INTRODUCTION:

Internet of Things (IoT) refers to a fundamental paradigm which is shortly gaining uphold and the new trend of wireless communication systems. There are several devices can be interconnected and communicated by using broad band^1,2. The IoT work is a subject which determines the wide spread presence of 'objects' or 'things' like sensors, aerial phones, tags, and actuators. The whole of the concern is to have the better addressing schemes to cooperate the near by neighbors mutually and censure to advances common targets^3,4. The Internet of Things virtually enables the links for the skilled objects, comparatively in the sensor, actuators to the entire Internet-accessible system. When this technology employed in inefficient place, it promotes the connection between the smart objects hence it optimally used in Ambient Assisted Living⁵. Live monitoring of the patients is done to check sugar and pressure were doctor can inject the patient to handle the situation from his own place⁶. The skilled things use wireless body networks can be monitored, controlled, laid-back using the Internet.

This achievement opens up the possibility of providing a careful and ongoing real-time monitoring of vital signs measurements provided by body sensors attached to patients⁷. In most of the occurrences, the body sensor is integrated watches for mobile applications and various personal devices which supports real-time signal monitoring to recover the medical benefits of the subject^8,9. In the healthcare system, IoT plays the role of collecting large-scale information data, and the grid for automation can update the software¹⁰. The Internet is abruptly growing shortly since last few decades and future continues to develop in restriction to complexity. According to survey report 2014, 42.3% of the present population was using the internet. Similarly, the security threats to the internet are also increasing aggressively to the internet evolution¹¹. There are nearly 600 crores of people aged above 60 in the universe are benefited due to IoT, and it may extend to twice the number by the year 2025 and attains the count of 2000 crores in 2050¹².

TECHNOLOGY OVERVIEW:

A concrete illustration of m Health Wireless body area network (WBAN) shown in figure 1 that connects to smart environments over IoT interfaces which oblige health information from the user. To efficiently process more information simultaneously technologies like RFID and Android are used¹³. As the first point of data group, sensor devices a well-known as wearables system will play a pivotal role to collect, process and correlate the data¹⁴.

Figure 1. mHealth WBAN (James Jin Kang et al.,)

SECURITY:

Security is the major challenge faced by the WSN designer¹⁵were IoT based technologies, use different types of the tags like Low frequency (LF) RFID, High frequency (HF) RFID, and Ultra-high frequency (UHF) RFID operated at different radio frequency bands to measure the distance between the observer and the tags. This approach may mismatch for passive tags to extend a few centimeters (low-frequency bandwidths) to the part of meters¹⁶. Healthcare framework is sensitive, and it is highly impossible to prohibit the complete unauthorized access trying to steal the information. It is essential to have the update in the file to know about the system⁹. Wireless computer networks and radio frequencies transfer data through radio bands which may be easy for the intruders to access, destroy the data, stolen or modified¹⁷. For a healthy environment, it is essential to ensure the security of system available mutually because the unauthorized user may become harmful to the system or patients. Several challenges in healthcare are curable, and some other problems are improbability to the doctors itself. To overcome such quality of issues we intended to contemporary technology which is called Ontology-based IoT Technology. In most of the cases medical data is secured by use of rotating cipher¹⁸. There are some of the security parameters which needs address for any IoT based communication and its systems. For secured transmission both network security and data security as to ensure. Hence table 1 lists the possible attacks to data in the networks and their corresponding measures.

TABLE 1: ATTACKS AND SAFETY MEASURES

Attacks	Effect of attack	Safety measures required
Data processing attack	Data alteration	Integrity
Data processing attack	Imitation	Data verification
Autophony attack	Hearkening	Privacy of data
Autophony attack	Tracing	Invisibility, location security
Transmission attack	Restate	Data freshness

IOT TECHNOLOGIES IN HEALTH CARE:

Wireless Body Area Network (WBAN) consists of the wireless device which is implanted over the human body to monitoring vital parameter in the remote location¹⁹. Wireless Personal Area Network (WPAN) comprises of small devices which is accessible by computer wirelessly these devices are a video camera, pressure humidity and so on situated on the body to sense the critical parameters and the data will be transmitted over the internet²⁰. Sensors like opto chemical transducer are used for its diverse class of sensing²¹. The gateway connects WBAN and WPAN to World Wide Web which plays sharps and flat role in connecting ad hoc devices with themachine. A gateway can be anything like Personal Digital Assistant (PDA), a smartphone, router, server or complete machine^22,23. IoT-based ambient assisted living ensures the action of well-being in life and safeguards to the senior people which include an application such as services, products, and so on. One of the principal goals of the ambient assisted living is it has the benefits to isolate the economy which has increased efficiency to fortuitous resources for society^24,25. IoT base inter operability involves many medical systems such as pulse oximeter, glucometer, weight machine, blood pressure meter, ECG^26,27. The telemedicine and telehealth devices have the integration of data which is different and profound thus it becomes complicated to accomplish through IoT.

IOT HEALTH CARE APPLICATION:

CLINICAL CARE:

In hospitals especially intensive care unit, needs continuous and close monitoring to regress possibly in a crisis case, which will give more chance to save patients life. IP-based sensors can derive remotely the following information that has a relationship with the patient's health situations and sends them over the network to caregivers for further re-examine and analysis. Also IoT Test beds helps in increasing the care to the patients²⁸.

REMOTE AREA MONITORING:

Elderly, child or chronically ill prefers to examine almost daily, the possibility of a remote monitoring will promote them avoid making rounds to the hospital for controls, sometimes because of their critical position the changes in their health situation goes unnoticed till the disease spreads to the crisis stage. Remote access sensor will promote caregivers to have pre-diagnosis and avoid the critical condition. Information can also be passed to nearby ambulance and police station for rescue process²⁹.

CLINICAL AWARENESS:

Information and communication technology undergoes many challenges to meet³⁰. Having the flexibility to notice the patient's requirement and the environment where he is situated, will significantly promote healthcare professionals to recognize the variations that can affect the health position of the patients. Because of the environmental issues has an essential portion of the health problem. In initiation, the change of temporary state of patients may increase the percentage of its uncertainty to disease and be a cause of patient health deteriorating. The use of specialized sensors to capture various information about patients physical environment. It will promote in urgency cases to well locate the patients and be aware of what quality of urgency intervention may be taken. Cipher text is so secured therefore extracting of message is difficult³¹.

METHODOLOGY:

IoT Based Healthcare Using BSN (Body sensor network) architecture comprises of on-body wearable sensors like EMG, EEG, and BP to collect the vital information and sends it to the local processing unit through the coordinator. The Local Processing Unit (LPU) can be any local device which works as a router between BSN nodes and the server by making use of any mobile network. In case of abnormality detection, LPU sends the alert to the family members and local healthcare station. In this network FR (family response), PR (physician response), ER (emergency response) are the Boolean variables which are either TRUE or FALSE. For an event when BP rate is less than or equal to 120 there is no action performed by the server. For a slight hike in BP say greater than 130 the information is sent to family members, for raise in BP say more significant than 145 calls to family members if not attended information passes to the local physician. Fornetwork security (Data verification, Invisibility, location security) and data security (Integrity, Privacy of data, Data freshness) was enforced, the network security provided by using lightweight authentication protocol, and data security is acquired by using OCB authentication encryption mode. The limitation will be if the collected signal from BSN is altered or misdiagnosed the similar treatment can cause death³².

Real-time data analysis of vital parameter (carbon dioxide, temperature, and humidity) makes use of non-invasive sensors like pulse-oximeter over the subject. The sensor collects the information about the carbon dioxide and lack of oxygen and its effect on the body. The rise in the level of carbon dioxide leads to decrease in the performance of human body^33,34. For the calculating amount of Co₂exposed to the patient, there is a unique Co₂ indicator³⁵ to predict the level of increase in the Co₂which may cause breathing issue, accelerated heart rate accomplished by fatigue. The architecture of real-time data analysis comprises of different layers namely data acquisition (kaa platform), data processing (apache storm), data storage(Mongo DB), data visualization (web application). Kaa application is the open source used to collect information from different sensors. Therefore, it integrateswith IoT devices, this platform has ability scale and has good fault tolerance. Apache storm is again open source which can process the streams of real-time data, the web application used for data visualization, and Mongo DB used for data storage. The designed platform integrates the hardware and software simultaneously decreases to the processing time, transmission time and storage. It is used to find the correlation between oxygen and carbon dioxide in the human blood. The main limitation of this approach is not applicable to the large-scalescenario, and additional sensors are tedious³⁶.

Rural health monitoring and control use CWC (cooperative wireless communication) in which virtual array was formed by connecting number of nodes together³⁷. CWC use AdHoc networks and WSN (wireless sensor networks) for optimum performance³⁸. Active RFID sensor use to transmit the physiological parameters collected from the subjectto local Rural Healthcare Center (RHC) these sensors forms the OLA (large opportunistic array) cluster, to support the patients one local hospital (RHC) will be active to help them at anytime. The advantage is that it reveals the trade-offs for latency, energy (saving up to 57% is saved because of green IoT) and through put. The main limitation of this propose techniques is that the radio nodes are half duplex³⁹.

In continuous Heart rate monitoring, the architecture divides into three layers such as sensing, transport, and application layer. The sampling frequency of ECG signal was set to 128Hz and blood fat; blood glucose is also monitored. Considering cost-effectiveness data transmission is divided into two parts initially data is sent from sensors to the connector and secondly, connecter sends data to a remote location, soit becomes much economical. There are four modes of operation to monitor system such as Real-time continuous monitoring where all the data sample is sent to a remote center with highest monitoring level and also ensures rapid response, Continuous transmissions in special hours like 1 or 2 hours after waking up and afternoon 3 to 4 clock, Event triggered transmission where sampled data is sent to aconnector which conducts data efficiently to remote server and Monitored data is stored in the smartphone when the patient feels uneasy may send arequest to the doctor it has alower level of monitoring the limitation of this approach it may increase network traffic⁴⁰.

Continuous monitoring of glucose system has sensors, microcontrollers, wireless communication block, energy harvesting and management components. The microcontroller performs the significant part of the work, soit consumes a more significant amount of energy due to this ultra low power microcontroller are used for operating in both active and sleep modes. It takes the glucose data from the patients who are implanted in the body and send in Serial Peripheral Interface (SPI) because it has a low power consumption rate. nRF (Wireless communication module) is used for sending data from microcontroller to gateway. The growth of WSN and WBAN has been reflected in IoT but there is no similar technology available for battery hence energy harvesting unit is used to increase the lifetime, the energy source to the battery are provided in two ways like the ambient energy source which is acquired through the surrounding environment like heat, wind where as the and Human power is harvested from the movement of the human body like the pressure of blood, breath rate and walking. For battery power, both sources are used, and the thermal energy is converted into the electrical energy by using TEG (Thermoelectric generator) and integrated into harvesting process. The data is collected from the sensor node which includes random and predefined data in this case the distance between sensor node and gateway is few meters. Therefore the sensor node sends the data to the high power which is compensated by variation in time. The limitation of this approach is not suitable for immobile patients⁴¹.

When the individual is unable to manage the Healthcare, then the responsibility shifts to the caretakers mostly the elderly is incapable of adapting the necessary skills required to manage the devices⁴². Therefore the IoT solutions are provided in such way that ends user is patient themselves; Proteus digital health is IoT enabled digital medicine, which comprises of tiny ingestible sensors and wearable sensor patch that monitors heart rate, blood pressure, and weight this information is shared between the doctors and patients usually with doctors having access to high-level information. The limitation would be providing additional information like critical issue disclosed to the patient’s may demotivate the user in taking control of their health, However health and its technological advancement such as IoT ensures the active participation of the patients⁴³.

In autonomous WBAN towards IoT based healthcare concentrates on three major parts namely solar harvester, Wearable sensor node and smart phone application. The energy harvested from the flexible solar panel is stored in supercapacitor which has unlimited energy. The wearable sensor include microcontroller (collects the information from the sensor and manages the power to reduce power consumption) wearable sensors (collect the information for ECG, EEG, and GSR) were fall detection is sensed by accelerometer also helps in sending an emergency notification.The wearable is the wrist-worn in hand and consist of the temperature sensor (collects the information about body temperature at different positions) and pulse sensor (measures heartbeat) and finally transmit to doctor and subject smartphone. The limitation of this approach may be the size of the solar panel may cause discomfort to the patients⁴⁴.

A secured IoT based healthcare system consists of system initialization phase and two authentication phases. The components used for IoT based communication consist of wearable body sensor, local processing unit (LPU) and body sensor network (BSN) these sensor collects bio-data from the human body and sends it to LPU and LPU sends it to BSN. For data analysis in the proposed method bio-sensors and LPU has to be registered initially and the data is stored in BSN server. It also developed the trusted boundary like During the registration phase the parameter received is under the secured channel, Sensors and LPU have secured storage, LPU to BSN and sensors to LPU are insecure, There area trusted BSN and safe database access and Public essential infrastructure is supported by the third party. In the first phase that is initialization phase all security parameters are agreed and shares the communication in the second phase that is authentication, the phase is used to exchange the data among the communication entities the drawback may be rectified by increasing the efficiency of the system⁴⁵.

IoT based low-cost remote monitoring system consists of a wristband which collects the patient's information by reducing the number of transducers. The microcontroller and raspberry pi are used to enable the Wi-Fi capability in the absence of the Wi-Fi the data is stored in raspberry and later transferred to the connected device. Also, the extra module can also be added to raspberry pi if required. The architecture of the wristband comprises of the temperature sensor (collects the information about the temperature of the body) and apulseoximeter (monitor the pulse rate and oxygen saturation in the blood) likely the reading is collected for every 3 minutes for two persons and data is stored in raspberry pi temporarily. In addition to low-rate wireless personal area network (LR-WPAN) which reduces the power consumption and increases the bandwidth, the receiver is programmed in such a way that it can communicate between ADC and raspberry pi later. The information is transferred to hospital database the limitation of this method would be adding additional sensors to the band is tricky⁴⁶.

Wearable anger monitoring system consists of biosensors and functional modules fixed in awristband which can be worn in hand collects the information about skin temperature, body motion and heart rate in addition to this GSM(global system for mobile communication) and Android app is used to measure this parameter. The measured parameter says about the anger level of the person and it is continuously monitored by accelerometer randomly ten students from age group of 19-25 is selected, and anger is detected the recording from each user is done at different intervals. Especially during exercise the temperature crosses the threshold value, and continuous body motion is detected by accelerometer and user feedback obtained is 91% accurate the performance found to be more innovative to monitor the human health the limitation of this approach would be collecting other relevant parameters like bio-signal may be difficult⁴⁷.

CONCLUSION:

IoT has broad application and uses throughout several areas still growth of internet of things in healthcare domain is preeminent hence this comprehensive review discusses in detail about attacks in healthcare systems and its similar IoT technologies. IoT helps both doctor and patients simultaneously because the patients are monitored all the time by other hand doctors also receives all the necessary information thereby this becomes a notice requirement in the medical field. The future work would be placing the nanosensors with minimum power consumption and minimum maintainers along the secured architecture were security challenges to be considered as the significant part of the work.

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Received on 17.02.2018 Modified on 15.04.2018

Research J. Pharm. and Tech 2018; 11(7): 3157-3162.

DOI: 10.5958/0974-360X.2018.00580.2