# Smart Healthcare Applications over 5G Networks: A Systematic Review
## 4 Conclusions  
The results obtained by the authors show that 5G in smart healthcare is still under development in the stages of proposal and feasibility analysis. This is mainly because the technology is not implemented globally. Barely 15.91% (\(n=7\)) of the studies reviewed involved of smart healthcare systems that were implemented and operational. However, after reviewing other related works, we saw a tendency to generate contributions related to research on 5G in smart healthcare, in theoretical proposals in the last several years [63; 64; 65], yet large-scale implementations and deployments have not gained momentum. In view of this, it is worth questioning whether the analyzed contributions really intend to achieve smart cities with real and functional smart healthcare applications or are simply marketing based on rhetoric. Considering the application areas, these results indicate that information transmission is the area least addressed by researchers. This is due to the technical requirements involving uninterrupted communication with ultra-low latency and high speed aspects. Additionally, in comparison with previous works, in [8], it is mentioned that telemedicine, or remote care, is one of the most prominent applications which can be enabled with 5G. This is evidenced by the classification in Figure 5, which shows that 38.63% (\(n=17\)) of systems are based on remote care. In addition, according to \"digital health trends 2022\" study Cortes [66], digital health will continue being related to the pandemic caused by COVID-19, in order to assist patients in monitoring and managing chronic diseases. Undoubtedly, this relates to continuous and real-time monitoring, which in our research represents 54.55% (\(n=24\)) of systems. Based on IoMT technology, it is observed that body sensors (40.91%, \(n=18\)) are the most used by different medical applications, for the transmission of physiological signals. Although wearable devices are also used for the same purpose, they only represent 6.82% (\(n=3\)) of the research. This is explained by the fact that sensors fulfill a specific task, unlike wearable devices, which are devices dedicated to several tasks. With the deployment of the 5G network, new remote-surgery systems are being developed which employ technologies such as teleoperated robots to operate on patients, even kilometers away from the surgeons. Nine (20.45%) of the studies presented used this technology, mainly in telesurgery systems. However, not all teleoperated robots were used in these clinical scenarios, as they are also used for other types of applications, such as robot-assisted remote ultrasound systems. We note that another key technology in the development of intelligent healthcare systems is AI, which, through machine learning algorithms, enables the diagnosis, monitoring, and prevention of diseases. Undoubtedly, this coincides with what was mentioned in a report published by the WHO, in which they highlight that AI has the capacity to improve the provision of medical services worldwide. In addition, they remind the readers that in the implementation of AI systems, ethical principles and people's rights must be respected, since, as with other technologies, they could be misused [67]. We observed that the communication protocol most used by the different systems is D2D communication (59.09%, \(n=26\)), since this technology allows direct connection of medical devices with or without network assistance [17] and is therefore widely used. In addition, it was evident that systems using teleoperated robots employ H2M communication, although in a lower percentage (27.28%, \(n=12\)), compared to D2D. Mainly, this is due to the fact that the 5G network is not yet available in all territories, so the contributions with this type of H2M interaction are still limited. It is expected that in the future when 5G is fully implemented, H2M communication will increase, enabling new remote-surgery systems, which is the field where this communication is required.