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Challenges of IoT in Healthcare

Chapter · August 2020

DOI: 10.1007/978-3-030-42934-8_2

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Chapter Title Challenges of IoT in Healthcare

Copyright Year 2020
Copyright Holder Springer Nature Switzerland AG
Corresponding Author Family Name Anmulwar
Particle
Given Name Sweta
Suffix
Organization Centre for Development of Advanced
Computing (C-DAC) R&D
Address Pune, Maharashtra, India
Email sweta.anm@gmail.com
Email anilg@cdac.in
Author Family Name Gupta
Particle
Given Name Anil Kumar
Suffix
Organization Centre for Development of Advanced
Computing (C-DAC) R&D
Address Pune, Maharashtra, India
Author Family Name Derawi
Particle
Given Name Mohammad
Suffix
Organization Norwegian University of Science and
Technology (NTNU)
Address Trondheim, Norway
Abstract This chapter discusses various challenges related to Internet of Things
(IoT) implementation into the healthcare sector, namely, data resource
management, security, loss of privacy, access control, and stakeholder
collaboration. IoT is going to be an integral part of the patient’s diagnosis,
treatment, recovery, and monitoring process in the near future. It is
evident that a large number of objects will be connected to the IoT
network. All these devices will generate unstructured data; these data
must be processed in a time-critical manner. Otherwise, it becomes
inadequate for real-time monitoring and decision-making, which requires
immense infrastructure, computation, networking, storage capacity, etc.
For monitoring purposes, it is critical to process and deliver data
in synchronization to the stakeholders like treating physician’s panel,
analytics platforms, healthcare providers, and insurance companies.
 Another challenge for IoT healthcare system is of patients’ data security;
these data flow in the network without any encryption. Any malicious
actor can access data and can cause severe consequences. Patient’s data
can be altered, and these corrupted data can be used to take the life and
death decisions. Data can be corrupted at the origin or in the network. The
concern is about how to trust the data received from sensors, which travel
across the network. In addition, privacy is also of extreme importance in
IoT healthcare system as the patients expect their information (medical
or otherwise) to be confidential. Only necessary information that is
required to provide the healthcare should be sent over the network.
The government also plays an important role while dealing with the
loss of privacy. A government may form laws to protect the sensitive
information of citizens.
Finally, IoT healthcare system is a collaboration between the healthcare
industry and the IoT sector. All the stakeholders, especially the one who
will make use of this system (e.g., nurses, patients, doctors), should
receive a precise and professional training, and to a large extent the
success of the IoT healthcare industry will be dependent on it.
Keywords Internet of Things - Healthcare - Security - Privacy - Big data -
(separated by “-”) Time-critical
 Challenges of IoT in Healthcare 1

Sweta Anmulwar, Anil Kumar Gupta, and Mohammad Derawi 2

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1 Introduction 3

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Healthcare industry has actively started to incorporate Internet of Things (IoT) 4

to improve the quality of healthcare services for the patient’s overall health. For 5

example, Open Artificial Pancreas System (OpenAPS) measures the amount of 6

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glucose in a patient’s bloodstream and automatically delivers the required amount 7
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of insulin into the system [1]. Another example is connected inhalers; it has a sensor 8

attached to the inhaler and is connected to the app on the mobile phone, and it aids 9

patients to self-manage their health condition better [2]. It clearly shows that IoT 10
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is going to be an essential part of the patient’s diagnosis, treatment, and recovery 11

process [3]. IoT can significantly/effectively address the issue of the rising cost of 12

healthcare through different applications like patient monitoring, clinical operations, 13

drug/medicine development, fitness measurement, and preventive care. According 14

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to the Allied Market Research group, the worldwide market for IoT healthcare will 15
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reach $136.8 billion by 2021 [4]. It exhibits IoT’s potential in the healthcare sector. 16

There are several advantages of implementation of IoT in healthcare like fewer 17

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errors in data collection, faster diagnosis, efficient patient care, and better resource 18

management in hospitals. 19
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Despite the advantages of the use of IoT in the healthcare sector, there are some 20

challenges and are depicted in Fig. 1. Data are essential parts of the decision-making
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process for the patient’s care. According to the International Data Corporation 22
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(IDC) by 2025, there will be 41.6 billion IoT devices, which will generate 79.4 23

S. Anmulwar () · A. K. Gupta

Centre for Development of Advanced Computing (C-DAC) R&D, Pune, Maharashtra, India
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e-mail: anilg@cdac.in
M. Derawi
Norwegian University of Science and Technology (NTNU), Trondheim, Norway

© Springer Nature Switzerland AG 2020

N. Gupta, S. Paiva (eds.), IoT and ICT for Healthcare Applications, EAI/Springer
Innovations in Communication and Computing,
https://doi.org/10.1007/978-3-030-42934-8_2
 S. Anmulwar et al.

Fig. 1 IoT challenges in

healthcare

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ZB (Zettabytes) of data [5]. This enormous unstructured data need to be processed 24
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in a time-critical manner/real-time. Data collection, processing, and interpreting the 25

results require huge resources in terms of storage, compute, and network. Critical 26

data related to monitoring has to be synchronized and analyzed in time to take the 27
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appropriate and informed decisions by the treating physician. 28

Security is one of the major challenges to the IoT in general [6]. When it comes 29

to healthcare, security becomes even more critical as the patient’s sensitive data 30

are flowing in the network without any encryption and can be used for medical
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identity theft, blackmailing, etc. Patient’s data can be altered by the hacker, and 32
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these modified data could be used to take life and death decisions for the patient. 33

IoT is on the verge to become pervasive in our lives, and it has already started to 34
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enter into our personal spaces like a home, car, and so on. There were incidences 35

where the car brakes were hacked; doors were locked and opened wirelessly, which 36
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shows the lack of security and privacy into the existing IoT systems [7]. 37
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IoT devices are heterogeneous in nature. Earlier IoT systems were considered 38

for small enterprises or home usage. Now, it has been envisioned that it will 39
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be used for large-scale projects like smart city, and almost everything will be 40

connected to the internet through the IoT devices/sensors/systems, which makes 41

the interoperability of systems a critical point. There is no open standard to 42

follow [8]. Every manufacturer has different firmware, communication protocol, 43

and frequencies on which the device operates. This could be the bottleneck for the 44

successful implementation of the IoT. 45

Stakeholders will determine the success or failure of the IoT implementation in 46

the healthcare industry. Various stakeholders, like healthcare service providers and 47

businesses, have to work together to create valuable services for the patients, which 48
 Challenges of IoT in Healthcare

makes stakeholder collaboration important. Unlike other sectors like industrial 49

automation, in the healthcare sector, there is a huge part that is dependent on the 50

human resource involved in diagnosis, educating the patient about the usage of the 51

IoT devices/sensors and taking the critical decisions. It clearly indicates that actual 52

implementation at the lower level is of extreme importance. 53

The remaining chapter is divided into four sections. It discusses the challenges 54

of data handling and resource management; security and privacy; interoperability; 55

and stakeholder collaboration and implementation for successful implementation of 56

the IoT systems in the healthcare sector. 57

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2 Data Handling and Resource Management 58

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All the IoT applications like remote monitoring, clinical operations, etc. are data- 59

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centric. Data are collected, processed based on the application-specific algorithm, 60

and finally, a decision is made. In the whole process, data play a vital role, and 61

when it comes to healthcare, time-critical execution and synchronization are of 62

extreme importance. There are different types of sensors in healthcare from which 63
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data are collected, like implantable sensors, wearable sensors, and others. There are 64

3.7 million devices in use today to monitor the various parts of the body, and this is 65
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going to exponentially increase with time [9]. Different applications have different 66

time-criticality factor requirements as shown in Table 1: 67

As mentioned in Table 1, remote patient monitoring has a high time-criticality 68

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factor. Processing and response time should be extremely low, e.g., monitoring 69

after the major surgery, cardiac arrest, and so on. Workflow optimization is the IoT 70

application in which the workflow, i.e., recording the patient’s data (from patient’s 71
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IoT device to the hospital’s database), registering at the hospital, and diagnosis, 72

is optimized. It significantly reduces the diagnosis time and can bypass all the 73
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paperwork related to healthcare. In this way, the quality of healthcare services 74

can be improved. If there is any issue with the healthcare services, it can be
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detected and corrected in time. With the help of the sensors, medical supplies, 76
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measurement equipment, medication, and diagnostic reports will be tracked and 77

hospital management will be notified in case of shortfall of the supply or expiry of 78

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the supplies and devices. Fitness measurement and preventive care are of relatively 79

low priority compared to the above-mentioned IoT applications (Fig. 2). 80

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Table 1 Application and IoT application Time-criticality factor

time-criticality factor
1. Remote patient monitoring High t2.1
2. Inventory management at hospitals Moderate t2.2
3. Workflow optimization High t2.3
4. Fitness measurement Low t2.4
5. Preventive care Low t2.5
 S. Anmulwar et al.

Fig. 2 Challenges related to

the data in IoT healthcare
systems

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Data collected from different IoT devices are enormous and are of unstructured
type which adds to the processing time further. These unstructured big data require
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a high-performance computing (HPC) systems to process the humongous amount of 83

data, which will drastically increase the infrastructure cost. Initial implementation
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cost is going to be at higher end due to infrastructure investment for healthcare 85

providers and business partners. Patients also have to invest in wireless setup at 86

home, sensors, bands, etc. But it will be minimal due to the reduced cost of sensors.
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87
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3 Security and Privacy 88

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IoT in healthcare consists of various types of body sensors to measure blood 89

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pressure, heart rate, temperature, etc. Security challenges related to IoT in general 90

are directly applicable and critical to IoT in healthcare. Security of the IoT systems 91
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is the biggest reason behind the IoT systems not being adopted at a larger scale 92

[10]. Mirai is a malware used in a large-scale network attack. It turns the Linux 93
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systems connected to the network into the remotely controlled bots. Mirai Botnet 94

is the example of the exploitation of the security loopholes in the IoT systems and
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how severely it can affect the IoT systems and networks [11]. Security was never a 96

focus in the initial development phase of IoT systems, and there was a competition 97

between businesses to develop IoT applications. Heterogeneity of devices, lack of 98

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encryption, and several attacks through the physical and cyber medium have caused 99

unauthorized access, data leakage, and hardware security issues. 100

It is evident that IoT devices will be ubiquitous. IoT is going to change our daily 101

lives in a way that is unimaginable at this point of time. According to the Cisco 102

reports, the number of IoT devices has already surpassed the world population [12]. 103
Challenges of IoT in Healthcare

IoT devices have already entered into our private spaces like home, car, and so on. 104

This indicates that IoT devices/network will have personal information like illness 105

information, medical reports, bank data, and social security numbers and raises the 106

concern of the privacy. 107

There are several factors that cause security issues as shown in Fig. 3. They are 108

discussed as follows: 109

• Architecture: Initially, the market focus was on IoT functionality rather than on 110

the security as there was a competition between the businesses to launch the IoT 111

products to catch up the market. Security was considered an add-on component 112

rather than the important one. 113

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• Lack of encryption: Data flowing in the IoT ecosystem are naked. Communi- 114

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cation from the sensors to the gateway, from the gateway to the cloud, is not 115

encrypted. Hacker can eavesdrop the communication or can hack the systems. 116

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• Access control: Access to the IoT data is relatively easier because of the weak 117

authentication schemes/vulnerable web portals. Access control is of extreme 118

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importance in the healthcare industry to protect the patient’s sensitive data from 119

malicious actors. D 120

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Fig. 3 Causes of security issues in IoT

 S. Anmulwar et al.

• Limited resources: IoT devices have limited processing power, memory, and 121

power (mostly, sensors are battery operated), making the implementation of 122

security-related protocols difficult, which are compute-intensive. 123

• Heterogeneity of devices: IoT is a complex ecosystem, and it consists of various 124

devices such as bracelets, cars, people, home appliances, medical appliances, 125

and many others. Each device sends and receives data in different formats, which 126

presents an opportunity to the cybercriminals to enter into the system. 127

• Lack of experience: IoT security is a relatively new field. Expertise related to 128

cybersecurity has to be applied to the IoT systems by taking into account the 129

limited resources. 130

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• Physical security: Not much attention has been paid to the actual hardware; 131

hardware may also have backdoors. Safety of the IoT hardware is of extreme 132

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importance; intruders can just access the data or change the configuration from 133

the device itself.

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134

• Complex ecosystem: IoT consists of sensors, actuators, microcontroller, gateway, 135

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and cloud. These sensors can be incorporated with home appliances, cars, fitness 136

bands, etc. It is difficult to secure the system having several components, which 137

requires different types of expertise. 138

To successfully incorporate IoT in the healthcare industry, following measures as 139

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shown in Fig. 4 should be taken to address security and privacy of the IoT system: 140
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• Port communication: Open ports are the readily available point of attack for 141

cybercriminals. No ports should be left open, and after the communication, 142

termination ports should be closed. 143

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Fig. 4 Techniques to secure

IoT systems
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Challenges of IoT in Healthcare

• Use of encryption: Data exchange in the IoT systems should be encrypted to 144

ensure the security of the patient’s sensitive data. It can help in preventing 145

the unauthorized access of the patient’s data, as well as eavesdropping of the 146

information by the hacker. 147

• Use of authentication: IoT web portals should be protected with strong pass- 148

words and authentication protocols. 149

• Access control to the hardware and software: Role-based access should be 150

designed to the IoT devices and data. So that only the authorized person should 151

get the patient’s sensitive data like treating physician pane, which is responsible 152

for the diagnosis, medication, and monitoring of the patient. 153

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• Hardware and middleware security: By ensuring the physical security of the 154

device, various threats like tampering of the device, data theft through USB, or 155

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stealing of the storage media, etc. can be prevented. Middleware connects the 156

applications to the things/sensors, and it should be secured.

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4 Interoperability D 158

Interoperability is the ability of systems to communicate with each other. Interoper- 159

ability is the critical factor for the success of the IoT. According to McKinsey and 160
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Company predictions, IoT interoperability will create almost 40% of its value [13]. 161

Healthcare industry makes use of various sensors to monitor patient’s health 162

remotely and in the hospital for medical supplies, etc. Wearable sensor devices used 163
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by patients can be from different vendors; there may be the case where a patient has 164

to use more than one wearable sensor device. All these sensor devices are supposed 165

to communicate with each other, but sensor devices from different vendors cannot 166
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communicate with each as they have different communication protocols. Because 167

of this problem, sensors have to be used from the same vendor so that sensors 168
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could communicate with each other; it is a potential bottleneck for the large-scale 169

implementation of IoT systems. It can cause vendor lock-in [14]. Interoperability

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170

issue even affects the development of the IoT applications exposing cross-platform. 171
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IoT is an evolving field, and it is evident that new type of sensor devices 172

in the different forms will be available in the market in the near future, and 173
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interoperability between already available devices and new devices is of extreme 174

importance (Fig. 5). 175

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Interoperability has three significant concerns, i.e., heterogeneity of devices, 176

nonuniformity of communication protocol, and no open standard to follow: 177

• Heterogeneous devices: IoT consists of devices starting from bracelets to home 178

appliances, people, car, etc. It is a challenge to develop a capability to communi- 179

cate with each other, and it has to be agreed upon collectively [15]. 180

• No open standard: There is no open standard to follow for the manufacturers. 181

Efforts have been made by the IEEE P2413 – Standard for an Architectural 182

Infrastructure for the Internet of Things [16], Iot-A created to develop architec- 183
 S. Anmulwar et al.

Fig. 5 IoT interoperability

challenges

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tures that can be applied in different domains [17], IoTivity [18], and Industrial
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Internet Reference Architecture (IIRA) [19], but nothing has been formalized as 185
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open standard yet. 186

• Nonuniformity of communication protocol: Each vendor has different firmware 187

and communication protocol. Only IoT devices from the same vendor can 188
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communicate with each other, and these devices cannot communicate with 189

the IoT devices from different vendors, which is the barrier to the large-scale 190

implementation of IoT [20]. 191

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5 Stakeholder Collaboration and Implementation 192

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Although security is perceived as the biggest challenge for the successful imple- 193
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mentation of IoT in the healthcare industry, stakeholder collaboration is of equal 194

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importance for the IoT implementation. Value creation is a collaborative process 195

[21], and all the stakeholders must come together to improve the quality of 196
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healthcare by means of IoT. Figure 2 depicts the various challenges pertaining to 197

stakeholder collaboration. 198

Healthcare providers, patients, healthcare payers, research laboratories, gov- 199

ernment authority, businesses, insurance agencies, and IoT application developers 200

are the stakeholders for the IoT implementation in healthcare. Healthcare service 201

providers and businesses have to work together to create value for all stakeholders 202

through innovative IoT services. Understanding the needs of the patients, doctor, and 203

hospital staff is of importance to create services. Data collection through interviews 204

and workshops has to be done. Further, these data have to be analyzed to get the 205
Challenges of IoT in Healthcare

Fig. 6 Stakeholder
collaboration challenges

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IoT and healthcare can be built. PR
insights/ideas for the creation of the IoT services. In this way, businesses around 206

207
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Lower level implementation is crucial to the success of IoT in the healthcare 208

industry [22]. Everything cannot be automated in the healthcare sector, and there
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209

is still a lot of human intervention in the healthcare industry. All the hospital staff 210

has to be professionally trained to make use of the IoT devices and the ecosystem. 211

Patients have to be educated for the use of IoT devices by the hospital staff. It is
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212

going to take some time to get used to the new IoT ecosystem (Fig. 6). 213
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6 Conclusion 214
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IoT is going to be an integral part of the patient’s diagnosis, treatment, and 215

recovery process. IoT data collection mechanism coupled with predictive ana- 216
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lytics will improve healthcare and reduce human errors. IoT in healthcare has 217

several challenges such as data handling, resource management, security, privacy, 218
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interoperability, stakeholder collaboration, and actual implementation. At present, 219

security is the biggest barrier to the success of IoT. Considering the enormous
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number of devices generating huge unstructured data, data handling and resource 221

management are also going to be a challenge in the near future. Interoperability 222

between IoT devices and creating values through stakeholder collaboration will 223

decide the success or failure of the IoT systems in healthcare industry. 224
 S. Anmulwar et al.

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authors.
AQ2. Please confirm the inserted citation for Figs. 2, 5, and 6.
AQ3. Please check if the edits made to sentence “Heterogeneity of devices . . . ”
retain the intended meaning.

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