# Critical Retrospection of Performance of Emerging Mobile Technologies in Health Data Management

Authors: Sonali Vyas; Deepshikha Bhargava; Jyoti Bhola; Javed Ahmed Ujjan; Sathyapriya Eswaran; Abdul Wahab Rahmani
Journal: Journal of Healthcare Engineering
 (2022)

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## Abstract

The recent advancement in mobile technologies has led to opening a new paradigm in the field of medical healthcare systems. The development of WBAN sensors, wearable devices, and 5G/6G wireless technology has made real-time monitoring and telecare of the patient feasible. The complex framework to secure sensitive data of the patient and healthcare professionals is critical. The fast computation of health data generated is crucial for disease prediction and trauma-related services; the security of data and financial transactions is also a major concern. Various models, algorithms, and frameworks have been developed to tame critical issues related to healthcare services. The efficiency of these frameworks and models depends on energy and time consumption. Thus, the review of recent emerging technologies in respect of energy and time consumption is required. This paper reviews the developments in recent mobile technologies, their application, and the comparative analysis of their performance parameters to explicitly understand the utility, capacity, and limitations. This will help to understand the shortcomings of the recent technologies for the development of better frameworks with higher performance capabilities as well as higher quality of services.


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## Body

## 1. Introduction

Mobile phones are playing an important role in this modern era. In this period of digitalization, the importance of mobiles has been increasing day by day in every field, such as schools, colleges, companies, healthcare services, and manufacturing. The wireless communication technology in mobile phones helps in the prevention of unwanted visits. There are various types of mobile applications which are used in various fields; especially, they have played a vital role in the medical field for the last 5–10 years. According to Liquid State (2018), there were about 318,000 mobile healthcare applications available for patients, about 200 apps are built every day, and we can assume that the number of healthcare apps will increase during the COVID-19 pandemic [1], the period in which all individuals prevent or avoid unnecessary or unwanted visits, especially hospitals, medical stores, and so on. Individuals want the facilities to be delivered to their doors, and it is possible by these applications; by medical id, we can share information about our health including blood type, whole physical statement, and diabetes that provides the exact information of blood sugar level and insulin. These apps are available for Android as well as iOS devices; Apple Health is available only for iPhone and all Apple devices, which is helpful in the monitoring of sleep, daily activities, food, heart rate, respiratory rate, and so on; it can be able to identify the location of patients by the GPS address in case of emergency and able to reach at the time of emergency. Eyecare Live helps in the treatment of problems related to the eyes within an hour, doctors can recognize the real-time condition of your eyes online and live, and this app is available on Android as well as iOS.WebMD Baby app is helpful in taking care of babies such as feeding, sleep, diapers, and growth because it can detect the essential things for their growth [2]. This app is available for Android as well as iOS devices. Recently, in the COVID-19 pandemic, the Cova app and Aarogya Setu app played an important role in digital or online communication with the relevant knowledge about corona [3,4]. The experts and medical staff are available for providing proper guidance when no one knows the effects of the SARS COVID-19. The fruitful knowledge is provided by the doctors and volunteers. Similarly, there are more applications, such as dminder, Medisafe Pill, Minder, MyFitnessPal, AliveCor drugs, and Comedication guide, which are available for mobiles [5–7].The advancement has emerged in this modern era in the healthcare system by wireless mobile communication (5G) with high-speed network and high data rates, and we can say that there is explosive growth in the mobile network [8]. According to the review of 2014, the predictable progress in mobile data will rise up to 15.8 Exabyte 2018-19 [9]. Mobile phones provide a number of facilities for expanding the capabilities by overcoming their limitations like battery life, limited memory, CPU, and big data analytical methods able to abstract values from the four Vs: volume, variety, velocity, and veracity. Mobile phones provide facilities for multiple tasks such as meetings, food, and online booking, which control unwanted visits; real-time navigation helps to find the exact way of suitable visiting places, especially for suitable hospitals and medical stores, online meetings with disease specialists, which helps in proper treatments and future medications, online bookings of appointment with doctors with good knowledge of diseases, online flights for the transportation, and so on. Healthcare applications require the bulk of computational and communicational resources. Some researchers discussed the dynamic access and collected a large amount of data of the patients, and this can be done by using mobile cloud systems and clouds in some cities.In the modern era, the death rates with noncommunicable chronic diseases such as heart diseases, diabetes, cancer, stroke, respiratory diseases, and genetic disorders increase day by day all over the world. We can say that a large amount of earnings of individuals goes to health treatments; data of loss of national income per year in different countries are shown in Table1.Table 1
Loss of national income per year in different countries.
CountryLoss of income in 2005Loss of income in 2015Accumulated lossBrazil2.79.349.2Canada0.51.58.5China18.3131.8557.7India8.754236.6Nigeria0.41.57.6Pakistan1.26.730.7Russian Federation11.166.4303.2UK1.66.432.8Tanzania0.10.52.5According to the EU, the number of deaths with chronic diseases is about two million throughout the year. To overcome the increased mortality rate, various organizations are trying to cure these heart diseases through organizing a number of programs, but these are done in the hospitals under the supervision of medical staff. People have less participation in these programs due to long distances and limited time, but there is a need to recognize the real-time condition of the patients. In these cases, mobile communication and mobile cloud computing play an important role in curing these noncommunicable chronic diseases [10].Wireless mobile communication and digital clinics play a pivotal role in mental health, especially in pandemic COVID-19; these are used routinely in daily life. The cognitive situation can be identified by smartphones apps which recognize the mental condition by measuring the depression level, anxiety, hours of sleep, and so on. These data can also help in the recovery of patients through shared decision-making. The symptoms of the disease can be collected by the digital clinic. Digital clinic for mental health is a new paradigm in the modern healthcare system. The digital clinic for mental healthcare includes synchronous health visits (by video, in person, or by phone call) for measurement-based healthcare, shared decision-making, and personalized medicine for health mental illness patients [11]. This hybrid mode of care includes discreet and/or real-time data collection of the patient using WBAN sensors. The successful implementation of the digital clinic has been observed at Beth Israel Deaconess Medical Center using an app, namely, mindLAMP, for serving patients with mood, anxiety disorder, and posttraumatic stress disorder. Similar types of digital clinics for mental health are established in the USA [12].Mobile phones have been used as a powerful tool for providing primary healthcare services in low- and middle-income countries, which includes the usage of short message services (SMS), multimedia messaging services, interactive voice response, video clips, audio clips, and images. These methods help to address logistics-related issues, patient education, clinical decision-making, and many more. In Ghana and Uganda, the use of mobile phones has helped to improve the performance of community health workers. A similar approach has been used in Indonesia, Columbia, some rural parts of India, Bangladesh, Nepal, Kenya, Tanzania, and Zambia, to name a few. However, certain challenges require special attention, such as the lack of proper training of the community health worker for using mobile Internet and network issues and weak technical back-end support. Other issues such as poor sustainability of pilot projects, cost of operations, maintenance, investment, management, age, technology proficiency, education level, and years of experience of the community health worker affect the mobile health services. The careful implementation and operation of mHealth services can mitigate these challenges [13].Mobile became a life savior tool in the time of the COVID-19 outbreak. During the COVID-19 pandemic, person-to-person contact and isolation became the critical parameters to tackle the pandemic. Mobile telehealth facilitates the contactless and real-time interaction of healthcare professionals, doctors, and patients for patient diagnosis, case discussion, decision-making, and personalized medicine. With the development of WBAN and BAN sensors, it has become possible to monitor and diagnose the patient in real time. Mobile telehealth also poses the risk of sensitive data theft and data misuse. To tackle the security, continuous efforts have been put to mitigate risks; blockchain and cloud security are the recent advancements [14].Mobile-based technology became a promising tool for hastening patient-doctor communication about sexual health concerns. Breast cancer is the leading cause of death in the female population. The distress related to emotional, physical, and mental health makes the problem and patient condition more complex. Mobile-based application is used for breast cancer patients for routine clinic encounters to boost patient confidence. This application also provides educational material related to breast cancer. The pilot test of this app certainly faces challenges such as scalability and availability of limited studies, which can be tamed in the near future [15].Telemedicine, along with other emerging mobile technologies such as e-diaries, remote patient monitoring, digital inhalers, and Bluetooth-connected wearable devices, is used as an effective measure for timing allergy, asthma adherence doctors, and healthcare consultation on mobile audio-video methods for general medicine. Also, the tracking of clinical information status in digital record for asthma, allergy, and anxiety disorder patients and autoreminders of medicine and severity of disorder alert can be done. The synchronized e-diary with mobile and smartwatches helps to maintain the digital record of medicine/inhaler. The increased frequency of medicine intake will alert the patient and healthcare professionals about the severity of the patient’s condition, suggest preventive measures, customize medication, and book doctor appointments [16].A similar approach has been implemented for patients suffering from chronic kidney disease, which affects the society disproportionally and is costly to society; telenephrology was found to be effective for CKD patients where time and distance between patients and healthcare professionals are critical. Telenephrology is able to decrease the mortality rate in CKD patients who were isolated demographically from the renal health services. Small-scale trials of telenephrology were found to be successful in some states of the USA and Canada; however, large-scale studies are still lacking [17].After the outbreak of the COVID-19 pandemic, the importance of smart health monitoring, telemedicine, and mobile health services has been globally realized. The Industry 5.0 and 5G technology have led to the emergence of WBAN and BAN sensors as well as devices that made the modern healthcare system possible [18–20]. The application of emerging mobile technologies has been shown in Figure 1.Figure 1
Applications of emerging mobile technologies in the medical field.The rigorous comparative analysis helps us to accurately select the model for different applications in medical as well as nonmedical fields. Thus, there is a need to review the recently emerging mobile technologies for their performance parameters such as energy, time, and memory consumption, as most of the frameworks are focused on WBAN sensors and devices whose performance capabilities are directly related to connectivity and available energy/power/battery. The present work summarizes the comparative studies of various mobile-based emerging technologies with their shortfalls and applications.Thus, the review of recent emerging technologies in respect of energy and time consumption is required. The present work reviews the developments in recent mobile technologies, their application, and the comparative analysis of their performance parameters to explicitly understand the utility, capacity, and limitations. This will help to understand the shortcoming of the recent technologies for the development of better frameworks with higher performance capabilities as well as higher quality of services.


## 2. State-of-the-Art Review

The selection and optimization of the user-defined parameters are made for easy access. Smart healthcare involves a variety of parties, including physicians and patients, hospitals, and research organizations. It is a multifaceted organism that encompasses sickness prevention and monitoring, diagnosis and treatment, hospital management, health decision-making, and medical research. Smart healthcare is based on information technologies, including Internet of Things, mobile Internet, cloud computing, big data, 5G, microelectronics, and artificial intelligence, as well as modern biotechnology. These technologies are widely used in all aspects of smart healthcare. Chronic noncommunicable diseases are mostly spread in the elderly population, the hospitals cannot be able to provide quick services, and care seems to be difficult among them because most of the population are elder; hence, their care and treatment are challenging. This can be done by using the mobile-medical system, which uses effective data decision-making modules, wireless mobile communication, and deep learning model 2014, combined sparse autoencoders (CSAE). The CSAE algorithm is the best for the detection of patients’ conditions; this is proved by the comparison between the four machine learning algorithms in terms of accuracy, sensitivity, and specificity, as shown in Figure2. The experimental results have shown the superiority of the CSAE algorithm with accuracy and specificity of more than 85% and sensitivity not more than 75%.Figure 2
The performance indicator for four chronic diseases showing the second validation of the CSAE algorithm.Figure2 shows that the use of CSAE and KNN is better than the use of other methods, proving the graphical representation with an accuracy of 93.03% and 91.66%, and NB and LDA show poor accuracy. Figure 3 shows the probability of exceeding standard values (gradual decline); exceeding the standard values indicates that the patients have multiple diseases. The accuracy of all algorithms is dropped by 30%. When multiple diseases are identified, the performance of algorithms is also most stable [3].Figure 3
The comparative analysis of the accuracy performance of the proposed algorithm when the prediction of the number of diseases is varying.IoTs play a vital role in the detection of diseases and communication with medical staff with the help of Wi-Fi ZigBee, which are interconnected by various types of devices. Sometimes, during the communication, the smart devices undergo cyberattacks like insider attacks, DDoS, and so on, which are responsible for vulnerabilities. There are several programs that are developed to overcome these attacks because the extended Coverage GSm protocols emerge with wide frag mouth protocol into the IoMT sectors. This scalability of the security model is evaluated by increasing the security nodes and by observing time changes. The protocol EC-GSM helps increase the speed of response time for every single task. In Figure4, it is shown that EC-GSM IoT consumes the minimum time of 423 ms to 2897 ms for up to 25 nodes. It shows that the wide-mouth frag protocol-based authentication schemes utilize less number of packets [21].Figure 4
Scalability rate for a number of nodes.As we know about COVID-19, coronavirus disease is caused by the severe acute respiratory syndrome virus (SARS-CoV (2)), which is announced as a pandemic by WHO. During the pandemic, there were very few speculations about the disease. A mobile application has been developed to track COVID-19 symptoms. The COPE consortium was established to bring together scientists all over the world with expertise in the field of big data research and epidemiology of COVID-19 symptoms. The proposed method was implemented in the UK in March 2020 and was successful in the real-time collection of population-level data.The time-domain-based biometric feature also plays an important role in IoTs-based healthcare devices. Some researchers collect data by applying mobile healthcare things. They are able to prove the security of these types of equipment, which also talks about the secure transformation of data from patients to doctors or medical staff. The IoTs are made up of various types of intelligent nodes which are interconnected with each other to visualize the data and for equations. The IoMTs are associated with many medical nodes and applications which are having the goal of providing better medical services.There are many devices that transfer the patient’s data through wireless communication, and therefore people are scared of security. According to the Health Insurance Portability and Accountability Act, wireless communications are responsible for providing the secure transformation of data from patients to medical staff. The IoTs consist of three layers, perception, network, and application. Figure5 shows that the generated biometrics keys, which are formed from different subjects, can be used for security purposes. From Figure 5, we can say that the IoT-based healthcare protocols consume less time and energy [22].Figure 5
Total energy and time consumption comparison of the proposed framework with similar existing models.Guo et al. have proposed a framework for efficient privacy promising mobile healthcare named FEEL-“federated edge learning system.” The proposed framework is targeted to improve training efficiency, interference performance, and privacy protection. The edge-based training task offloading design has been evaluated for performance and comparative analysis with existing models. The proposed model helps to collect patient data from mobile and other WBAN devices and then process the data at a local hospital server instead of uploading the whole data to the cloud. This will help to reduce the burden of data security, and only processed information is uploaded to the cloud after the addition of noise to the data. The noise addition to the data prevents data misuse by unauthorized users. The implementation of the neural network at the edge servers helps in the training of patient data. The proposed framework has been evaluated for energy, memory, and time consumption with an increasing number of offload layers and presented in Figure6.Figure 6
The variation of energy, time, and memory consumption with changing number of offloading layers for FEEL framework.As shown in Figure6, the training time includes local training time, communication time, and third-party aggregations time. The gradual decreasing trend in time consumption is observed with an increasing number of offloading layers. A similar trend is observed in energy and memory consumption. In the proposed network, only one offloading layer is directly connected to mobile devices, and the remaining are connected to servers which help in reduction in CPU consumption, memory, and energy by 79.23%, 54.43%, and 51.4%, respectively, when compared to the conventional federal learning system along with improved accuracy and high data security [23].In this modern era, advanced computing systems and mobile-based technologies inspired the development of cloud-based real-time health monitoring. There are some limitations of transfer of data of patient’s health to the clouds, which is responsible for the latency consuming more time and energy. It can be reduced or overcome by using some algorithms fog-based computing systems in the healthcare system. This is based on the gigabit passive optical network (GPON) access network and energy-efficient fog computing model (EEFC), which is based on mixed-integer linear programming (MILP). Mohamad O.I. Musa et al. observed that 36% to 52% of energy is consumed. By this, we can also develop a real-time experimental heuristic, energy-optimized fog computing (EOFC) heuristic.The use of EEFC minimizes the energy and time consumption; as shown in Figure7, the energy consumption used in the processing of the EOFC heuristic is the same as that in the EEFC model. The energy consumption of both decreases as the ideal consumption decreases. This is due to the domination of energy consumption of networking equipment. Figure 7 also shows the comparison of energy savings between both models, which shows that the energy consumption of the model decreases from 83.1% to 0.3% when increasing the percentage reduction of ideal power from 0% to 100% [24].Figure 7
Energy consumption of various equipment and processing of EECCC model, EEFC model, and EOFC heuristic with various idling conditions.As we know, mobile applications and wireless communications are more prominent nowadays and increase the use of IT and increase the cyberspace. This is expected to increase in the future, and in this pandemic, IoMT is a necessity for the coming days; hence, cybersecurity is basically assumed to be a challenge.The data of patients are very sensitive and need protection from cyberattacks. For example, the government of the US establishes the data security act, Health Insurance Portability and Accountability Act (HIPPA ACT 2020). There are many healthcare industries that are unable to accept healthcare cybersecurity by increasing the trends of cyberspace, fraud, theft, and cyberattack. In Figure7, the author shows the comparison of energy consumption in the author’s protocol with others. The energy consumption by using the AES algorithm is 1.21 microjoule/byte. Figure 7 clearly shows the scheme outperformance from others based on the same platform, which is effective in securing the patient`s confidential data [25].For the improvement in chronic diseases diagnosis, the mobile healthcare system provides bilateral solutions, also offers the real-time monitoring of chronic diseases, and helps to support the maintenance of a healthy lifestyle and immediate diagnosis of health conditions. Figure8 shows the solution based on the cloud and shows how the framework is suitable and has higher priority vectors.Figure 8
Energy and time consumption comparison for various models with the proposed model during login and authentication model.Figure9 also shows the weakness and strengths of every solution. The strength of the hybrid solution is located in between the support factors. Qurishi et al. at least have focused on two things—the first is the development of the architectural framework and the second one is the development of new evolutionary models—and focused on developing the best solution for decision-making which is based on multimedia decision-making methods (MCDM) which are also known as analytical hierarchy process (AHP). With the help of graphical representation, there is a try to find the best results by using the best hybrid frameworks, and it is observed that the AHP method is the best method to solve the problems [10].Figure 9
Ranking of cloud-based solutions for various platforms based on the main criteria.Smartphones play a pivotal role in the detection of daily life human activities of patients, especially old, aged, and children. According to the survey of some researchers in this modern era, the number of deaths or mortality rate with chronic diseases increases because the elder ones prefer to live alone. Therefore, it is necessary to provide care for them, which is possible through the detection of daily activities using some wearable smart devices or smartphones, and by applying human activity recognition (HAR) algorithms; however, the HAR algorithm lacks classifying accuracy, which requires high computation.Group-based context human activity recognition (GCHAR) has been implemented for achieving high accuracy without requiring high computation. GCHAR system is made up of two different stages, trading stage and classifying stage, which is further trifurcated into three categories; the first is sensing and processing, the second is feature extraction, and the third is group-based context-aware method. GCHAR algorithm is able to recognize the accurate activities as shown in Figure10, in which the value of GCHAR for each activity is accurate when compared with other algorithms. This is the proof of the accuracy of GCHAR for each daily activity, and the KNN algorithm achieves the second highest rank. The recognition of human activity by using the GCHAR algorithm is able to recognize and advance in the overall performance and real time. This is due to the use of a two-level hierarchical model, which can improve classification accuracy [26].Figure 10
Comparison of F1 score for various activities among GCHAR and other algorithms.Jongs et al. have given information about the use of mobile technologies in the study of biological mechanisms, metabolism, human behavior, phenotypic and genotypic characters, brain activity pattern, brain structures, and so on. For better performance of these Android functions, they used various protocols. The assessments are near to real-time conditions.Hussian et al. have proposed the security among mobile health applications and the protection of privacy of users, which is possible by the use of a framework that provides security policies. The framework is composed of two different layers: the security module layer (SML) and the system interface layer (SIL). The framework is based on effectiveness and efficiency. The effectiveness is evaluated by the presentation of the framework in contrast to the security attack, and efficiency is evaluated by the comparison of performances such as memory, energy consumption, and CPU utilization. Due to highly advanced working and capabilities, smartphones replaced computers, as shown in Figure11.Figure 11
Comparison of device battery consumption when checking the context update.According to some specialists, the Android operating system is at the topmost position, it has a market share of more than 85%, and more than 3.5 million mobile applications are available on Google Play. Out of them, many applications have emerged in the medical field. Hussian et al. projected the use of the mHealth apps security framework (MASF), which has been added to the system and provides security from data threats, DNB attacks, data leakages, and so on. Figure12 shows the experimental proof about the use of MASF against cyberattacks that is very effective.Figure 12
Total memory overhead comparison with and without MASF algorithm.It also gives fruitful results in other terms such as time, energy consumption, and memory usage. It can prove that the framework MASF is compatible with both the Android ecosystem and the healthcare community. This is due to the fact that it is incorporated into the Android system with minimal changes [27].


## 3. Conclusion and Future Scope

Various emerging mobile bases technologies, their application domain, and framework have been discussed thoroughly with the application domain and application range, along with their limitations. This work focuses on the performance parameters of the proposed framework as most of them deal with WBAN sensors and devices where power consumption and energy-based performance are major constraints. The rigorous comparative analysis helps us to accurately select a model for different applications in the medical as well as nonmedical filed. The latency issue and time consumption of the various emerging frameworks have been analyzed and compared with other similar models. The comparison of the various models and frameworks has been made on various platforms, which needs more standardization. However, the availability of several functions can sometimes make a system difficult to use and discourage healthcare workers from learning how to use it. The thorough review of the emerging mobile-based technologies helps to lay the foundation and benchmark for future research to develop more efficient models, frameworks, and algorithms and achieve higher performance capabilities as well as better quality of services.



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