IoT-Based Smart Health Monitoring System: Investigating the Role of Temperature, Blood Pressure and Sleep Data in Chronic Disease Management

ABSTRACT


INTRODUCTION
Nowadays, we live in a digital realm where objects and devices are intricately linked to each other.It is the internet that bestows these devices with "smart" capabilities, enabling them to interact and share data through online connectivity.The term "Internet of Things" (IoT), coined by Kevin Ashton in 1999, pertains to the notion of data on the internet being linked to an ever-evolving global service architecture [1,2].The IoT is an extensive network of interconnected devices that store and collect data about their nearby environment.Hence, the IoT is acknowledged as an ecosystem of interlinked devices.It plays a vital role in enabling remote access and control of digital devices within our existing framework.This creates an avenue for digital devices and physical objects to enrich the realms of community, methodology, and commerce.These devices span the spectrum from minuscule nanochips to larger routers and are harnessed alongside sensors, actuators, and software to establish communication among themselves.The IoT boasts a broad spectrum of applications and is experiencing rapid and expansive growth.
The healthcare sector has been significantly impacted by services and innovative concepts, providing solutions to a myriad of healthcare challenges.With the ever-growing demands in healthcare and ongoing technological advancements, new services are continuously integrated.These services are now an essential component in the development of IoT healthcare systems [3].In an IoT environment, each service offers a suite of healthcare solutions.The definitions of these services are not standardized, and the distinctiveness of IoT healthcare systems primarily resides in their practical applications.Consequently, providing a universal definition for each concept can be challenging.Nevertheless, for a glimpse into the subject matter, the following section will offer descriptions of some of the most commonly employed IoT healthcare services (as depicted in Figure 1).
IoT has emerged as a significant focus of development, particularly in the advancement of healthcare monitoring systems.The fundamental objective of these IoT-based healthcare monitoring systems is to accurately track individuals and create linkages between various services and objects globally, all facilitated through the internet.This permits the gathering, sharing, monitoring, storage, and analysis with respect to the data produced by these objects [4].Nonetheless, the IoT represents a groundbreaking paradigm in which all interconnected physical objects in diverse, intelligent applications, such as smart cities, smart homes, and smart healthcare, can be accessed and managed remotely.The crucial aspect of diagnosing medical conditions and monitoring patients holds a crucial role in delivering healthcare, as well as the deployment of sensor networks on the human body can greatly enhance this process.Furthermore, this information can be conveniently accessed from any part of the world at any given moment [5].Patients facing severe injuries or residing in remote areas might encounter challenges when trying to reach the hospital.In such situations, they can leverage video conferencing to engage with their healthcare providers, thereby enhancing their well-being while saving both time and money.This technology allows patients to conveniently record and monitor their health status using their mobile phones [6].Telemedicine serves as a valuable tool to enhance the healthcare of patients experiencing severe injuries or residing in remote areas, eliminating the challenges of physically reaching a hospital.Video conferencing, a prevalent telemedicine method, empowers patients to have real-time communication with their healthcare providers.This not only enhances the quality of treatment but also reduces the time required for invasive procedures [7].Patients can also use video conferencing to record their health conditions using their phones and share them with their doctors [6].Telemedicine can also be used for rehabilitation, such as in the case of severe acquired brain injury, where patients can receive home motor and cognitive rehabilitation through video conferencing [8].The IoT's potential benefits will lead to enhanced, personalized treatment, ultimately improving patient outcomes while concurrently reducing the costs associated with healthcare management.Here, IoT enables healthcare providers to remotely monitor their patients and optimize appointment scheduling.Patients can also elevate their athome healthcare routines, reducing the need for frequent doctor visits and the chances of receiving unnecessary or unsuitable medical interventions at healthcare facilities.As a result, the quality of medical care and the safety of patients may see improvements, while the overall cost of healthcare could decrease [4,9].In the foreseeable future, we can anticipate the emergence of a home-based health monitoring system, which will not only improve convenience but also optimize hospital operations.To realize this vision, it will be crucial to extensively employ IoT sensors for the continuous monitoring of both individuals and their surroundings.This endeavor will greatly aid in the monitoring of chronic disease management and the progress of rehabilitation.As we progress towards a future that integrates virtual consultations for remote medical care, the IoT will play a pivotal role in enabling efficient data connections from various locations [10].
The majority of current IoT initiatives and research are in their early stages, primarily concentrating on the deployment as well as configuration of technology in diverse contexts and scenarios.These approaches are not yet widely adopted.Hence, the objective of this paper is to devise and implement an IoT-driven healthcare monitoring system.This system amalgamates a variety of sensors and devices to gather patient health data, ultimately enhancing their quality of life.The key contribution of this paper is to provide an extensive exploration of IoT-based healthcare monitoring systems, laying out a roadmap for the benefit of future researchers, educators, and scientists.It aims to establish a novel IoT-based healthcare monitoring system that holds the potential to transform healthcare by harnessing modern technology to elevate patient care and overall quality of life.
The paper is structured into five sections.Section 2 reviews related studies in the IoT-based healthcare domain, with Section 3 describing the research methodology and materials used in the proposed system.Next, Section 4 presents experimental results and discussions, focusing on security and protocols for IoT healthcare monitoring systems.Finally, Section 5 offers the paper's conclusion and directions for future research.

LITERATURE REVIEW
The integration of IoT technology in healthcare has emerged as a revolutionary force, reshaping the industry's landscape.IoT in healthcare involves the interconnection of sensors, medical devices, as well as healthcare information systems, enabling real-time data collection, analysis, and decision-making [11].This technology has various applications and benefits, including: IoT devices have the capability to autonomously gather health metrics, such as heart rate, blood pressure, temperature, and other vital metrics, from patients who are not physically located in a healthcare facility.This eliminates the necessity for patients to make trips to healthcare providers or manually collect their own data [12].This empowers healthcare professionals to oversee the health status of patients and offer timely interventions, resulting in enhanced patient outcomes and decreased healthcare expenses [13].
IoT-enabled devices and applications have made interactions with doctors easier and more efficient, increasing patient engagement and satisfaction [12].Patients can conveniently arrange appointments, retrieve their medical records, and engage in communication with healthcare providers, ultimately contributing to an improved overall healthcare experience.
IoT technology can streamline healthcare operations by optimizing the pharmaceutical manufacturing process, allowing for quick and efficient access to patient data, and facilitating medication refills [14].This can lead to reduced costs and improved efficiency in healthcare delivery.Realtime data collection and analysis provided by IoT devices enable healthcare professionals to make more informed and timely decisions.Algorithms can be employed to analyze the data and suggest treatments or generate alerts, helping healthcare providers deliver personalized and effective care.
Bovenizer and Chetthamrongchai [15] conducted a literature analysis to evaluate the present study on IoT-based healthcare monitoring systems and comprehensively evaluated the existing solutions and experiences in remote patient monitoring systems.Al-Adwani and Al-Siyabi [16] conducted a systematic review focused on the integration of IoT into health monitoring systems.They explored how IoT wearable devices can gather and transmit data concerning patients' blood pressure, heart rates, and blood glucose levels.Furthermore, they also explore how IoT can help improve healthcare by providing real-time monitoring of patients.Boikanyo et al. [17] mentioned that the literature review summarizes some existing solutions and experiences in remote patient monitoring systems, discusses wearable sensors for remote health monitoring, and compares different solutions.Waleed et al. [18] explored the challenges of large data in IoTbased patient monitoring and discussed methods for processing as well as analyzing large data sets to improve patient monitoring.Abdulmalek et al. [19] investigated their work on wireless-and wearable-sensor-based IoT monitoring systems.They provide a comprehensive classification of healthcare-monitoring sensors and explore the practical applications of these sensors, which encompass heart-rate detection, body-temperature measurement, activity recognition, blood-glucose monitoring, and sleep monitoring.Meanwhile, Tyagi et al. [20] have made substantial efforts to emphasize the significance of an IoT-cloud-enabled healthcare system.Their primary aim is to not only enable the illustration and traceability of healthcare stakeholders but also to ensure the enhancement of healthcare services.They put forward a cloud-IoT framework through which medical data can be securely transmitted with the patient's consent and other healthcare stakeholders' involvement.The overarching goal of their system is to establish a network encompassing entities like hospitals, physicians, patients, laboratories, and pharmacies.Semwal et al. [21] have developed an IoT-based smart e-healthcare system that incorporates sensors, a mobile app, a Bluetooth connectivity module, and cloud integration.This system offers a cost-effective, secure, and highly adaptable platform for the exchange of critical medical data between patients, medical professionals, and remote centers.The authors have also tackled the challenge of computational device and network unavailability by introducing a feature for offline data storage, with automatic cloud synchronization when connectivity is restored.On the other hand, Tyagi et al. [20] have proposed a communication architecture for sensorbased IoT healthcare service systems.This architecture includes a secure single sign-on authentication method and a robust coexistence-proof protocol.Their authentication scheme is well-suited for safeguarding IoT-based healthcare environments equipped with various sensor types, ensuring both strong entity authentication and secure data communication.Wu et al. [22] introduced the significance of an IoT-based wearable health monitoring system specifically designed for the remote monitoring of physiological parameters in quarantined patients.This system enables healthcare providers to remotely and continuously monitor patients in real-time, leading to potential improvements in patient outcomes.Hamim et al. [23] explore and address the existing demands for wearable technologies focused on healthcare, emphasizing the potential for further development to meet patients' needs more effectively.Their proposition involves the integration of additional sensors, including those for respiratory rate, blood pressure, and blood glucose.The incorporation of these sensors could provide consumers with a comprehensive health monitoring system capable of tracking all essential bodily parameters.
Both the hardware and software systems responsible for sensing communication and decision-making functions have gained paramount importance.This is attributed to the fact that the application of specific technology can significantly augment the capabilities of an IoT system [24,25].Consequently, in the integration of various healthcare applications with an IoT system, a range of cutting-edge technologies have been embraced.These technologies can be broadly classified into three groups: identification technology, communication technology, and location technology, as illustrated in Figure 2.

Figure 2. Classification of IoT technology
Tamilselvi et al. [26] introduced a system that leverages IoT and smart sensors for monitoring the health parameters of coma patients.This includes tracking indicators such as body temperature, heart rate, eye movement, and oxygen saturation percentage.The data obtained from these sensors is transmitted to the smartphones and laptops of authorized individuals through a cloud server for further analysis and decision-making.The system focuses on monitoring two critical parameters of critically ill patients, namely body temperature and pulse rate.It alerts the doctor in case of any critical condition, allowing for immediate action.
Selvaraj and Sundaravaradhan [27] analyze the latest research articles on IoT-based healthcare systems, concentrating on monitoring architecture, efficiency, data management, advantages, and limitations.Also, it highlights the potential of IoT in detecting symptoms, accurately predicting diseases, and monitoring healthcare issues for elders while also addressing challenges such as high power consumption, limited resources, and security issues.Greco et al. [28] observed that IoT solutions in the healthcare sector are progressing from basic structures to intricate smart systems capable of offering analytics, identifying activities, and rendering decisions.They also discussed the implementation of AI and machine learning techniques in healthcare IoT systems requires computational capacity, which is often only available through cloud services.

Benefits of IoT in healthcare
IoT offers a multitude of valuable advantages for individuals, society, the environment, consumers, and businesses.Nevertheless, like any technology, it comes with a set of benefits and drawbacks.Table 1 provides a comprehensive list of the primary benefits that IoT brings.In the realm of healthcare, IoT-based applications and systems have ushered in a transformative era, essentially realizing the visionary world that people from the 1990s could only imagine.IoT has played a pivotal role in revolutionizing internet communication, contributing significantly to the advancement of numerous challenging domains, with healthcare standing out as a key beneficiary.Its ease, precision, and flexibility have notably bridged the gap between doctors, patients, and healthcare services, thereby enhancing the overall healthcare landscape.

No.
Benefits Reference Challenges Reference

1.
IoT in healthcare offers convenience, real-time disease management, cost reduction, and improved patient care, ultimately leading to healthier lives and automatic alerts for timely interventions. [29] IoT in healthcare presents challenges related to data integration, requiring solutions to ensure smooth data management and analysis. [30] 2.
Incorporating IoT technology ensures timely medication, with automatic alerts to both patients and their family members, enhancing patient care and safety. [31] IoT in healthcare raises security concerns that must be addressed to safeguard patient data and privacy effectively.
Doctors benefit from simplified and efficient patient record management through the use of technology. [37] IoT in healthcare leads to the generation of unstructured, rapidly growing, and diverse data, posing challenges in data management and analysis.[38] 4.
IoT in healthcare brings energy efficiency, saving both time and money in healthcare operations.[36] IoT in healthcare involves hardware implementation and design optimization challenges that need to be carefully addressed for efficient and effective use in healthcare applications. [39]

5.
IoT in healthcare enables doctors to provide offtime medical services efficiently.[40] Implementing medical analytics in IoT healthcare poses challenges that demand meticulous problemsolving for precise and efficient data analysis in healthcare contexts. [41] 6.
IoT in healthcare offers simplicity, affordability, and ease of use for both healthcare providers and patients. [42] Intelligence in medical care leverages advanced technologies and data analytics to enhance healthcare delivery, diagnosis, and treatment for improved patient outcomes and resource optimization. [31] IoT has empowered healthcare professionals and hospital staff, enabling them to perform their duties with greater precision, efficiency, and reduced cognitive load.A testament to this can be found in the applications outlined in Table 2.The integration of IoT into the medical field has delivered remarkable benefits to patients, and it's notably user-friendly and easy to use.
IoT has diverse applications across various sectors, with the most prominent sectors depicted in Table 2 based on current technological solutions.Notably, the most critical and rapidly advancing areas where IoT is making an impact are within the industrial sector [43,44].In the upcoming years, we can anticipate a significant expansion of IoT technology applications within the healthcare domain [45].The healthcare sector is continually seeking innovative approaches to enhance service delivery, reduce costs, and elevate the quality of care.Consequently, it is poised to increasingly rely on IoT technology [46].The adoption of these technologies empowers patients to adhere to self-care principles, resulting in cost-effective healthcare services, heightened patient satisfaction, and improved self-management.Additionally, IoT-based systems offer the capability to remotely monitor the physiological status of patients requiring continuous attention [47,48].Secured and smart medical healthcare system [54] 6.
Decision-making and home-based medical health monitoring system for neurologically disabled patients [55] 7.
Application for patient posture recognition using supervised learning [39]

RESEARCH METHODOLOGY
This section will explain the methods used in order to design the proposed health monitoring system.The proposed methodology entails the collection of data, including the patient's body temperature, pulse rate, sleep duration, and toilet usage frequency.This information is gathered by the ESP8266 Wi-Fi Module, which then transfers the data to a cloud server.The ESP8266 module maintains its connection with the Arduino and establishes internet connectivity to relay the collected data to the server [56].
To depict the sequence of operations and data flow within the IoT healthcare monitoring system, Figure 3 presents a flowchart.This visual representation highlights how various components collaborate to optimize data from body temperature, pulse rate, pressure pad, and ultrasonic sensors, illustrating the system's workflow.

Temperature sensor
The temperature sensor is a compact, semi-circular hardware component.To measure the temperature [58], the user simply places their finger on the sensor, which then gradually adjusts to the user's temperature and records the data in the Arduino.The data collected by this sensor is in Celsius format.For precise temperature measurement, an LM35 sensor is used, boasting an accuracy level of +/-0.4 degrees Celsius.This sensor operates based on the thermocouple principle, converting analog signals into a digital format.It offers superior accuracy compared to thermistors, as demonstrated in Figure 5.

Ultrasonic sonar sensor
We employed a sonar sensor to monitor the patient's toilet schedule.The HC-SR04 ultrasonic sensor operates by utilizing sonar, similar to how bats determine distances to objects.It delivers precise non-contact range detection with stable and accurate readings, all within a user-friendly package.We positioned the ultrasonic sonar sensor on the toilet door so that every time the door is moved by the patient, it triggers a notification.This enables us to keep track of the number of times the patient uses the toilet, aiding in the assessment of their health status, as illustrated in Figure 6.A pressure pad is employed to monitor a patient's sleep duration.Placed beneath the patient's pillow, the pressure pad detects when the individual lies down, causing the two distinct components of the pad to make contact.This contact results in a surge in voltage registered by the Arduino, and the period during which this high voltage is sustained is interpreted as the patient's sleep duration, as depicted in Figure 7.

Pulse sensor
The Pulse Sensor is a plug-and-play heart-rate sensor compatible with Arduino, offering various data outputs such as Cardio Graph, Pulse Rate, and Inter Beat Interval.Nevertheless, we chose to focus on the Pulse Rate per minute for our convenience.The sensor's data can be accessed by placing it on the patient's fingertip or earlobe.We observed a heart rate of 121 BPM in the monitored patient, along with an IBI of 1826 ms.During moments of relaxation, the patient's heart rate decreased to approximately 80-90 BPM, whereas excitement or physical stress caused it to rise above 120 BPM.These heart rate variations aligned with expected changes in behavior and physical stress, supporting the underlying theory [23] as illustrated below (Figure 8).

Software description
To facilitate the analysis of the data gathered through the Arduino sensors, a storage solution is required.To fulfill this need, ThinkSpeak, an IoT analytics platform, proves invaluable.ThinkSpeak enables the aggregation, visualization, and analysis of real-time data streams in the cloud.The ESP-8266 serves as the intermediary between the Arduino and the internet, tasked with transmitting the essential data to the ThinkSpeak server.The ESP-8266 receives data from the Arduino and, leveraging a Wi-Fi connection, dispatches the acquired data to the ThinkSpeak server.

RESULT AND DISCUSSION
In this paper, the hardware was utilized individually for body temperature monitoring, heart pulse monitoring, sleeping time as well as toilet use.For each body health parameter, data results were methodically examined under varying behavioral and environmental influences.This was conducted to discern the sensor performance in response to specific changes.
Following the completion of individual sensor implementations, all the sensor systems were integrated into a single functioning system.Data collection from the sensors was facilitated by the ESP-8266 Wi-Fi module, which transmitted the data to the ThinkSpeak cloud.Subsequently, leveraging the capabilities offered by ThinkSpeak, we could display data and issue alert messages as needed.

Temperature graph
The temperature sensor integrated into the system offers a range of valuable benefits.First, it continuously monitors the patient's body temperature, enabling early detection of abnormalities and rapid medical intervention.Moreover, this sensor extends its capabilities by measuring the surrounding environment's temperature, providing insights into patient comfort.Its ability to relay data to an Arduino facilitates remote monitoring, allowing doctors to access real-time information and historical trends.The system also sends alerts and notifications, ensuring timely responses to temperature fluctuations, and it also reduces the risk of infection transmission, enhancing safety in healthcare settings.Overall, this temperature sensor plays a pivotal role in enhancing patient care, enabling early intervention, and offering valuable data for medical decision-making (Figure 9).It illustrates an example of the patient temperature, displaying the information collected from the Sensor (LM35 sensor).The body and environment temperatures that alert the doctor through email are shown in (Figure 10).

Pulse graph
Pulse sensors, also known as heart rate sensors or heart rate monitors, are electronic devices designed to measure and monitor an individual's heart rate in real-time subsequent calculation of data such as Inter-Beat Interval (IBI) and Beats Per Minute (BPM), offers a multitude of advantages in healthcare.The sensors provide real-time, accurate data on a patient's heart rate, enabling continuous monitoring and early detection of irregularities or arrhythmias.Automated calculations of beats per minute and inter-beat intervals streamline the monitoring process and enhance healthcare efficiency.Additionally, historical data can be analyzed to track long-term trends and inform treatment decisions.The system also sends alerts and notifications to ensure timely responses to critical changes in a patient's condition, ultimately resulting in enhanced patient outcomes as well as potentially reduced healthcare costs.Upon implementing the ESP-8266 code to transmit pulse sensor data to ThinkSpeak, we observed that initially, some values appeared slightly elevated, likely due to noise factors.However, over time, these fluctuations subsided, and we began to notice a more typical pulse pattern, as illustrated in Figure 11

Pressure pad sensor
A pressure pad sensor is designed to detect and measure changes in pressure applied to its surface.The sensors provide continuous monitoring of a patient's sleep patterns, allowing doctors to assess sleep quality and detect sleep disorders early.Beyond sleep assessment, pressure pad sensors are instrumental in fall detection, triggering alerts when a patient leaves the designated sleep zone unexpectedly, reducing the risk of injuries.The sleeping time detected from the sensor is shown in (Figure 12).The results were either 0 or 1.One signifies that the person is in the sleep zone, whereas zero means that the person is in the non-sleeping zone (awake).The automation of sleep monitoring streamlines the process, enhancing doctor's efficiency and enabling data-driven care plans.Overall, the pressure pad sensors enhance patient comfort, safety, as well as the overall quality of care, while potentially reducing healthcare costs through efficient monitoring and proactive interventions.

Sonar sensor
A sonar sensor is a sensor that uses sound waves to detect and measure the distance to objects.The sensors monitor patient's environment and record toilet usage, and ensure patients with specific healthcare needs maintain proper hygiene and comfort while allowing for the early detection of health issues.The sensor provides valuable information, such as infection control, as changes in bathroom usage patterns can signal infections or other health concerns.The toilet usage detected from the sensor is shown in (Figure 13).The results were either 0 or 1.One signifies the number of times that the patient used the toilet, and zero indicates that the patient did not use the toilet.The collected data enables doctors to provide patient-tailored care plans, track medication adherence, and assess risks.The sensors facilitate remote monitoring and communication with doctors by promoting independence and dignity.

Figure 13. Toilet usage tracker
The adoption of IoT technology in the field of healthcare has marked a significant advancement in patient care, diagnosis, and healthcare management.This research paper aims to develop and implement an IoT-driven healthcare monitoring system that seamlessly integrates various sensors and devices for collecting patient health data with the objective of enhancing the quality of life.The primary contribution of this paper lies in its in-depth exploration of IoT-based healthcare monitoring systems, providing a roadmap that can be valuable for future researchers, educators, and scientists.This paper presents a groundbreaking IoT-based healthcare monitoring system that holds the potential to transform healthcare by harnessing modern technology to elevate the level of patient care and overall quality of life.

CONCLUSION
The proposed system is well-suited for individuals dealing with chronic health conditions.Through a computer or smartphone, healthcare professionals, such as doctors and nurses, can remotely monitor patients' vital statistics, including temperature, blood pressure, sleep patterns, toilet usage, and heart rate, irrespective of the patient's location.This system offers the advantage of saving patients both time and money by reducing the need for frequent travel, especially for those residing in suburban or rural areas.The suggested framework holds the potential to enhance the quality of healthcare services on a national scale.Looking ahead, there is potential to integrate AI-based algorithms into the device, enabling it to recognize unusual sensor signals or disturbances and issue alerts.This paper introduces a health monitoring device equipped with a range of sensors to track vital health parameters, offering a holistic approach to patient care.

Table 2 .
Application of IoT in health