**2. IoT in biomedicine: Medical IoT**

In the medical field, IoT can be useful in remote patient monitoring (monitoring blood pressure, checking heart rate, checking biometric parameters, or even checking hearing aids), it can be used in the management of diseases in chronic patients or in case of medical emergencies. The advantages of IoT systems used in medicine are that they can continuously and reliably monitor patients and facilitate the digital storage of patients' personal health information. This type of technology helps in the formation of medical databases and their interconnection for a much better management of patient care. Studies show that at this moment, IoT technology will lead to the greatest advances in medicine and will generate revolutionary treatments for patients [15].

IoMT or the Internet of Medical Objects represents the Internet of Things used in healthcare applications. This relatively new market is in continuous growth worldwide with a valuation of over 150 billion dollars in the year 2022 and an increase of \$357.45 billion from 2022 to 2028. There are several IoMT solutions on the market but also at the study level that include sensors, wearable systems, including remote access to medical services and monitoring systems of daily activities or hospital systems that increase the quality of patient care, thus fully covering the need for patient care [16].

#### **2.1 Technologies**

At this moment in the market, when it comes to healthcare Internet of Things technology, there are several companies that are changing the way IoT is used in medicine. IoMT includes medical devices but with assault and monitoring of public health services, chronic patient care, and distance [17].

In the following lines, we will describe the main IoMT technologies and their principles.

#### *2.1.1 Integrated platforms*

Software and hardware integrations for multiple data extractions between medical devices are a real necessity at this point. In this direction, those at Elemental Machines have developed LabOps, a hardware and cloud-based software platform that helps laboratory operations for research and development, clinical laboratories, quality control, and diagnostics of the type [18].

Those from Philips have developed the Phillips Capsule Platform that allows the easy integration of devices used in patient monitoring, thus allowing much easier access to medical data [19].

Also, data about the environment in which we live can help medicine to detect and prevent diseases. Aclima is a platform created in partnership with Google, the Environmental Defense Fund, and researchers from the University of Texas at Austin, to measure air quality in big cities. A series of factors such as transport, energy consumption, and weather are taken into account. The collected data can thus be used in the prevention and management of cardiovascular and respiratory diseases [20].

## *2.1.2 Remote temperature store monitoring for vaccines*

In less developed countries, IoMT tries to solve some apparently trivial problems, such as improving health conditions by creating conditions for storing and administering vaccines. This is how the ColdTrace System was developed, which provides remote temperature monitoring for refrigerators where vaccines are stored in rural clinics and health facilities. This way healthcare workers can safely administer lifesaving vaccines [21].

Not only in less developed countries did this need to use IoT for monitoring the temperature in storage refrigerators appear. Even large pharmaceutical companies like Pfizer have adopted IoT in many ways. It has partnered with IBM and implemented IoT to help produce and distribute COVID-19 vaccines. Thus, Pfizer used IoT sensors to track and monitor shipments of COVID-19 vaccines and ensure safe temperatures over long distances [22].

#### *2.1.3 Remote patient monitoring*

The most common application of IoT devices for healthcare is remote patient monitoring security using sensors that can automatically collect biometric status values. Thus, the need for patients to travel to health centers or to collect the necessary parameters for correct monitoring was eliminated [23].

Remote patient monitoring using AI takes various forms; starting from simple systems that follow the sleep and breathing patterns of a baby (https://systemone.id)

#### *Internet of Things – New Insights*

and reaching systems that are capable of providing over 10 million diagnostic results for tuberculosis, Ebola, HIV by transmitting medical diagnostic data in real time [24].

Biometric data such as oximetry or blood pressure values obtained from patients can be uploaded to platforms such as Honeywell's Genesis Touch, which aims to keep patients connected with care providers through remote locations [25].

The IoT application in monitoring vital parameters is useful in collecting data about patients and assisting them in case of accidents. The software applications used are based on algorithms that can be used to analyze the data so that a treatment can be recommended or to generate alerts. The same principle is applied in their case of continuous and automatic monitoring of glucose levels in patients. They automatically record glucose values and can alert patients when glucose levels are problematic [26].

#### *2.1.4 Depression and mood monitoring*

There are numerous challenges related to monitoring a patient with depression or a bad emotional state because they are not always aware of the state they are in. In these situations, IoT devices can gather information about patients' depression symptoms and general mood by collecting and analyzing data such as heart rate, blood pressure, or eyeball movement [26].

A new method of monitoring these states was launched by the Abilify MyCite from Otsuka. They made an aripiprazole tablet (an antipsychotic drug used to treat various mental and mood disorders) embedded with an ingestible event marker (IEM) sensor. So the sensor sends data to a mobile app that allows users to then review "data on medication intake and activity level, as well as self-reported mood and rest quality." These data can be accessed through a secure web portal, by the attending physician, or by family members and friends [27].

#### *2.1.5 Other examples of IoT/IoMT*

IoT sensors manage to achieve continuous monitoring of Parkinson's patients' symptoms, giving patients the freedom to lead their lives in their own homes.

Apart from the portable devices presented, there are also devices in the IOMT that actually provide the patient's treatment. Some examples include devices for Hand hygiene monitoring, connected inhalers that can alert patients when they leave inhalers at home, ingestible sensors that collect information from digestive and other systems in a much less invasive way, or smart contact lenses [28].

Robots used in surgery represent an important branch of IOMT because with their help surgeons can perform complex procedures, thus reducing the size of incisions and faster healing for patients [29].

As a summary of what was previously presented, at this moment, according to the specialized literature, we can classify IoT in Biomedicine Technologies as follows:


*Application of Internet of Things (IoT) in Biomedicine: Challenges and Future Directions DOI: http://dx.doi.org/10.5772/intechopen.113178*


#### **2.2 Applications**

The Internet of Things (IoT) has revolutionized the way we live our lives, yet studies show medical IoT modules are still not being used to their full potential. What is known for sure at this moment is that the Internet of Things can help transform the way health systems work and the way they provide patient care [29].

IoT in medicine is in a continuous development process and today manages to solve many medical care problems involving several levels.

Facilitating hospital management is made by room control systems, equipment monitoring and fault warning, management of equipment, medicines, and consumables, personnel performance analysis, and regulation of the flow of patients.

Improving the quality of medical services by using IoT in monitoring the vital signs of patients' health in operating and postoperative wards or online diagnostics through telemedicine solutions.

Improving the quality of the doctor-patient relationship by checking health indicators during the day with fitness bracelets, glucometers, and cuffs for measuring pulse, sending automatic reminders for activities, medications, or doctor visits, and notification of changes in vital signs with data [30] (**Table 1**).

Therefore, IoMT is a valuable technology for all players active in the health field, including public hospitals, private clinics, medical professionals of various profiles, insurance companies, and, of course, patients.

#### **2.3 Challenges**

Because we are talking about a new technology, it also faces many challenges in its application in the medical field. The main challenge is data security.

Remote patient monitoring devices cannot currently secure the collection of personal medical data. Data collected by medical devices qualifies as protected health information under HIPAA and similar regulations. As a result, IoT devices could be used as gateways for data theft if they are not secured. According to the latest studies, approximately 82% of healthcare providers report that they have experienced attacks against IoT devices.

Solutions would be the development of secure IoT hardware and software systems. Another challenge given the fact that no one at the moment can ensure that IoT devices in the health field are well managed, there is no protection system in place so that these devices are not used for other purposes than those that were created.



#### **Table 1.**

*Different monitoring applications with the help of IoT.*

It is also not legal to decommission patient monitoring devices that have an older version of software or firmware that makes data theft possible.

The solution to these challenges would be to correctly discover and classify all IoT devices in a healthcare provider's network. Thus, once networks of IoT devices are identified, classified, regulated, and secured in an established manner, managers can track device behavior to identify anomalies, perform risk assessments, and segment vulnerability against mission-critical devices [43, 44].

At this moment, an important challenge is represented by the final cost of medical devices. That is why studies are directed toward the design of IoT devices with sensors at affordable prices, easy to install, and maintain [45].

The general conclusions regarding the implementation of IoT in healthcare will be based on the existence of a clear and robust code of practice for data management, privacy, and cyber security. At this moment, IoT in medicine is limited to applications in the form of research projects in the field of health. The results of the current studies provide an excellent opportunity for healthcare systems to proactively predict health problems and diagnose, treat, and monitor patients both in and out of the hospital.

It is predicted that in the future, more traditional healthcare delivery practices will be supplemented or replaced by the IoT, as the adoption of technology-enabled healthcare services increases and enables healthcare systems to offer flexible models of care. In the context of IoT-enabled medical service delivery, more research is needed on the efficiency of blockchain storage compared to centralized cloud-based storage solutions (**Figure 3**).

Clinical guidelines on digital health prescriptions and the adoption of sound policies on the remuneration of primary and secondary care services delivered through IoT also need to be legislated.

All these aspects must be supported through research, in order to finally obtain a rate of acceptability and increased digital literacy of consumers and clinicians in the context of IoT use [46].

Another important aspect is that the technical preparation necessary for the implementation of IoT by those who offer medical services was not taken into account, even though the complete digitization of the medical sector is being attempted. Also, medical clinics must solve the cyber security problem and cover the lack of an adequate infrastructure for the implementation of IoT in health systems [32].

## **2.4 Future directions**

The Internet of Things (IoT) is a fascinating technology and the possibilities of application in the medical field are limitless.

#### **Figure 3.** *Introducing medical IoT challenges.*

At this moment, future research directions focus on the development of ingestible sensors and nanotechnologies that can help collect medical data in real time.

Robotic surgery has already been used in specific healthcare applications that require stable and long operational procedures.

Another field in which IoT will find applicability is the field of health insurers who will use IoT devices to calculate risk premiums with a long-term effect on patients with chronic diseases.

Companies like Google have already filed patents for contact lenses and other healthcare IoT technologies.

Health systems can be improved with the help of IoT, which can bring many benefits: simplifying decisions, reducing costs, creating better and personalized treatment plans, more efficient results, and, finally, a healthier life.

These benefits will also come with challenges such as building secure and easy-to-use IoT devices with the right software and a secure system in terms of data security [32].
