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Developing IoT Based Smart Health Monitoring Systems: A Review

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 Revue d'Intelligence Artificielle
Vol. 33, No. 6, December, 2019, pp. 435-440
Journal homepage: http://iieta.org/journals/ria

Developing IoT Based Smart Health Monitoring Systems: A Review

Ashikur Rahaman, Md. Milon Islam*, Md. Rashedul Islam, Muhammad Sheikh Sadi, Sheikh Nooruddin

Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna 9203, Bangladesh

Corresponding Author Email: milonislam@cse.kuet.ac.bd

https://doi.org/10.18280/ria.330605 ABSTRACT

Received: 23 September 2019 Internet of Things (IoT) based smart health monitoring system is a patient monitoring system
Accepted: 2 December 2019 in which a patient can be monitored 24 hours. In the present world, IoT is changing the
infrastructure of technologies. By facilitating effortless interaction among various modules,
Keywords: IoT has enabled us to implement various complex systems such as smart home appliances,
intelligent smart health monitoring, smart traffic control systems, smart office systems, smart environment, smart vehicles and
internet of things, ECG sensor, smart temperature control systems and so on in very little space. Health monitoring systems
temperature sensor, pulse sensor, review are one of the most notable applications of IoT. Many types of designs and patterns have
already been implemented to monitor a patient’s health condition through IoT. In this paper, a
review of IoT based smart health monitoring systems is presented. The latest innovative
technologies developed for IoT based smart health monitoring system with their merits and
demerits have been discussed. This review aims to highlight the common design and
implementation patterns of intelligent IoT based smart health monitoring devices for patients.

1. INTRODUCTION the patient. It is also referred to as the pulse rate of the body.
The normal pulse rate of a healthy adult is 60 to 100 beats per
Internet of Things (IoT) is now a reliable technological minute. The average human pulse rate is 70 beats per minute
standard and a heavily researched field. Sensors are being used for males and 75 beats per minute are for females. Females
almost everywhere in the present time, from everyday products aged 12 and older have faster heart rates than males [7]. The
to industrial monitoring systems. The use of IoT and sensor- rate changes with illness, due to damage to body, heart, and
based intensive health care systems are increasing rapidly [1]. exercise. Hence heart rate is essential in determining one's
IoT makes our life smarter, more efficient and easier. Using a health condition. Diabetes is a very common disease
smartphone as the data computing platform, the prototype throughout the world. According to the World Health
model [2] provides user-friendly voice recognition and alert Organization (WHO), there are about 422 million people in the
functionalities. world suffering from diabetes and the amount is increasing day
Several life-threatening diseases can be easily monitored by by day [8].
IoT based systems. Cardiovascular Disease (CVD) is a Smart health monitoring devices determine the health
common disease which is the cause behind most of the deaths condition i.e. rate of the pulse, body temperature, respiratory
in the world. At present, with the revolution of information and rate, blood glucose rate, the position of the body, ECG, EEG,
technology, smartphone-based health monitoring systems are and other things by using sensors. The sensors are connected
becoming more popular. These systems can be used to collect and controlled through various microcontroller-based systems
real-time health information and give feedback to patients and such as Arduino, raspberry pi, etc. The microcontroller collects
medical specialists [3]. Allowing every single person to the data using sensors. The collected biomedical data is usually
examine their health, and advising them to find immediate stored in servers [9]. From the stored data, the device can
treatment in case of emergencies, can result in saving that decide whether the patient’s condition is normal or abnormal.
person’s life. The use of these monitoring systems can decrease This device provides real-time health care observation for
medical fees for the nation in the long run [4]. Nowadays, due doctors and medical assistants where they can use the data
to widespread mobile internet access, the combination of anytime. Here the main advantage is that the device has low
mobile internet with a health service system using android power consumption, better performance, high sensitivity and
open-source design has become very easy [5]. In recent years, easy set up [10].
Electrocardiography (ECG) has become an easily accessible It is assumed that by 2020 there will be about 26 to 50 billion
service for everyone. By recognizing the small difference in network-connected devices and 100 billion by 2030 [11].
voltage generated by the cardiac muscle, an ECG can properly Raspberry pi is the most common platform for IoT. It is a
determine the heart's functionality. Using a smart device, Linux-based low-cost device. Raspberry Pi and IoT have
doctors and patients can continuously observe the heart rate and collectively ushered a new era in the field of healthcare systems.
can get important data and take proper steps to prevent severe With the combination of sensors such as pulse rate sensor,
damages [6]. Heart rate and body temperature are some of the temperature sensor, accelerometer, and respiration sensor, a
most important traits of the human body which are major Raspberry Pi can be transformed into a mini-clinic. These
contributors to determining a patient's health condition. The systems are being used in many parts of the world [12].
number of heart bits per minute is denoted as the heart rate of Microcontroller units (MCU) are being used as the main

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controller of the systems but they do not support parallel data health condition of patients. The system provides feedback
handling. after determining the condition of the patient.
Handling multisensory data in a parallel way can reduce time. In this paper, we are going to focus on IoT based healthcare
A field-programmable gate array (FPGA) is such a circuit that systems that employ sensors, smartphones, and microcontroller
has a real-time performance and unique hardware logic control unit based approaches, working procedures of the reviewed
system. Hence, FPGA has now become more famous than systems, the limitation and the working capability of each
MCU in multi-sensor data handling in the IoT environment. system.
For these reasons, new advancements have been made using The remainder of the paper is organized as follows: Section
FPGA rather than MCU [13]. II describes IoT in health care systems. Section III describes the
A general architecture of a smart health monitoring system literature on developing healthcare systems including
has been illustrated in Figure 1. Different types of sensors have taxonomy and components. Section IV, V and VI demonstrate
been used in different types of health monitoring systems. In sensor-based, smartphone-based and microcontroller-based
Figure 1, the sensors collect data from the patient and send healthcare systems. The discussion and future
those data to the processing unit. The processing unit compares recommendations are provided in Section VII. Finally, the
those data with previously-stored cloud data and detects the review is concluded in Section VIII.

Table 1. Summary of the reviewed smart health monitoring systems

Major Hardware
Author Year Feedback Device Uses Cost
Components
Blood pressure sensor, body
Moser and Melliar- Chronic disease
2015 Smartphone weight sensor, pulse oximeter, Cost- effective
Smith [4] progression
glucometer, accelerometer

Wi-Fi module, Bluetooth,

Kong et al. [5] 2016 Mobile phone Chronic disease Low cost
RFID, ECG, blood pressure

Heart rate sensor, Bluetooth,

Cardiovascular
Turner et al. [6] 2017 Smartphone microcontroller, electrode Costly
disease
pads, display

Arduino Uno, temperature

sensor, heart rate sensor, body Heart problem, noise
Kumar et al. [9] 2017 Monitor High cost
position sensor, Wi-Fi detection
module,
Smartphone, ECG, Bluetooth, temperature
Penmatsa and Reddy Detecting
2016 laptop, VGA sensor, heart rate sensor, Low cost
[10] abnormalities in heart
display Arduino, bio-sensor
Raspberry pi, heartbeat
Kumar and sensor, temperature sensor, Respiration rate
2016 Monitor Expensive
Rajasekaran [12] respiration sensor, monitoring
accelerometer

CPLD,ARM7TDMI-S,
Desai and Toravi temperature sensor, gas Pulse, temperature
2017 LCD display Expensive
[13] sensor, heartbeat sensor, and smoke detection
raspberry pi

Raspberry pi, Lo-Ra module,

Hearing loss,
temperature sensor, humidity
Wu et al. [18] 2019 Smartphone headache, rapid pulse Costly
sensor, pulse sensor, WSN,
rate detection
WDM, UV, CO2 sensor
ECG, pulse sensor,
Ahouandjinou et al. temperature, camera, Heart problem, fever
2016 Monitor Costly
[19] environmental sensor, detection
Bluetooth, ZigBee, RFID
Accelerometer, voice sensor, Hyper functional
Mehta et al. [22] 2012 Smartphone Low cost
microphone, disorder detection

ECG, Bluetooth, heart rate Cardiovascular

Gao et al. [23] 2013 Smartphone Low cost
sensor, disease
Trivedi and Cheeran Body temperature, Bluetooth,
2017 Mobile app Fever, hypothermia Cost- effective
[25] Arduino Uno
Arduino Uno, glucometer,
Sabbir et al. [26] 2016 Mobile app Diabetes mellitus Low cost
Bluetooth, display

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 Figure 1. System architecture of the health monitoring systems

2. IOT IN HEALTH CARE SYSTEM The taxonomy of the reviewed smart health monitoring
system is shown in Figure 2.
IoT in the health monitoring system has given us a big
advantage in the development of modern medical treatment
[14]. Due to advances in VLSI technology, the sensors have
become smaller which has enabled the development of
wearable solutions. Due to consistent internet connectivity, the
devices are becoming more efficient and powerful. IoT based
health monitoring devices monitor a patient 24/7. At any
crucial moment, the devices generate necessary signals by
analyzing statistical data [15]. As IoT based devices are
constantly connected to the internet, the patients can be
remotely monitored and necessary measures can be taken in Figure 2. Taxonomy of the reviewed smart health monitoring
case of an emergency. IoT based devices can thus provide both systems
detection and emergency response services.
There are significant differences between normal health
monitoring systems and IoT based health monitoring systems. 4. SENSOR-BASED HEALTH MONITORING SYSTEM
Incorporating IoT in health monitoring systems is a challenging
task [16]. Some of the challenges are discussed below: Different affiliations shall be listed in separate lines. Do not
Most of the IoT initiatives have not been successfully insert any punctuation at the end of each affiliation. If all the
implemented yet. authors are affiliated to the same organization, type that
IoT generates a massive amount of data, which requires affiliation just once. The sensor-based health monitoring
specialized big data and data warehouse systems for proper system gathers information about the patient’s health condition
management. through an electronic data signal and notifies the patient via an
Security is a big issue for IoT systems. Hackers can easily audio alarm. Among the various types of sensors, ECG,
obtain sensitive private data of users in case of buggy or temperature and pulse rate sensors are widely used. Most of the
outdated security protocols. health monitoring devices used body temperature sensors (Max
Obsolete infrastructure can generate problems as they are not 30205), pulse rate sensor, temperature sensor (BME 680) [17].
up to date with recent security protocols. In some health monitoring systems, other sensors such as
humidity sensor, RFID sensor, biochemical detecting sensor
such as a glucometer, body position sensor, and respiration
3. LITERATURE ON DEVELOPING HEALTH sensor, CO2 sensors are also used. Wu et al. [18] proposed a
MONITORING SYSTEM wrist wearable body area network (WBAN) architecture for the
healthcare system using cloud computing. The system works in
In recent times, many health monitoring systems have been both industrial and home environments. However, the
developed to monitor the health condition of patients. We are developed system is wire connected. Making the device
reviewing some recent works developed in this field. wireless would increase the flexibility of the system.
In this review, all the systems have been classified based on Ahouandjinou et al. [19] proposed a Radio-frequency
the priority of hardware components, that is, which components identification (RFID) based smart intensive care unit (ICU)
have been used more than the others. Therefore, all the systems system that collects medical data in a real-time system. The
have been categorized into three different categories as follows: system has three layers. They are the physical layer, logical
(1) Sensor-based health monitoring systems, layer, and application layer. The physical layer consists of the
(2) Smartphone-based health monitoring systems, sensors used for data collection purposes. The data collected by
(3) Microcontroller-based health monitoring systems. the sensors in the physical layer is processed in the logical layer.

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The logical layer handles the media access management tasks transmitting the heartbeat of an individual to a smartphone. As
and inter-sensor communications. The application layer takes the device tracks the continuous heart rate, patients can easily
actions based on the processed data generated by the logical get their real-time heart rate info from the device monitor.
layer. However, the condition and behavior of the patient However, it doesn’t track heart rate continuously and cannot
cannot be determined in the reviewed system as the system detect cardiovascular disease properly.
used irrelevant data. Most of the reviewed systems used Android-based
smartphones. Android is a mobile operating system based on a
modified version of the Linux kernel and other open-source
5. SMARTPHONE-BASED HEALTH MONITORING software, designed primarily for touchscreen mobile devices
SYSTEM such as smartphones and tablets. Android provides easy access
to sensor data of smartphones compared to other proprietary
Smartphones are one of the most useful resources in the operating systems, which is required for easy development of
world. A smartphone normally contains 14 types of sensors smartphone based health monitoring systems. There are now
[20] and many more sensors are going to be added in the future. more than 2.5 billion active Android devices. Android devices
The voice monitoring system in a smartphone is a significant now hold 75.85% of the total mobile operating system market
feature. Many hardware systems have been developed share. So, the development of android-based healthcare
leveraging the flexibility of this feature. Some of the sensors systems is very feasible.
that are included in a smartphone are the wireless sensor,
Bluetooth module, Accelerometer, Fingerprint sensor,
Gyroscope, Magnetometer, Barometer, Proximity, GPS 6. MICROCONTROLLER-BASED HEALTH
tracker, Camera, NFC-near field sensor which are widely used MONITORING SYSTEM
in developing health monitoring systems [21]. Another main
advantage of a smartphone is the mass storage facility of a Microcontrollers are the most common and used devices in
smartphone. Modern smartphones can easily store the patient’s health monitoring systems throughout the world. MCU's are
data in primary storage. Android-based smartphones can be very useful for the fast processing of raw sensor data. FPGA is
used for data streaming, device information management, and widely used for parallel processing of huge amounts of data.
easy interaction. An MCU was used to interface among the sensors [24]. Due to
Mehta et al. [22] developed a mobile voice health monitoring the very small size of microcontrollers, it is effectively used for
system using a smartphone that uses the accelerometer sensor. portable solutions. Today, raspberry pi is one of the most
In the reviewed system a miniature accelerometer is used as a commonly used microcontroller-based platforms in the field of
voice sensor and the smartphone is used as the data acquisition health monitoring systems.
platform. The system is placed around the neck of the patient. Trivedi and Cheeran [25] proposed an Arduino based health
Although this system utilized the frame based vocal parameters, parameter monitoring system controlled by a smartphone
the raw accelerometer data can also be used for monitoring application. All the data obtained from sensors are in analog
purposes. Gao et al. [23] proposed a multi-lead ECG health form. The data is sent to the Arduino Uno board. The collected
monitoring system based on a smartphone. In this system, analog values are converted into digital by inbuilt analog to
seven lead real-time ECG is used for acquiring the signal. The digital converter. The digital values are transferred to a
sampling rate is up to 500 Hz. Due to the massive amount of smartphone through Bluetooth. The system used a Bluetooth
ECG data, it is very hard for doctors to detect abnormalities. So, module which doesn’t cover a large area. Sabbir et al. [26]
an automatic alarm system is used. The alarm turns on if the developed an m-Health solution for diabetes patients. It is a
system detects abnormal ECG data. However, an average alarm home environment system. This device allows a diabetes
delay (13.37sec) occurs in this system which reduces the patient to monitor his/her health condition, physical activities,
accuracy rate. Moser and Melliar-Smith [4] proposed a control diets, insulin dose and to consult with doctors. However,
personal health monitoring system using a smartphone named the developed system has no clinical validation. Kumar et al.
WellPhone. The device uses speech synthesis and speech [9] proposed an IoT based smart health monitoring. The system
recognition technology to communicate with the user. It keeps application is divided into three layers. They are the detecting
a record of the semantics and big-data that are related to the layer, the application layer, and the transportation layer. In the
data obtained from the measurement device. The data is also detecting section, a DS18B20 sensor has been used for
stored on the mobile phone. However, the data of Well phone detecting body temperature and a pulse sensor is used for
is non-clinical. detecting a pulse. In the transportation layer, the information is
Kong et al. [5] designed a mobile phone-based wireless uploaded into the cloud from Arduino through the Wi-Fi
health service system. The system is designed for family health module and Ethernet shield. At last, the application layer
treatment. This system has three parts namely: data collects information from the server. However, the
communication designation, android mobile client designation, microcontroller in Arduino Uno is not suitable for handling too
and system server designation. The data communication many sensors at the same time.
system processes the communication between the server and Penmatsa and Reddy [10] developed a system that detects
the android terminal. The mobile client designation works on abnormalities in ECG and transmits the signal via Bluetooth. It
the intelligent terminal of the android system. The system is a low-cost device. Here, three lead ECG signals are acquired.
server is the webserver which is responsible for the control The signals are then sent to a circuit and finally presented in an
center and the back-end data management system. However, as oscilloscope. However, the small range of the used Bluetooth
the amount of data is huge, SQLite cannot provide satisfactory module is a limitation of the system. Using the Wi-Fi or IR
results. MySQL can be used to overcome this limitation. Turner modules might overcome the range limitation. Kumar and
et al. [6] introduced a continuous heart rate monitoring system. Rajasekaran [12] proposed an IoT based patient monitoring
It is an embedded system that uses wireless signals for system. Raspberry Pi is the main logic unit of the system. The

438
signals of sensors are sent to the raspberry pi through an help the patient to take necessary emergency measures, which
amplifier circuit and signal conditioning unit (SCU). Using the can potentially save the patient’s life. IoT can help in this
internet, the data of the raspberry pi can be accessed from any regard. IoT based health monitoring systems can monitor the
part of the world. However, the system only works in indoor patients in real-time and warn the patient of any abnormalities.
conditions. However, the IoT architecture must have the facilities to ensure
Desai and Toravi [13] designed a smart home and heartbeat the proper security of sensitive data. Also, the used sensors
monitoring system using a wireless sensor network (WSN). must be small in size so that they can be easily incorporated
The system used Spartan 3 with FPGA architecture for parallel into various systems. Finally, the use of various machine
data computation. All the sensors are connected with a learning and deep learning algorithms might make the systems
microcontroller and an LCD shows the result provided by the more accurate and robust. The idea of a smart health
MCU. However, all the components of the system are not monitoring system using the IoT architectures is a novel
embedded in a single device. contribution in the field of medical science and it will reduce
health issues and unwanted deaths.

7. DISCUSSION AND RECOMMENDATION FOR

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