*3.2.1 Analysis of scopes of higher impact*

With the term "scope," we refer to the topics on which each study focuses on contributing to the area of IoT systems applied to ehealth and telemedicine. After the analysis, we have found studies whose scope is related to the provision of a health service, proposing models, system designs, and/or implementations of a complete system or a component of an IoT system. On the other hand, scopes focused on improving some characteristic of IoT systems that are relevant when applied to healthcare have also been identified.

**Figure 2** illustrates the scopes in the analysis. It can be seen that the majority of studies focus on providing solutions for the field of monitoring. The reader should know that a division has been made in this scope, distinguishing between studies that explicitly indicated or from which the character of real-time monitoring could be clearly inferred. The total number of studies that fit this domain was 83. These data

**Figure 1.** *Publications with more impact per country (N = 186).*

*Perspective Chapter: Internet of Things in Healthcare – New Trends, Challenges and Hurdles DOI: http://dx.doi.org/10.5772/intechopen.104946*

#### **Figure 2.**

show that the main purpose of the application of IoT to healthcare is to monitor patients, ubiquitously or integrated into rooms, for better control of vital signs or physiological parameters. This result is consistent with the main use for which IoT systems are used. Continuing with the analysis focused on areas of application, the next most common are those related to diagnosis. The creation of models that help the medical professional to give a diagnosis stands out mainly Machine Learning models that can be integrated into the system, sometimes complemented with architectures equipped with resources to apply Fog computing, as well as with the decentralization of processing with computing at the edge, trend that is currently increasing with the optimization of hardware and AI frameworks for model integration and consumption reduction [195]. Additionally, the applications are not restricted to the field of healthcare in the personal context, but also in the workplace [196]. To a lesser extent, we also find the use of IoT to facilitate the remote diagnosis of the patient. This last result may be related to the existing limitations to provide appropriate resources to remote centers or isolated areas that allow establishing reliable connections with sufficient transmission quality. The least relevant areas currently are self-care and remote rehabilitation. The first of these two areas mentioned was the one that had the greatest impact at the beginning of the use of IoT for healthcare, currently being on the slope of enlightenment or plateau of productivity in the hype-cycle curve. The low frequency of appearance of rehabilitation as a field of study may be due to the difficulty in carrying out rehabilitation tasks remotely.

Focusing on areas related to the improvement of system features, studies focused on maintaining the security of the IoT system are more frequent, that is, on avoiding transmission failures, network hacks, or data corruption. Additionally, we find studies focused on providing encryption protocols to ensure the authenticity and privacy of the patient. These last two scopes are often intrinsically related to system security. These results reveal the great challenges that exist in the integration of IoT systems in the Electronic Health Records of health systems: to be able to relate the data to the patient without compromising their privacy, as well as to manage the enormous amount of information collected avoiding losses, falsification information, and other security breaches. Very close in relevance we find the improvement of the performance of the system, that is, looking for better response times in the transmission and processing of information. Again, it is a challenging topic, especially in combination with equipping the system with authentication, privacy, and security protocols, which slows down IoT systems, which must be addressed for this type of system to be useful in terms of practicality.

#### **Figure 3.**

*Scope trends. At top, classification grouped by year analyzed in the study. At left, scopes related to the system's application approach. On the right, scopes focused on improving the characteristics of the IoT system.*

In the results, we also observe that the studies related to the study of interoperability and the analysis of usability, user experience, and degree of acceptance have very little impact. These types of studies are not frequent, and yet, they address determining aspects in the adequacy of IoT systems to the health environment; its correct application depends on the fact that the implemented system is practical and perceived as useful. The little research on these issues may be the greatest limitation of these systems in the future.

**Figure 3** shows the trend of these areas in the years considered for the analysis. Although a drop in the number of papers is perceived in 2021, this may be due to the fact that there has not yet been a stabilization in the number of citations on studies that contribute novelties to the field of research. Both graphs show how in recent years there has been a decrease in the impact of research aimed at providing solutions with IoT systems, and instead, there has been an increase in interest in research that focuses on improving some characteristics of the system architecture, mainly in security and privacy. This result again reveals indications of the situation of these systems in the hype-cycle curve, seeing reduced interest in deepen for new applications and consolidating their use by focusing on the greatest limitations that this set of technologies has, that is, aspects of security, privacy, and performance.

#### *3.2.2 Interest in applied technologies*

Paying attention to communication technologies, the charts in **Figure 4** reveal a varied set of alternatives. In these graphs, only those studies that have used and revealed the technologies applied in the implementation of IoT systems are taken into consideration. As a result, 87 articles were considered. The charts highlight the use of Bluetooth technology, in both its older versions and BLE, and Wi-Fi. Despite being a technology adapted to IoT, the use of LoRa is not frequent. GSM and GPRS technologies continue to be used, mainly because they have a greater network infrastructure for these technologies and because they are more in line with the user profile that

*Perspective Chapter: Internet of Things in Healthcare – New Trends, Challenges and Hurdles DOI: http://dx.doi.org/10.5772/intechopen.104946*

#### **Figure 4.**

*Most common communication technologies in studies that carry out an implementation of an IoT system (N = 87). Top-right chart considers only those studies whose sensing acquisition devices are wearable (N = 36).*

these systems are aimed at, mainly older people or those who are not familiar with new technologies.

Among the studies that reveal the communication technologies used, only 36 focus on the use of systems with exclusively wearable devices for data acquisition. In these studies, a lower use of MQTT is revealed in favor of the use of technologies such as Zigbee. Wi-Fi technology is still the most frequently used; however, there is a remarkable decrease.

The most frequent technologies identified in the analyzed studies include Machine Learning and Deep Learning for the fields of monitoring and diagnostic support. In the fields of security, privacy, and authentication, the use of Blockchain stands out. On the other hand, Fog computing and edge computing are the technologies for which the greatest interest is shown in the field of performance improvement. This is one of the most current trends, driven by systems equipped with more specialized hardware processing units [197].
