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to a patient or person by the use of a personal emergency response system (PERS). The PERS uses a wearable smart device which connects to a call center or emergency medical service available round the clock to respond to any activation of the device Bridgera Rescue is an emergency response application which provides security personnel with the touch of a button. It is useful for any person who is in immediate need for security such as elderly at home [38]. These systems can also be a substitute for monitoring safety for aging patients by personal care workers. It has been shown that such PERS has reduced healthcare costs, saved lives, and has been accepted well by the patients [39]. But usage of PERS system despite availability has been low. The push-button device activator needs to be worm constantly or should be immediately accessible. In a study with persons with disabilities, only 16% of participant used it with concerns about falling was the most common reason for PERS usage and 3 out of 4 users felt greater security using it [40, 41]. Moreover, despite availability, PERS was not activated 83% of the time by the elderly after a fall while they were on the floor for more than 5 minutes [42]. High rate of non-usage has led to evaluation of newer PERS systems; hands-free automated speech recognition system utilizing ceiling mounted microphone array system may be more effectively usable but is still under research [43].
1.7 Community Segment
Health kiosks are devices which can provide services like connecting patients to healthcare providers or dispense products such as medicines. Kiosks are a useful way to decrease the burden on human healthcare workers and reduce the time spent by patients and healthcare workers in obtaining data. It is seen that the tasks performed and data obtained by kiosks are valid but not all data collected is usable with many users inputting data which was random and not usable or not related [44]. Installation of digital kiosks has been associated with various patterns of use as time passes with an initial rapid increase in the first 5 months followed by a rapid reduction in usage thereafter. This rapid initial rise seen is due to enthusiastic usage by patients older than 15 years [45]. Kiosk usage is determined by user friendliness but it is seen that older users and are less likely to be at ease at using the Kiosk system while skilled workers are more likely to use it compared to other groups [46].
1.8 Telehealth and Remote Patient Monitoring
The notable revolution came through the medical industry being more of physical and touch-based system when partial replacement gradually started with the virtual mode. Though this industry still remains more a touch-based sector where no replacement for personal visits is possible in cases of physical examination, surgical needs, and health emergency as well. But virtual consultations are getting popular and patients as well as their attendants are able to manage the health conditions and acquire medicaments timely. Few examples include video consultations, telecalling, video observations, digital tests, and reporting systems. There are few areas where telehealth has creeped in and has made things easy and more accurate.
The developments include the vital sign parameter (VSP) measurement and the virtual visit being quite popular through the audio/video consultations. The most common usage is among the patients with chronic diseases, elderly populations, disabled patients, and paediatrics as well. Data analysis from Medline since 2003–2004 indicates that telesystems prevailed that time as well but lack of standard practices and lack of evaluation framework for legal, ethical, clinical, and technical aspects lacked for practical implementation [47].
Virtual visits and telehealth are also cost effective in monitoring chronically ill patients. Studies indicate that virtual visits between trained home healthcare nurse and chronically ill patients have improved patient outcome at a much lower cost in comparison to the traditional method of skilled personal interaction of home healthcare visits [48]. In cases of chronic acute respiratory illness, the result seemed to be different. Increased convenience may tap into unmet demand of healthcare and new utilization increased overall healthcare spending in case of such diseases. Net annual healthcare spending increased in respiratory disease which showed direct-to-consumer telehealth increased access for many patients but increased utilization of services and healthcare overall spending also increases [49].
Similar kind of tool for children with special healthcare needs program called as the U Special Kids (USK) by University of Minnesota made families was launched. The program connected virtually both the children with special healthcare needs and nurses at USK also from rural and urban backgrounds. These virtual visits through video conferencing provided more information than telephone call as management of such special children became far better [50].
Virtual clinic systems have transformed even the rural India healthcare scenario. The virtual e-clinics expand the outreach of healthcare facilities in rural regions by connecting the local medical practitioners and health workers who connect patients with the qualified specialist doctors in the city through video conferencing technologies. These virtual modes consisted of smart phones, laptop/computers, medical monitors, and other assisted devices and under supervision of local health worker in lines with the standard protocols. This becomes need of the hour as qualified doctors are not available in remote areas but quality healthcare consultations can still be offered through virtual e-clinics [51].
Remote patient monitoring can monitor data, reduce readmissions, and improve patient outcomes after discharge from hospital. Remote monitoring can help healthcare workers address issues which could be managed without hospitalization. This can decrease the number of readmissions and also lead to better outcomes. Patients on remote monitoring are discharged with wearable smart devices which monitor vital signs like blood pressure, pulse rate, oxygen saturation, and weight and when used with video conferencing can help diagnose and save time while preventing confusion. Any concern can be detected early and treated early and complications prevented. Surveys have shown that a majority of patients over 40 are willing to use a remote health monitoring device if it reduced their physical visits to the hospital or doctor [52]. A meta-analysis of 13 studies with more than 3,000 patients of patients with chronic heart failure between 2003 and 2013 showed that remote patient monitoring reduced mortality significantly in comparison to the usual care with the group which had the quickest intervention having the lowest mortality rate. It was also seen that groups of patients with the high frequency of monitoring and those on remote medication 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