**6.1 Tyagi et al.**

*Internet of Things (IoT) for Automated and Smart Applications*

ensure that their information is kept secure.

expect to be asked for their consent [51].

innovation to promote HIE among hospitals [52].

of system capacity to the following causes:

the need for information exchange.

• Address shortage: another important issue that hinders the adoption of HIE is the storage of health information in a single pool. Cloud computing or other related technologies may be used as storage to allow healthcare practitioners to access and utilise health information at any time and place. Storing information online emerges as the most popular choice even though most users have expressed their concerns about storing their personal information on the Internet. In addition, the collected data must be managed and comply with standard formats and protocols in order for them to be retrieved and used by other healthcare providers. However, a common standard protocol for these data is yet to be devised [45]. Furthermore, patients should be allowed to access to their own data and be given the right to dispose of these data freely and

• Patient consent: the success of HIE also depends on public support, the willingness of patients to share their health information and their consent to have their health information shared with other parties via HIE [49, 50]. A study that examined the attitudes of patients towards giving consent revealed that the majority (91%) of the participating adult patients expect to be asked for their consent before their identifiable records are accessed and used for health provision, research or planning while only 9.2% of these respondents do not

• Compatibility: compatibility refers to the degree to which the potential adopters perceive innovation as consistent with their values, previous experiences and needs. Therefore, based on physicians' expectations, the HIE system should be compatible with their work style and needs to motivate them to adopt such technology. This issue has a significant effect on the usage of

• Hospital workflow: Healthcare professionals need to transform the HIE system to satisfy their demand for a faster access to patient information, which in turn can reduce their workflow. Issues related to workflow are important barriers that prevent the implementation of technologies in some health practices. Physicians in practices without EMR are generally reluctant to use computers to write prescriptions because these technologies are unavailable in many examination rooms. Therefore, HIE must promote consistency in workflows by facilitating staff training to improve their efficiency and by providing clinical

• System capacity: in order to facilitate HIE, the systems being used in hospitals should be effective and sustainable. Zhang et al. [15] attributed the limitation

○ The failure to implement tecihnological advancements in most hospitals

○ The delayed development of a standard-compliant HIE system in many hospitals.

○ The overlapping functions among the needs of several regions, which reduce

However, exchanging patient records, including summaries and test results, among healthcare practitioners is not yet considered a norm in many countries. In the US, New Zealand and Canada, the current capacity of healthcare practitioners

and the need to upgrade the HIE system to improve its capability.

information with minimal effort at any time or location [53, 54].

**50**

Given the increasing demand of health organisations for access to patient records around the world, Tyagi et al. developed a cloud IoT-based healthcare framework and proposed *Platform as a Service* (PaaS) and *Infrastructure as a Service* (IaaS), which help patients find the best care at the optimal cost by allowing them to securely store and share their health information to healthcare organisations [56]. Patients can perform self-assessment to monitor their conditions and find hospitals that provide the healthcare services they need the most. However, the benefits of the cloud-IoT-based healthcare framework are offset by issues related to trust, privacy and security, all of which must be addressed before healthcare providers decide to adopt this framework. Moreover, the security requirements for the implementation of this model are yet to be fulfilled and its results need to be tested [56]. **Figures 6** and **7** summarise this framework.
