/SIBIRCON.2015.7361852.

[76] T. S. Lin, P. Y. Liu, and C. C. Lin, “Home Healthcare Matching Service System Using the Internet of Things,” Mob.
Networks Appl., vol. 24, no. 3, pp. 736–747, 2019, doi: 10.1007/s11036-018-1087-y.
Jo

[77] N. Semwal, M. Mukherjee, C. Raj, and W. Arif, “An IoT based smart e-health care system,” J. Inf. Optim. Sci., vol. 40,
no. 8, pp. 1787–1800, 2019.
[78] P. Chatterjee, L. J. Cymberknop, and R. L. Armentano, “IoT-based decision support system for intelligent healthcare -
Applied to cardiovascular diseases,” in Proceedings - 7th International Conference on Communication Systems and
Network Technologies, CSNT 2017, 2018, pp. 362–366, doi: 10.1109/CSNT.2017.8418567.
[79] A. M. C. Drăgulinescu, A. F. Manea, O. Fratu, and A. Drăgulinescu, “LoRa-Based Medical IoT System Architecture
and Testbed,” Wirel. Pers. Commun., pp. 1–23, 2020, doi: 10.1007/s11277-020-07235-z.
[80] A. Winterlich, I. Stevenson, A. Waldren, and T. Dawson, “Diabetes Digital Coach: Developing an Infrastructure for e-
Health Self-Management Tools,” in Proceedings - 2016 9th International Conference on Developments in eSystems
Engineering, DeSE 2016, 2017, pp. 68–73, doi: 10.1109/DeSE.2016.56.
[81] T. Nguyen Gia et al., “Low-cost fog-assisted health-care IoT system with energy-efficient sensor nodes,” in 2017 13th
International Wireless Communications and Mobile Computing Conference, IWCMC 2017, 2017, pp. 1765–1770, doi:
10.1109/IWCMC.2017.7986551.
[82] L. Ungurean and A. Brezulianu, “An internet of things framework for remote monitoring of the healthcare parameters,”
Adv. Electr. Comput. Eng., vol. 17, no. 2, pp. 11–16, 2017, doi: 10.4316/AECE.2017.02002.
[83] V. Choudhari, V. Dandge, N. Choudhary, and R. G. Sutar, “A portable and low-cost 12-lead ECG device for sustainable
remote healthcare,” in Proceedings - 2018 International Conference on Communication, Information and Computing
Technology, ICCICT 2018, 2018, vol. 2018-Janua, pp. 1–6, doi: 10.1109/ICCICT.2018.8325879.
[84] M. S. Hossain and G. Muhammad, “Cloud-assisted Industrial Internet of Things (IIoT) - Enabled framework for health
monitoring,” Comput. Networks, vol. 101, no. 0, pp. 192–202, 2016, doi: 10.1016/j.comnet.2016.01.009.
[85] M. Neyja, S. Mumtaz, K. M. S. Huq, S. A. Busari, J. Rodriguez, and Z. Zhou, “An IoT-based e-health monitoring
system using ECG signal,” in 2017 IEEE Global Communications Conference, GLOBECOM 2017 - Proceedings, 2018,
vol. 2018-Janua, pp. 1–6, doi: 10.1109/GLOCOM.2017.8255023.

48
[86] M. Ryan Fajar Nurdin, S. Hadiyoso, and A. Rizal, “A low-cost Internet of Things (IoT) system for multi-patient ECG’s
monitoring,” in ICCEREC 2016 - International Conference on Control, Electronics, Renewable Energy, and
Communications 2016, Conference Proceedings, 2017, pp. 7–11, doi: 10.1109/ICCEREC.2016.7814958.
[87] M. I. Rizqyawan, M. F. Amri, R. P. Pratama, and A. Turnip, “Design and development of Android-based cloud ECG
monitoring system,” in Proceedings - 2016 3rd International Conference on Information Technology, Computer, and
Electrical Engineering, ICITACEE 2016, 2017, pp. 1–5, doi: 10.1109/ICITACEE.2016.7892444.
[88] H. Ozkan, O. Ozhan, Y. Karadana, M. Gulcu, S. Macit, and F. Husain, “A portable wearable tele-ECG monitoring
system,” IEEE Trans. Instrum. Meas., vol. 69, no. 1, pp. 173–182, 2020, doi: 10.1109/TIM.2019.2895484.
[89] B. Tan et al., “Wi-Fi based passive human motion sensing for in-home healthcare applications,” in IEEE World Forum
on Internet of Things, WF-IoT 2015 - Proceedings, 2015, pp. 609–614, doi: 10.1109/WF-IoT.2015.7389123.
[90] L. Plant, B. Noriega, A. Sonti, N. Constant, and K. Mankodiya, “Smart E-textile gloves for quantified measurements in
movement disorders,” in 2016 IEEE MIT Undergraduate Research Technology Conference, URTC 2016, 2018, vol.
2018-Janua, pp. 1–4, doi: 10.1109/URTC.2016.8284077.
[91] A. Kuusik, M. M. Alam, T. Kask, and K. Gross-Paju, “Wearable m-assessment system for neurological disease
patients,” in IEEE World Forum on Internet of Things, WF-IoT 2018 - Proceedings, 2018, vol. 2018-Janua, pp. 201–
206, doi: 10.1109/WF-IoT.2018.8355165.
[92] C. T. Lin et al., “IoT-Based Wireless Polysomnography Intelligent System for Sleep Monitoring,” IEEE Access, vol. 6,

of
pp. 405–414, 2017, doi: 10.1109/ACCESS.2017.2765702.
[93] J. Hong and J. Yoon, “Multivariate time-series classification of sleep patterns using a hybrid deep learning architecture,”
in 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom), 2017, pp.

ro
1–6, doi: 10.1109/HealthCom.2017.8210813.
[94] A. Choi, S. Noh, and H. Shin, “Internet-based unobtrusive tele-monitoring system for sleep and respiration,” IEEE
Access, vol. 8, pp. 76700–76707, 2020, doi: 10.1109/ACCESS.2020.2989336.
[95]

[96]
-p
M. F. Domingues et al., “Insole optical fiber sensor architecturefor remote gait analysis - an eHealth Solution,” IEEE
Internet Things J., p. 1, 2017, doi: 10.1109/JIOT.2017.2723263.
S. Nataraja and P. Nataraja, “IoT based application for e-health an improvisation for lateral rotation,” in RTEICT 2017 -
re
2nd IEEE International Conference on Recent Trends in Electronics, Information and Communication Technology,
Proceedings, 2018, vol. 2018-Janua, pp. 1018–1021, doi: 10.1109/RTEICT.2017.8256753.
lP

[97] E. Patti, M. Donatelli, E. Macii, and A. Acquaviva, “IoT Software Infrastructure for Remote Monitoring of Patients with
Chronic Metabolic Disorders,” in 2018 IEEE 6th International Conference on Future Internet of Things and Cloud
(FiCloud), 2018, pp. 311–317, doi: 10.1109/FiCloud.2018.00052.
[98] T. N. Gia et al., “IoT-based continuous glucose monitoring system: A feasibility study,” Procedia Comput. Sci., vol.
na

109, pp. 327–334, 2017, doi: 10.1016/j.procs.2017.05.359.

[99] P. Zhang, D. Schmidt, J. White, and S. Mulvaney, “Towards precision behavioral medicine with IoT: Iterative design
and optimization of a self-management tool for type 1 diabetes,” in Proceedings - 2018 IEEE International Conference
on Healthcare Informatics, ICHI 2018, 2018, pp. 64–74, doi: 10.1109/ICHI.2018.00015.
ur

[100] M. A. Al-Taee, W. Al-Nuaimy, A. Al-Ataby, Z. J. Muhsin, and S. N. Abood, “Mobile health platform for diabetes
management based on the Internet-of-Things,” in 2015 IEEE Jordan Conference on Applied Electrical Engineering and
Computing Technologies, AEECT 2015, 2015, p. Jordan; King Abdullah II Fund for Development; Phi, doi:
Jo

10.1109/AEECT.2015.7360551.
[101] S. J. Wu, R. D. Chiang, S. H. Chang, and W. T. Chang, “An Interactive Telecare System Enhanced with IoT
Technology,” IEEE Pervasive Comput., vol. 16, no. 3, pp. 62–69, 2017, doi: 10.1109/MPRV.2017.2940967.
[102] “Wearable-Based Human Activity Recognition Using an IoT Approach,” J. Sens. Actuator Networks, vol. 6, no. 4, p. 28,
2017, doi: 10.3390/jsan6040028.
[103] C. Li, X. Hu, and L. Zhang, “The IoT-based heart disease monitoring system for pervasive healthcare service,” in
Procedia Computer Science, 2017, vol. 112, pp. 2328–2334, doi: 10.1016/j.procs.2017.08.265.
[104] P. K. Gupta and P. K. Muhuri, “A novel approach based on computing with words for monitoring the heart failure
patients,” Appl. Soft Comput., vol. 72, pp. 457–473, 2018.
[105] J. H. Abawajy and M. M. Hassan, “Federated Internet of Things and Cloud Computing Pervasive Patient Health
Monitoring System,” IEEE Commun. Mag., vol. 55, no. 1, pp. 48–53, 2017, doi: 10.1109/MCOM.2017.1600374CM.
[106] I. Zagan, V. G. Gaitan, A. I. Petrariu, and A. Brezulianu, “Healthcare IoT m-greenCARDIO remote cardiac monitoring
system - concept, theory of operation and implementation,” Adv. Electr. Comput. Eng., vol. 17, no. 2, pp. 23–30, 2017,
doi: 10.4316/AECE.2017.02004.
[107] S. Raj, “An Efficient IoT-Based Platform for Remote Real-Time Cardiac Activity Monitoring,” IEEE Trans. Consum.
Electron., vol. 66, no. 2, pp. 106–114, 2020, doi: 10.1109/TCE.2020.2981511.
[108] Q. U. A. Mastoi, T. Y. Wah, R. G. Raj, and A. Lakhan, “A novel cost-efficient framework for critical heartbeat task
scheduling using the internet of medical things in a fog cloud system,” Sensors (Switzerland), vol. 20, no. 2, p. 441,
2020, doi: 10.3390/s20020441.
[109] M. W. Raad, T. Sheltami, and E. Shakshuki, “Ubiquitous tele-health system for elderly patients with Alzheimer’s,”
Procedia Comput. Sci., vol. 52, no. 1, pp. 685–689, 2015, doi: 10.1016/j.procs.2015.05.075.
[110] J. Navarro, F. Doctor, V. Zamudio, R. Iqbal, A. K. Sangaiah, and C. Lino, “Fuzzy adaptive cognitive stimulation therapy
generation for Alzheimer’s sufferers: Towards a pervasive dementia care monitoring platform,” Futur. Gener. Comput.

49
 Syst., vol. 88, pp. 479–490, 2018, doi: 10.1016/j.future.2018.06.018.
[111] F. Mohamedali and N. Matoorian, “Support dementia: Using wearable assistive technology and analysing real-time
data,” in Proceedings - 2016 International Conference on Interactive Technologies and Games: EduRob in Conjunction
with iTAG 2016, iTAG 2016, 2016, pp. 50–54, doi: 10.1109/iTAG.2016.15.
[112] L. Berbakov, B. Pavković, V. Marković, and M. Svetel, “Architecture and partial implementation of the remote
monitoring platform for patients with movement disorders,” in 2017 Zooming Innovation in Consumer Electronics
International Conference: Galvanize Your Creativity, ZINC 2017, 2017, pp. 22–25, doi: 10.1109/ZINC.2017.7968653.
[113] M. A. Serhani, M. El Menshawy, A. Benharref, S. Harous, and A. N. Navaz, “New algorithms for processing time-series
big EEG data within mobile health monitoring systems,” Comput. Methods Programs Biomed., vol. 149, pp. 79–94,
2017, doi: 10.1016/j.cmpb.2017.07.007.
[114] M. S. Mahmud, H. Fang, and H. Wang, “An Integrated Wearable Sensor for Unobtrusive Continuous Measurement of
Autonomic Nervous System,” IEEE Internet Things J., vol. 6, no. 1, pp. 1104–1113, 2019, doi:
10.1109/JIOT.2018.2868235.
[115] S. Howard, A. Lang, S. Sharples, and D. Shaw, “See I told you I was taking it!—Attitudes of adolescents with asthma
towards a device monitoring their inhaler use: Implications for future design.,” Appl. Ergon., vol. 58, pp. 224–237, 2017,
doi: https://doi.org/10.1016/j.apergo.2016.06.018.
[116] S. Sareen, S. K. Sood, and S. K. Gupta, “IoT-based cloud framework to control Ebola virus outbreak,” J. Ambient Intell.

of
Humaniz. Comput., vol. 9, no. 3, pp. 459–476, 2018, doi: 10.1007/s12652-016-0427-7.
[117] C. Nadrag, V. Poenaru, and G. Suciu, “Heart Rate Measurement Using Face Detection in Video,” in 2018 12th
International Conference on Communications, COMM 2018 - Proceedings, 2018, pp. 131–134, doi:

ro
10.1109/ICComm.2018.8430116.
[118] Y. Fang, C. Li, and L. Sun, “Design of an Early Warning System for Patients with Cardiovascular Diseases under
Mobile Environment,” Procedia Comput. Sci., vol. 96, no. C, pp. 819–825, 2016, doi: 10.1016/j.procs.2016.08.258.
[119] -p
K. U. Nigam, A. A. Chavan, S. S. Ghatule, and V. M. Barkade, “IOT-BEAT: An intelligent nurse for the cardiac
patient,” in International Conference on Communication and Signal Processing, ICCSP 2016, 2016, pp. 976–982, doi:
10.1109/ICCSP.2016.7754293.
re
[120] O. S. Albahri et al., “Fault-Tolerant mHealth Framework in the Context of IoT-Based Real-Time Wearable Health Data
Sensors,” IEEE Access, vol. 7, pp. 50052–50080, 2019, doi: 10.1109/ACCESS.2019.2910411.
lP

[121] R. Sandhu, H. K. Gill, and S. K. Sood, “Smart monitoring and controlling of Pandemic Influenza A (H1N1) using Social
Network Analysis and cloud computing,” J. Comput. Sci., vol. 12, pp. 11–22, 2016, doi: 10.1016/j.jocs.2015.11.001.
[122] V. Vijayakumar, D. Malathi, V. Subramaniyaswamy, P. Saravanan, and R. Logesh, “Fog computing-based intelligent
healthcare system for the detection and prevention of mosquito-borne diseases,” Comput. Human Behav., vol. 100, pp.
na

275–285, 2019, doi: doi.org/10.1016/j.chb.2018.12.009.

[123] L. García, J. Tomás, L. Parra, and J. Lloret, “An m-health application for cerebral stroke detection and monitoring using
cloud services,” Int. J. Inf. Manage., 2018, doi: 10.1016/j.ijinfomgt.2018.06.004.
[124] S. K. Sood and I. Mahajan, “A Fog-Based Healthcare Framework for Chikungunya,” IEEE Internet Things J., vol. 5, no.
ur

2, pp. 794–801, 2018, doi: 10.1109/JIOT.2017.2768407.

[125] I. K. A. Enriko, M. Suryanegara, and D. Gunawan, “My Kardio: A telemedicine system based on machine-to-machine
(M2M) technology for cardiovascular patients in rural areas with auto-diagnosis feature using k-Nearest Neighbor
Jo

algorithm,” in Proceedings of the IEEE International Conference on Industrial Technology, 2018, vol. 2018-Febru, pp.
1775–1780, doi: 10.1109/ICIT.2018.8352452.
[126] S. K. Sood and I. Mahajan, “Fog-cloud based cyber-physical system for distinguishing, detecting and preventing
mosquito borne diseases,” Futur. Gener. Comput. Syst., vol. 88, pp. 764–775, 2018, doi: 10.1016/j.future.2018.01.008.
[127] S. K. Sood and I. Mahajan, “Wearable IoT sensor based healthcare system for identifying and controlling chikungunya
virus,” Comput. Ind., vol. 91, pp. 33–44, 2017, doi: 10.1016/j.compind.2017.05.006.
[128] S.-H. Chae, D. Moon, D. G. Lee, and S. B. Pan, “Medical Image Segmentation for Mobile Electronic Patient Charts
Using Numerical Modeling of IoT,” J. Appl. Math., vol. 2014, pp. 1–8, 2014, doi: 10.1155/2014/815039.
[129] A. Masood et al., “Computer-Assisted Decision Support System in Pulmonary Cancer detection and stage classification
on CT images,” J. Biomed. Inform., vol. 79, no. January, pp. 117–128, 2018, doi: 10.1016/j.jbi.2018.01.005.
[130] Z. Zhang, Y. Zhang, L. Yao, H. Song, and A. Kos, “A sensor-based wrist pulse signal processing and lung cancer
recognition,” J. Biomed. Inform., vol. 79, pp. 107–116, 2018, doi: 10.1016/j.jbi.2018.01.009.
[131] J. Jebadurai and J. Dinesh Peter, “Super-resolution of retinal images using multi-kernel SVR for IoT healthcare
applications,” Futur. Gener. Comput. Syst., vol. 83, pp. 338–346, 2018, doi: 10.1016/j.future.2018.01.058.
[132] K. Guo, T. Li, R. Huang, J. Kang, and T. Chi, “DDA: A deep neural network-based cognitive system for IoT-aided
dermatosis discrimination,” Ad Hoc Networks, vol. 80, pp. 95–103, 2018, doi: 10.1016/j.adhoc.2018.07.014.
[133] T. Ivascu, B. Manate, and V. Negru, “A Multi-agent Architecture for Ontology-Based Diagnosis of Mental Disorders,”
in Proceedings - 17th International Symposium on Symbolic and Numeric Algorithms for Scientific Computing, SYNASC
2015, 2016, pp. 423–430, doi: 10.1109/SYNASC.2015.69.
[134] P. M. Kumar, S. Lokesh, R. Varatharajan, G. Chandra Babu, and P. Parthasarathy, “Cloud and IoT based disease
prediction and diagnosis system for healthcare using Fuzzy neural classifier,” Futur. Gener. Comput. Syst., vol. 86, pp.
527–534, 2018, doi: 10.1016/j.future.2018.04.036.
[135] K. Divya Krishna et al., “Computer Aided Abnormality Detection for Kidney on FPGA Based IoT Enabled Portable

50
 Ultrasound Imaging System,” Irbm, vol. 37, no. 4, pp. 189–197, 2016, doi: 10.1016/j.irbm.2016.05.001.
[136] P. Verma, S. K. Sood, and H. Kaur, “A Fog-Cloud based cyber physical system for Ulcerative Colitis diagnosis and
stage classification and management,” Microprocess. Microsyst., vol. 72, p. 102929, 2020, doi:
doi.org/10.1016/j.ins.2020.05.070.
[137] H. Yu, “Research and optimization of sports injury medical system under the background of Internet of things,” Trans.
Emerg. Telecommun. Technol., p. e3929, 2020, doi: 10.1002/ett.3929.
[138] M. W. L. Moreira, J. J. P. C. Rodrigues, J. Rodrigues, N. Kumar, K. Saleem, and I. V. Illin, “Postpartum depression
prediction through pregnancy data analysis for emotion-aware smart systems,” Inf. Fusion, vol. 47, pp. 23–31, 2019, doi:
10.1016/j.inffus.2018.07.001.
[139] A. Walinjkar and J. Woods, “ECG classification and prognostic approach towards personalized healthcare,” in 2017
International Conference On Social Media, Wearable And Web Analytics, Social Media 2017, 2017, vol. 2017-June, pp.
1–8, doi: 10.1109/SOCIALMEDIA.2017.8057360.
[140] R. Ani, S. Krishna, N. Anju, M. S. Aslam, and O. S. Deepa, “Iot based patient monitoring and diagnostic prediction tool
using ensemble classifier,” in 2017 International Conference on Advances in Computing, Communications and
Informatics (ICACCI), Sep. 2017, vol. 2017-Janua, pp. 1588–1593, doi: 10.1109/ICACCI.2017.8126068.
[141] S. K. Sood and I. Mahajan, “IoT-fog-based healthcare framework to identify and control hypertension attack,” IEEE
Internet Things J., vol. 6, no. 2, pp. 1920–1927, 2019, doi: 10.1109/JIOT.2018.2871630.

of
[142] P. Arulanthu and E. Perumal, “An intelligent IoT with cloud centric medical decision support system for chronic kidney
disease prediction,” Int. J. Imaging Syst. Technol., 2020, doi: 10.1002/ima.22424.
[143] J. J. Rodrigues Barata, R. Munoz, R. D. De Carvalho Silva, J. J. P. C. Rodrigues, and V. H. C. De Albuquerque,

ro
“Internet of Things Based on Electronic and Mobile Health Systems for Blood Glucose Continuous Monitoring and
Management,” IEEE Access, vol. 7, pp. 175116–175125, 2019, doi: 10.1109/ACCESS.2019.2956745.
[144] W. Lu, F. Fan, J. Chu, P. Jing, and S. Yuting, “Wearable computing for internet of things: A discriminant approach for

[145]
10.1109/JIOT.2018.2873594.
-p
human activity recognition,” IEEE Internet Things J., vol. 6, no. 2, pp. 2749–2759, 2019, doi:

A. Ghani, “Healthcare electronics—A step closer to future smart cities,” ICT Express, 2018, doi:
re
10.1016/j.icte.2018.01.009.
[146] A. Subasi, M. Radhwan, R. Kurdi, and K. Khateeb, “IoT based mobile healthcare system for human activity
lP

recognition,” in 2018 15th Learning and Technology Conference, L and T 2018, 2018, pp. 29–34, doi:
10.1109/LT.2018.8368507.
[147] A. H. T. E. De Silva, W. H. P. Sampath, N. H. L. Sameera, Y. W. R. Amarasinghe, and A. Mitani, “Development of a
wearable tele-monitoring system with IoT for bio-medical applications,” in 2016 IEEE 5th Global Conference on
na

Consumer Electronics, GCCE 2016, 2016, pp. 1–2, doi: 10.1109/GCCE.2016.7800404.

[148] J. Gómez, B. Oviedo, and E. Zhuma, “Patient Monitoring System Based on Internet of Things,” in Procedia Computer
Science, 2016, vol. 83, no. Ant, pp. 90–97, doi: 10.1016/j.procs.2016.04.103.
[149] J. Bao, M. Ye, and Y. Dou, “Mobile phone-based internet of things human action recognition for E-health,” in
ur

International Conference on Signal Processing Proceedings, ICSP, 2017, pp. 957–962, doi:
10.1109/ICSP.2016.7877972.
[150] M. Tariq, H. Majeed, M. O. Beg, F. A. Khan, and A. Derhab, “Accurate detection of sitting posture activities in a secure
Jo

IoT based assisted living environment,” Futur. Gener. Comput. Syst., 2018, doi: 10.1016/j.future.2018.02.013.
[151] S. Oniga and J. Sütő, “Human activity recognition using neural networks,” in Proceedings of the 2014 15th
International Carpathian Control Conference (ICCC), 2014, pp. 403–406, doi: 10.1109/CarpathianCC.2014.6843636.
[152] J. Zhao and G. Li, “Study on real-time wearable sport health device based on body sensor networks,” Comput.
Commun., vol. 154, pp. 40–47, 2020, doi: https://doi.org/10.1016/j.comcom.2020.02.045.
[153] L. Y. Mano et al., “Exploiting IoT technologies for enhancing Health Smart Homes through patient identification and
emotion recognition,” Comput. Commun., vol. 89–90, pp. 178–190, 2016, doi: 10.1016/j.comcom.2016.03.010.
[154] M. S. Hossain and G. Muhammad, “Emotion-Aware Connected Healthcare Big Data Towards 5G,” IEEE Internet
Things J., vol. 5, no. 4, SI, pp. 2399–2406, 2017, doi: 10.1109/JIOT.2017.2772959.
[155] C. S. Fujiwara, C. M. Aderaldo, R. H. Filho, and D. A. A. Chaves, “The Internet of Things as a Helping Tool in the
Daily Life of Adult Patients with ADHD,” in 2017 IEEE Global Communications Conference, GLOBECOM 2017 -
Proceedings, 2018, vol. 2018-Janua, pp. 1–6, doi: 10.1109/GLOCOM.2017.8254442.
[156] J. Berrocal, J. Garcia-Alonso, J. M. Murillo, D. Mendes, C. Fonseca, and M. Lopes, “Context-aware mobile app for the
multidimensional assessment of the elderly,” in 2018 13th Iberian Conference on Information Systems and Technologies
(CISTI), 2018, pp. 1–6, doi: 10.23919/CISTI.2018.8399239.
[157] Z. Zhong, Z. Fan, and F. Cao, “Basket based sorting method for activity recognition in smart environments,” in IEEE
World Forum on Internet of Things, WF-IoT 2018 - Proceedings, 2018, vol. 2018-Janua, pp. 161–166, doi: 10.1109/WF-
IoT.2018.8355092.
[158] M. Rossi, A. Rizzi, L. Lorenzelli, and D. Brunelli, “Remote rehabilitation monitoring with an IoT-enabled embedded
system for precise progress tracking,” in 2016 IEEE International Conference on Electronics, Circuits and Systems,
ICECS 2016, 2017, pp. 384–387, doi: 10.1109/ICECS.2016.7841213.
[159] A. Al-Mahmood and M. O. Agyeman, “On wearable devices for motivating patients with upper limb disability via
gaming and home rehabilitation,” in 2018 3rd International Conference on Fog and Mobile Edge Computing, FMEC

51
 2018, 2018, pp. 155–162, doi: 10.1109/FMEC.2018.8364058.
[160] A. Kos and A. Umek, “Wearable Sensor Devices for Prevention and Rehabilitation in Healthcare: Swimming Exercise
with Real-time Therapist Feedback,” IEEE Internet Things J., p. 1, 2018, doi: 10.1109/JIOT.2018.2850664.
[161] S. Vukićević, Z. Stamenković, S. Murugesan, Z. Bogdanović, and B. Radenković, “A new telerehabilitation system
based on internet of things,” Facta Univ. Ser. Electron. Energ., vol. 29, no. 3, pp. 395–405, 2015.
[162] Y. Jiang, Y. Qin, I. Kim, and Y. Wang, “Towards an IoT-based upper limb rehabilitation assessment system,” in
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS,
2017, pp. 2414–2417, doi: 10.1109/EMBC.2017.8037343.
[163] D. Bilic, T. Uzunovic, E. Golubovic, and B. C. Ustundag, “Internet of things-based system for physical rehabilitation
monitoring,” in ICAT 2017 - 26th International Conference on Information, Communication and Automation
Technologies, Proceedings, 2017, vol. 2017-Decem, pp. 1–6, doi: 10.1109/ICAT.2017.8171641.
[164] B. Tan and O. Tian, “Short paper: Using BSN for tele-health application in upper limb rehabilitation,” in 2014 IEEE
World Forum on Internet of Things (WF-IoT), 2014, pp. 169–170, doi: 10.1109/WF-IoT.2014.6803143.
[165] Y. Fan, P. Xu, H. Jin, J. Ma, and L. Qin, “Vital sign measurement in telemedicine rehabilitation based on intelligent
wearable medical devices,” IEEE Access, vol. 7, pp. 54819–54823, 2019, doi: 10.1109/ACCESS.2019.2913189.
[166] I. Bisio, A. Delfino, F. Lavagetto, and A. Sciarrone, “Enabling IoT for In-Home Rehabilitation: Accelerometer Signals
Classification Methods for Activity and Movement Recognition,” IEEE Internet Things J., vol. 4, no. 1, pp. 135–146,

of
2017, doi: 10.1109/JIOT.2016.2628938.
[167] C. Y. Zheng and J. Yunus, “The accessibility, affordability, and availability of long-Term monitoring system for
children with movement disorders-Proposed development the Malaysian context & opportunities,” in IECBES 2016 -

ro
IEEE-EMBS Conference on Biomedical Engineering and Sciences, 2017, pp. 774–779, doi:
10.1109/IECBES.2016.7843555.
[168] M. N. Alkhomsan, M. A. Hossain, S. M. M. Rahman, and M. Masud, “Situation Awareness in Ambient Assisted Living

[169]
-p
for Smart Healthcare,” IEEE Access, vol. 5, pp. 20716–20725, 2017, doi: 10.1109/ACCESS.2017.2731363.
A. Veiga, L. Garcia, L. Parra, J. Lloret, and V. Augele, “An IoT-based smart pillow for sleep quality monitoring in AAL
environments,” in 2018 3rd International Conference on Fog and Mobile Edge Computing, FMEC 2018, 2018, pp. 175–
re
180, doi: 10.1109/FMEC.2018.8364061.
[170] D. De Venuto, V. F. Annese, and A. L. Sangiovanni-Vincentelli, “The ultimate IoT application: A cyber-physical
lP

system for ambient assisted living,” in Proceedings - IEEE International Symposium on Circuits and Systems, 2016, vol.
2016-July, pp. 2042–2045, doi: 10.1109/ISCAS.2016.7538979.
[171] E. Almeida, M. Ferruzca, and M. del P. M. Tlapanco, “Design of a system for early detection and treatment of
depression in elderly case study,” in Lecture Notes of the Institute for Computer Sciences, Social-Informatics and
na

Telecommunications Engineering, LNICST, 2014, vol. 100, pp. 115–124, doi: 10.1007/978-3-319-11564-1_12.
[172] M. K. Hassan, A. I. El Desouky, S. M. Elghamrawy, and A. M. Sarhan, “A Hybrid Real-time remote monitoring
framework with NB-WOA algorithm for patients with chronic diseases,” Futur. Gener. Comput. Syst., vol. 93, pp. 77–
95, 2019, doi: doi.org/10.1016/j.future.2018.10.021.
ur

[173] N. E. Tabbakha, W. H. Tan, and C. P. Ooi, “Indoor location and motion tracking system for elderly assisted living
home,” in Proceeding of 2017 International Conference on Robotics, Automation and Sciences, ICORAS 2017, 2018,
vol. 2018-March, pp. 1–4, doi: 10.1109/ICORAS.2017.8308073.
Jo

[174] L. A. Durán-Vega et al., “An IoT system for remote health monitoring in elderly adults through a wearable device and
mobile application,” Geriatr., vol. 4, no. 2, p. 34, 2019, doi: 10.3390/geriatrics4020034.
[175] D. Mrozek, A. Koczur, and B. Małysiak-Mrozek, “Fall Detection in Older Adults with Mobile IoT Devices and Machine
Learning in the Cloud and on the Edge,” Inf. Sci. (Ny)., 2020, doi: doi.org/10.1016/j.ins.2020.05.070.
[176] H. Ben Hassen, W. Dghais, and B. Hamdi, “An E-health system for monitoring elderly health based on Internet of
Things and Fog computing,” Heal. Inf. Sci. Syst., vol. 7, no. 1, p. 24, 2019, doi: 10.1007/s13755-019-0087-z.
[177] J. Wurm, K. Hoang, O. Arias, A. R. Sadeghi, and Y. Jin, “Security analysis on consumer and industrial IoT devices,”
Proc. Asia South Pacific Des. Autom. Conf. ASP-DAC, vol. 25-28-Janu, pp. 519–524, 2016, doi:
10.1109/ASPDAC.2016.7428064.
[178] P. Asghari, A. M. Rahmani, and H. H. S. Javadi, “Internet of Things applications: A systematic review,” Comput.
Networks, vol. 148, pp. 241–261, 2019, doi: 10.1016/j.comnet.2018.12.008.
[179] E. Casilari, J. A. Santoyo-Ramón, and J. M. Cano-García, “UMAFall: A Multisensor Dataset for the Research on
Automatic Fall Detection,” Procedia Comput. Sci., vol. 110, pp. 32–39, 2017, doi: 10.1016/j.procs.2017.06.110.
[180] A. Sene, B. Kamsu-Foguem, and P. Rumeau, “Telemedicine framework using case-based reasoning with evidences,”
Comput. Methods Programs Biomed., vol. 121, no. 1, pp. 21–35, 2015, doi: 10.1016/j.cmpb.2015.04.012.
[181] www.statista.com, “challenges to implementing telemedicine practices of U.S. in 2017,” 2019.
https://www.statista.com/statistics/870073/telemedicine-program-implementation-challenges/ (accessed Nov. 03, 2019).

52
Appendix
Table A1 Diseases definition addressed in the academic literature

Seq Classification Disease Name Definition

Psychiatric diseases have traditionally been considered as “mental" rather than
as "physical" illness. This is because they manifest with disordered
psychiatric disease
functioning in the areas of emotion, perception, thinking and memory and/or
have had no clearly established biological basis.
One of the serious ageing diseases nowadays is
dementia whose common symptoms are a
progressive loss of cognitive functioning,
Alzheimer's
including problems with memory, perception,
decision making, temporal and spatial
reasoning
A common disorder with prevalence of
approximately 5% in general population

of
characterized by more sever and persistent
Depressive Disorder
disturbance of mood, with loss of interest and
enjoyment. It is the major risk factor for

ro
1
suicide.
Usually following a stressful event. Such as

Emotional Disorder
-p serious medical diagnosis or major accident.
The major symptom included anxiety, anger,
depression and altered activity. The symptoms
re
are transient and usually resolve completely
within few days.
It is a chronic psychotic disorder with attack of
lP

remission and relapse. The main characteristic

Mental Illness feature of this illness is learning disability and
attention deficient, mode disturbance , loss of
insight, delusions and hallucination
na

Sleep disturbance is associated with many

Sleep Disorder – Insomnia psychological and organic diseases and differ
in its type and severity accordingly.
Diseases that affect brain, spinal cord, peripheral nerves lead to defect in
ur

Neurological diseases sensory, motility and mental state of patient including speech, smell, and
visual disturbance.
Jo

Is the third most common cause of death after

cancer and ischemic heart disease. It
Cerebral Strock
considered as the most common cause severe
physical disability.
Is the tendency to have seizures with signs
Epilepsy and/or symptoms due to abnormal, excessive
or synchronous neural activity in the brain.
Disorder of movement lead to either extra,
2
unwanted movement like hyperkinesias or
Abnormal movement and
tremor or too little movement like hypokinesia.
gait disorder
Gain disorder is walking disturbance due to
many neurological disorder.
Diseases that affect the myline sheath of the
Demylinating Diseases -
nerve. The most common cause of long term
multiple Sclerosis
disability in adult.
Clinical syndrome characterized primarily by
bradykinesia, slow movement with increased
Parkinson Disease
tone, rigidity, tremor and loss of postural
reflexes.
Is concern particularly with frail older people in whom physiological capacity
3 Geriatric Medicine
is to reduce that they are incapacitated by even minor illness
Community Medicine and Medicine that deal with best possible practice which can be introduce the best
4
General Practice healthcare system with better communication between patient and medical
 staff.
Includes disorders of kidney and urinary tract, like infection, inflammation,
5 Renal Disease
malignant disease, renal stone and renal failure.
Is the establishment of foreign organism or infectious agents in or on human
Infection Disease host, this may be result in colonization if micro organism exists at an
anatomical site without causing harm.
Ebola
6
Pandemic Influenza
Group of contagious condition whose principal
Transmitted Diseases mode of transmission is by specific way, like
sexual, blood born, insect bite … etc.
Are diseases that deal with cancer of various organ include diagnosis and
Oncological Diseases various types of treatment like chemotherapy, radiotherapy and surgical
management.
Lung cancer is the one of the leading cause of

of
cancer deaths in both women and men.
7 Manifestation of Lung cancer in the body of
the patient reveals through early symptoms in
Lung Cancer

ro
most of the cases treatment and prognosis
depend on the histological type of cancer, the
stage (degree of spread), and the patient's

8 Dermatological Diseases
-p performance status.
Disorder that affect human skin function( protection, fluid balance, sensation
vitamin D synthesis … etc). these diseases either because of defect in skin
re
component or reflect changes of internal diseases.
Ophthalmological Diseases that affect the eye lead to disturbance in acuity and quality of vision
9
Diseases because of infection, inflammation, tumor or vascular disorder.
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Disorder of musculoskeletal system a rise from processes affecting bones,

Rhumatological Disorder joints, muscles or connective tissue such as skin and tendon. Principle
10
and Rehabilitation manifestations are pain and physical disability. Rehabilitation mean
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management of physical disability.

Are responsible for a major burden of diseases and death with condition such
as tuberculosis pandemic influenza, and pneumonia. The increasing
11 Respiratory Diseases
prevalence of allergy, asthma, chronic obstructive pulmonary disease and
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tobacco-related.
Endocrinology concerns the synthesis, secretion and action of hormones
which is the chemical messengers released from endocrine glands that
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coordinate the activities and metabolism of many different cells.

Metabolism are processes that regulate the balance of fluid, electrolyte, ions
Endocrine and metabolic
12 and other substance like carbohydrate, lipid protein, drugs …. etc inside
disorder and diabetes
human body.
Diabetes mellitus is a clinical syndrome characterized by an increase in
plasma blood glucose because of disturbance in pancreatic B cells function
which are responsible for insulin hormone production.
Dealing with defect of heart and blood vessel, which are the most common
13 Cardiovascular Disorder cause of death on all over the world. The evidence base for prevention of
cardiovascular diseases is stronger than for almost any other disease group.
Highlights

• Systematic review of IoT-based telemedicine practice enabled for disease prevention and
health care service promotion is presented.
• Mapping the research landscape of IoT- based telemedicine topology along with its platform
and architecture into a coherent taxonomy.
• Crossover among telemedicine healthcare services/applications and human diseases under IoT
is presented.
• Figure out the motivations, challenges and recommendations of using IoT-based telemedicine
into various categories.
• Several issues and innovative key solutions surrounding IoT-based telemedicine are explored.

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A.S. Albahri Ph.D in Artificial Intelligence from Universiti Pendidikan Sultan Idris (UPSI), Malaysia. He
received his M.Sc. degree in ICT from Arts, Sciences and Technology University in Lebanon, Beirut, Lebanon
in 2014. Specialist in Medical Informatics and Health Sciences. He is a member and reviewer in lots of prestige
journals by Clarivate Analytics. Currently, working as lecturer at University Pendidican Sultan Idris (UPSI). His
research interest is: AI Applications on Telemedicine, Disaster Management, E-health, mHealth, Machine
Learning, Multi-Criteria Decision-Making (MCDM), IoT, Big data, student evaluation. Published many papers
in WoS (ISI) databases under affiliation A.S. Albahri.

Jwan K. Alwan M.sc. in information systems from Osmania university, Hyderabad, India -2014 . She received
her B.Sc. from University of Technology department of computer science – information systems in 2005.
Currently, she is working as a lecturer at University Pendidican Sultan Idris (UPSI). She is a member of steering
committee at different international conferences and one of volume editor’s members. Her research area
interests are:E-Healtcare, IoT, Telemedicine, Machine learning, data mining, big data and management
information systems.

Zahraa K. Taha M.sc. in Electronic and communication engineer from University of Baghdad, Iraq -2013. She
recevied the B.Sc. in Electrical Engineering from University of Baghdad, Baghdad, Iraq, in 2008. She is
working as a lecture at Unversity Pendidican Sultan Idris(UPSI). Her current research interests include machine

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learning, pattern recognition, internet of things, data mining and Medical Image Processing.

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Sura F. Ismail M.sc. in computer science from University of Baghdad, Iraq -2013. She recevied the B.Sc. in
computer science from University of Baghdad, Baghdad, Iraq, in 2008. She is working as a lecture at Unversity
Pendidican Sultan Idris(UPSI). Her current research interests include machine learning, pattern recognition,
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internet of things, data mining and Medical Image Processing.
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Rula. A. Hamid Ph.D. in Artificial Intelligence from Informatics Institute for Postgraduate Studies at the Iraqi
Commission for Computers and Informatics, Iraq. She received his M.Sc. degree in software engineering from
Informatics Institute for Postgraduate Studies at the Iraqi Commission for Computers and Informatics in 2013.
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Specialist in Artificial Intelligence and E-Learning. Currently, working as lecturer at University Pendidican
Sultan Idris (UPSII). Her research interest is: AI Applications on data Management ,E-tourism, Machine
Learning, Multi-Criteria Decision-Making (MCDM), IoT, data mining, student evaluation. Published many
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papers in Scopus databases under affiliation Rula.A.Hamid .

A. A. Zaidan received the B.Eng. degree in computer engineering from the University of Technology, Baghdad,
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Iraq, in 2004, the M.Sc. degree in data communications and computer network from the University of Malaya,
Malaysia, in 2009, and the Ph.D. degree in artificial intelligence from Multimedia University, Malaysia, in
2013. He led or was a member of many funded research projects. He is currently a Senior Lecturer with the
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Department of Computing, University Pendidikan Sultan Idris. He has published more than 150 papers in
various international conferences and journals. His research areas include artificial intelligence, decision theory,
data communication and networks, AI applications on telemedicine, and e-health.

B. B. Zaidan received the B.Sc. degree in applied mathematics from Al-Nahrain University, Baghdad, Iraq, in
2004, and the M.Sc. degree in data communications and information security from the University of Malaya,
Malaysia, in 2009. He led or was a member of many funded research projects. He is currently a Senior Lecturer
with the Department of Computing, University Pendidikan Sultan Idris. He has published more than 150 papers
in various international conferences and journals. His research areas include artificial intelligence, decision
theory, information security and networks, and multi-criteria evaluation and benchmarking.

O. S. Albahri: Received his B.Sc. degree in Computer science in 2011 from Al Turath University College,
Baghdad, Iraq. Then, he received his M.Sc. degree on computer science and communication in 2014 from Arts,
Sciences and Technology University in Lebanon, Beirut, Lebanon. After that, he received his Doctor of
philosophy (PHD) in (Artificial Intelligence) from Universiti Pendidikan Sultan Idris (UPSI) in 2019, Tanjung
Malim, Malaysia. He is currently working as a Senior Lecturer with the Department of Computing, University
Pendidikan Sultan Idris. He led or member for many funded research projects and He has published more than
43 papers at various international ISI/WOS journals. He is a member and reviewer in lots of prestige Clarivate
Analytics journals. His research areas are Artificial Intelligent, Decision Theory, Information Security, and
Medical Informatics.
A. H. Alamoodi: Received his B.Sc. in Information and Communication Technology in 2015 from
Limkokwing University, Malaysia. Then, he received his M.Sc. degree on Computer Networking in 2017 from
Limkokwing University, Malaysia. Currently, He is candidate Doctor of philosophy (PhD) student in Universiti
Pendidikan Sultan Idris (UPSI), Tanjung Malim, Malaysia. He is currently working as a Senior Lecturer with
the Department of Computing, University Pendidikan Sultan Idris. He has published more than 3 papers at
various international conferences and prestige journals His research areas are Artificial Intelligent, Data Science
and Prediction, and Machine learning.

M. A. Alsalem: Received his B.Sc in Computer Science in 2010 from University of Mosul, Iraq. Then, he
received his M.Sc. degree on computer Science in 2014 from University of Mosul, Iraq. He is working as
lecturer at University of Mosul, Iraq. Currently, he is candidate Doctor of philosophy (PhD) student in
Universiti Pendidikan Sultan Idris (UPSI), Tanjung Malim, Malaysia. He led or member for many funded
research projects and He has published more than 25 papers at various international journals. His research areas
are Machine Learning, Telemedicine, and Multi-Criteria Decision Making.

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Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships
that could have appeared to influence the work reported in this paper.

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