management had a lower mortality [53]. Remote patient monitoring inpatients with chronic heart failure can greatly enhance care of such patients by anticipating episodes of decompensation. This can improve communication between patients and their doctors and can increase independence of patients. A handheld device called Blue Box developed at the University of Houston with three biosensors to monitor two lead ECG, bioimpedance, and photoplethysmography was used on healthy subjects. The ECG sensor measured the RR interval and the QRS duration, and heart rate. Data from the BlueBox obtained from healthy subjects was compared to the cardiac output measured by Echocardiography and was found to have a linear correlation. Such devices may in the future be useful to remotely monitor patients with heart failure [54]. A new wearable peritoneal dialysis device developed by AWAK Techologies, Singapore, can remotely monitor automated peritoneal devices on patients and was associated with significant decrease in the number of hospitalizations per patient year and also reduced the number of days patients were hospitalized. In a study, the device showed that remote monitoring reduced the rate of hospitalization compared to those not remotely monitored with fewer days spent in hospital [55]. Remote patient monitoring also helped reduce hospitalization costs in Medicare patients with heart failure due to shorter duration of hospitalization from early diagnosis and treatment [56]. Remote patient monitoring not only can reduce costs of healthcare but also has shown to be efficient in patient management but more prospective studies with economic analysis are needed [57].
Ethical issues hold the key in telehealth due to privacy and confidentiality. The ethical challenge lies with the data leakage and abuse which has potential to harm both the patient and healthcare providers. Aspects relating to relationships, trust building during virtual visits, telehealth influences healthcare service delivery, treatments costs, quality of life, and fear of identity exploitation are some interconnected dots which highlight the ethics of telehealth [58].
1.9 IoMT in Healthcare Logistics and Asset Management
Transportation and delivery of healthcare products and services include pharmaceuticals, surgical supplies, medical devices, consumables, and equipment used in medical field. Here, IoMT in transportation and shipment of medicines is used in monitoring temperature sensors, humidity content, end-to-end visibility solutions to track customized medicines for cancer patients using RFID including bar codes, drones, and many more other new developments. The RFID technology for logistics management in IoMT is contactless, fully automatic technology. With almost negligible manual interventions, this can work in toughest of harsh environmental issues. An automatic identification technology such as an Auto-ID system based on RFID technology is an important asset for inventory systems for two reasons. First of all, the visibility provided by this technology allows an accurate knowledge of inventory level by eliminating the discrepancy between inventory record and physical inventory. Secondly, RFID technology can prevent or reduce sources of errors. Benefits of using RFID technology include the reduction of labor costs, the simplification of business processes, and the reduction of inventory inaccuracies [59].
IoT can improve efficiency of equipment use in healthcare. Hospitals have thousands of equipment in inventory and managing them efficiently is a major concern. It is seen that only one-third of the equipment is being utilized was about 32%–38% while hospitals are spending a huge amount of money on assets that are not properly utilized. IoT can also efficiently help track and sterilize surgical equipment, thereby reducing hospital-acquired infections. Tracking of equipment by healthcare workers becomes easier and makes workflow more efficient. IoT can remind of timely service of equipment, thereby increasing their lifespan. The materials management is quite crucial to maintain the timely supplies of medical devices, stock, and consumables, devices like pacemaker or lenses or implants should be not overstocked but also not get expired. Hence, long-term inventory management can help in stock planning and efficient scheduling of supplies which further reduces cost and warehousing burden [60]. Inventory management can be optimized through technology and use of IoT for tracking and data to create models for ideal inventory management using Artificial Neural Networks and Fuzzy Logic [61]. IoT using RFID technology can automate the process of health asset management by tracking medical equipment spread across various departments or hospitals. It can help reduce the volume of inventory by improving utilization of existing assets and help in planning acquisition of new assets more efficiently. Pilferage and loss of equipment can also be reduced and the weak spots of inventory management can be located using smart devices and software applications [62]. IoT can thereby greatly benefit healthcare by optimizing workflow leading to faster response during emergencies, improve utilization of existing assets, and make resource allocation more efficient [63]. Patient flow management systems can improve patient transport in hospitals between units or different buildings by booking the travel and automatically sending request for transport and sending real-time monitoring information of the trip. This can save costs by timely delivery of patient to the operating room or a CT scan or MRI unit and avoid delays and prevent inconvenience to patients [64]. In addition, IoT can also increase efficiency of healthcare staff and productivity by managing personnel.
1.10 IoMT Use in Monitoring During COVID-19
A continuous patient monitoring wearable called the VitalPatch received emergency use authorization from the United States FDA. This device can continuously monitor QT interval ECG in patients undergoing COVID-19 treatment with hydroxychloroquine and chloroquine which are known to prolong the QT interval. Such monitoring can decrease the adverse events due to these drugs in hospital and after discharge [65].
Another clinical wearable device from Northwestern University and Shirley Ryan AbilityLab which features a flexible device, the size of a postage stamp placed on the skin of the notch above the sternal bone paired with a flexible pulse oximeter, allows doctors to monitor the three symptoms of fever, breathlessness, and cough by measuring the temperature and tiny vibrations from the skin and along with oxygen levels in the body in patients without any symptoms allowing for monitoring of patients progress and treatment response. Development of an algorithm to distinguish COVID from non-COVID causes of the symptoms is in progress by collecting thousands of hours of data from such devices by remote monitoring of patients [66]. Although wearable devices in medicine reduce the need for healthcare workers in chronic diseases and allow the elderly to live independently while improving the quality of care, they are still significant challenges [67]. The LifeVest by Zoll is a wearable cardioverter defibrillator device, which is worn around the waist and collects ECG data and informs and alerts the patient in case of a life-threatening arrhythmia. Conductive gel is deployed automatically by dry electrodes attached to the device before giving a shock to the patient. This can be lifesaving to patients who are at high risk for sudden cardiac death due to such arrhythmias. The device can also automatically deliver a shock if the patient has been rendered unconscious [68].
The model of telehealth has been quite prevalent in pandemic times of COVID-19 especially for high-risk obstetric patients. In order to prevent them from exposure of corona virus at the personal visit at the healthcare centre, the Columbia University Irving Medical Centre efficiently and effectively implemented a telehealth process. Covering important aspects of close patient surveillance, engagement, escalation protocols, effective communication, and coordination through easy-to-follow algorithms reduced the virus exposure risk to all concerned. In the last decade, telehealth including the various healthcare apps and remote monitoring equipment have emerged as quite cost effective and convenient to those class of patients who had limited healthcare service accessibility due to pandemic scare [69]. During COVID-19 pandemic, telehealth rapidly took over almost in specialities like even prenatal care at Irving Medical Centre. Super specialized domain like high-risk pregnancies prenatal screening, surveillance, and examinations to reduce personal visits was made possible through telehealth and virtual visits. This reduced patient travel, virus-risk exposure for obstetric patients who had underlying medical or fetal conditions, and being tailor made for specific patients was fruitful [70].
1.11 Conclusion
Information Technology (IT) has not only been an engine of growth for economies of many nations but has
