Journal of Medical Systems (2020) 44: 72

https://doi.org/10.1007/s10916-020-1534-8

SYSTEMS-LEVEL QUALITY IMPROVEMENT

IoT Based Predictive Maintenance Management

of Medical Equipment
Abdulrahim Shamayleh 1 & Mahmoud Awad 1 & Jumana Farhat 2

Received: 22 October 2019 / Accepted: 28 January 2020 / Published online: 20 February 2020
# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Technological advancements are the main drivers of the healthcare industry as it has a high impact on delivering the best patient
care. Recent years witnessed unprecedented growth in the number of medical equipment manufactured to aid high-quality patient
care at a fast pace. With this growth of medical equipment, hospitals need to adopt optimal maintenance strategies that enhance
the performance of their equipment and attempt to reduce their maintenance costs and effort. In this work, a Predictive
Maintenance (PdM) approach is presented to help in failure diagnosis for critical equipment with various and frequent failure
mode(s). The proposed approach relies on the understanding of the physics of failure, real-time collection of the right parameters
using the Internet of Things (IoT) technology, and utilization of machine learning tools to predict and classify healthy and faulty
equipment status. Moreover, transforming traditional maintenance into PdM has to be supported by an economic analysis to
prove the feasibility and efficiency of transformation. The applicability of the approach was demonstrated using a case study from
a local hospital in the United Arab Emirates (UAE) where the Vitros-Immunoassay analyzer was selected based on maintenance
events and criticality assessment as a good candidate for transforming maintenance from corrective to predictive. The dominant
failure mode is metering arm belt slippage due to wear out of belt and movement of pulleys which can be predicted using
vibration signals. Vibration real data is collected using wireless accelerometers and transferred to a signal analyzer located on a
cloud or local computer. Features extracted and selected are analyzed using Support Vector Machine (SVM) to detect the faulty
condition. In terms of economics, the proposed approach proved to provide significant diagnostic and repair cost savings that can
reach up to 25% and an investment payback period of one year. The proposed approach is scalable and can be used across
medical equipment in large medical centers.

Keywords Medical equipment . Maintenance . Healthcare . Failure management . Sensors . Internet of things . IoT

Introduction accuracy. As a result, the number of medical equipment need-

The healthcare industry is always trying to improve health
system operational efficiency, minimize risks and use the lat-
est technology equipment [1, 2] to assure the diagnosis
This article is part of the Topical Collection on Systems-Level Quality
Improvement
* Mahmoud Awad
miawad@aus.edu
1 strike a balance between maintenance costs and level of ser-
Industrial Engineering Department, American University of Sharjah
College of Engineering, Sharjah 266666, United Arab Emirates
2 Maintenance strategies can be classified into s Preventive
Biomedical Engineering Department, American University of
Sharjah College of Engineering, Sharjah 266666, United Arab
Emirates
ed to treat patients has increased significantly in the last de-
cade. The growing number of equipment is making a signifi-
cant contribution to the mounting healthcare costs making it
contradicting the emphasis of making healthcare affordable.
Stewart [3] reported that the number of medical equipment
increased by 62% over the past 15 years while the average
utilization rate of mobile equipment is only 42%; thus, in-
creasing hospital’s acquisition budgets and maintenance costs.
Due to the complexity and criticality of equipment, appropri-
ate maintenance management strategy becomes very critical,
especially when considering limited budgets and the need to
vices [4].
Maintenance (PM), Predictive Maintenance (PdM), and Run
to Failure (RTF) or Corrective Maintenance (CM). By far, PM
72 Page 2 of 12
is the most commonly applied and implemented in the health
industry. PM is performed regularly after a scheduled time or a
certain amount of usage regardless of the equipment condition
[5, 6]. Tinga [7] suggested that the PM approach has been
useful in reducing the number of failures but still considered
an expensive method in addition to the constraint of system
availability every time the maintenance action needs to be per-
formed. On the contrary of CM and PdM are performed only
when the need for maintenance arises, not based on a certain
time passage or a certain usage [8]. Moreover, PdM can help in
shortening the diagnostics time to uncover failure causes faster.
In both cases, the implementation of the PdM strategy will
increase the equipment availability because of the ability to
detect a failure in the early stages and minimize spare parts
inventory holding costs. Besides, implementing such a strategy
will have a positive impact on equipment lifetime and quality,
leading to higher levels of safety and reduced times of break-
down and emergencies which can threaten people’s lives [9,
10]. Using IoT-based PdM where sensors are utilized to collect
data will provide a better picture of equipment health status and
provide warnings that will trigger scheduling a maintenance
action before reaching the breakdown point.
Internet of Things (IoT) is gaining an increasing momen-
tum in the healthcare industry due to its boundless applica-
tions resulting in enhancing the quality of the industry and the
satisfaction levels of patients. Hospitals, for example, are put-
ting great effort into applying IoT technology so doctors can
monitor their patients using sensing and wireless technology
[11–13]. With the introduction of IoT, PdM usage among
manufacturing companies is expected to grow up to 83% in
the coming two years [14]. Similarly, PdM is expected to
reduce costs by 12%, increase uptime by 9%, reduce safety,
health, environmental, and quality risks by 14% and extend
the lifetime of an asset by 20% [15]. In the healthcare industry,
The basic three steps toward building a PdM program in-
volves data acquisition, data processing, and decision making.
Different PdM techniques can be applied to evaluate the con-
dition of the equipment such as vibration, oil, and thermogra-
phy analyses, etc. [9]. For example, vibration analysis is a com-
mon technique used to evaluate moving parts of an electro-
mechanical system and predict failures such as motor break-
down, belt, chain slippage, and gear and sprockets wear out.
Machine learning (ML) is another enabler of PdM pro-
grams. In a data-driven ML approach, previously collected
data is being used to understand and identify the progress
properties of the damage and therefore predict the future state.
Based on the obtained data under various healthy and faulty
conditions, suitable mathematical models can be employed to
monitor the trend of the data [16]. Data-driven approaches are
divided into two main categories: Artificial Intelligence (AI)
approaches and statistical ones. The AI approaches include
Neural Network (NN) [17–19] and fuzzy logic [20, 21] while
statistical approaches include Gaussian Process (GP),
J Med Syst (2020) 44: 72
regression [22], Support Vector Machine (SVM) [23, 24],
least squares regression [25], gamma process [26], Wiener
processes [27], and hidden Markov model [28].
Many researchers and practitioners used SVM for PdM
maintenance. For example, Konar [29] used SVM for bearing
fault detection of a three-phase induction motor using vibra-
tion signal during start-up. Results showed that the SVM clas-
sifier gave excellent results since it is very simple and easy to
implement compared to other methods such as Artificial
Neural Networks (ANN). Similarly, Hu [30] proposed a new
method for fault diagnosis based on an Improved Wavelet
Package Transform (IWPT), a distance evaluation technique,
and SVM. The optimal features are used as an input into the
SVM to identify different abnormal cases. The proposed
method is used for rolling element bearings fault detection,
and testing results showed that SVM could reliably separate
different fault conditions and identify the severity of incipient
faults. Shafri and Ramli [31] also conducted a study to com-
pare SVM and decision tree classification methods for image
classification. They suggested that the overall accuracy of the
SVM is higher than the decision tree by an average of 4%
which indicates a better image classification. Finally,
Stretcht et al. [32] conducted a comparative study between
SVM, K-Nearest Neighbours (KNN), and decision trees to
predict a student’s performance. They suggested that SVM
has the highest prediction accuracy of the three algorithms.
The purpose of this article is to propose an IoT-based ap-
proach to collect data on medical equipment along with ad-
vanced ML methods to improve maintenance effectiveness,
which will enhance medical equipment efficiency and reduce
maintenance cost and effort. Such an approach enhances the
movement from PM to PdM maintenance which results in cost
reduction and improves equipment availability. The rest of the
article is structured as follows: The proposed approach is pre-
sented in “Methodology” section and demonstrated using a
case study in “Case Study: Vitros Immunoassay Analyzer
(VIA)” section followed by classification method selection
in “Classification Method Selection” section. Economic fea-
sibility is presented in “Economic Feasibility” section while
conclusions and future work in the last section.
Methodology
The proposed approach for transforming medical equipment
maintenance to IoT-based PdM consists of ten necessary steps
shown in Fig. 1, and the details of each step as follows:
Step 1: Review maintenance logs of all medical equip-
ment and collect failure-related information: this
includes failure incidents and maintenance orders
logs. Such a review will be used to determine
equipment with high frequent failure rate, time
to repair, and downtime. Moreover, the review
J Med Syst (2020) 44: 72
Fig. 1 Methodology steps
will be used to determine the most frequent fail-
ure or symptoms of failure.
Step 2: Determine the criticality of equipment in terms of
failure effect severity. The operation of some equip-
ment such as ventilation and dialysis are more criti-
cal than others. Based on the output of step 1, i.e.,
failure rate and determination of criticality. The need
for transforming the maintenance strategy for each
equipment is determined and equipment are priori-
tized accordingly.
Step 3: Analyze failure modes for selected equipment: one
effective tool to analyze failure modes is Failure
Mode and Effect Analysis (FMEA). FMEA is used
to identify the associated failure modes, their effect
on the functionality of the equipment, potential
causes, and the corresponding needed actions to pre-
vent or detect the cause.
Step 4: Determine the most appropriate maintenance strate-
gy based on the failure mode and equipment, con-
sidering cost, efforts, and personnel safety. If the
equipment is not critical and components are unlike-
ly to fail, then a CM would be the best strategy. If
failure is driven by a wear-out mechanism or the
failure pattern is known, then a PM would be the
best. Finally, if the failure were random in nature
with no specific pattern, then PdM would be the best
one.
Step 5: Needed feature for fault detection: determine equip-
ment health indicators needed to detect faults and
evaluate them. Either data-driven, physics-based, or
hybrid of both approaches can be used. In the case of
Page 3 of 12 72
a data-driven approach, all potential parameters are
collected and analyzed so “significant features” are
only selected for further analysis. This method is
referred to as a feature selection step. The under-
standing of the physics of failure mode is utilized
to narrow down parameters to be collected. For ex-
ample, in this work, only the vibration signal is mea-
sured since it is directly indicative of failure mode
under study. The failure mode under investigation is
the inability of the machine to move or analyze
blood samples due to belt slippage that may be
caused by the gradual movement of tensioners or
wear or tear of several components in the system.
The machine will become inoperative and a failure
code would show up on the main screen of the ma-
chine. Other examples of features are voltage, cur-
rent, or sound.
Step 6: Data collection: once the features to determine
equipment health are selected, data that covers both
faulty and healthy conditions is collected. In many
cases, such data collection is built into the equip-
ment and there is no need for extra hardware or
processing. However, there are cases where addi-
tional sensors are needed to collect and process data.
In any case, IoT-based infrastructure to collect data
without interfering in equipment operation is need-
ed. One technological enabler of the IoT-based so-
lution is the Wireless Sensor Network (WSN).
WSN consists of sensor nodes, each of which is
equipped with a radio transceiver, a small micropro-
cessor, and several sensors to collect data. Since the
sensor nodes have some intelligence, data can be
processed as it flows through the network. In our
case, an accelerometer was needed to collect vibra-
tion signals in addition to a processor with Matlab
installed was also used for data processing and ma-
chine learning implementation.
Step 7: Signal processing and feature extraction: In many
cases, the health indicator of the collected data
comes in the form of a signal that needs to be proc-
essed, and certain features are extracted from this
signal to be processed later. Signal processing in-
cludes signal filtering, amplification, correlation,
and compression to reduce artifacts and noise levels
for a better quality of the signals. Examples of filter-
ing techniques are wavelet and Fourier transforma-
tion, which are used to remove or reduce noise and
enhance the characteristics of the signals. Examples
of signal features are the mean, maximum, area un-
der the curve, root-mean-square value (RMS).
Extracting features from pre-processed signals is
then performed which can be an initial indicator
for a fault or failure [33].
72 Page 4 of 12
Step 8: Feature selection: Once features are extracted from
the collected signals, the most significant and con-
tributing features are extracted and used. Statistical
tools such as Principal Component Analysis (PCA)
and correlation are very common approaches for
feature extraction.
Step 9: Classification: Different predictive models based on
machine learning such as decision trees, SVM,
Artificial Neural Networks (ANN) or regression
can be used to analyze and classify the data into
different categories [34]. Usually, collected data is
divided into two sets: training and testing. A training
set is used to build a predictive model while the test
data set is used to evaluate the model. Once verified,
the model can be used for predicting the class or
health of new profiles and the future status of the
component or system.
Step 10: Evaluate the economic feasibility of IoT-based
PdM: At this stage, a cost-to-benefit analysis is
performed to estimate the evaluation of the finan-
cial benefit gained from the investment of the IoT
system. Hardware and software solutions selected
should take into consideration all the requirements
of full-scale real-life implementation.
The proposed IoT-based PdM method is applied to one of
the local hospital labs. Details on implementation are provided
in the next section.
Case Study: Vitros Immunoassay Analyzer
(VIA)
The proposed approach is evaluated using a case study for one
of the largest hospitals in Sharjah, United Arab Emirates. The
hospital serves around 60,000 patients annually, and asset
management (acquisition, operation, and maintenance) repre-
sents 40–60% of the total hospital budget. The maintenance
logs were reviewed for the Hospital under study (HUS) in
terms of regular PM and RTF maintenance jobs. Figure 2
summarizes the top five medical equipment in terms of
Coagulaon Analyzer
Hematology Analyzer
Modular Auto Analyzer
Biochemistry Analyzer
Vitros Immunoassay Analyzer
0 5 10 15 20 25 30
2015 2016 2017
Fig. 2 Medical equipment breakdown frequency
J Med Syst (2020) 44: 72
breakdown frequency due to unplanned failures during the
2015–2017 period.
Based on equipment failure rate and criticality assessment
analysis, the Vitros Immunoassay Analyzer (VIA) was chosen
since it has the highest failure rate in the laboratory depart-
ment. Moreover, VIA is an immunodiagnostic equipment re-
sponsible for performing several medical blood tests such as
HIV, BHCG, and Hepatitis. VIA was commissioned in 2015
and has been utilized 24/7 since then. CM is outsourced to an
outside maintenance service contractor. As a result, and in the
case of VIA failure, this company, to fix the equipment. The
time to diagnose and repair the equipment ranges from 2 to
24 h which impact physician ability to diagnose patients and
offer treatment. Table 1 summarizes the errors obtained that
triggered the maintenance of the Vitro analyzer by the opera-
tors during the 2015–2017 period. Based on maintenance re-
cords of the service provider and discussion with technicians,
the dominant one is belt slippage of the metering arm and
contributes to 40% of failures; this error will be the focus of
this case study. Other occurring errors are related to the pro-
boscis line (tube) which is part of the aspiration probe and
sample-metering pump that drives the air and regulates its
flow through the aspiration probe. The first four errors in
Table 1 may generate a “motor flag error” on the screen which
shutdown the analyzer and require calling the maintenance
contractor. The average time to repair is 24 h, which includes
technician travel to analyzer site, diagnosis, and fixing the
failure. The belt slippage is caused by the gradual movement
of tensioners in addition to the wear and tear of the belt. Since
there are many components involved in the system, the failure
incidents are random and time to failure has no specific pat-
tern. Figure 3 depicts the mean cumulative function (MCF) of
time to slippage failure since the commissioning of one of the
Vitro analyzers. Each point on the graph represents a slippage
failure while cumulative time to failure is shown on the x-axis.
The scatter of the points and shape factor of the best–fit failure
distribution suggests a constant failure rate with an average of
one failure every two months. The belt is driven by a stepper
motor part of a sample-metering arm mechanism, which is
Table 1 Analyzer errors percentages
No. Error Count % Error
1 Regent loading error 6 13.3
2 Belt slippage 18 40.0
3 Luminometer voltage out of range 8 17.8
4 Inner ring did not reach home location 3 6.7
5 Calibration error 2 4.4
35 40 45 50
6 Unable to meter sample fluid 4 8.9
7 Others 4 8.9
J Med Syst (2020) 44: 72
Fig. 3 Mean cumulative function (MCF) of slippage failure
responsible for drawing a certain amount of blood sample
from a sample tube through a cup. The drawn sample is mixed
with a specific reagent inside the incubator based on the re-
quested test.
Fig. 4 Example of healthy and faulty vibration signals in the time domain
Page 5 of 12 72
Since the vibration signature of the equipment will change
when slippage occurs, two accelerometers were mounted clos-
er to the belt to collect vibration data. Blood-sampling pro-
cessing is fully automated, i.e., repetitive and lasts 8 s. A total
of 50 vibration profiles for each accelerometer were measured
representing 30 healthy processes and 20 faulty ones. Each
profile represent a simulation of blood sample operation that
extends for 8 s. The output profile is a time series of g-loads
versus time in a tabular format. Healthy profiles were gener-
ated with the system running normally; i.e. belt is not lose or
tightened. Moreover, the VIA analyzer was checked during
operation to ensure no error codes are flagged with the smooth
movement of belt and pulleys. The faulty profiles were gen-
erated by testing the belt at different levels of small to major
slippage. The major slippage occure when the belt has a slack
of approximately 2 cm. When the belt slip, the VIA analyzer
will shift into a shutdown mode and an error code “motor flag
error” appears on the control panel. Figure 6 shows vibration
signal examples for healthy and faulty ones plotted separately
and combined during the 8-s interval. As can be seen in Fig. 4,
it is hard to distinguish between the two profiles using visual
inspection.
72 Page 6 of 12
Fig. 5 Example of healthy and faulty vibration signals in the frequency domain
Following the collection of the data, the signal-
processing step is performed to filter and extract features.
Vibration signals were collected in the time domain, so we
had to transform them into the frequency domain using the
Fast-Fourier Transform (FFT) algorithm since it enhances
the signal-to-noise (SNR) ratio of the original signal.
Figure 5 illustrates vibration signals in the frequency do-
main of an interval of 500 Hz for the second sensor as an
example.
Following the FFT and based on the surveyed literature,
17 different features were extracted from the frequency
domain profile for all vibration profiles of the two sensors
[35–41]. Examples of these features are mean, median,
root mean square (RMS), skewness, kurtosis, and energy
among others.
Next, a PCA and correlation analysis was carried out to
select a smaller set of significant factors without losing impor-
tant information. Correlation analysis suggests a strong corre-
lation between sensor 1 and 2 with a Pearson correlation co-
efficient of 0.65. Such a result suggests that one sensor is
enough for classification decision making. In addition, this
will have a positive impact on reducing the total cost that is
associated with implementing the IoT-based PdM approach.
J Med Syst (2020) 44: 72
Classification Method Selection
Several ML classification methods were investigated to select
the most accurate one for VIA belt slippage failure. In our
case, we tested the model using the k-folds cross-validation.
Table 2 summarizes some of the classifiers and their accuracy
percentages for the first and second sensors, respectively,
using k-fold cross-validation. In the k-fold cross-validation,
the 50 profiles are divided into 5 folds, so each fold contains
10 profiles. Training will be done on k-1 fold while testing
will be done for the held folds. The k-fold validation method
gives a good estimate of the predictive accuracy of the final
model trained with all the data. It requires multiple fits but
makes efficient use of all the data, so it is recommended for
small data sets like ours. The accuracy percentage of classi-
fiers using k-fold cross-validation is the average of the accu-
racy percentage for each iteration.
The results obtained in Table 2 indicate that the accuracy of
classifiers using sensor 1 is superior to sensor 2 regardless of
the classifier. This can be attributed to the closeness of the
accelerometer to the belt since sensor 1 is closer to the belt
than sensor 2. In general, linear SVM provided good results
relative to other classifiers.
J Med Syst (2020) 44: 72 Page 7 of 12 72

Fig. 6 Linear SVM model

confusion matrix using cross-
validation

Figure 6 shows the confusion matrix of the linear SVM
using 5-fold cross-validation. In machine learning, the perfor-
mance of prediction models is mainly assessed through con-
fusion matrices. A confusion matrix is a tabulation of the true
class labels against the predicted ones as shown in Fig. 6.
Out of the seventeen features initially used for modeling,
only four critical features were selected to develop the SVM
model. These features based on importance are kurtosis, peak-
to-peak, standard deviation, and (RMS). SVM model accura-
cy of 96.1% is obtained using these three critical features and
drops to 82.4%, 92.2%, 92.2%, and 94% if kurtosis, peak-to-
peak, standard deviation, and RMS are removed from model
respectively. Figures 7 and 8 below show scatter plot of the
four critical features. Healthy profiles that were flagged as
healthy are designated as 1-correct in Figures7 and 8.
Similarly, faulty profiles classified as faulty are referred to as
0-correct. The SVM incorrectly flagged two health profiles as
features. The distance between each vector that represents select-
ed features and the hyperplane is used to assess the health status
of the equipment as well. Classification threshold is determined
using the distance between any profile represented by the vector
[kurtosis, peak-to-peak, standard deviation, RMS] extracted from
the vibration profile data and the hyperplane represented in Eq.
(1). If the output of Eq. 1 is positive, then the profile is predicted
as healthy. Otherwise, is predicted as faulty.
The mathematical formulation of the hyperplane involves
the use of a training set (xi, yi) where i = 1,2,3……, l, xi ∈ Rn,
the class label yi ∈ {+1, −1} which is either positive or nega-
tive, n is the number of features and l is the number of training
data points. The linear SVM approach aims to construct a
classifier in the form of Eq. (1) [42]:
 
N
yðxÞ ¼ sign ∑ αi yi xTi x þ b ð1Þ
I¼1

faulty; those were referred to as 0-incorrect.

where αi are positive real constants, b is a real constant, and
Both Figs. 7 and 8 separates the healthy (class 1) and faulty
xTi x is the kernel function. Table 3 below provides a summary
(class 0) well. Both figures also show the two healthy profiles
of the VIA case SVM model parameters.
classified incorrectly as faulty. The working concept of SVM
Several additional performance indicators can be estimated
involves finding a hyperplane that can separate data classes,
using the results of the confusion matrix. These indicators are
i.e., healthy and faulty in the n-dimensional space, where n rep-
a function of the following variables:
resents the number of features used which in this case four
n00 number of true healthy profiles that are predicted
healthy as well.
Table 2 Accuracy percentages of the classifiers n10 number of true faulty profiles that are predicted healthy.
Classifier K-fold n01 number of true healthy profiles that are predicted faulty.
n11 number of true faulty profiles that are predicted faulty
Sensor 1 Sensor 2 as well.
Fine Tree 94% 80%
Medium Tree 94% 80% Below are several important performance indicators esti-
Linear SVM 96% 82% mated for the linear SVM classification method adopted for
Quadratic SVM 94% 84% VIA belt slippage failure:
Cubic SVM 92% 78% n00 þ n11 28 þ 21
Accuracy ¼ ¼ ¼ 96:1%
Fine Gaussian SVM 94% 84% n00 þ n01 þ n10 þ n11 28 þ 2 þ 0 þ 21
72 Page 8 of 12 J Med Syst (2020) 44: 72

Fig. 7 Scatter plot of kurtosis Vs

peak-to-peak

n00 28
True Negative Rate ðspecificityÞ ¼ ¼ ¼ 93:3% Figure 9 below shows the receiver operator characteristic
n00 þ n01 28 þ 2
(ROC) curve based on the 5-fold cross validation. The ROC
False Positive Rate ðfprÞ curve shows the true positive rate (TPR) and the false positive
n01 2 rate (FPR). The solid circle marker on the plot shows the
¼ 1−False Negative Rate ð1−fnrÞ ¼ performance of the current SVM predictive model with a 1.0
n00 þ n01 28 þ 2
TPR and 0.07 FPR. This indicates that the model would in-
¼ 6:7% correctly classify 7% of healthy profiles to the faulty class.
n11 21 Another point of interest on the ROC curve is the one with
True Positive Rate ðsensitivityÞ ¼ ¼ ¼ 100% zero FPR; see the point with the arrow in Fig. 9. SVM model
n10 þ n11 0 þ 21

Fig. 8 Scatter plot of standard

deviation (Stdev) Vs RMS
J Med Syst (2020) 44: 72 Page 9 of 12 72

Table 3 Linear SVM model parameters consequences is less harmful than a false positive (classifying
αi yi x1 : RMS x2 : Kurtosis x3 : Peak − to − peak x4 : Stdev a faulty system as healthy) in this particular case.
Since the stepper motor is used to rotate the diver pulley to
1 -1 −0.334 1.249 1.239 0.368 drag the belt, the motor torque or current might be used for
1 −1 −0.436 0.527 0.400 0.219 flagging belt slippage event. However, such an approach re-
1 1 0.161 1.367 1.084 0.194 quires accessing the motor controller which the original man-
0.061 1 0.931 2.951 2.974 1.319 ufacturer of the VIA did not allow for. If proven, using motor
1 −1 −0.397 0.465 0.266 0.186 current or torque would be superior since it did not require any
1 −1 −0.498 −0.057 −0.242 0.013 additional hardware. Moreover, the error code can be specific
1 1 0.348 −0.167 0.340 0.023 to the belt slippageEconomic Feasibility.
1 1 0.221 1.130 1.273 1.003
1 1 0.277 −1.135 −0.665 0.321
1 1 0.209 −1.096 −0.602 0.033
0.639 1 0.475 −0.571 −0.164 0.252 Economic Feasibility
1 1 −0.566 −0.601 −0.938 −0.862
1 −1 −0.428 −0.110 −0.284 −0.120 The proposed IoT system relies on using wireless accelerom-
0.7 −1 −0.540 −0.283 −0.493 −0.126 eter sensors connected wirelessly with the Data Acquisition
1 −1 −0.285 −1.085 −1.187 −0.765 (DAQ) card. Once data is captured by the DAQ, it will be sent
wirelessly via the internet to clouds for processing and deci-
sion-making. Vibration profiles will be sent daily and the
associated with this point will result into a 0.5 TPR, which is SVM method will be used to decide whether to schedule an
not favorable. A perfect performance is represented by the appointment for repairing the arm mechanism or keep running
right angle to the top left of the plot where no profiles are VIA as is. A health-monitoring interface will be built accord-
misclassified. The area under the curve number is a measure ingly to be available online for technicians of the service pro-
of the overall quality of the classifier model with larger area vider without the need for them to be presented physically
indicates better performance. with the equipment.
In summary, an SVM prediction model based on four fea- Table 4 summarizes costs and benefits estimation for
tures was fitted with an acceptable accuracy of 96%, a true implementing the IoT-PdM system in US dollars. The costs in-
positive rate of 93%, and a false positive rate of 7%. As indi- volve the proposed approach related equipment procurement,
cated by the ROC curve, the SVM model can be used for labor costs, communication and cloud service costs, and opera-
process monitoring to flag faulty behavior. Keep in mind that tions and maintenance (O&M) costs. Investment cost includes
having a false alarm (classifying a healthy system as faulty) the acquisition system and software. Benefits, on the other hand,
include reduction of opportunity cost, breakdown cost, inventory
cost, secondary damages as well as extending the life of the
equipment. The current corrective maintenance practice relies
on running the VIA until failure. Once failure is flagged using
the “motor flag failure” and analyzer becomes inoperative, lab
operators call maintenance contractor technicians to come,

Table 4 IoT-PdM system costs and benefits ($)

Cost category Value Benefit category Value

Equipment: --8170 Opportunity costs + 2723

- Accelerometers
- DAQ
- PC
O&M (10% of capital) −1068 Inventory cost + 817
Labor −19,021/yr Breakdown cost +102
Communication
- Internet subscription −1960/yr
- Cloud services
Software licenses −2350
Total cost 32,749 Total Benefit 33,595
Fig. 9 ROC curve of linear SVM based 5-fold cross validation
72 Page 10 of 12
diagnose, and fix the issue by tightening or replacing the belt.
The average time to repair is 24 h in which the analyzer is down.
PdM implementation will predict the belt slippage earlier before
the shutdown, so the lab operator can call technicians while still
running the analyzer. More importantly, lab operators do not need
to call maintenance technicians to diagnose the issue and hospital
technicians can be trained to tighten the belt themselves. PdM
reduces the number of equipment down time by reducing the
number of unplanned stops. Thus, the availability of hospital
equipment increases and its usage as well, so the equipment is
more utilized which generates more profit over the saved time.
According to the hospital under study, VIA machine performs
around 50 tests per day and the minimum cost per test is around
$55 which will result in an opportunity cost of $2723 for each
reduced breakdown of the machine. Inventory costs will be re-
duced since failure can be predicted; the backup materials stored
in inventory are reduced as spare parts can be ordered when
required. The cost reduction is estimated to be around $817
[43]. PdM also reduces the number of times the machine is
disassembled as it is now disassembled only when required.
Therefore, the machine lifetime is extended [43]. The use of
IoT and PdM can reduce the cost up to 25% by reducing the
time to repair by up to 50% and extending the life of the equip-
ment up to 36% [44]. Therefore, if the cost per breakdown is
around $136, after implementing the approach it will be reduced
by 25%, which is around $102. Since the failure was detected in
advance, sequential damage was prevented from occurring. For
example, the failure of the sample-metering arm can be identified
and fixed before other sequential damages occur. According to
[43], repairing before machine failure occurs reduces the repair
bill by ten times. One should notice that soft savings such as
patient satisfaction and doctor’s ability to diagnose patients faster
are not included in this analysis since it is hard to quantify.
Based on an inflation rate of 2.2% [45], Minimum
Attractive Rate of Return (MARR) of 8% and Value-Added
Tax (VAT) of 5% [46], the Net Present Value (NPV) was
estimated to be $85,177 over the estimated life of VIA equip-
ment which is 11 years and a payback period of one year.
Since the NPV value is positive, then it yields that the
projected earnings generated exceed the anticipated costs.
Therefore, PdM implementation is expected to be profitable
and it is advisable to invest in it. Conclusion and Future Work.
In this work, we addressed the issue of lacking the imple-
mentation of the predictive maintenance (PdM) strategy along
with the Internet of Things (IoT) technology in the healthcare
industry. The goal is to demonstrate how the efficient use of
such an approach can result in many benefits that will be
reflected in more efficient resource utilization in any industry
in general and the healthcare industry in specific. In addition
to increasing the system’s reliability especially in critical de-
partments, implementing the PdM strategy will be a revolu-
tionary breakthrough in the healthcare industry. It will not
only provide maintenance to the medical equipment but also
J Med Syst (2020) 44: 72
it will restrict the undesired growth of errors that normally
occur by following a time-based or a failure-based strategy,
and eventually leads to a complete malfunction of the equip-
ment. Despite the challenges that were faced with carrying out
this work, the impact that will be gained if this approach is
applied was motivating to go through hard times and especial-
ly after contacting top healthcare equipment manufacturers
and realizing that they are moving towards applying a similar
approach to what we are proposing.
In this work, an IoT-based PdM methodology that can be
applied to any medical equipment was formed and applied to
the Vitros machine to achieve the objective of fault diagnosis
and prediction. After studying the equipment maintenance
logs and performing failure criticality assessments, the most
critical failures were determined and ranked based on their
criticality. Next, the dominant failure mode was simulated
for data collection, classification, and modeling using the most
common machine learning tools. Finally, the economic feasi-
bility of the proposed approach was studied, and results indi-
cated that such a strategy is worth investing in. Although
relying on vibration signal is only valid for the belt slippage
failure of the VIA only, the proposed PdM approach can be
used for other failure modes and other medical equipment.
Depending on the physics of failure, other parameters such
as current, voltage, temperature…etc. can be investigated for
fitness of use in predicting and classifying faults.
As for future work, the proposed methodology that has
been discussed previously can be applied to more failure
modes and other medical machines as well, to improve the
quality of services, patients’ safety, and reduce the associated
risks and costs due to sudden failures. Moreover, some ML
techniques are sensitive to data size, so more data can be
collected and prediction model is re-evaluated.
Compliance with Ethical Standards
Conflict of Interest All three authors declare that they have no conflict
of interest.
Ethical Approval This article does not contain any studies with human
participants or animals performed by any of the authors.
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