# Rural Healthcare IoT Architecture Based on Low-Energy LoRa
## 6 Discussion  
The increased life-expectancy of people due to improved living standards would burden medical systems. Connected healthcare provides an opportunity for affordable and sustainable medical services. The current research takes advantage of well-established network infrastructure and thus offloads the communication component to prior investments. Enhanced living environments (ELE) and smart homes could establish a common framework for providing services and interaction with inhabitants of the house [57]. However, a healthcare system for the rural population would not benefit or would have limited benefits from such infrastructures. For this reason, a new architecture focused on the constraints associated with rural environments is needed. We review several diverse scenarios that present a starting point to identify challenges the system would face to address this issue. These scenarios should be analyzed in the context of a rural environment. We can illustrate this point for the lost person scenario. In urban areas, such cases would be reported to emergency services that have resources that, when mobilized, could extend the search in a large geographical area. Eyewitnesses and social media could be used to locate the person. Technology assistance is also available, including phone tracking of internet-connected devices, cell tower-based locations. Bluetooth tags attached to clothes or personal items could also be used [58]. Each of these options is very limited or nonexistent in rural areas. Emergency services are usually located at a greater distance and have fewer staff and resources. There is less chance of finding eyewitnesses, and using technology to locate a person is very limited. The case of environmental and safety monitoring could be considered a part of the smart home system. Designing or upgrading houses for smart homes is more difficult for rural places, considering that some solutions require cloud connection, and the investment could be prohibitively expensive. The main challenges in implementing the connected healthcare system in rural areas arise from the high likelihood of lack of connectivity infrastructure, including mobile networks, and the need to make the system affordable. A viable system should be self-sufficient and assume the worst case, rather than the best case, from the point of view of established infrastructure. Thus, we assume no prior network exists for the system to take advantage of. We analyzed the existing network solutions, including extended-range networks, and we identified that the LPWAN network is the best fit. The main factor in determining this is to ensure the minimal cost for installing few IoT devices to address a specific need instead of requiring a full deployment for each household. In the extreme case, we would have a single IoT device deployed, in which case the device should have a communication link to the network without deploying additional network devices. In addition, all IoT devices are required to have a battery operation capability as, in some cases, external power might not be available or require additional installation. Based on the previous comparison of LPWAN technologies [5], we are using LoRa communication with the LoRaWAN MAC layer for network communication. We propose a fog-based architecture emphasizing offloading data collection, pre-processing, and partial decision-making to the e-healthcare gateways. Due to the limited bandwidth of LoRa and  
Figure 10: Mechanical wake-up with delay circuit. the need for energy preservation, each node in the fog network should maximize longevity unless a priority event is suspected that requires the full performance of the system. Long-term data storage exists at each network layer to minimize bandwidth utilization while preserving valuable data. This data is extracted during servicing of the devices. In addition to reducing network utilization, there are additional tactics that can be used for energy conservation.