Technologies for Interoperable Internet of Medical Things Platforms to Manage Medical Emergencies in Home and Prehospital Care: A Scoping Review (Preprint)

Abstract

The aging global population and rising prevalence of chronic disease and multimorbidity have strained healthcare systems, driving the need for expanded healthcare resources. Transitioning to Home-Based Care (HBC) may offer a sustainable solution, supported by technology and innovation such as Internet of Medical Things (IoMT) platforms. Although IoMT platforms have the potential to streamline healthcare delivery, reaching their full potential is often challenging due to interoperability issues. These challenges hinder communication and impose risk to patient safety. Gaining more knowledge about addressing higher levels of interoperability issues is essential to unlock the full potential of IoMT platform.

The purpose of this scoping review is to summarize best practices and technologies to overcome interoperability issues in IoMT platform development for prehospital and home-based care (HBC).

This review adheres to a protocol published in 2022. Our literature search followed a dual search strategy and was conducted up to August 2023, including the following electronic databases: EEE Xplore, PubMed, Scopus, ACM Library, National Center for Biotechnology Information, SAGE Journals, and ScienceDirect. After the title, abstract and full text screening performed by two reviewers, 158 final articles were left for inclusion. To answer our three research questions, we proceeded from two models defined in the protocol: a 6-level interoperability model and a 5-level IoMT reference model. Data extraction and synthesis were conducted through thematic analysis using Dedoose. The review's findings, including common technologies and standards, were presented through a combination of narrative descriptions and graphical representations.

The primary technologies and standards reported for interoperable IoMT platforms in prehospital and home-based care (HBC) include cloud computing (n=19), REST APIs (n=17), Wi-Fi (n=17), Gateway (n=15), and JSON (n=14). MQTT (n=7) and WebSocket (n=7) were commonly used for real-time emergency alerts, while fog and edge computing were often combined with cloud computing for enhanced processing power and reduced latencies. In contrast, technologies associated with higher interoperability levels, such as Blockchain (n=2), Kubernetes (n=3), and OpenEHR (n=2), were less frequently reported, indicating a focus on simpler platforms in most studies.

IoMT platforms that support higher levels of interoperability have the potential to deliver personalized patient care, enhance the overall patient experience, enable early disease detection, and minimize time delays. However, our findings highlight a prevailing emphasis on lower levels of interoperability within the IoMT research community. While Blockchain, Microservices, Docker and OpenEHR are described as suitable solutions in the literature, these technologies seem to be seldom employed in IoMT platforms for prehospital care and HBC. Recognizing the evident benefit of cross-domain interoperability, we advocate a stronger focus on collaborative initiatives and technologies to achieve higher levels of interoperability.