Healthcare in Asymmetrically Smart Future Environments: Applications, Challenges and Open Problems

Abstract

The Internet of Medical Things (IoMT) offers promising ways to meet healthcare needs of patients recovering in their own homes and other environments. Interconnected and resilient smart systems offer innovative and cost-effective ways of supporting patients by capitalizing on available devices and networking infrastructure. However, future environments will not be uniformly smart, and there will be asymmetries where our environments’ (home, work, etc.) resources and capabilities differ. Technological solutions will need to adapt to such asymmetries and provide high-quality service and equitable healthcare. This article presents a systematic mapping study that explores opportunities and challenges in building next-generation IoMT smart systems for future environments. The study spans academic literature published in the decade from 2011 to 2021, profiling it from three distinct perspectives: Smart Systems, Future Environments, and Tech-Assisted Health. Each perspective was explored via a Domain Expert-Driven Systematic Mapping protocol to establish where the research is focused and to identify research gaps. From an initial search of 495 studies, 113 were mapped to a set of predefined ontology classes, spanning 6 strategic focus categories. The mapping identified sensing technologies for medical vitals and sensor fusion technologies to combine measurements for more complex analysis, cloud platforms, and connectivity challenges; health conditions that have received the most attention in healthcare smart systems; issues and opportunities in handling large data volumes in integrated smart systems; as well as security and privacy challenges. We find that future middleware frameworks will require a greater degree of interoperability and maturity to fully deliver value. Promising middleware and integration frameworks will require significant adaption and refinement to coexist effectively with current healthcare technologies. Privacy and security are critical factors in healthcare but are currently poorly supported by IoT infrastructures, especially across multiple environments.