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The benefits and challenges of Implementing Smart hospital projects: A

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Abstract—Humans have always tried to look after in healthcare is a priority for certain countries, others lag in
themselves and their families since the beginning of time. The this regard [6].
more the fourth industrial revolution is spreading and
transforming practically every industry, the more it is difficult A. Problem statement
for any discipline to avoid adapting and changing key strategies Healthcare should be cost-effective, of high quality, and
and processes. Engineering techniques to deliver healthcare guaranteed to everyone as a right. With the continuous
services coinciding with the development of medical equipment increase of operational medical costs and higher customer
that requires less human interaction are gaining popularity expectations, achieving the latter with a traditional healthcare
around the world. Clinical processes, management systems, and scope is almost impossible. With the introduction and
infrastructure in smart hospitals are optimized, redesigned, or integration of smart healthcare, a shift from being hospital-
built entirely new. The aim of this study is to explore the benefits
centered toward patient-centered is created. Novel
and challenges of smart hospital deployment. A Methodical
technologies and pieces of equipment are introduced to favor
Literature Review was used where 42 existing publications were
analysed. The research databases and keywords were iteratively
the best patient health outcome. Despite these benefits, there
considered. The review analysis revealed that while the are still significant barricades imposed by political and
healthcare sector seeks new ways to improve internal economic agendas in some world regions to fully invest in
procedures, personnel efficiency, productivity, and integrating smart healthcare in hospitals [4].
communication to achieve better results, it must maintain a Due to socio-economic factors like poverty, lack of
laser-like focus on improving care quality. By adding smart infrastructure, and capacity development, the sub-Saharan
technology into the care framework, it will boost patient
African region has been relatively absent in the domain of
satisfaction and improve patient care. Smart healthcare
provides patients with more efficient and preventive care.
healthcare. At the same time, exceptions exist, for example,
Doctors may not have to wait for the patient to need medical the use of Smart Wearable Mobile devices and cloud
help before they can help. They can now use technological computing in South African healthcare [7].
monitoring gadgets to prevent critical hygienic issues from B. Aim of the study
occurring.
The paper aims to explore the benefits and challenges of
Keywords—Smart hospital, smart healthcare, Internet of the implementation of smart hospital projects.
Things, review The impact of implementing smart hospital projects will
I. INTRODUCTION be presented through a systematic review of various case
studies worldwide.
Health care is a basic need and fundamental right of every
human being [1]. Since the dawn of ages, humans have C. Scope of the study
always strived to take care of themselves and their people. The scope of the paper is not limited to a specific region
Thus, the concept of health care was born by great gurus such of the world, but an emphasis on Africa and South Africa is
as Hippocrates and Leonardo da Vinci who laid the made. In addition, this study did not include digital
foundation of health care as we know it today [2][3]. technologies for natural and pharmaceutical development,
Nowadays, with the fourth industrial revolution taking traditional EHR (Electronic Health Record) and EMR
over and changing the routine of almost every industry in the (Electronic Medical Record) development, traditional
world, it is hard for any discipline not to adapt and change healthcare force chain operation, or healthcare threat and
core strategies and processes. The health sector was not left insurance.
behind, with novel technologies and equipment added almost II. METHODOLOGY
daily [4]. Worldwide, the interest is shown in engineering
approaches to deliver healthcare services that concur with the The investigation is carried out using a Methodical
development of medical devices that need less human Literature Review. The search was undertaken on previous
interaction. This accomplishment is achieved by using the relevant publications. To identify those existing publications,
Internet of Things (IoT), which connects physical objects and the research databases and keywords were considered. The
the internet [5]. following are the keywords used to identify relevant research:
“Smart hospital”, “smart health care”, and “benefit and
Recent technologies have transformed care processes and challenges”.
the outcomes produced by the health sector, for instance,
patient safety. Smart healthcare is also a contributor to the These keywords were found in the title of the research,
socio-economic development of several countries in the the abstract, and the entire publication. A custom
world. For example, 20% of the US GDP is dedicated to modification strategy was used to further verify the citations
health expenditures. While integrating technological features that were left behind in the databases.
 Between 2016 and 2022, 80% of the papers were the introduction of industry 4.0 in 2011, its impacts have been
published in peer-reviewed English-language journals, felt in our daily activities, and no field has remained
conference proceedings, and book chapters (to date). This unchanged [8]. Hence, the concept of smart health care has
was done on purpose to keep the focus on recent acceptable been introduced. As a relatively new field, few literature
research. Emerging information technologies relevant to examples have been written, making it difficult to define it
healthcare systems and medical devices were also categorically. Nevertheless, some authors tried to bring a
considered. more insightful approach to smart healthcare, allowing us to
picture the concept better. Smart health care can also be
The title and abstract reading of all the relevant papers defined as the discipline that includes most of the industry 4.0
was done in the first pass of filtering, using qualitative criteria pillars, massive data analysis, the Internet of Things (IoT),
such as application, regency, and credibility. Then the wireless sensors, radio frequency identification (RFID), and
exclusion and inclusion criteria (Table I) were also applied: many others [9]. In Addition, smart care can allow doctors to
TABLE I. INCLUSION AND EXCLUSION CRITERIA monitor patients’ vitals even when they are not in physical
Inclusion criteria Exclusion criteria
contact [9]. Smart health care can be considered a preventive
and personalized care system compared to the reactive
Studies written in English. Non-English studies.
traditional healthcare system [10].
Publications from 2016 to 2022 Publication before 2016
With the inputs above on smart health care, it is safe to
Research relevant to the topic. Research not relevant to the topic. say that smart healthcare is this new discipline of medicine
Research that focuses primarily that embraces industry 4.0 pillars which include smart tools
on the benefits and challenges of - and devices, the Internet of Things, and RFID, just to mention
implementing smart hospital. a few [11]. Smart healthcare has the purpose of providing
more efficient and preventive care to patients. This means
Following that, a complete review of the pre-selected that doctors do not have to wait for the patient to require
publications. After some deliberation, the final filtering of medical attention to assist, and they can now prevent critical
articles was decided. The data grafts were developed through sanitary situations from happening by utilizing technological
consensus and iterative review prior to the automated hunt. monitoring devices [12].
The author information, paper title, publishing time and type, B. Evolution of the health care sector
the exploratory approach used, evaluation, and findings were
all included in the draft. Figure 1 depicts the flow diagram for Smart hospitals are just components of Health care 4.0, an
the process of paper selection: application of industry 4.0 pillars in the health sector. In the
same way, there have been four industrial revolutions
Research aim (Industry 1.0 - industry 4.0), and there have also been four
The paper aims to explore the benefits and challenges of the transitions in the health sector (Health care 1.0 – Healthcare
implementation of smart hospital projects. 4.0). The first revolution in the health care sector (Health care
1.0) involved a basic encounter between the patient and the
Databases: Emerald insight, Elsevier, Science direct Springer, and
doctor. The patient would consult the doctor for treatment and
Scopus. prescriptions. This system has been the oldest in health care.
Keywords: “Smart hospital”, “smart health care”, and “benefits and The second revolution (Health care 2.0) has seen significant
challenges” development by introducing medical equipment such as
(n= 98 after removing duplicates) ultrasound, imaging test equipment, and monitoring
equipment. The invention of computers has paved the way for
Application of inclusion & exclusion criteria the third revolution (Health care 3.0), where computer
(n= 62) networks and telehealth have been widely used. During this
transition, patients can consult with doctors using computers
without meeting them face to face. With the fourth industrial
Studies that do not provide benefits or challenges of implementing revolution emerging, Health care 4.0 was also introduced.
smart hospitals, smart health care, after reading the title and abstract
The use of most of the industry 4.0 pillars led to the
introduction of smart hospitals and clinics where patients use
wearables monitoring devices to monitor their vitals, RFID is
Exclusion of full-text articles not related to this research topic. used to control medical samples, and IoT is used to manage
physical buildings [6].
42 articles were included in the review analysis C. Smart healthcare: a global perspective
Clinical processes, management systems, and maybe
even infrastructure are all optimized, redesigned, or built-in
The results are reported
in smart hospitals. All of which are enabled by a digital
networking infrastructure of networked assets to give a
Fig. 1. Flow diagram for the research publication selection process valuable service or insight that was not before conceivable or
available to improve patient care, experience, and operational
III. REVIEW ANALYSIS efficiency [13].
A. Smart Healthcare definition Delivering a meaningful insight service, which was
Health care is one of the basic human needs before previously impossible or unavailable, is a vital component for
modern medicine as we know it; humans studied plants and smart hospitals. This is what elevates a hospital's digital
herbal remedies to heal and take care of their bodies. Since capabilities to the level of true smartness. It is not enough to
digitize or make the hospital paperless (although this is a 2) Challenges of adopting IoT in healthcare.
tremendous accomplishment). Data, insight, and access are Users' security and privacy may be jeopardized by IoT
three critical components of the smart hospital system. Even devices. Unauthorized access to IoT devices could put
now, data is collected, albeit not necessarily from all medical patients' health and personal information at risk [24]. For
systems, but it is not aggregated to extract "smart" entities operating in separate domains, to build confidence for
information, which can be done by feeding it in to analytics digital health transactions, inter-realm authentication is
or machine learning tools. This data must be accessible to the required. Shibboleth is a federated identity solution that
user — a doctor, a nurse, facility personnel, or any other allows users to authenticate entities both within and outside
stakeholder — via a desktop, smartphone, or another of organizations [25][26]. Health Information Exchange
handheld device interface, allowing them to make critical (HIE) improves healthcare delivery by allowing varied
decisions more quickly and efficiently. Operations, clinical healthcare institutions to safely and reliably communicate
duties, and patient-centricity are all handled by these patient information electronically. Currently, HIE is built
components [13]. using the Internet of Things 99 ways to implement the
following potential solutions: trade facilitated by the
D. Internet of Things (IoT)
consumer exchange that is directed and exchange that is
The Internet of Things (IoT) has been widely used to based on a query [27][28][29]. Communication is one of the
connect accessible medical resources and provide geriatric most difficult aspects of establishing smart or connected
and chronic illness patients with trustworthy, effective, and health. Many gadgets now include sensors for data collection,
smart healthcare [14]. They go on to say that smart healthcare and they frequently connect with the server in their native
can improve the performance of public services and medical language. Because each manufacturer has its own protocol,
infrastructure by allowing real-time data to be collected and sensors from different manufacturers may or may not be able
analyzed swiftly, as well as recognizing and responding to to communicate with one another. Because of the fragmented
sudden and unexpected situations. Thanks to the smart software environment and privacy concerns, valuable data is
perception within an IoT, resources in the medical center may usually isolated on data islands, undercutting the core reason
be handled and controlled correctly [15]. behind IoT [30].
The Internet of Things (IoT), which allows data collection E. Smart healthcare in Africa
and exchange, has a wide range of applications in daily life,
including healthcare. Healthcare-related IoT (H-IoT) is a Resilience comes in a variety of forms. Globally, there is
group of prospective next-generation technologies in the a constant push for efficiency and cost reduction, increased
healthcare area that promises to improve healthcare by bacterial resistance, climate change, and future energy and
providing data-driven insights. While effective in practice, water scarcity resilience. There is growing recognition that
new data problems have arisen as a result of the opaque the environment in which patients are treated and cared for
black-box systems [16]. plays an important role in their recovery. These factors are
just as essential in Africa, but they `are rare and typically
IoT applications and devices are expanding to fulfill the exacerbated by outdated and overburdened healthcare
demands of a technology world as the smart building market facilities, as well as tight finances for new construction or
grows. In the healthcare industry, IoT innovation renovations [31]. There are various barriers to smart health
opportunities are always changing. Medical facilities come adoption in Sub-Saharan Africa, including poverty, scarcity
with their own set of issues and perks. Environmental of human resources, a lack of existing infrastructure,
controls and security solutions, as well as wearable sensors connectivity deficiency, high connectivity expenses, lack of
and cloud-connected medical equipment, are all examples of capacity development, and policy issues [32].
IoT applications in healthcare. The influence of IoT in
healthcare has a favorable impact on the patient experience Lately, the healthcare application of Artificial
[17]. Intelligence (AI) in Africa has only seen a few pilots and test
cases [33]. A partnership including researchers and a social
1) Benefits of adopting IoT in healthcare. enterprise has been developing an AI planning application to
Patient comfort and convenience are improved as a result improve the scheduling of community health workers
of the Internet of Things, resulting in higher patient (CHWs) in African communities [34].
satisfaction and faster recovery times. Physicians may use Ubenwa is a Nigerian start-up that uses signal processing
IoT healthcare devices, wearable technologies, and data and machine learning to improve the diagnosis of birth
access to better monitor patients and give better-informed asphyxia in low-resource settings [35]. In addition, A study
therapy [18] [19] [20]. Patients, physicians, and staff are safer in Zambia investigated the use of artificial intelligence to
with IoT security support systems [21]. UV light sanitation diagnose diabetic retinopathy. It showed significant and
systems keep environments clean and help to keep people promising results when compared with human assessments.
healthy [22].
It was clinically acceptable in detecting referable diabetic
Telemedicine, according to the International Society for retinopathy [36]. The computer-aided diagnosis of
Telemedicine and eHealth, is defined as the delivery of pulmonary tuberculosis from chest radiographs has been
healthcare services by all healthcare providers. It makes use tested in a pilot study in Tanzania and Zambia using
of information and communication technology to share CAD4TB software. The results were impressive, as CAD4TB
accurate data for the diagnosis, treatment, and prevention of performed well compared to human diagnosis [33][37][38].
disease and injury. Telemedicine can provide a welcome A group of five high school girls developed an app based
relief from the haphazard nature of patient records. on open-source software developed by MIT to identify fake
Simultaneously, it can reduce the patient's traveling costs and drugs in Nigeria. In 2018, they won a Silicon Valley
remove any correspondence barriers that many rural contest for their stellar idea. In 2019, a
healthcare clinics confront in an emergency [23].
Nigerian pharmacist and architect Adebayo Alonge won the the work process, improving healthcare decisions with more
grand prize at the Hello Tomorrow Global Challenge for data, allowing patients to interact electronically with their
his artificial intelligence hyperspectral platform for healthcare providers, and ensuring that machines are
authenticating drugs [33] [39][40]. operational [9].
F. Healthcare in South Africa The benefits of smart health are the provision of a smooth
hospital experience, reduced error rates, efficient time usage,
There are numerous elements that makeup healthcare
improved communication, better-extended care, better safety,
sector systems to be complex or resulting. The health system
and security. While the healthcare industry looks for
in South Africa is primarily public, with a small but rapidly
increasing private sector. In the South African health sector, alternative methods to improve internal procedures,
there is a wide range of services available, from free primary employee efficiency, productivity, and communication to
health care to highly specialized and high-tech treatments achieve better results, it must become laser-focused on
available in both the public and private sectors. In some enhancing care quality. Only by incorporating smart
places, however, the public sector is overburdened and under- technology into the care framework will these institutions
resourced because it serves about 80% of the population. The improve patient satisfaction and elevate patient care to new
private sector, on the other hand, is mostly commercial in heights.
nature and caters to the middle and upper classes, the majority As a result, the demand for large-scale solutions such as
of whom are members of medical plans. The majority of the the Internet of Things (IoT), Cloud Computing, and Fog
country's health professionals work in the private sector [41]. Computing, which connect heterogeneous devices to transmit
Institutions in the public sector have suffered from bad and process large amounts of data without requiring explicit
management, underfunding, and failing infrastructure as a human-to-human and human-to-machine interactions, is
result of this two-tiered system, which is inequitable and growing at an exponential rate. Furthermore, merging HPC
inaccessible to a wider proportion of South Africans. With paradigms with BANs and smart healthcare services offers
the full weight of sicknesses faced by the public sector, such several key benefits, including scalability, storage, and
as tuberculosis, the health care system must be revitalized and processing to handle both online and offline data streams.
restructured [42]. The following are the major benefits of smart healthcare
that have been identified [48]:
In South African hospitals and other parts of the world,
 Wide availability.
old paper-based systems are still used to archive patient
information. If a doctor or a caretaker needs to access it, it  Instant and reliable treatment.
will require more labor [43]. When using paper-based  Cost reduction.
methods, information can only be retrieved in one location,  Effectiveness of medicine and disease control.
which might be a problem if the person is out of town and the  Easy usage.
other hospital does not have medical data. When repetitive  Improved communication.
testing is required, this takes a lot of time, resources, and
money. In healthcare, data storage must be improved. In other B. Challenges
nations, cloud storage is one of the storage options for There are several obstacles to overcome, such as the
medical records [44]. Authorized parties, doctors, and infrastructure and skills required to integrate smart health
caregivers can access medical records from anywhere using technologies into regular operations. Sharing sensitive
cloud storage. The advantages include ease of access, low information about patients via the internet raises severe
cost, increased productivity, and efficiency, all of which lead security and privacy concerns. When collecting data from
to scalable cost savings. patients, security is a difficult need to meet. In smart
Existing Medical Services Integration Strategies for healthcare, confidentiality is a critical security requirement.
Portable Wearable Gadgets and Distributed Computing A cyber-attack on the smart healthcare system is possible.
There has been a significant amount of research on flexible The practitioners' reluctance and unwillingness to employ
medical care and remote monitoring [45]. One concept these new technologies in medical practice is a serious barrier
launched a year and a half ago in South Africa, is Undertaking [9].
Masiluleke, a mobile wellbeing drive that promotes Hospitals are also facing issues such as a lack of financial
HIV/AIDS awareness, training, and treatment. It presently resources because of cost pressure. 18 countries spend less
sends between 1 and 2 million messages every day to South than US$ 10 per capita on health each year, while 31
Africans, providing data or instructing them to phone the countries spend less than US$ 20 per capita. According to a
public Guides wellness line [46][47]. recent short assessment of six East, Central, and Southern
African countries, the average government budget for ICT in
IV. KEY FINDINGS AND DISCUSSION
health for the next three years will be US$ 0.32 per capita per
A. Benefits year, compared to US$ 55 in the US [32].
As the world continues to be transformed by smart Numerous issues plague Africa. The high cost of
technology, healthcare has become a proactive technology telemedicine, limited deployment of telecommunications
adopter, owing to the massive influence technology has infrastructure, absence of health policy and enabling
shown in increasing patient safety and reducing healthcare legislation for telemedicine, and the scarcity of health
costs. Smart healthcare has also become a reality due to the professionals are all obstacles to its adoption and
Internet-enabled smart gadgets, which allow patients to development in Sub-Saharan Africa.
receive medical treatment from anywhere on the planet. The following are the major challenges of implementing
Smart healthcare's most common advantages are streamlining smart healthcare [48]:
 Scalability and interoperability.
  Higher power consumption. in information communication technology, and there is no
 Low latency tolerance. doubt that implementing smart hospital projects provides
 Need for a user-friendly device. major benefits to all health care stakeholders (affordable
 Security and privacy. health care, cost-effective health services, and so on).
 Computational Intensity.
The critical areas where smart healthcare implementation
C. The impact of Smart healthcare has had a huge impact were discussed, including data
Smart hospitals use information and communication collection, analysis of patient outcomes, and medicals, to
technology-based settings, particularly those based on IoT name a few. The major benefits that are driving the processes
optimization and automated operations, to improve existing of digital healthcare adoption nationally and internationally
patient care procedures and add new features. The demands were also discussed. In addition, some possible solutions
of the three core services supplied by smart hospitals, namely were exploited to enable even faster digital healthcare
services for medical staff, patients, and administrators, must deployment, as well as the challenges of impoverishment.
be considered while making hospital management decisions. While the healthcare industry is becoming more
By combining multiple digital technologies based on the interested in harnessing the Internet of Things (IoT) and big
Internet of Things, the information platform in hospital data technologies to improve efficiency, some difficulties
management unites digital devices, intelligent buildings, and must be overcome before digital health care can become a
employees. This technology can also be used to identify and mainstream reality. Certain smart healthcare technologies are
monitor patients in hospitals, track instruments, and still in their early stages of development and require large
biological material, and supervise medical staff on a regular resources to maintain and improve. There is the possibility of
basis. Smart healthcare is utilized in the pharmaceutical an unknown risk if it is used inappropriately. To summarize,
industry for drug manufacturing and distribution, inventory smart hospitals' future directions include system integration,
management, anti-counterfeiting, and other activities. refinement, and automation [18].
B. Recommendations for future studies
A unique radio-frequency identification (RFID) tag can
be issued to each user to ensure that hospital resources are Further studies are needed to properly comprehend the
circulated in a secure, dependable, stable, and efficient direct and indirect consequences of the shift to smart hospital
manner, and the data can be stored in a database that can be initiatives. With the economic, social, legal, and ethical
tracked and retrieved via mobile devices in terms of decision- elements of smart health care services in mind, further study
making, the establishment of an integrated management should be conducted to shed light on the solutions that may
platform may facilitate activities such as resource allocation, be adopted to make smart health project adoption more user-
quality analysis, and performance analysis, as well as lower friendly and cost-effective. In addition, future studies should
medical costs, maximize resource utilization, and aid also elaborate further on the latest healthcare technologies
hospitals in making development decisions. Patients can use and the ways in which these are impacting the hospital of the
a variety of services to improve their patient experience, future.
including physical examination systems, online This study has some limitations; these limitations are gaps
appointments, and doctor-patient contacts. These future smart hospitals or smart healthcare research can
computerized technologies lower the amount of time it takes explore. Therefore, this study suggests the following for
for patients to obtain medical treatment, cut patient wait future studies:
times, and provide more individualized care [49]. The review of this study used a few databases. Despite the
fact that these databases contain outstanding peer-reviewed
The development of mature concepts and systems has publications, they do not contain all peer-reviewed
evolved from the emergence of smart healthcare. However, publications on the topic of this study. Future systematic
with the rise of new technologies and challenges, there is still review research could broaden the database scope to gain
a lot of room for progress and a lot of work to be done. Smart more insight into this problem.
healthcare is now lacking in macro direction and The review included peer-reviewed English papers; a
programmatic papers, resulting in a lack of clarity in few book chapters were also reviewed. To maintain the high
development goals and, as a result, a waste of resources. quality of the publications examined. However, book
Furthermore, medical institutions must improve data integrity chapters may contain valuable information that should be
and establish common standards across departments and included in future studies. Therefore future research should
organizations. There are also compatibility difficulties consider more books or book chapters on this topic.
between different systems and devices. Smart healthcare, The above limitations are important because they offer a
from the patient's perspective, lacks appropriate legal clear picture of the current state of this research topic and a
constraints, raising worries about personal information and clear direction on the areas that need to be addressed in future
privacy breaches. Some customers have difficulty navigating research.
technology. ACKNOWLEDGMENT
V. CONCLUSION AND RECOMMENDATIONS The authors would like to thank the following students
from the University of Johannesburg: Tafadzwa Chapwanya,
A. Conclusion
Sepitsi Montgomery Chepape, Boitumelo Herminah
The internet of things (IoT) is changing the way we think Chiloane, N.N. Dingiso, and Unathi Diniso, for their
about and deliver health care. There are rapid advancements contribution to this study.
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