IoT Equipped Intelligent Distributed

Framework for Smart Healthcare Systems

*
Sita Rani1, Meetali Chauhan2, Aman Kataria3 and Alex Khang4

1Department of Computer Science and Engineering,

Gulzar Institute of Engineering and Technology,
( Affiliated To I.K.G. Punjab Technical University, Kapurthala)
Gulzar Group of Institutions, Khanna ( Ludhiana)
Punjab, INDIA- 141401.
[email protected]

2
Department of Computer Science and Engineering,
Gulzar Institute of Engineering and Technology,
( Affiliated To I.K.G. Punjab Technical University, Kapurthala)
Gulzar Group of Institutions, Khanna ( Ludhiana)
Punjab, INDIA- 141401.
[email protected]

3
Project Associate
CSIR-CSIO, Chandigarh
INDIA-160030
[email protected]

4Professor of Information Technology,

GRITEx and VUST,
VIETNAM .
[email protected]

Abstract: The fundamental aim of the healthcare sector is to incorporate different technologies
to observe and keep a track of the various clinical parameters of the patients in day to day life.
Distant patient observation applications are becoming popular as economical healthcare services
are facilitated by these apps. The process of data management gathered through these applications
also require due attention. Although cloud facilitated healthcare applications cater a variety of
solutions to store patients record and deliver the required data as per need of all the stakeholders
but are affected by security issues, more response time and affecting the continues availability of
the system. To overcome these challenges, an intelligent IoT based distributed framework to
deploy remote healthcare services is proposed in this chapter. In the proposed model, various

1
entities of the system are interconnected using IoTs and Distributed Database Management
Systems is used to cater secure and fast data availability to the patients and health care workers.
The concept of Blockchain is used to ensure the security of the patient’s medical records. The
proposed model will comprise of intelligent analysis of the clinical records fetched from
Distributed Database Management Systems secured with Blockchain. Proposed model is tested
with true clinical data and results are discussed in detail.

Key Words: Blockchain; Distributed Database Management System (DDBMS); IoT; Response
Time; Security; Smart Healthcare.

1. INTRODUCTION

Health is the most essential aspect of living. In current times, the modern
society is suffering from a number of problems like multiple organs
failure & various chronical diseases due to stress & anxiety. So, the
society requires appropriate facilities, resources, and services from the
hospitals such as medications, doctors & nurses on time [1, 2]. With sharp
rise in chronic diseases & pandemic era of Covid-19, a sudden hike can
be seen in usage of smart healthcare systems. In order to provide efficient
healthcare services to the patients, a major role is played by smart
healthcare system. This has reduced mandatory physical presence of
patients at hospitals [3-5]. E-healthcare system have provided high
quality care to the patients by providing online medical services at homes
itself. Earlier, there was a communication gap between patients & doctors
due to unavailability of doctors in case of emergency. But now, advanced
communication systems and Internet of Things (IoT) technology has
made this possible by providing effective communication paradigm. IoT
is an appropriate solution to administer such problems occurring in

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healthcare systems. This paradigm is used to collect patients’ data which
is analyzed by doctors to provide medication & medical treatment
remotely. This automation in smart healthcare monitoring system has
reduced risk of patient’s life by providing on time medical help to them
in case of emergency. There are various monitoring systems such as
sensors to collect data, IoT gateway to distribute data, and cloud-based
storage for storing patients’ data to get examined by doctors. IoT acts as
a chain, responsible to collect all the information communicated from
smart devices via internet. Patients can receive their health records using
mobile healthcare apps [6].

1.1 Internet of Things (IoT)

IoT is a concept which reflects connectivity of devices, services, and

system in terms of machine- to -machine and man- to –machine [7, 8].
This helps to achieve automation which can be seen in a wide range of
areas, such as smart cities, healthcare, traffic management, logistics, and
waste management. IoT has provided incredible outlook to modern
healthcare system by facilitating human life with healthcare apps, fitness
programs, remote health monitoring, emergency help, etc. In
collaboration with medical devices, such as sensors & imaging devices,
the service providers can provide best guidance to the patients. Thus, IoT
based healthcare services are expected to reduce medical costs and
increase for the patients.

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Recently evolved IoT-based wireless technologies have helped to prevent
& diagnose chronical diseases and provide real-time monitoring.
Database records and servers play a vital role to maintain medical
records, and provide facilities to the patients in need of hour. Table.1
describes the IoT integrated advanced technologies which are useful in
domain of healthcare [9].

Table 1. IoT-integrated Technologies and Their Benefits in the Domain

of Healthcare

Technology Description
Big data Data is stored which provides a quick review
easily in healthcare systems when required
Helps to maintain clinical records, bills, medical
history of patients
Cloud Useful to store on demand data & specifies the
computing content via internet
This helps to visualize the data resources which
helps the doctors to work effectively
Smart sensors This device provides accurate results & monitors
all medical parameters
This device controls various aspects such as blood
pressure, oxygen levels, temperature & sugar
levels
Software It is used to get associated with patients’ data,
medical tests & reports
It reduces the communication gap between
doctors & patients
Artificial This concept evaluates, predict, analyze & helps
intelligence in decision making

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 This concept with help of algorithms predict &
controls diseases
Actuators This device helps to maintain accuracy in
calculated parameters
This device helps to control system & makes it act
according to the requirements
Virtual Reality It provides digital information & improves
patients safety
It provides real-time information with integration
of humans with electronic systems

A generalized IoT- based automatic framework developed for healthcare

systems is shown in Fig. 1. It describes the results predicted using IoT
integrated technologies [10-12].

Fig.1 IoT- based Automatic Design Framework

The major role played by IoT in the domain of healthcare is in the areas
of silent symptoms of patients. Early diagnosis might prevent severe

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illness & saves patients from untimely death. So, early diagnosis might
save patients life. In current times, the IoT based health applications focus
on medical treatments of the diseases and monitoring the health of the
patients via analyzing various parameters using smart devices. The
healthcare system is slowly switching to remote healthcare by providing
E-health services at homes. Fig.2 shows the IoT-based healthcare
application framework to facilitate the residents. There are many
applications existing for patient monitoring. In addition, various
networks such as Wireless Body Area Network (WBAN), Wireless Local
Area Network (WLAN), Radio-frequency Identification (RFID) and
Wireless Personal Area Network (WPAN) assist in automatic
identification and data capturing [13].

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 Fig.2 IoT-based Healthcare Application Framework

1.2 Smart Healthcare

Using traditional healthcare facilities, it was difficult to diagnose and

treat patients in case of emergency, which was used to cause mental
trauma, cardiovascular disorders, anxiety & depression to the patients and
their family members. With launch of smart healthcare applications and
services a wide variety of online facilities got available to people at
homes.

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 Fig.3 Smart Healthcare Services

Fig.3 highlights some of the smart healthcare services which have

provided ease to human beings with secure services, such as availability
of online appointments with doctors, storing medical records of patients,
and consultancy to the patients in case of emergency [14]. The whole
healthcare system is connected via wireless technology and database is
maintained using cloud computing.

Table 2 shows various smart applications launched with the purpose to

make them available all-time to the people. These applications facilitate
the people with various health services. They can analyze various
parameters themselves on daily basis and opt workout & healthy eating

8
habits accordingly. Various remedies can be followed without consulting
doctors just by adapting healthy lifestyle [9, 15].

Table 2. Healthcare Applications and Services

Application Services
Health Assistant Body temperature, fat, weight, BP, glucose level check
Calorie Counter Calories count from the food eaten
Pedometer Steps taken and calories burnt
Period Tracker Record of menstrual cycle in women
Google Fit Running, cycling and walking activities
Water Your Water drinking habits and alerts
Body
Heart Rate Heart beat
Monitor
Smart Watch Number of steps taken, BP, heart rate, calories burnt
On Track Blood glucose level
Diabetes
Finger Print Body temperature
Thermometer

1.3 DBMS

IoT based distributed technology plays a vital role in smart healthcare

system. Distributed healthcare system has interconnected various
medical resources with sensors and actuators such as ECG, BP machine,
EMG, and Glucometer. With sharp rise in usage of IoT, there has been a
major contribution of distributed database management system
(DDBMS) to provide efficient healthcare services to patients. The
distributed healthcare system acknowledges various parameters such as

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blood pressure (BP), sugar levels of diabetic patients etc. via health
monitoring devices. Efficient remedies & medical prescription can be
suggested by doctors in case of emergency to the patients. The purpose
of DDBMS is to extend the healthcare services from various domains of
hospitals to patients at homes. The DDBMS in collaboration with IoT-
based healthcare are dedicated to provide various services using a variety
of healthcare applications with other important resources which include
laptop, mobile phones, sensors, actuators, medical equipment, e-patients,
patients records stored using cloud computing, medical staff of doctors
& nurses, and database of patient’s records. Fig.4 shows collaborative
healthcare system comprising IoT & DDBMS [16].

Fig.4 Distributed Healthcare System

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1.4 Artificial Intelligence (AI)

Artificial Intelligence (AI) is a concept which has no boundaries in terms

of smart development. It contains the ability of algorithms in machines to
analyze the results without human intervention. The induction of AI with
smart devices in the domain of healthcare has set an ideology for
healthcare systems to a new level [17]. With advancement in healthcare
systems, health status of people has reached a new level. AI embedded
machines comprising sensors help to monitor and diagnose symptoms of
diseases at earlier stages. This whole system acts like a robotic nurse for
patients who takes care, monitor, and record patient’s health condition
with consistency. Using AI algorithms, various roles & responsibilities
are carried out which requires intelligence in the areas of image analysis,
speech recognition, under water communication, pattern recognition &
decision making [18-23]. This provides assistance to suggest best way to
cure health. The collaboration of AI algorithms makes it easier to make
accurate predictions in laboratories, such as blood group detection, and
disease predictions [24]. So, AI is the preferable choice when it comes to
decision making [25].

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 Fig.5 Smart Healthcare using AI

AI algorithm is a mixed composition of various technologies which

includes natural language processing (NLP), machine learning, neural
networks & robotic systems. AI is used in multiple fields of smart
healthcare, such as cancer treatment surgeries, neurology, and
cardiology. Fig.5 provides an outlook of AI based healthcare system. AI
based healthcare system requires a balanced approach which can be
achieved through support from all domains such as doctors, nurses, labs,
radiologists, pharmacy, and emergency medical services.

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1.5 Blockchain Technology

Blockchain in healthcare is linking of patient medical records, doctors,

hospitals, nurses, medical staff , and health communities for the welfare
of patients [26].

Blockchain is a kind of framework used to provide secure data exchange

and management process [27]. The basic idea of blockchain is to share
data via peer-to-peer network. This helps to communicate data to
authenticated users. They can modify or delete data records accordingly.
In healthcare sector, the presence of sensitive information which needs to
be secured from third party users to maintain a privacy & security is
critical. Due to such sensitive content, blockchain concept has been
incorporated in healthcare sector to handle security systems. In addition,
the blockchain concept has been used widely to resolve problems of
central administration in database securely [28] .

Blockchain has eliminated the need to govern or manage the

authentication based on trust & transparency. Blockchain has further
enhanced in terms of privacy & security using cryptographic hash
functions. Some of the blockchain applications in healthcare are
compilation of visitor’s details, patients’ records, records of lab results,
and treatment details of patients. All such details are ensured by
blockchain process which includes ambulatory services & data
assistance. A commonly observed problem with medical data is the

13
duplication or mismatch of details during analysis of patient’s records.
Such issues are tackled using hash function in the blockchain process
which includes hashed ledger instead of using a primary key. In addition
to this, a blockchain concept is based on certification, due to which claims
can be automatically verified whenever required. Blockchain has reduced
data compilation as well as cost [29]. It has also reduced wastage &
chances of fraud due to digitization of complicated datasets [30].

2. SECURITY ISSUES IN SMART HEALTHCARE SYSTEMS

There are many security issues in the deployment of smart healthcare

systems, discussed below:

2.1 Communication Media

Healthcare devices are connected to global as well as local networks via

wide range of wireless links such as Bluetooth, GSM, WIFI, and Zigbee.
But wireless network makes traditional security schemes less appropriate.
Therefore, it is very difficult to manage security protocols which can
handle both wired and wireless technologies equally [31].

2.2 Topology Issues

IoT-integrated healthcare devices are connected over various types of the

network for data collection, storage, and computation [32]. But the
problem occurs when they exit from network due to certain failure. This
cause dynamic network topology issues [33, 34].

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2.3 Scalability

With increase in IoT devices, there is requirement to integrate them in

global information network. Therefore, to design a scalable security
scheme without considering security related requirements become a
tough task [6, 35].

2.4 Mobility & Energy Constraints

IoT based devices are dynamic in nature. They work on batteries. But, as
different networks have different configurations, more efficient security
algorithms are required for mobility [36, 37].

2.5 Memory Constraints

Most of the IoT based devices have limited memory, which is one of the
major issues faced in storage of data and functioning of the devices [38].

2.6 Multi-Protocol Network

IoT devices communicate with other devices over the local network using
network protocols. In addition to this, some IoT devices communicate
with IoT service providers via IP network. But security experts face
problems related to sound security solutions for multiple protocol
communication [39].

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2.7 Tamper Devices

An attacker might try to tamper the devices in physical mode and may
extract cryptographic secret content. He might modify, delete, or replace
the content with malicious data [6, 40].

3. EXISTING HEALTHCARE SYSTEMS

The task of data management plays a very important role to administer

different types of the services in smart healthcare systems. The efficient
storage of patient health data facilitates disease diagnosis, vaccine
scheduling, and deployment of other health services. In the current
scenario of smart healthcare framework, penitent health data is
maintained in the electronic form using cloud architecture. Over the time,
different authors have proposed different secure techniques and
frameworks to store patients’ data. In [41], authors presented a novel
approach for sharing patient data in a secure way. Using this technique,
patients’ data is organized and shared through a semi-trusted server. In
this technique, every attribute of each patient record is saved and
transmitted in encrypted form. The scalability of the medical data is the
main feature of this method. In [42], another conflux approach using
encryption mechanism and digital signature is proposed for secure
transfer of medical records. In [43], authors discussed the disadvantages
of the approach presented in [42], and introduced a new method to

16
overcome the issues. Authors in [44-46], proposed a number of
authentication mechanisms and data transfer protocols to secure the
storage and transfer of medicals records on different types of machines
and mobile devices. Many authors proposed different privacy preserving
techniques to secure electronic medical records in the distributed smart
healthcare systems. Although, lot many efforts are put by the researchers
to secure medical data of the patients in smart medical systems adopted
by various hospitals, this can also make the faster access of the records
inconvenient in emergency situations. Emergency care providers and
doctors may face hurdles to provide first aid and other medicals services.
To resolve these challenges, medical industry, researchers, and
academicians have introduced many smart gadgets/devices to monitor
individuals’ health and store health parameters [47, 48]. But these
devices are vulnerable to data thefts and failures [49].

To address various security issues in exiting healthcare systems, many

blockchain models are proposed by the researchers. More secure
solutions are proposed by storing the hash tables for cloud data in the
blockchain nodes [50-53]. Another, more secure technique is presented
by the authors in [54]. This model is proposed to access medical records
by the doctors and patients. In [55], authors proposed a multi-workflow-
based system to manage various processes, like clinical trials and
complicated surgeries. To store patient’s medical data more securely, and
manage personal information efficiently, a novel platform framework is

17
 proposed by the authors [56]. Remote monitoring of the patients and
wearable gadgets are highly prone to data stealing [2]. To identify
malfunctioning devices in a network is also a tedious job. Many authors
carried out their work focusing these challenges. In [57], authors
proposed a novel model to address the privacy challenges in remote
monitoring systems. Few other systems are also proposed by the
researchers for secure smart-contract based remote patient monitoring
[28, 58, 59].

Table 3. Comparative Analysis of the Exiting Work with

Proposed Work

Ref. Year IoT- Medical AI- Distribute Locate

No. Facilitated Records Based d Record Malfunctioning
Remote Smart Storage IoT-Device
Monitorin Contrac
g t
[55] 2020  ✓ ✓ ✓ 
[57] 2018 ✓ ✓ ✓ ✓ 
[58] 2019 ✓ ✓ ✓ ✓ 
[28] 2020  ✓ ✓ ✓ 
[59] 2020  ✓ ✓ ✓ 
[60] 2020  ✓ ✓ ✓ 
[61] 2020  ✓ ✓ ✓ 
Proposed ✓ ✓ ✓ ✓ ✓
Work

The model presented in this paper stores patient health records in a

blockchain based network. This secure system is proposed for IoT-based
patient health monitoring. Smart contract is supported by Artificial

18
Intelligence to locate the malfunctioning nodes. We have used 5 different
attributes to characterize the performance of the proposed model. Main
features of the various existing solutions proposed by the authors, and
their comparison to the proposed system is summarized in Table 3.

4. PROPOSED MODEL

The proposed framework is implemented in four layers, i.e., Hospital,

remote IoT-integrated medical nodes, distributed medical records, and
AI-based smart contract, as shown in Fig. 6.

Fig. 6 Proposed Model: Framework

• Hospital- Basically, this layer acts as an information warehouse.

It keeps complete patients’ information using various attributes;

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 few important ones are patient id, patient name, disease history,
and medicines prescribed.
• Distributed Medical Records- This layer is integrated with
hospital layer. Medical records stored in the hospital layer are
distributed across the different nodes to make them secure using
blockchain network.
• AI-based Smart Contract-This layer is merged between hospital
and distributed medical records layer, IoT nodes and hospital
layer, and IoT nodes and distributed medical records layer. It aids
the process of decision making, breach detection, and to check for
malicious data.
• Remote IoT-integrated Medical Nodes- These nodes are used
to sense the various health parameters of the patients and transfer
the sensed data securely to blockchain protected distributed
databases.

Working of the proposed model is depicted with the flowchart shown in

Fig. 7.

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Fig. 7 Proposed Model: Working

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5. RESULTS AND DISCUSSION

This section focusses on the results obtained with the proposed model.
The proposed model is evaluated using time taken by the transaction,
throughput, and latency. To gather results, total 5 different nodes were
deployed, i.e., 4 IoT devices to sense data, and one hospital node. The
blockchain to secure distributed medical records on the hospital node was
deployed using the Ethereum platform. Our work is deployed on the
blockchain using AI supported smart contract. The results obtained for
the deployed IoT devices, i.e., transaction processing time and average
delay are shown in Table 4 and Table 5 respectively.

Table 4. Transaction Processing Time for IoT-based Medical Devices

Processing Time (Seconds)

Number of Device 1 Device 2 Device 3 Device 4
Transactions
50 20 22 18 23
100 31 41 37 45
150 55 62 58 67
200 82 84 73 91

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Table 5. Average Delay in Transaction Processing for IoT-based
Medical Nodes

Average Delay (Seconds)

Number of Device 1 Device 2 Device 3 Device 4
Transactions
50 0.8 0.9 0.7 0.8
100 2.1 2 1.9 1.7
150 2.4 1.8 2.6 2.1
200 3.6 3.2 3.3 3

Fig. 8 Transaction Processing Time: Medical IoT Nodes

23
 Fig. 9 Average Delay: Medical IoT Nodes

As discussed above, two important parameters considered to evaluate the

deployed model are transaction processing time and average delay. As
shown in Fig.8 and Fig.9, transaction processing time and average delay
for all used IoT-based medical devices is almost similar. So, the proposed
model is highly scalable in terms of number of smart medical devices as
well as number of transactions executed. Our proposed model ensures
blockchain based secure storage and access of distributed medical records
in a smart hospital framework.

6. CONCLUSIONS

Smart distributed healthcare systems are rapidly becoming popular. They are
fulfilling the medical needs of modern society in more transparent, secure and
convenient way. Along with all these features, the proposed blockchain model
also protects the healthcare system from a single point of failure using AI-based

24
smart contract technique deployed at the hospital layer. The medical records of
the patients are stored in distributed databases. The proposed framework is
tested in real time environment for two important parameters, i.e., transaction
processing time and average delay. The proposed system can further be
enhanced by incorporating more efficient AI algorithms to improve the
processing time in the blockchain network to minimize average delays.

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