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Development of Smart Healthcare Web System using PWA with AI: A Review of
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 Development of Smart Healthcare Web System using PWA with AI: A
Review of Related Literature

Kimberlyn Fernando
[email protected]
School of Advanced Studies
Saint Louis University

development, and these include Accelerated

ABSTRACT Mobile Pages, Single Page Applications, Voice
Search Optimization, Blockchain Technology,
This paper has discussed the creation of a AR/VR, and Motion UI. And according to a study
smart healthcare web system using the emerging done by Dzhangarov et al. [1], the most notable
technologies, Progressive Web Application, and modern trend in web development nowadays is
Artificial Intelligence. The current state, as well focused on Progressive Web Application (PWA)
the issues and challenges of these technologies in and the implementation of Artificial Intelligence
smart healthcare system, was identified, and it (AI) in different fields of industry.
was found that they are still relatively new, with
issues still focused on accuracy, compatibility, In the study of Adetunji [2], Progressive
design, security, and ethical issues. Aside from Web Application (PWA) is an emerging technology
that, PWAs were compared to their predecessors, that is currently gaining academic involvement in
native applications, and hybrid applications in terms of research. Basically, PWA is a concept of
terms of their features. And overall, PWAs were how to develop a mobile application that is
found to be the best solution when it comes to the progressively advanced with trends in web
creation of effective healthcare web system. Based technologies. PWAs are served initially from a
on SWOT analysis, PWAs were found to have an remote web server, but the good thing about them
advantage in making patient-centered is that they can simply be visited through a
applications and the development of a secure browser app [3]. Before the rise of PWAs, there
communication channel for medical professionals. were native and hybrid apps, but unlike these two,
However, being relatively new, studies on the PWAs are better because of their additional
future challenges of these technologies still benefits like offline capability, significant
require further elucidation. efficiency, and background synchronization. As
“progressive” applications, they combine the
KEYWORDS excellent features of both native and web
development strategies to function as the better
Progressive Web Application, Artificial development approach ultimately.
Intelligence, Smart Healthcare system
On the other hand, Artificial Intelligence
1 INTRODUCTION emphasizes the creation of an intelligent machine
that acts and works like humans. Computers with
The advancement of web technologies in AI are designed to do Speech Recognition,
the information technology industry has Learning, Planning, and Problem-solving [4].
revolutionized the way we convey the original These two emerging technologies are gaining
web development and has now promoted a brand- academic involvement in terms of research
new service environment. There is a wide range of interest applied in various industries such as
emerging technologies under the umbrella of web
education, entertainment, e-commerce, and Considering the limitations of the existing
healthcare system. healthcare system applications that were
developed using the traditional mobile
development, the need for a better technology that
can simultaneously adapt with that of the
At present, a part of research in the new healthcare system must be emphasized. This was
industrial era is focused on improving healthcare supported by Talukder et al., [9], wherein they
system services [4]. In 2016, a study by John stated that to deploy a reliable user experience
Hopkins showed that medical errors are the third and service that performs independently from the
leading cause of death in the U.S alone, network conditions to users, Progressive Web
responsible for more than 250,000 deaths per Application and Artificial Intelligence can both be
year, and the number of deaths has been potential candidates. PWA will now capture
multiplying every year since then. In the study of patient data, then integrate this data with a
Tuli et al. [5], the number of patients, types of diverse set of medical knowledge sources and
analysis, the number of data that need to be pass and deploy it to AI to support differential
processed, and response time requirements are diagnosis, prognosis, and patient stratification.
becoming more demanding. Various novel Integrating PWA in healthcare web system will
diseases are being discovered every day, new help improve the quality of performance of the
treatments and cures need to be processed. Hence, application because of its most significant
healthcare web system applications need to be advantage, the offline support. In the study of Lee
developed and deployed using robust and scalable et al. [10], with the use of the offline capabilities of
frameworks that provide high-quality results in PWA, the overall UX improves, since it results in
the least time [5]. Tian and his team [6] stated that faster loading time which in the case of healthcare
Smart healthcare system is a health service system web system, tedious work of assessment of every
that uses various kinds of technology such as patient's detail and keeping the entire data safe
wearable devices, the Internet of Things, or and secure is now more efficient.
internet connectivity to access information and
connect between people, materials, and Although PWAs and AI in healthcare
institutions that are under healthcare system system applications had significantly improved for
service. This service manages and intelligently the past few years, the advancement tends to be
responds to the medical ecosystem. delimited by several issues. According to Loreto et
al., [11], some issues involving PWA include its
But despite these, existing smart security flaws, design flaws issue that exposed
healthcare system applications are still limited by their users to a possible cybersecurity attack that
several constrains. In fact, the study of Kumar et infers the victim’s history of visited PWAs.
al. [7] concluded that the performance of these Meanwhile, in the study of Gambhir et al. [12],
applications is affected by the network conditions even though most popular browsers support PWA,
in which the mobile devices are accessing the web. there are still issues regarding the features and
For instance, the transmission medium, such as compatibility. Progressive Web Application is not
bandwidth, reliability, and stability of the optimal on Apple’s iOS. The absence of features
connection are just few of the affected like web push notifications, lack of installation
components of the network condition. prompt, and the full-screen mode are some of the
Furthermore, in their study, Rego et al. [8] downsides of PWA in iOS. In addition to that,
explained that ironically, while applications used WebKit, Safari’s engine, has announced that they
in a working environment should ideally improve are not supporting several APIs that will give
its process, the network itself can slow down its access to the native functionality [12]. Due to the
performance and traditional mobile development limitations that iOS and other browsers have
is incompetent. when it comes to Progressive Web Application
now delimited some of its functionality. Moreover, 1. Research journals articles were obtained from
in the case of AI, in the study of Jian [13], issues reputable peer-reviewed journal database
such as security issues, AI errors, and privacy libraries.
issues, and the most controversial is the ethical
issues are what AI is facing.[13].
2. Research journal articles should be published
In view of those mentioned above, this from the year 2016-2021.
paper aims to discuss the impacts of the
applications of recent improvements of 3. A research journal should focus on PWA and AI
Progressive Web Application and Artificial in Smart Healthcare system, other mobile
Intelligence. In addition, it also aims to create a development approach that can cater to smart
comparison of other development approaches that healthcare system, or has the same research
also cater to smart healthcare system applications. interests, including other technologies that can
This paper will focus on answering the following address the problems of smart healthcare system
questions: systems.

4. A research journal that provides a

1. What are the issues and challenges of PWA
comprehensive review of how the said
with AI in healthcare system?
technologies will give viable solutions to the
stated issues and challenges.
2. What are the solutions that can address the
stated problems?
The result will be presented in a table.

3. Which among mobile development approach

2.2 Identifying the Issues and Challenges
technologies can be the best to cater to smart
of PWA with AI in Healthcare system
healthcare system?
Systems
2 Methodology
The findings for the issues and challenges
of Progressive Web Application and Artificial
2.1 Defining Search String
Intelligence in the field of healthcare system were
The findings of this study in this literature identified by reviewing the collated journal
review were published studies collected from articles from the various electronic database
Google Scholar, Science Direct, Research Gate, and sources. Furthermore, the current status in
Semantic Scholar. The keywords used to search implementing smart healthcare system using PWA
were a combination of pwa and ai in healthcare and AI was also identified and discussed
system, progressive web applications, artificial accordingly.
intelligence, progressive web application and
2.2.1 Advanced Search
artificial intelligence in the field of healthcare
system, issues, and challenges of smart healthcare
An advanced search for the current
system, and healthcare system issues, mobile
status and issues and challenges of PWA and AI in
development approaches. The data gathered from
healthcare system applications was done; all data
the initial searches in the following electronic
collected from the sources were sorted out using
database used criteria to break down the number
the given criteria to select the best appropriate
of the relevant studies in the review. The selected
journal articles.
criteria include the following to search for the
most relevant article:
All journal articles collected without
practical discussion were eliminated from the
study. While the other journal articles that
showed likely results were furtherly analyzed and discussed regarding their capabilities and features
reviewed. All collated issues and challenges that can cater to the issues and challenges.
together with its references will be presented in a
table. With this, the current issues and challenges A feature comparison was done by
of PWA and AI in healthcare system applications presenting them in a table. After comparing the
were discussed. features from the table, the best approach that can
cater to smart healthcare was considered. A more
2.3 Determining the Solutions for Smart in-depth study and analysis on the chosen
Healthcare System Problems approach were done. A SWOT (strength,
weakness, opportunities, threats) table analysis
A study of the possible solutions for every was also done to further evaluate the chosen
issue and challenge in the PWA and AI in approach.
Healthcare system systems was conducted, and
several solutions were identified. 3 RESULTS AND DISCUSSION

This paper focused on utilizing 3.1 Search String Result

Progressive Web Applications for smart
healthcare system. Additionally, a minimal In Table 1, the list of research databases
implementation of Artificial Intelligence was also where journal articles were taken and the
included. Thus, this paper identified both corresponding number of results were presented.
solutions from PWA and AI for the improvement
of smart healthcare system. Other technologies
that can address the issues are also added and
discussed including other mobile development
approaches that can cater to smart healthcare
system. Table 1: Search String Filtered Result

2.3.1 Identifying the Solutions Research Database Filtered Results

A list of all selected journal articles was Google Scholar 478

reviewed to identify the issues and challenges of
Science Direct 370
smart healthcare system and their solutions. And
all possible solutions were listed and further
Semantic Scholar 486
studied. A table was created to list the suggested
solutions and its references to the stated issues
ResearchGate 299
and challenges. Reviewing back the stated issues
and challenges of smart healthcare system in
Presented in Table 1 is the result of the
order to select the best possible solutions to
search processes to collate journal articles for this
them.
study. A set of criteria was used to narrow the
search string and select the articles. Keywords
2.4 Comparing Different Mobile
were also utilized further to filter the results of
Development Approaches that can cater to
the searched journal articles. A total of numbers of
Smart Healthcare System forty journal articles were gathered for this study.

This section presented the different 3.2 Issues and Challenges of PWA with AI
possible solutions that can address to smart
in Smart Healthcare system
healthcare system problems. The solutions were
 Table 2 shows the summary of issues and and data inconsistency will occur. In the study of
challenges enumerated and presented from Guan [13], stated that, even though reports have
various peer-reviewed journal articles. been claiming that systems are more reliable and
accurate, but concerns regarding this still entail an
Table 2: Issues and Challenges of PWA and AI in accuracy issue, in the context of diagnosing, which
Healthcare system systems. does not apply to all patients. The issue of
accuracy also affects the reliability of the
application, which in the case of health care
Issues and Reference applications, misuse of medical knowledge [2].
Challenges
In the study of Lee and his colleagues
Accuracy [26], [27], [29], [28], [29] [10], they concluded that, after a systematic
[30][34][36] review of the implementation of PWA in smart
healthcare system, several aspects of security and
Security and [10], [11] [13], [15],[17], privacy issues were identified. In the review of the
Privacy [19], [20], [21], [22], implementation of smart healthcare system using
PWA and AI, security and privacy issues are one
Ethical Issues [13], [18], [19], [20],[32]
most raised concern [11]. Security and privacy, as
defined by Guan [13], safety, privacy,
Compatibility [3],[8], [11], [12] [16], [17],
transparency, and fairness of the information in
[21],
the mobile application are all important and
should be considered consistent in medical ethics.
Design [3], [8], [16], [10], [11],
These aspects constitute vital rules and norms for
[12], [17], [18], [20], [21],
a trustworthy application for the patients. Having
[23]
dependently relied on these applications, said by
Khan and his colleagues [15], strong security must
Two emerging technologies under web
be imposed on these applications as it contains
development are Progressive Web Application
personal information as well, and to guarantee
and Artificial Intelligence [1] that can be applied in
that users of these applications can rely on this
healthcare system Services, which is currently
platform. But new types of security attacks and
gaining popularity in research [2]. However,
privacy-invasive attacks are being an issue not
despite that PWAs and AI in healthcare system
only in healthcare system applications but also in
applications had significantly improved for the
other kinds of applications, this has been an issue
past few years, the advancement tends to be
since technology emerges [17]. Similarly, in the
delimited by several issues [11] [12]. Here are
study conducted by Gerke et al. [19], cybersecurity
several results of the implementation of smart
is being an issue in the integration of AI in smart
healthcare system applications using Progressive
healthcare system.
Web App and AI and their issues and challenges.
In the medical setting, AI is one of most used
According to Khan et al. [15], accuracy is technologies owing to its ability to study the data
one of the main drawbacks of smart healthcare and actually improve it. However, it has a major
system. The accuracy issue pertains to how drawback: the vulnerability of the underlying
accurate and reliable the information or content is infrastructure to both physical and cyber threats.
presented in the application. Because the content For instance, a conducted study shows the
in healthcare system applications is usually based exploitation of such vulnerabilities by cyber actors
on more than one source of information, the and criminals that result in them stealing or even
platform’s accuracy should be high enough to be a influencing the flow of money and essential
reliable source if not, issues such as medical records [19] [20]. Moreover, Linden [21]
misinformation, misdiagnosis, miscommunication, mentioned that even push notification, a feature of
PWA, can also pose security threats because it can experience the full potential of PWA, most
be used to phish passwords or to lure a user to the especially patients and hospital staff who needs to
attacker’s website. Security is a crucial aspect in use it [17] [21].
terms of implementing healthcare system
applications as it can not only affect a patient’s Related to compatibility is the issue of the
status, but legal matters will also be at risk [22]. design, which under design has sub-components
such as the lack of documentation and API.
Aside from that, ethical issues, according According to Wahlstrom in his study, the issues in
to Wisetsri and his team [18], explained that AI the design and responsiveness of the interface
systems are used to justify that human physician affect the usability of healthcare system
will not be replaced by machines to make better applications [3] [8]. Since this application is
clinical decisions. But to provide training, medical marketed towards patients and medical
research, diagnosis, medical treatments, decision- authorities, the usability of the application is
making supports. Ethical problems in the field of important as they are constantly under pressure
healthcare system include safety of the patients, and hectic times. Thus, the design of the
high efficacy, data privacy, information and application should be user-friendly and easy to
informed consent, the right to decide, the “right to follow [16][10][11]. Another issue under
try,” costs, and access. With AI, however, it is not consideration of design is the lack of
enough to follow these basic principles [13]. documentation; this might be because of the fact
According to Sun and his colleagues, ethical that a lot of newly developed web technology was
challenges include challenges related to moral used, which not always were that extensively
principles and moral considerations implied in the covered in the documentation. [12] [17]. Also,
use of AI in healthcare system. Failure to comply Wenzel et al. [24] stated that “the advantage of a
with these, implementation of smart healthcare web browser-based multi-platform application
system will be for nothing, public trust is usable on any device comes at the price of being
important when implementing a platform most limited to a web browser’s provided resources and
especially in the field of medical [19] [20]. Application Programming Interfaces (APIs)”
[18][20]. In relation to compatibility issues is the
In the study of Wahlström [3], another API issue, because support for service workers
concern in the implementation results of PWA and (set of APIs), the core technology of PWAs, is
AI in smart healthcare system is the issue of under development for the major browsers that
compatibility. In the context of the PWA currently do not support it, namely the Safari and
approach, one of the factors that may hinder the Edge browsers concluded by the study of
adoption of the healthcare system application is Walstrom [21][23]. Given the various issues under
browser compatibility [8][11]. Although most of the design category, a PWA can still be
the PWA features are available on all platforms, implemented; however, as mentioned above, the
Apple’s IOS, on the other hand, is not entirely full potential of PWA cannot be achieved without
compatible with some of the features of PWA. In solving these issues [25].
addition to that, WebKit in, Safari’s engine is still
underdeveloped; it also doesn’t support several These are the reviewed issues and
APIs that will give access to the native challenges of PWA with AI in the implementation
functionality [12] [16]. The lack of compatibility of of smart healthcare system.
the full feature of PWA in iOS includes web push
notifications, offline mode, lack of installation In this paper, there are two leading
prompt, and the full-screen mode. PWA can be technologies under web technologies and
visited in any kind of browser; however, the issue concepts that could cater to the above issues and
of browser compatibility with few versions of challenges, which are Progressive Web
browsers may hinder some features and will not Technology and Artificial Intelligence.
3.3 Solutions to the Issues and Challenges use of Service [17] [21]
Workers [35]
The previously mentioned issues and
challenges were present during the early 2) Using Cache
development of PWA and AI in healthcare system. API to extend the
Fortunately, the recent improvements in PWA and PWA potential to
AI have upgraded their features to make them IOS
more applicable in the medical setting.
3)Using the
Table 3: Solutions for the Stated Issues and Background Sync
Challenges of PWA and AI in smart healthcare API
system Design 1)Utilizing [8] [17] [25]
Issues and Suggested Solution References Application Shell [37]
Challenges
Accuracy 1) Integration of [26 [27] 2) Using New Web
more precise [29] [28] Push APIs
Medical [29]
Knowledge [30][34][36] 3) Using the
extension of PWA
2) Integration of which is the PWA-
Machine Leaning EU (end-user)
and Deep approach
Learning in AI
Under the issue of 1) Accuracy, the use of
Security and 1) Utilizing Cloud [2] [5] [10] more accurate medical data and the right
Privacy Storage using [27] [32] integration of AI in smart healthcare system
REST service [34] systems will provide a better accurate result.
Implementing an effective architecture of smart
2) Adding a healthcare system using AI and PWA will offer a
Service Worker wealth of improvements to the healthcare system
industry [26 [27] [29].
3) The use of
Medical Also, in the study of Ahuja [36], suggested
Librarians that the integration of Machine Leaning and Deep
Leaning improves the performance of AI in terms
Ethical 1) Compliance [13][18] of image classification, text analysis, and speech
Issues with ethical and [19] [20] and facial recognition
medical principles [32]
Because AI is mainly the one who works
2) Instilling public the magic of rationalizing the situation, the
trust towards accuracy level of this has been one of the critical
based decision issues of any application that tends to present
important results. But according to Mansour et al.
3) Transparent [28], during their experimentation regarding the
process of diagnosis of heart disease and diabetes, the
integrating AI accuracy of Artificial Intelligence diagnosis has
assistance exceeded the accuracy level due to the recent
Compatibility 1) Utilizing the [2] [8] [11] improvement and discovery under AI. In a similar
study, Kamruzzaman [29] concluded that the comply and follow the medical-legal laws to
recent development of AI could be used to ensure that AI and PWA will be successfully
produce detection of cancers in the early stages, implemented in a way that is ethically and legally
finding the genetic code linkages, developing new correct [13] [20] [32].
drugs, and other healthcare system purposes [30].
And for the Compatibility issue,
For the issue of 2) Security and Privacy, according to Biørn-Hansen and his team [17],
according to the study of Reeves and his features such as offline capabilities, push
colleagues [32], the most significant challenge notifications, and installation prompts are
they have encountered in their implementation of available regardless of any approach. The Cross-
smart healthcare system is how to balance ease of platform is compatible in the hybrid and PWA
access, maintain the security of contact approaches; while the latter with some limitations
information while continuing to preserve clinical with regards to supported operating systems and
team members’ time, and reducing cognitive load. platform feature API access.

According to Terán et al. [34], deploying However, in a survey conducted by

the database of the healthcare system using the Holsby [35], the recent advancement of PWA in
PWA in the cloud and can be accessed from any browser compatibility has upgraded. As a
device regardless of the type of connection. With multiplatform approach towards web application
the use of Representational State Transfer (REST) development, PWAs are intended to work on most
services, necessary measures to ensure the desktop and mobile platforms (i.e., iOs, Android,
security and integrity of the medical information Windows, etc.). Such a feature is plausible with the
are done. accessibility of the application via browser, which
is already available on most operating systems
Lee and his team [10], also added a [40]. But what sets it apart is that it can
security concern. The use of service worker is only independently function of the network conditions
supported on HTTPS websites which states that due to three essential key components: the Cache
each registered service worker script is delivered API (enables the storage and retrieval of content),
over Transport Layer Security (TLS). This means Service worker (intercepts network requests), and
that the prevention of a script injection from a Background Sync API (enables cache network
man-in-the-middle (MITM) attacker (attempts to request).
abuse the service) will be prevented.
Lastly, for the issue of Design with sub-
As for the 3) Ethical Issues, in the study issue components such as the lack of
of Gerke et al. [19], the components of PWA and AI documentation and API access. In the study of
in smart healthcare system application that needs Tandel and his team [25], the utilization of
to realize is the full potential of AI in healthcare Application Shell provides an optimal user
system: experience. Application Shell Architecture is
served up by the Service Worker. The content is
delivered that is often cached by the service
1) informed consent to use of shared data, worker from its source through API requests. This
2) safety and transparency of medical records, is the first-to-render user interface of the PWA,
3) algorithmic fairness and biases, and making sure that the user experiences fast
4) data privacy rendering of content to avoid the feeling of a slow
application most especially when used by medical
It is required for all stakeholders, authorities that has hectic schedules. The AppShell
including AI makers, patients, healthcare system is made up of static assets and interface
professionals, and regulatory authorities, to components, meaning it should not depend on any
external dynamic data to render. While having the Discussed in this section is the feature
application shell the content load separately and comparison of Progressive Web Application
improves the user’s perception of the (PWA), Native Applications and Hybrid in terms of
performance and usability of the healthcare the characteristics that make them suitable for
system application [17] [38] [39]. smart healthcare system applications.

Additionally, even at present, the

On one hand, native mobile application
traditional approach towards PWA is limited to
development approach consists of using a specific
the regarding of users to act as co-designers. De
Software Development Kit (SDK) that is specific to
Andrade Cardieri and Zaina [37] suggested a
every operating system. For instance, Android
PWA-EU (end-user) approach, which is an
applications often use the java programming
extension of the PWA architecture together with
language and Android frameworks while iOS apps
end-user development (EUD) concepts. The
use Objective-C and Apple's frameworks [16].
approach is known to result in two positive
benefits. The first one is that it is used by the
On the other hand, as its name implies, a
developers on the design/development time, and
hybrid app can appear and work as a native
the other is that it allows end-users to select a
application with the help of hybrid development
variety of designs depending on their preferences,
frameworks, and at the same time, as an
ultimately making them participate in its final
application that is built with web-based
design. Hence, in a nutshell, end-users are given
technologies. This “hybridization” is done through
active participation due to the meta-design
the wrapping of the web-based code in a native
concepts provided by this approach.
layer/container and use of a generic JavaScript
Meanwhile, with the use of new Web Push API to have access to most of the native apps.
API available in certain browsers, Progressive
Web Apps can provide a similar experience as the For further feature comparison of the three
native apps by leveraging push notifications to mobile development approaches was presented in
draw users back into the app [10] Table 4.

While having PWA as the emerging Table 4: Comparison of Native, Hybrid, and PWA
technology of smart healthcare system
Features Native Hybrid PWA
applications, before there were native apps and
hybrid applications. Through the past decade,
Installable ✓ ✓ ✓
mobile users have witnessed the evolution from
native apps to hybrid ones, until eventually the
modern-day apps, the PWAs.
Offline support ✖ ✖ ✓

Being the predecessor of the latter, there Background ✓ ✓ ✓

are a number of issues and limitations associated synchronization
with native and hybrid apps. Hence, in the
following section, each will be analyzed in detail. Cross-Platform ✖ ✓ ✓
Availability

Security Layer ✖ ✖ ✓
3.4 Comparison among Three Mobile
Development Approach that can cater to Desktop Capability ✖ ✖ ✓
Smart Healthcare System
Updated ✖ ✖ ✓
 the integrity of the application. While PWAs can
Push notification ✓ ✓ ✓ only be accessed via a secured layer (HTTPS)
✓ - is applicable, ✖ - not applicable which provides a high level of security for the
application. The safety and security of medical
Installable is the feature of having the information and patient information as well as a
ability of a mobile application to be installed on a top priority of a smart healthcare system
user’s device [2]. This feature is possible among application.
the three-development approach. In the context of
medical settings, the smart healthcare system Desktop Capability is a feature that
applications should be installable every time it is enables a desktop approach which means they can
needed most especially when the situation is be viewed and used on laptops and desktops
critical. computers without any problem. Every
application developed using the PWA approach is
Offline support pertains to a browsing desktop compatible not unlike the Native and
experience even when a browser is offline [10]. Hybrid approach where apps can only be accessed
This feature is only available in Progressive Web on mobile devices with the required and specific
Application. According to Adetunji and his team, platform [2] [21].
every app developed using the PWA approach has
the ability to run to a great extent without an Updated constantly pertains to how
internet connection due to the presence of service frequently the development update is being
workers. Having this feature in a smart healthcare distributed. Adetunji and his colleagues stated
system application will greatly help its users use that applications developed using the Native and
this whenever it is needed even when situations the Hybrid development approach are usually
such as slow-speed internet connection occurs. downloaded and can only be updated whenever
an update is accepted by the owner of the mobile
Background synchronization is the device. While PWA approach due to the fact that
ability to synchronize data with the server in the the apps are loaded from the webserver, once an
background [8]. This feature is possible among the update is made by the developer, the apps are
three-development approach. automatically updated and integrated on all
mobile devices where the app resides which also
Cross-Platform Availability is the ability facilitates the same view for all users. Information
for a mobile app to be distributed or made within the healthcare system application should
available on all mobile platforms. Unfortunately, be constantly updated to ensure the latest update
this feature is not possible for the native of the medical information of a patient.
development approach. As for the Hybrid
development approach, the use of JavaScript Push Notification is the ability to display
Bridge made it possible to run across other information to users. This feature is available for
platforms, while the PWA development approach the three-development approach being compared.
is the only development approach that enables a Surprisingly, unlike any other web application,
mobile application available to all mobile with the use of caching assets, PWAs are able to
platforms without re-engineering for each offer an offline experience, unlike regular web
platform and also with no overhead incurred [2]. apps. With the help of service workers, they are
also able to send user push notifications just like
Security Layer pertains to the security of native applications [21] Push notifications are
the application whereas mobile applications important to healthcare system applications to
developed using the Native and the Hybrid provide a heads-up to its users for important
development approach are not deployed on a alerts.
secured layer which can result in a compromise in
 Table 5 presents a SWOT analysis [2] Adetunji, Oluwatofunmi & Ajaegbu, Chigozirim
adapted from Rego et al. [8], which further & Nzechukwu, Otuneme. (2020). Dawning of
compares the PWAs with other developmental Progressive Web Applications (PWA): Edging Out
approaches. By definition, SWOT analysis refers to the Pitfalls of Traditional Mobile Development.
the techniques that enable an organization to American Scientific Research Journal for
identify its strengths (S), weaknesses (W), Engineering, Technology, and Sciences. 68. 85-99.
opportunities (O), and threats (T) related to its
competitors. [3] M. Wahlstrom. (2017). Exploring progressive
web applications for health care: Developing a

Table 5: SWOT Analysis of PWA Strengths Weaknesse Opportunit Threats

s ies
In this analysis, Strengths are
characteristics of the PWA that establish an 1) PWAs 1) PWAs 1) Efficient 1)
advantage over competitors and Weaknesses give run only on do not developme Restrictiv
it and disadvantage. Opportunities are elements in the HTTPS have full nt of the e
the environment of the PWA that can be used to protocol access to applicatio functional
making it all low- n, since it ity on the
gain advantage and Threats are elements in the
highly level avoids the Safari iOS
environment that represent a risk to the PWA. secured [2] features of waste of browser
[8] [10]. mobile time and [3] [8]
Overall, it can be summed up that based devices [2] resources [17] [21].
on each app’s strengths, weaknesses, 2) The [8] [11] spent on
opportunities, and threats, PWA is the best single app [17]. the
application to be used in the healthcare setting. is developme
developed 2) Not too nt of a
that can run many native app
4 CONCLUSIONS AND FUTURE using browsers [8]
RECOMMENDATIONS mobile web support
browsers this
This paper has demonstrated the fact that [2][3] [8] technology
PWAs have invaluable potential when it comes to [11] [17]. as of today
their applications in smart healthcare system, [2] [11]
[17].
despite them being still not widely adopted by
PWA to gather patients' self-assessments.
many. When combined with AI, PWAs were found
to have indispensable features (i.e., offline
[4] Habeeb, Ahmed. (2017). Introduction to
support, security, and performance) that makes
Artificial Intelligence.
them a great candidate application to be used in 10.13140/RG.2.2.25350.88645/1.
the medical setting. It is recommended that future
works must validate the disease-based diagnosis [5] Tuli, S., Wander, G., Wander, P., Gill, S. S.,
models of PWAs and AIs and combine them with Dustdar, S., … Rana, O. (2019). Next Generation
other digital health tools. Technologies for Smart Healthcare system:
Challenges, Vision, Model, Trends and Future
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