Exploiting Internet of Things and its Application in Healthcare Domain

Abstract

Internet of Things (IoT) is a network of physical devices such as sensors, actuators, electronic device, software and actuators which allows data transmission and reception across these modules. Internet of things has made significant strides in consumer, enterprise and infrastructure spaces. It has penetrated in every well known market today. A few examples of IoT devices are Nest learning thermostat, Amazon echo dot, Kisi smart lock, fitbit etc. In this paper we will be discussing and stressing about some of the main stream applications and implementation of IoT in healthcare domain.

We would also be discussing how the use of IoT devices can be helpful in reducing unnecessary intervention of physicians and help maintain a healthy environment for the patients. The use of small and portable devices can be very beneficial in terms of efficiency and vital support to patients. However, the many challenges that this environment presents need to be addressed. In the methodology part this paper would be discussing a simple implementation of a ZigBee based body sensor network. This would be an alert mechanism system combined with regular analysis of patient's condition. Finally, this paper discusses the major benefits and demerits of IoT in the field of healthcare. We shall also discuss about the extra security needed in IoT devices. We will discuss all these issues and present you with a simple prototype that can be developed.

Index Terms: Internet of Things (IoT), IoT applications, ZigBee, Representational State Transfer Application Programming Interface (REST API), Networking, Healthcare, Network Security.

I. Introduction

IoT in healthcare has a vast range of application, for instance IoT can be used to monitor a person's heart and also it can be used to locate a colony of animals by inserting a bio chip transponder in to the animals. Internet of Things or IoT is basically a network of physical devices, home appliances embedded with sensors, actuators, and software and hardware components which are inter-connected. This physical network of devices allows communication and exchange of data across them. IoT allows us to create a more direct integration of the physical world into a computer based system. We can also say that IoT is an ability to transfer the acquired data over the time to a safe server without human intervention. IoT has penetrated every well known market today. The number of IoT devices seems to be booming year by year. It is estimated that the IoT devices have increased 31% year-over-year. The market for IoT is projected to reach 7.1 Trillion USD by 2020, says the sources in Wikipedia [4]. A simple representation of IoT is shown in the below.

Figure 1a: Representation of IoT

Figure 1b: Representation of IoT

IoT applications are boundless and are only limited to human imagination. We can broadly classify IoT applications into consumer applications, enterprise applications and Healthcare applications. One of the major implications of IoT is its influence in healthcare industry. According to recent US budget an efficient and innovations in healthcare domain could save up to 300 Billion USD, these figures show a need for little technical advancement in the field of telemedicine and healthcare. IoT helps us to provide a very efficient and cost effective approach to innovate few of the medical aspects needed for patient's convenience and health. Simple remote health monitoring and emergency notification systems are examples of IoT in healthcare domain. Below is an image of IoT in healthcare.

Figure 2: IoT in Healthcare

The healthcare domain presents opportunities for a significant number of applications of wireless sensor technology. Chronic Disease Monitoring and Personal Wellness Monitoring are few of the IoT applications. Chronic diseases contribute to about three fourth of medical care costs in the US alone. Chronic diseases include diabetes, asthma, heart diseases and sleeping disorders. Chronic diseases can be classified into:

a)Episodic patient monitoring: This is often utilized in non-critical patients to track specific indicators and identify the progress of the disease or recovery.

b)Continuous patient monitoring: This is often associated to patients with acute conditions that require frequent care and to keep close watch on the patient's health status.

c)Patient alarm monitoring: This can also trigger alarms based on preset conditions that are specific to the patient.

By adding few features to RPM, we can address some of the chronic diseases. The RPM would significantly help many patients and would be very cost effective and efficient. The RPM process would help in correct diagnosis of the patient. A sample RPM mechanism to encounter chronic diseases is shown below.

Figure 3: Remote Patient Monitoring (RPM)

An Emergency notification system is a one way broadcast of messages to an individual or group of individuals, which would alert them with a pending or any current emergency. For instance an Amber Alert is a mechanism incorporated by government to alert all the citizens in the vicinity.

Another example is when a patient needs immediate attention he/she can press a one click notification on the IoT devices to alert the concerned authority.

This Emergency notification system can easily be incorporated with IoT and help the patients immediately when necessary. A sample Emergency notification system is shown below.

Figure 4: Emergency Notification Systems

Another key application of IoT is its use in elderly care. Smart houses incorporated with smart IoT devices can be a key aspect to take good care of needy people. For instance a voice control can assists users with vision impairment or personals with mobility problems. An example of elderly care is shown below.

Figure 5: IoT implied in elderly care

In the methodology part of the paper we would come up with an idea to implement a ZigBee based patient monitoring system. That is a set of sensors would be attached to a patient's body that would monitor the heart rate, room temperature, humidity of the room, blood sugar levels, RBC counts, WBC counts and an emergency button. These devices would communicate with each other over a network and transmit the data via the ZigBee protocol to the doctor's end or the hospital side. The data from these sensors would be captured and analyzed thoroughly and periodically. The data format and file transfer uses JSON and REST respectively.

Later in the paper we would discuss few benefits and disadvantages of IoT in healthcare. We would also discuss a brief about the security threats that are associated to the data transfers from the client to the server end and vice versa. We would come up with some network security concepts to overcome the necessary threats.

The conclusion of the paper would include future scope for IoT in healthcare domain, a discussion about few challenges that needs attention and few statistics of usage of IoT in healthcare obtained from internet [4].

II. Methodology

To Implement a Remote Patient Monitoring system, we have taken a simple approach which can be very effective. The Following are the basic things that are used to implement this design.

a) ZigBee transmitter can be used at the patient end. The device could wrap up the data acquired and send the data to a Cloud in JSON format with POST request across the REST.

b) ZigBee receiver can be used at the hospitals end. The device could continuously keep listening to the data in the Cloud. The received data will be GET request across the REST. The data acquired would be in JSON format. A clear front end application can be written to alert the respective officials.

c) modern Micro-Controller such as 8051 or NXP series Micro-Controllers can be used as a driving force to support the ZigBee and the sensors.

d) set of sensors attached to the patient and the Micro-Controllers. These sensors include.

• A room temperature sensor
• A pulse rate sensor
• A humidity sensor
• A blood sugar sensor
• White Blood and Red Blood Cell sensor
• A push button for the emergency notification

e) display monitor for the observer.

Using the devices listed above we can create an IoT of devices communicating over a network and sharing the data amongst them.

A. Patient Side Implementation

On the patient side we have a collection of sensors accumulating data and transferring it to a microcontroller. At the microcontroller we have a threshold value that can be set and the acquired data can be compared with this threshold value. If there are any discrepancy the microcontroller would pass on the data to the ZigBee transmitter. The transmitter formats the acquired RAW data into JSON (JavaScript Object Notation). The following JSON data is posted to a Cloud using REST – POST request. This data is placed in cloud and the receiver can acquire this data and alert the observer end. A block diagram of the patient side implementation is shown below.

Figure 6a: Patient Side Implementation

B. Physician Side Implementation

On the Physician side we have a very simple implementation, the ZigBee Receiver keeps listening to the Cloud and keeps continously performing the REST – GET request from the cloud. The format of data acquired would be in JSON. This data can be used to build a clean and clear website that would statistically show a patients health condition. This technique used in implementationcould save a lot of time and is cost effective for the Patient. A block diagram of the physician's side implementation is shown.

Figure 6b: Physician's Side Implementation

C. Rest api

REST stands for representational state transfer it is a web service that allows the transmission of data over the HTTP (Hyper Text Transfer Protocol). REST is fast and reliable. When used with HTTP we get a variety of operations that can be performed on the data. Operations such as POST and GET are used to post the data to the cloud and retrieve the data from the cloud. REST provides safer transmission of data and is highly responsive. Our approach uses HTTP hence we are using REST services. However there are other approaches such as instead of wrapping the data in JSON, the data can be wrapped in XML (Extensible Markup Language) and use AJAX (Asynchronous JavaScript and XML) to load the data into the physician's side.

D. Json

JSON stands for JavaScript Object Notification. It is a file formatting system. In our implementation we can format the acquired data as JSON and transmit it over the network using REST. JSON is simple and light weighted, hence making it a easier to implement and more reliable. Another approach is to use XML. XML has been most likely been replaced by JSON, which is much faster and easier for reading into JavaScript programs.

III. Discussion

So far in this paper we have had brief introduction about the IoT devices and have implemented a simple approach of Remote Patient Monitoring system. By using simple concepts and a cheap implementation cost we can efficiently provide effective treatments to the patients. However there are few aspects that need to be looked upon. In this section of the paper we would be discussing the major benefits and downsides of IoT in healthcare. Also we will go through a brief discussion on securing the network and transmitting the acquired data safely over a network.

A. Benefits of IoT in Healthcare

Benefits of IoT in healthcare are vast. The use of IoT in healthcare has bought in a new dimension into the study. It has bought in new concepts such as data analytics, Robotics etc in the field of healthcare. In future we could also incorporate Artificial Intelligence in this domain. Below is a sample image of major advantages of IoT.

Figure 7: Advantages of IoT in healthcare

Here are some of the major benefits of IoT in healthcare.

Low Costs: A patient can be monitored anywhere in world with the help of Remote Patient Monitoring Systems. This mechanism would reduce down the doctor visits and provide less stay in hospital environment.

Effective Treatment: As the data from the cloud collected is in real time, effective treatment can be provided to the users. Hence reducing the usage of unnecessary drugs to the patients. This helps the patient to get accurate treatment and also reduces costs spent on unnecessary drugs.

Better Patients Experience: Patients experience, can largely affect the outcome of any treatment, hence we need a proactive treatment which allows time to time intervention by the physicians. Since the data accumulated is real time, doctor's diagnosis is improved as the time proceeds.

Management of Drugs: Since we know what exactly a patient needs, we can manage drugs very effectively and efficiently.

Fewer Mistakes: Since the data is a real time acquisition, mistakes could be very minimal. Hence making the system more efficient than the conventional techniques.

Hospital Information Management System: The HIMS system will ensure that the entire process of treatment will go paperless. The following system is a platform for doctors, staff, patient's etc to view the information that is shared across them. HIMS opens up a path way for analyzing the data. As we know in the 21st century data analytics is very much important and if we have enough data then we can incorporate Artificial Intelligence in this field. However this is still far from implementing.

B. Disadvantages of IoT in Healthcare

As no system in this world is foolproof, IoT in healthcare domain comes with few major worries. The worst of them is the lack of security that has to be incorporated for these devices. Since IoT is a newer technology there isn't a proper security standard that has been set up. Only in recent times after a few security threats a standard set is being maintained. Apart from security threats another major problem is data privacy, since we are dealing with a lot of data, privacy has to be imminent.

Here is an image to briefly tell us about the major IoT problems.

Figure 8: Cons and Risks of IoT in healthcare

The major demerits of IoT in Healthcare domain are listed below.

Data Privacy: In the current world trends, data is everything so we have to protect data and ensure that data cannot be leaked in any form or format to the real world. The biggest and most worrying con in the IoT application is data privacy and its protection.

Security Breaches: Since IoT are a group of physical devices that talk over a common network they can be attacked by a simple attack from called DDOS (Distributed Denial of Service). Hence we have to secure and should not compromise on any data and shield them from cyber attacks. By adding more security features we have to invest more on software and hardware.

Device Maintenance: IoT devices are usually tough and need no maintenance. However we are talking about healthcare domain. Here all the devices have to be in perfect condition to provide the HIMS with absolute data. Hence these IoT devices needs to be checked frequently and calibrated accordingly.

Human Errors: Proper knowledge transfer has to be provided to the users or the persons who are monitoring these devices. Improper knowledge leads to very bad consequences. Hence these observers have to be certified and be absolutely sure prior taking any decisions.

C. Network Security in IoT devices

Securing a network is very important, we need to implement basic protocols and bring in common standards in IoT devices. Here are few steps that can enhance the security aspects of IoT in healthcare.

IoT Authentication: Authenticating IoT devices would ensure that the users who are using are legitimate. Adding simple passwords or two factor authentication could help in achieving authentication.

IoT Encryption: Encrypting data with standard encryption techniques such as AES 256, RSA 1024, one time pad helps maintain data integrity and disallows any hackers to access the data that is being sent over the channel. Below are the figures for few encryption techniques that can be used for IoT devices.

Figure 9a: Advanced Encryption Standard (AES)

Figure 9b: RSA Encryption and Decryption

IoT API Security: For REST based API, data integrity has to be addressed. Though a standard encryption technique cannot be maintained over all the IoT devices, we should ensure that we add enough security standards to protect data.

IV. Conclusion

In this paper, a brief outline of IoT devices has been introduced. We have discussed about the Internet of Things and its implications on the healthcare domain. At the beginning we discussed about the Remote Patient Monitoring system and implemented the same using a ZigBee based body sensor network. We also had a brief discussion about the REST and JSON file formatting techniques and its implication on the project.

We then discussed about the major benefits and disadvantages of the IoT in healthcare. At the end we added few points on the network security aspects of the IoT.

Since the application of IoT devices in healthcare has a huge market a security standards can be maintained to protect all these devices as data integrity and authentication are key to a success of these products if they have to survive.

Future work is to implement a circuitry that would draw very minimal amount of power and add in more sensors on to the network and also use the HIMS system much effectively.

We conclude this paper by telling that the scope for IoT in healthcare is huge and the healthcare future in IoT looks bright.

V. References

[1]Sybase, Mobile computing in healtcare, http://was.sybase.com/mec/2959healthcare.pdf

[2]D. K. Vawdrey, E. S. Hall, C. D. Knutson, A self-adapting, transportaware mobile patient healthcare insfrastructure. http://www.poketdoktor.com/PoketDoktorArchitecture.pdf

[3]William Stallings, Cryptography and Network Security: Principles and Practice, 7th Edition(Textbook)

[4]https://en.wikipedia.org/wiki/Internet_of_things

[5]https://en.wikipedia.org/wiki/Remote_patient_monitoring

[6]https://en.wikipedia.org/wiki/Emergency_notification_system

[7]https://en.wikipedia.org/wiki/Representational_state_transfer

[8]https://en.wikipedia.org/wiki/JSON

[9]http://e-health-connect.com/

[10]http://e-health-connect.com/IOT-healthcare-chronic-diseases-monitoring.html

[11]http://www.archer-soft.com/en/blog/5-benefits-internet-things-hospitals-and-healthcare

[12]https://theiotmagazine.com/internet-of-things-iot-healthcare-benefits-2aae663c5c79

[13]https://insidebigdata.com/2017/02/25/4-pros-cons-medical-iot/

[14]https://www.forbes.com/sites/gilpress/2017/03/20/6-hot-internet-of-things-iot-security-technologies/#4e33a8021b49

[15]http://www.insurancechat.co.za/2017-09/mtn-business-rolls-out-a-dedicated-internet-of-things-iot-network/

[16]https://medtechboston.medstro.com/blog/2015/10/07/boston-scientific-competition-seeks-ideas-for-remote-patient-monitoring/

[17]https://article.images.consumerreports.org/prod/content/dam/cro/news_articles/health/CRO_Health_MobileHelp_06-14

[18]https://www.digitalnewsasia.com/digital-economy/mediatek-to-provide-surfboards-for-the-iot-wave

[19]https://web2.qatar.cmu.edu/~dabousen/Default%20-%20Copy%20(2).html

[20]http://developer.arrayent.com/developer-guides/alert-guides/push-notification-alerts-guide/

[21]https://www.tutorialspoint.com/cryptography/advanced_encryption_standard.htm

[22]https://officialhacker.com/security-researchers-able-to-crack-1024-bit-rsa-encryption/

[23]http://www.ijera.com/papers/Vol3_issue5/CJ35483486.pdf

[24]https://github.com/Neeraj-Venugopal/zigbeeBasedBodySensor

[25]http://automation-baseline.com/en/process-factory-2/pharma-2/iot-potential-improve-healthcare/

[26]https://www.cleveroad.com/blog/iot-in-healthcare-industry--see-why-it-has-a-promising-future"

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