A Comparative Study in The Application of IoT in Health Care Data Security in Telemedicine

Chapter 9
A Comparative Study in the Application

of IoT in Health Care: Data Security
in Telemedicine
G. A. Pramesha Chandrasiri, Malka N. Halgamuge

and C. Subhashi Jayasekara
Abstract Internet of Things (IoT) is the backbone of telemedicine and its data
security has become a significant concern that requires further attention. Therefore,
this study was conducted with the aim of analyzing telemedicine systems, focusing
on data security measures. Thirty peer-reviewed research studies published in 2018
were reviewed and compared according to certain parameters, viz., algorithms, IoT
sensors, data encryption ability, communication mechanisms, mobile accessibility,
protocols, software, and platforms. The results illustrate that transmitting sensitive
medical data over the Internet has been identified as a major threat, and solutions such
as ciphertext-policy attribute-based encryption and Secure Better Portable Graphics
(SBPG) architecture have been developed to authenticate and protect data by con-
current encryption and watermarking. Furthermore, the comparison reveals that data
encryption is the most frequently used secure data transmission method and 32% of
the reviewed studies have focused on this. Regarding the most frequently used tech-
nologies, Raspberry Pi3 Edge platform (with the usage percentage of 60), TCP/IP
protocol (with usage of 38%), and ECG and temperature sensors (with usage of 20%)
have been discussed. Additionally, telemedicine has focused on standalone systems,
and, in this context, integrated systems with micro-services are yet to be improved.
Therefore, this study compares and analyzes the significant technical trends, secu-
rity trends, widely used IoT sensors, platforms, and protocols; the aim is to help the
researchers to gain a better insight into telemedicine to improve healthcare services
by maximizing the capabilities of Internet of Things.
Keywords IoT · Telemedicine · Algorithms · Encryption · Platform ·

Architecture · Sensors · Big data · Health care
G. A. Pramesha Chandrasiri · C. Subhashi Jayasekara

School of Computing and Mathematics, Charles Sturt University, Melbourne, VIC 3000, Australia
e-mail: pramesha_chandrasiri@yahoo.com.au
C. Subhashi Jayasekara
e-mail: subhashi@ieee.org
M. N. Halgamuge (B)
Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville,
VIC 3010, Australia
e-mail: malka.nisha@unimelb.edu.au
© Springer Nature Switzerland AG 2019 181

Z. Mahmood (ed.), Security, Privacy and Trust in the IoT
Environment, https://doi.org/10.1007/978-3-030-18075-1_9
182 G. A. Pramesha Chandrasiri et al.
9.1 Introduction
The Internet of Things (IoT) in telemedicine involves the inter-connected devices

and technologies. Recently, it has raised greater concerns over the security of health-
related data. There exist several types of research [1–4], based on the IoT applications
in telemedicine suggesting that IoT can be used to monitor patients, provide imme-
diate treatments, and keep track of health records since the IoT approach offers the
provision of quick and accurate medical services [1] with real-time connectivity.
While security threats are the primary issue in telemedicine area, the other problems
of concern include mechanisms such as data storage and data access. To overcome
the data security issues, researches have proposed a secure and trusted communica-
tion architecture by cyphertext-policy attribute-based encryption [1]. This encryption
uses algorithm pattern identification, data filtering, authentication, and authorization,
and the proposed model gives security at the communication link by allowing user
authentication and privacy management.
Another application of IoT in telemedicine includes telemedicine platform for
diabetes control and management called “Saleem” [2]. The proposed architecture
collects behavioral and health data from patients and performs data mining to produce
useful information. The results are visualized to the end parties including doctors
and patients. The proposed platform provides feedback and alerts messages to the
patients to avoid complications in the disease. Patients can compare symptoms with
other patients, and doctors can give recommendations to patients to prevent severe
situations in the future.
An algorithm for IoT-enabled telesonography [3] is another example of the appli-
cation of IoT in telemedicine. This novel algorithm helps to scan ultrasound to
validate data automatically. In this system, the scanned ultrasound videos are sent
to an expert for analysis. If the scanned ultrasound video contains a smaller num-
ber of representative frames, then the non-expertise can go for rescanning until the
representative data for diagnosis is obtained.
Fiber Bragg grating-based monitoring system [4] for age care and nursing facilities
uses IoT sensors to monitor pulse rate, temperature, movements, and bed exit. Using
this system, residents in aged care facilities can be remotely controlled to provide
better care for them. If there are any strange behaviors, they will be detected by the
system which will give alerts to the staffs and doctors in their mobile devices, and if
the residents need help, the warnings can be made through the system as well.
Big data also plays a significant role in telemedicine as converting big data into
meaningful visualized data chunks helps for better understanding of data elements.
There are also systems [5, 6] to monitor health using visualizing techniques to check
and monitor patient’s status and draw a polygon on a map, visualizing the markers
in the area where every marker runs in a circular view showing different parameters
to monitor patient’s health status. These systems are user-friendly because it visual-
izes graphics that would help to monitor patients remotely by supporting geoJSON
standards.
9 A Comparative Study in the Application of IoT … 183
IoT cloud-based network for anesthesia online monitoring [7] is another applica-
tion of IoT in telemedicine. Through an Android app, the proposed system lets the
doctors remain connected to the patients all the time, and the medical data of patients
can be shared on the cloud via a web application allowing teleconsulting. Using this
method [8], the doctors can check the data shared from any location at any time. It
provides three drugs monitoring, body temperature, and pH level monitoring.
PillSense [9] is another system designed to monitor patients. It is capable of
reminding patients to take medicines when an unusual health condition is detected,
and the messages are sent via emails or SMS (Short Messaging Service). It can moni-
tor health indicators such as blood pressure, body temperature, heart rate, respiration
rate, and movements of the body. Also, this system has a set of different sensors
and interfaces to detect changes and abnormalities. Finally, the system decreases the
human errors and makes the process of providing medications more efficient and
effective while tracking the health conditions seamlessly.
Researches have also introduced a cloud-based heart rate variability (HRV) remote
monitoring system [10, 11]. It is low cost, easy to apply, and accurate, and ensures the
security of data, while the system is acting as the interface between health care and
the patient. This novel health monitoring system analyzes the HRV by extracting
data from wearable sensors attached to the user. The system has been tested, and
all the tests have shown positive and successful results. Also, the proposed method
enables warning messages to the patients as well as to the doctors.
IoT in telemedicine has also been used in systems that consist of wireless sensor
networks and diaphragmatic electromyogram (EMGdi) [12] for respiratory diseases
by introducing a norm-based method where the network collects physiological data
(EMGdi), performs compression, and sends signals to a smartphone in a low-cost,
reduced-energy consumption way. Also, a novel architecture called BodyEdge [13]
has been designed to boost healthcare applications. This has reduced bandwidth and
low processing time. It has been tested on different hardware platforms. This system
can run on low-cost and data loading, and processing delay can be very low due to
network conditions.
Another application of IoT in telemedicine is an experiment focused on SBPG
architecture using data protection and authentication with concurrent encryption and
watermarking in smart health care [14]. It discusses the requirements of having
an automated analysis of biomedical images, and secure communication using IoT
infrastructure. This research has been conducted to develop the energy-efficient real-
time architecture to validate the security of medical images where the medical data
can be stored securely, and integrity can be verified. Further researches should be
carried out on nonimage biomedical data as future work.
As discussed above, since the security of medical data becomes more challeng-
ing, the researchers have introduced a system which can translate text data into the
form of images. This system [15] has been developed using 2-D discrete wavelet
transform 1-level, and 2-D discrete wavelet transforms 2-level steganography with
hybrid encryption. The proposed system hides the confidential and sensitive medical
data by transmitting them into a cover image. As a result of this technique, even
when the system has been hacked, the data will not be visible to the hackers.
The m-Green-cardio embedded system [16] proposes a device that is wearable

and that detects the immediate situations of patients depending on ECG data that
it collects. There are models [17] based on system modeling languages to monitor
elderly people by monitoring phycological signals, where the model collects real-
time data and is very useful compared to other similar models.
Medication monitoring systems as reported in [6, 18] are useful in the telemedicine
field. In previous studies, “sensing techniques” have been used within the IoT-based
applications. The medication monitoring systems with the medication bottles include
a magnetic switch, an accelerometer, and a load cell to allow mobility, and user
acceptance of the system. Actual experiments were carried successfully, and the
results of the experiment included monitoring patients and a multisensory system. A
significant advantage of this research is the system working on a single-cell battery
for 22 days while monitoring multiple health-related tasks.
Considering all those studies conducted so far, it is evident that different researches
have been focused on different areas of IoT in telemedicine. However, there were no
significant records of any research publication that compares and analyzes the latest
trends in applications of IoT in telemedicine. Therefore, this study aims to provide an
insight into the areas that require to be addressed in the field of IoT in telemedicine.
As shown in Fig. 9.1, this study aims to compare and contrast the existing and
reported applications of IoT applications in telemedicine, by discussing the most
frequently used platforms, protocols, data encryption enabled models, and the sensor
usages of the IoT in telemedicine.
Fig. 9.1 Analysis of peer-reviewed studies and determination of significant and most frequently
used features of IoT in telemedicine
9.2 Methodology
The present research was conducted using 30 peer-reviewed research studies pub-
lished in 2018 and the required data collected from these articles. During the study,
13 IoT sensor devices, 5 platforms, and 7 types of protocols were recognized for
further analysis. For the extraction of data, the following data inclusion criteria were
used.
Data Inclusion Criteria
A system consists of two major parts: software and hardware. For the software
component of a system, we considered the algorithms, the software, and the platforms
used in the research papers. The aim was to investigate the encryption mechanisms
for security. To study the hardware side of the systems, we considered the IoT devices,
mentioned in these studies, as the core components. As IoT requires a communication
element to connect with other devices, communication mechanism, protocol, and
mobile accessibility were considered for discussion. Therefore, altogether, collected
data from the articles were further analyzed according to eight identified criteria in
telemedicine and security measures as follows:
• Algorithms,
• IoT devices,
• encryption mechanisms,
• communication mechanisms,
• mobile accessibility,
• protocols,
• software, and
• platforms.
Table 9.1 presents the extracted data according to the criteria as defined above.
9.3 Evaluation of Collected Data
The results were generated after conducting a further analysis of data gathered under
each criterion (as mentioned above) from the tabled information (as presented in
Table 9.1). The results were in terms of the same eight criteria as were used for the
extraction of relevant data (as presented in Table 9.1). Results are presented in the
following subsections.
Table 9.1 Comparison of features available in IoT devices in telemedicine
186
Articles Algorithms IOT devices Encryption Communication Mobile Protocols Software Platforms
enabled? mechanism access
allowed?
Albalawi Secure Com- IOT sensor Yes. Radio Yes TCP/IP IOT hub Big data
and Joshi [1] munication IOT adapter Ciphertext- frequency/bi platform
Algorithm contextual sensor policy communications
CP-ABE and attribute-
AES based
algorithm encryption
(CP-ABE)
Alelyani and Machine IOT sensors, HIS, No – Yes – – –
Ibrahim [2] learning self-quantification
deep
learning
algorithms
Bharath and Diagnostically – No WebRTC Yes Session initiation – –
Rajalakshmi driven peer-to-peer protocol/jingle
[3] compression communication
algorithm
ultrasound
video
validation
algorithm
Foo et al. [4] Simple IOT sensor No – Yes Internet protocol Service Tomcat
algorithm FBG-based optical application- platform
using fiber sensors programming
variance polysomnography interfaces
devices, IoT
thermometer
BCG sensor mat
G. A. Pramesha Chandrasiri et al.
(continued)
Table 9.1 (continued)
allowed?
Kuusik et al. Data Motion sensor No – Yes Internet protocol PIP platform
[5] visualization units (IMUs) (IP)
algorithm IoT sensor
Wireless sensors
Aldeer et al. PillSense Motion sensors No – Yes – – –
[6] operation Weight sensors
algorithm Magnetic switch
sensor
Accelerometer
Hussein Pan- IOT sensor Yes Two-way Yes – – Cloud
et al. [7] Tompkins Homomorphic wireless computing
QRS encryption communication along with
9 A Comparative Study in the Application of IoT …
detection (HE) the BSN data

algorithm stream
middleware
Elhoseny Combination IP camera Yes – Yes Communication MATLAB –
et al. [9] of advanced steganogra- protocol R2015a
encryption phy
standard, and technique
Rivest, and a hybrid
Shamir, and encryption
Adleman
algorithms
(continued)
187
188
allowed?
Zagan et al. – Temperature No Modbus Poll Yes GSM/GPRS/3G/TCP- Microcontroller MCBSTM32
[11] sensor IP software kit and Keil
development
platform
hSensor
platform
Aloi et al. Stress Body sensors No Multi-radio and Yes IoT device – Azure cloud
[12] detection Communication multi- management platform
algorithm engine technology protocol Raspberry
Client–server Application protocol Pi3 edge
communication CoAP, MQTT, platform
BE-GTW LwM2M
interface
management
Saha et al. – Heartbeat sensor No – Yes – Putty Raspberry Pi
[13] Blood pressure software
sensor
Respiration sensor
Temperature
sensor
Accelerometer
sensor
(continued)
allowed?
Mohanty BPG CMOS sensors, Yes, two – Yes – – –
et al. [14] compression digital signal layer
algorithm., routing and a encryption
novel complex system seamless
algorithm CPU, SDC (Secure integration
called the digital camera) of water-
scale BPG encoder, marking,
adaptive BPG decoder, encryption
object Javascript decoder, facility is
tracking and BPG viewer secure better
(SAOT) portable
graphics
(SBPG)
Kotronis – IOT medical No Bluetooth low Yes IPSec – Healthcare

et al. [15] sensors energy (BLE) or network
ZigBee internet
Aloi et al. – Multi-radio and Yes Application Yes Public/private cloud – BodyEdge, a
[12] multi-technology protocol, CoAP, platforms novel
communication MQTT, Raspberry Pi3 single architecture
Mall range LwM2M board and ii) Zotac BE-GTW
communication CI540 NANO Pc architecture
ZigBee, ZWAVE, Edge (Raspberry
Wi-Fi, Bluetooth, Pi3)
Bluetooth low Edge (Nano PC)
energy, Azure cloud
ANT+, Z-wave,
ZigBee, Wi-Fi,
189
LTE/5G
(continued)
190
allowed?
Wu et al. Compressed WBAN sensors No Wireless body Yes – – –
[17] sensing area network
algorithm (WBANs)
Diaphragmatic
electromyogram
(EMGdi),
Hussein Pan- WBAN sensors Yes. Using ZigBee wireless Yes – – Cloud
et al. [7] Tompkins advanced communication computing
QRS encryption system platform
detection standard along with
algorithm (AES) the BSN
Data stream
middleware
Guo et al. – WBAN sensors No On-the-go Yes – – The medical
[19] (OTG) wire to network
keep platform
communication
Stradolini – WBAN sensors No. But uses Bidirectional Yes TCP/IP Qt Creator Therapeutic
et al. [10] pre-shared communication 3.2 software drug
access with Qt 5.3 monitoring
feature, to libraries. (TDM)
secure platforms
transfer data
(continued)
allowed?
Islam et al. – WBAN sensors No Short-range Yes Standard protocol – –
[20] communications
technology
Saha et al. – WBAN sensors No. But uses – Yes – Raspbian Raspberry Pi
[13] a role-based
user authen-
tication
Santos et al. Sliding WBAN sensors No Physiologically- Yes Communication – –
[21] window aware protocol
algorithm communication
architecture
Hamici et al. Novel WBAN sensors No – Yes TCP/IP – –
[22] genetic
algorithm
Genetic
cryptography
algorithm
(continued)
191
192
allowed?
Nadrag et al. Pulse WBAN sensors No – Yes – – Android and
[23] detection Raspberry Pi
algorithm
Video-based
heart rate
Detection
algorithm
AdaBoost
learning
algorithm
Hamici et al. Novel WBAN sensors Yes – – TCP/IP protocol – –
[22] genetic
algorithm
End-to-end
node-server
security
algorithms
Cryptographic
algorithms
Rajagopalan AES and WBAN sensors Yes Image Yes – – –
et al. [24] gold code symmetric communication
algorithm block cipher mechanism
AES
algorithm
(continued)
allowed?
Galletta Nonlinear WBAN sensors No Video Yes – – MyGene
et al. [25] regression communication Friends Web
algorithm platform
Satyanarayana A K-NN WBAN sensors No Cellular IoT Yes – – Raspberry Pi
et al. [26] (K-Nearest communication
Neighbor)
based
algorithm
Chakravorty – WBAN sensors No – Yes – – Raspberry Pi
et al. [18]
Lavanya Signature WBAN sensors Yes – Yes – – PREDIX
et al. [27] verifying iFOGSIM
algorithm
Enciso- – WBAN sensors No – Yes – – DHIS2
Quispe et al.
[8]
193
9.3.1 Use of Algorithms, Communication Mechanisms,

Mobile Accessibility, and Software
According to the analysis on algorithm, only 66.67% of the reported studies have
discussed these and 50% of them have used data analysis algorithms once the data
were collected from sensors. The rest have only displayed detected data without
analyzing. Moreover, the algorithms are specific to the purpose and the output of
the system and therefore, we were unable to compare algorithms to find the most
suitable algorithms for the development of integrated systems.
As for the communication mechanisms, it is noted that a variety of 16 different
mechanisms have been considered. However, the most common mechanisms have
been: Radio frequency, two-way wireless communication, ZigBee wireless com-
munication system, and image communication mechanism for the enablement of
encryption. Considering the mobile accessibility of the system, it is noted that all the
systems allowed mobile accessibility. Moreover, only 23% of the reviewed studies
have discussed the used software; and these were of seven different varieties. Out of
these, only IoT hub and MATLAB R2015a were the software systems that enabled
encryption.
As for the analysis of the remaining four criteria (usage of IoT sensors, encryption
ability, used platforms, and used protocols), and for the possibility of their application
to a generic integrated system, results are presented in the following four subsections.
9.3.2 Use of IoT Sensors in Telemedicine
Figure 9.2 shows that the frequently used sensor types in 2018 have been ECG
sensors and the temperature sensors: their usages being 20% each. Blood pressure
sensors and motion sensors were used moderately, and the sensing devices such as
fiber sensors, motion sensors, and contextual sensors were used less frequently.
9.3.3 Use of Encryption in IoT Data Transmission

in Telemedicine
Figure 9.3 shows the Encryption Usage of Data Transmission in the IoT in
telemedicine. 32% of the conducted research has enabled encryption as an extra
feature in the application of IoT in telemedicine, while the majority of remaining
68% have enabled encryption in earnest.
Fig. 9.2 Usage of IoT sensors in telemedicine
Fig. 9.3 Encryption usage

of data transmission in IoT in
telemedicine
9.3.4 Use of IoT Platforms in Telemedicine
Considering the platform usage of IoT in telemedicine, Fig. 9.4 shows that the major-
ity of 60% of the research used Raspberry Pi and the platforms such as PIP, hSensor,
Tomcat, and big data are equally and moderately common in the telemedicine field
showing approximately 10% of the usage in each case.
Fig. 9.4 Platform usage of IoT in telemedicine
Fig. 9.5 Usage of IoT protocols in telemedicine
9.3.5 Use of IoT Protocols in Telemedicine
Figure 9.5 presents the usage of IoT protocols in telemedicine. It is found that most
used protocol is TCP/IP where the contribution is 38% of the total usage. The sec-
ond most used protocols have been Internet protocol and communication protocol
where its contribution is around 15%. Moreover, protocols such as session initiation,
standard, IPSec, and Application contributed only 8% each, of the total.
9.4 Discussion
The current study focuses on comparing and analyzing the IoT-based applications in
the telemedicine sector as reported in the literature published during the year 2018.
Telemedicine and IoT technologies are typically dealing with an extensive number of
connected devices and health data stores and exchange data between those devices.
Thus, the security and privacy are the utmost important factors in such telemedicine
application and related applications. Also, the platforms must be able to fulfill the data
security requirements in every aspect. During the study, we have explored various
IoT-based sensors used in telemedicine. Further, we have examined 30 peer-reviewed
articles and analyzed the proportion of the use of encryption features for data trans-
mission in different telemedicine applications. Moreover, we have also investigated
related platforms and protocols used in telemedicine in the 2018 publication year.
Many research articles related to IoT in telemedicine published in the year 2018
[1, 14] have focused on general security issues [1] and have proposed algorithms to
overcome the problems. There is no detailed discussion on specific telemedicine ser-
vices related issues, which can be generally applied as “Security data transmission”
[13]. Most of the proposed systems [9] have not been tested in the real environment,
and further experiments and observations should be carried out to test and prove their
accuracy and reliability.
Another drawback in the research is that most of the proposed architectures [2] can
detect only one disease, although these could have been applied to detect multiple
diseases simultaneously as well as increasing the accuracy of determination. For
instance, the studies conducted to validate videos in the telemedicine sector [3] have
only 96.5% accuracy in identifying a representative frame in the ultrasound video.
There is a risk of 3.5% where it is not able to locate representative frames. Since
there still is a risk of not recognizing a disease accurately, further researches should
be conducted to increase the probability closer to 100%. Moreover, the systems are
generally based on the data that are collected by sensors only [4]. If there are faulty
sensors that can harm the patient, there is no method to identify them in advance.
Although there are machine learning algorithms [5] that can be helpful to analyze
data, still, there is a possible risk of converting collected data into a visual form.
However, systems should be further developed to be more intelligent with fault
detection in advance and alert the necessary authorities.
Developing “Integrated” systems is another area that should be addressed in IoT-
based telemedicine. For instance, Pill sensing system [6] which can only be used in
pill-based medication systems can be improved for non-pill used monitoring systems
as a part of IoT-based patient monitoring systems. A lot of other sensors could
be connected to monitor various body conditions enabling the “Integrated” system
features. A system designed for IoT for telemedicine practices enabled by AndroidTM
Application with Cloud System Integration [7] has been proposed as an application
to alert about critical patients one at a time. This can be further developed to alert
about multiple critical patients simultaneously.
Another research reported in [9] has proposed a system to change the room envi-
ronment depending on the data collected by the sensors. There is still a risk to rely
on a few sensors as the measurements can be limited and a patient can have more
complex and complicated health situations which cannot be detected by the available
sensors. Furthermore, the research article [12] targeting low-cost and energy-saving
communication capacity has not focused on the quality of the signals. This is a very
important area which required attention, as the data transmitting plays a significant
role in IoT in telemedicine.
Considering the quality of experiments, there is a study [13] conducted using
100 participants. This sample size is too small—if there was possibility of using
data from a large number of participants, the quality of the research would have
been increased. Also, efficiency is another area that should be discussed although
there are systems that give less attention to that [14]. A proposed “Model-based
Approach” as reported in [15] translates text data into the form of images. It is a
unique way of transmitting medical data over the Internet. In the system, encryption
mechanisms and other security mechanisms have been used. However, it requires to
focus on high capacity, unpredictable, high deterioration steganography techniques
where even though the system is been hacked, the data will not be visible to hackers.
The most effective method to anchor Electronic Medical Records (EMR), Elec-
tronic Health Records (HER), and Personal Health Records (PHR) is for the bio-
logical community to guarantee the privacy and integrity of the information. This is
a functioning examination region where methodologies incorporate utilizing cryp-
tographic natives, for example, those dependent upon basic public foundation and
public clouds to guarantee information confidentiality and privacy [28]. In this sce-
nario, data are encrypted before redistributing to the cloud. Nonetheless, this restrains
the accessibility of the data, as for healthcare suppliers, we need to unscramble the
(conceivably noteworthy) data [29]. Moreover, exploring diverse techniques for big
data databases [30, 31] and accurate estimation of sensor power consumption would
be another critical aspect of the IoT platform [32, 33].
Another exciting method as discussed in [34] provides multilevel security mecha-
nism by exploiting the watermarking and chaotic encryption technique for telehealth
applications. A delicate watermarking strategy which depends on singular value
decomposition (SVD) and Arnold change for giving secure medical image trans-
mission is presented in a study in [35]. Examining the proposed approach against
different attacks demonstrated its enhanced execution. It concerns the peak-signal-
to-noise ratio (PSNR) and accuracy of altering recognition in contrast with a portion
of the ongoing methods [36–39]. The other comparable medical image watermarking
procedures are introduced in many more studies as well [40–45].
In this research, we have investigated the IoT sensor usage in IoT-based
telemedicine context as addressed in recent studies. We have explored different types
of sensors and found that the ECG and temperature sensors are the most commonly
used sensors. Besides, we have studied and analyzed the encryption facility usage
in IoT telemedicine applications and found that most studies were not able to fulfill
the encryption facility in data transmission. Consequently, we have seen that big
data platforms, tomcat platforms, pip, hSensor platforms, and Raspberry Pi3 edge
platform are the most common types of platforms that allow the data encryption
feature.
Our research demonstrates that the significant research areas including IoT sensor
usage, platforms, and protocols used in IoT telemedicine segment have also been used
by previous similar research studies. During the survey, we found that investigations
have only focused on one disease or two at a time. Thus, we can see that the future
researches should be focusing on inventing a system that detects several disorders
together as an integrated system. Moreover, future research in telemedicine context
could consider implementing an integrated system that can remotely monitor patients.
9.5 Conclusion
This study compares and analyzes the applications of IoT in telemedicine sector in
the research publication year 2018 showing that the data security in telemedicine is
a significant concern. Having the ability to collect data, analyze, and distribute it fast
has become the main reason for this concern although it facilitates the medical field
to work more efficiently. However, according to our study, the available algorithms
can be used to minimize the risk of security and privacy of data. Moreover, big
data platforms, Tomcat platforms, pip, hSensor platforms, Raspberry Pi3, and Edge
platform are the most common types of platforms that allow data encryption. The
research also shows that the communication mechanisms such as two-way wireless
communication and ZigBee wireless communication system enable the data security.
Therefore, we can conclude that a combination of an underlying software that enables
encryption along with a communication mechanism that ensures the privacy of data
over transmission can provide a more secure system for IoT systems in telemedicine.
Furthermore, we also conclude that the researchers have been focused on a single
disease or health condition or a few at a time in the recent past. Hence, the future
researchers should ideally focus on inventing systems that detect several illnesses
together as an integrated system to make the maximum use of IoT technology to help
the medical field. Considering the vast number of available sensors to detect different
symptoms, robust algorithms to analyze, and finally transmit to different channels,
it opens the possibilities for integrated systems. Furthermore, future research in
telemedicine could consider an integrated system that can remotely monitor patients
without direct human interactions. This automation process can be helpful to increase
accuracy and also to alert the doctors and care workers whenever the sensors detect an
anomality in a patient’s body. With the end goal of accomplishing a unified structure,
our current study hopefully provides critical technical and security trends with the
most frequently utilized IoT sensors, platforms, software, and protocols in 2018.
In conclusion, it will hopefully also guide the researchers and related authorities to
improve telemedicine sector by expanding the capabilities of the Internet of Things
in this field.
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Chapter 9

A Comparative Study in the Application

G. A. Pramesha Chandrasiri, Malka N. Halgamuge

Keywords IoT · Telemedicine · Algorithms · Encryption · Platform ·

G. A. Pramesha Chandrasiri · C. Subhashi Jayasekara

© Springer Nature Switzerland AG 2019 181

The Internet of Things (IoT) in telemedicine involves the inter-connected devices

The m-Green-cardio embedded system [16] proposes a device that is wearable

9.3 Evaluation of Collected Data

detection (HE) the BSN data

Kotronis – IOT medical No Bluetooth low Yes IPSec – Healthcare

9.3.1 Use of Algorithms, Communication Mechanisms,

9.3.2 Use of IoT Sensors in Telemedicine

9.3.3 Use of Encryption in IoT Data Transmission

Fig. 9.2 Usage of IoT sensors in telemedicine

Fig. 9.3 Encryption usage

9.3.4 Use of IoT Platforms in Telemedicine

Fig. 9.4 Platform usage of IoT in telemedicine

Fig. 9.5 Usage of IoT protocols in telemedicine

9.3.5 Use of IoT Protocols in Telemedicine

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