IoT‐based remote monitoring system: A new era for patient engagement

Abstract

Internet of Things (IoT) is changing patient engagement in healthcare by shifting from traditional care models to a continuous, technology‐driven approach using IoT‐based Remote Monitoring Systems (IoT‐RMS). This research seeks to redefine patient engagement by examining how Internet of Things (IoT) technologies can impact healthcare management and patient–provider interactions at different phases. Additionally, it presents the relationship between patient engagement stages and IoT‐RMS, which promotes patients' active participation using technological health management tools. The study emphasizes that IoT‐RMS improves patient engagement, organized into three main stages: enabling, engaging, and empowering. This approach shows how technological progress encourages patient involvement and empowerment, leading to improved health results and personalized care. A systematic review and narrative analysis of Web of Science (WOS), Scopus databases, IEEE, and PubMed yielded 1832 studies regarding patient engagement and technology. Despite the optimistic findings, the article highlights the need for more research to evaluate the durability of technology interventions and long‐term effectiveness.

1. INTRODUCTION

In the healthcare realm, patient engagement refers to the active involvement of patients in their healthcare; this can include self‐management of their health and wellness [1]. This can empower individuals and increase their sense of control over their health. Research has shown that patient participation can enhance health outcomes by increasing adherence to treatment regimens and promoting lifestyle changes to improve health [2]. Patient engagement has evolved from an essential patient‐doctor relationship to a multifaceted interaction that includes patients, doctors, families, and technology. At first, patient participation primarily involved direct communication and care decisions between the patient and clinician [3, 4]. The healthcare landscape has developed to acknowledge families' important role in the care process and decision‐making [5]. Technology has enhanced patient‐doctor‐family relationships by integrating and coordinating them through digital platforms.

However, there is a need for more comprehensive methods to identify and assess these stages of patient engagement. Traditional patient engagement, which forms the basis of current measures, does not adequately capture the dynamic and multifaceted nature of this process. Additionally, different scholars emphasize different aspects of patient engagement [6, 7].

Remote Monitoring Systems (RMS) based on the Internet of Things (IoT) IoT‐RMS is a system that allows healthcare providers to keep close to their patient's health and status while they are out of the hospital, practice, or clinical setting [8].

The shift from traditional patient interaction methods to integrating Internet of Things (IoT) technologies has ushered in a new era of innovation. This move improves the quality of care and changes the patient‐provider relationship by introducing a new form of interaction known as patient engagement with technology. Patient engagement with technology is distinct from patient engagement using technology; according to the literature, using technology for engagement regards technology as a mere tool for facilitating traditional forms of engagement [9]. In contrast, the former emphasizes patients' active interaction and incorporation of technology into their health management routines.

The current gap in the literature lies in the insufficient exploration of how these technologies can accurately capture the dynamic and dimensionality of patient engagement. The integration of IoT technologies introduces new dimensions of interaction that are not adequately addressed by existing literature. Specifically, there is a need for comprehensive methods to identify and assess the stages of patient engagement, incorporating the capabilities of IoT‐RMS. This research aims to address this gap by exploring the stages of patient engagement and how the evolving of IoT‐RMS can redefine patient engagement and provide more accurate information to reflect the multifaceted interactions between patients and technology. That can be achieved by mapping the capabilities of IoT technology to the different stages of patient engagement. This research will contribute to a comprehensive understanding of how IoT‐RMS can be leveraged to empower patients and promote active engagement in their healthcare journey. This research aims to provide answers to the posed research question:

• How can the capabilities of IoT technology be mapped effectively to the different stages of patient engagement?

2. RESEARCH METHOD

This research adopts a systematic review and narrative synthesis. This approach combines the interpretative elements of a narrative synthesis with the rigorous systematic review methodology, which collects and analyses data systematically while providing a narrative synthesis to contextualize and explain the findings following the approach outlined by [10]. This research employs narrative synthesis, a data analysis technique that can be effectively used in systematic reviews to synthesize findings from various studies. This approach entails interpreting and telling the information, or experiences represented in the data, resulting in better knowledge of the research issue's context and intricacies [11]. We carefully gathered data from Web of Science (WOS), Scopus databases, IEEE and PubMed. Our research leveraged specific search terms to address the multifaceted topic of patient engagement with technology comprehensively. These terms included “patient engagement,” “patient participation,” “patient activation”, “remote monitoring system ”, “telecare ”, “telemedicine. ”, and “e‐health ”. The review spanned publications up to June 2023, with a rigorous content validation process eliminating irrelevant papers based on their titles, abstracts, and full texts. Papers were selected for their direct relevance to the study's scope and contribution to developing the engagement construct. Table 1 illustrates the inclusion and exclusion criteria for the study. This meticulous process led to a distilled collection of 35 significant papers after removing duplicates and those that did not meet the specified criteria. Figure 1 shows the flow of information through the different phases of article selection.

TABLE 1.

Study inclusion and exclusion criteria.

Inclusion criteria

Exclusion criteria

English‐language studies (qualitative, quantitative, or mixed‐methods) that have undergone peer review. Research emphasis: Investigations concerning patient engagement, participation, activation, and technology utilisation (e.g. remote monitoring systems, telecare, telemedicine, e‐health). Outcome measures: Research must document results about patient engagement, including but not limited to enhanced health outcomes, patient satisfaction, or expanded healthcare accessibility facilitated by technology. The studies should have been published no later than ten years ago to maintain their applicability and account for technological advancements.

None peer review grey literature, editorials, opinion pieces, and conference abstracts comprise the content. Research articles that were not published in the English language. Irrelevant emphasis: Research that concentrates on implementing technology at the provider side without involving patients directly. Duplicate studies refer to publications that present findings from the same study population or dataset. Studies about patient engagement which are unrelated to the use of technology such as patient engagement in clinical research.

FIGURE 1.

Flow of information through the different phases [12].

The data extraction stage was designed to identify the stages of patient engagement, alongside the role of IoT‐RMS. The key data points focused on definitions and dimensions of patient engagement, such as participation and activation. Subsequently, the stages of patient engagement were mapped. The essential elements of IoT in healthcare were also identified, particularly in relation to their applications in healthcare systems. The RMS phases within healthcare were examined as well. A narrative synthesis was employed to integrate the extracted data, illustrating the relationship between patient engagement and IoT‐RMS. This synthesis underscored that patient engagement encompasses multiple stages, each of which can be significantly enhanced through the application of technological solutions.

3. RESULTS

3.1. Patient engagement definition

Patient engagement is a process and a practice that is impacted by the patient‐provider connection as well as the environment in which healthcare is delivered [2]. Patient engagement refers to a partnership between patients and health professionals across different healthcare system levels to improve healthcare quality, as [13] stated. Patient engagement is described as the willingness and ability to actively choose to participate in care in a way that is unique to the individual, in collaboration with a healthcare practitioner or institution, to improve outcomes or care experiences [14]. Engaged patients are active medical team members, communicating with them frequently to better manage their health during treatment [15] from literary sources. Table 2 illustrates the multi‐dimensional concept of patient engagement.

TABLE 2.

Multi‐dimensional concept of patient engagement.

References	Concepts	Characteristics
[13, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26]	Participation, activation	Refers to a patient's readiness and ability to actively manage their health and healthcare.
[18, 19, 21, 27]	Involvement	Highlights the active involvement of patients in the healthcare process, regarding them not solely as recipients of care but as essential stakeholders in their treatment.
[9, 21, 28, 29, 30]	Empowerment	A procedure by which individuals are granted increased autonomy regarding choices and behaviours that impact their well‐being. This idea pertains to empowering individuals to make well‐informed decisions and engage in behaviours that enhance their health and welfare.

Patient engagement can enhance activation, empowerment, or participation and the desired health outcomes. All the related terms refer to concepts with a narrower scope than engagement. However, activation, empowerment, and greater participation may all affect patient engagement.

Patient engagement includes Patient activation because it emphasizes the active readiness of patients in their healthcare decision‐making. Participation of patients in decision‐making processes ensures that their preferences and values are considered, which can contribute to more patient‐centered care. Moreover, Patient involvement is essential for patient engagement because it demonstrates a patient's readiness and capacity to manage their health continually. Activated patients are better equipped to interact with healthcare providers, pursue health information, and make informed decisions.

Patient engagement outcomes in Patient empowerment indicate that individuals who are empowered are actively involved in their healthcare. Patients are more likely to participate in their care, communicate effectively with healthcare providers, and advocate for their needs when they have the knowledge, skills, and confidence to make informed decisions about their health.

Considering all the information from the literature, we can reform the definition of patient engagement with technology by considering all the concept's dimensions. Therefore, Patient engagement with technology is a dynamic and transformative approach to healthcare characterized by patients' proactive and knowledgeable use of digital tools, platforms, and devices to manage their health. This paradigm emphasizes the active interaction and comprehension of technology within patients' health routines, as opposed to the passive use of technology as a facilitation tool for conventional forms of engagement. It encompasses a multifaceted process in which individuals access information, communicate with healthcare providers and seamlessly incorporate digital resources into their healthcare decision‐making, resulting in an ultimately more empowered and self‐reliant patient population.

3.2. Stages of patient engagement

The literature on patient engagement describes a process divided into three stages: enabling, involving, and empowering. The consensus on the initial stage, enabling, indicates a widespread acknowledgement of the fundamental processes required for successful patient involvement [6, 7, 31]. This entails equipping patients with essential resources, knowledge, and assistance to participate actively in their healthcare. This stage is crucial as it establishes the foundation for future involvement and participation in healthcare decisions.

The enablement phase commences by furnishing patients with the essential resources, tools, and information required to comprehend their health conditions and the intricacies of the healthcare system.

Its priorities are tailoring interventions or strategies to the specific requirements of each patient, guaranteeing that every individual receives the appropriate type of assistance to initiate their journey towards engagement [32, 33]. It consists of two essential elements. Motivation behavioural approach: Encouraging patients to actively engage and participate in decisions related to their health and healthcare [34]. Enabling technology: Helping people access health information and communicate with providers through digital tools, health apps, and other technologies [23].

The literature shows different opinions about the following phases. The second step might be interpreted as extending the engagement process through involvement or constituting the engagement itself. If engagement is seen as the second stage, it highlights a strengthening relationship where patients are more active in their treatment procedures [35]. Alternatively, categorizing involvement as the second stage may suggest a more comprehensive process that includes both the beginning and intensification of patient involvement [36, 37].

During the involvement phase, patients actively participate in their healthcare by collaborating with providers. Active patient involvement requires ongoing communication and feedback channels between patients and healthcare professionals [38, 39]. Involvement focuses on sustaining active participation and interaction [40]. The key element of this stage is continuous monitoring, which involves observing an individual's health condition. involvement is inherently connected to this practice. This continuous monitoring guarantees that patient care remains flexible, responsive to alterations in the patient's condition or preferences, and consistently in line with the patient's objectives and anticipations [41, 42].

The third stage, Empowerment, is widely acknowledged by academics as a crucial moment where patients acquire the capacity to make well‐informed decisions about their health in partnership with healthcare professionals. Patient engagement reaches its highest point, with the patient being an active participant in decision‐making rather than just a recipient of care [43, 44].

Empowered patients are granted complete authority over their healthcare choices. Empowerment is manifested via quantifiable results, including connection, self‐management, and decision‐making ability [45]. Connected refers to patients' integration into the healthcare system via technology. This involves utilizing digital platforms for health monitoring, accessing medical information, and communicating regularly with healthcare experts and support systems to keep patients informed and supported throughout their health journey [44, 46]. The empowerment of patients to take the lead in their healthcare by making well‐informed decisions that align with their values and preferences results in improved health outcomes [7]. Self‐management refers to patients having the knowledge, skills, and confidence needed to handle their health conditions. Self‐management involves enabling individuals to handle duties concerning their everyday health, including managing medications, adapting lifestyles, and participating in self‐care activities [23, 36]. Figure 2 illustrates patient engagement stages and the characteristics of each stage.

FIGURE 2.

Patient engagement stages.

3.3. Definition of internet of things remote monitoring system in healthcare

RMS is an approach to promoting health and patient care. Patients' medical and physiological data is communicated digitally from their homes to healthcare facilities through phone, Internet, or videoconferencing [47]. The Internet of Things (IoT) is the modern innovation of the Internet and a rapidly expanding study field, particularly in healthcare [48]. IoT refers to the interconnected network of physical things or ‘Things’ that can exchange data with other devices/systems via the Internet. Ashton (2009) described IoT for the first time in the supply management domain in 1999. With the increased usage of wearable sensors and smartphones, IoT monitoring of health aids is used to accurately diagnose health conditions [9]. RMS is an approach to promoting health and patient care. Patients' medical and physiological data is communicated digitally from their homes to healthcare facilities [47]. The RMS is a technique that enables medical service providers to monitor a patient's health condition remotely. The application of RMS relies heavily on modern technology to acquire patient data. RMS technology positively impacts the patient's overall health, particularly the physician's ability to view patient information [45, 49].

According to [50], Remote Monitoring Systems (RMS) based on the Internet of Things (IoT) IoT‐RMS is a system that allows healthcare providers to keep close to their patient's health and status while they are out of the hospital, practice, or clinical setting. [51] state that IoT‐RMS enhances patient care by utilizing digitally transmitted health‐related data. This shared information enables the early detection and treatment of disease signs, the education of patients, and the enhancement of the patient‐physician relationship.

Throughout this paper, IoT‐RMS will refer to a non‐invasive device that transmits data automatically to a web portal or mobile app for patient self‐monitoring, health care evaluation, and clinical decision‐making, and medical professionals can keep track of a patient's vital signs [52].

3.4. Essential element of IOT‐based RMS

Understanding the key components of IoT‐based Remote Monitoring Systems (RMS) requires examining the architecture of IoT in healthcare, specifically IoT‐RMS, and how this architecture aligns with the stages of RMS. An IoT‐based healthcare system can utilise many IoT healthcare architectures. The design comprises multiple components collaborating to carry out data gathering and processing operations to deliver essential information to the end user, physician, or caretaker [53]. The IoT system follows a well‐recognized layers architecture. These layers include the perception layer, networking layer, middleware layer, and application and business layer. The architecture is depicted in Figure 3. The layers are explained by [52, 54, 55, 56, 57, 58, 59, 60].

FIGURE 3.

General overview of an IoT system architecture.

The perception layer: It is situated beneath the physical or hardware layer, which can be considered an intermediary layer. This layer is responsible for data collecting and showing; data that has been prepared is then transmitted to the network layer. Network layer: This layer aims to establish a connection between all smart devices so that they may exchange and share health data. This layer securely communicates health data from patients to the base station through many protocols and technologies, including Zigbee, Bluetooth, infrared, and Wi‐Fi. Middleware layer: This layer provides name and address‐related services to its requester. Programmers developing health IoT (HIoT) applications are not limited to a particular equipment platform when dealing with heterogeneous objects. This layer collects health information from the network layer and saves it in a database. The application/business layer: This layer is responsible for procuring healthcare services, which combine and assess the data obtained from the preceding layers. This stratum can deliver superior healthcare services to fulfil patients' demands. The efficacy of HIoT systems will be contingent upon the implementation of suitable business models, technologies, and innovations; thus, this stratum is tasked with overseeing all operations and healthcare provisions via the development of flowcharts, business models, and graphs.

A comprehensive understanding of the correlation between patient engagement and IoT‐RMS requires a thorough comprehension of the operational stages of RMS and their integration with the overarching architecture of IoT systems. A practical analysis of the integration of RMS in healthcare, specifically for patient engagement, can be conducted by considering the critical stages of the RMS: data generation, data processing, and information consumption. It can be regarded as the three primary phases of a workflow in an IoT‐RMS, a general healthcare system built upon an IoT‐based architecture [61, 62, 63, 64, 65, 66, 67]. The phases in question are delineated as follows (see Figure 4):

FIGURE 4.

The correlation between the architecture of IoT healthcare and the RMS phases in healthcare systems.

Data generation: The data generation phase encompasses acquiring and producing the requisite data by utilizing diverse sensors, medical devices, and patient or healthcare team participation in direct data entry. Following this step, the acquired data is transmitted by the network layer, which is executed via the perception layer. Data processing: During the data processing phase, created data is analyzed using data analysis tools and well‐known mechanisms, such as machine learning techniques. This stage is executed via the middleware layer. Information consuming: The results and analytics of the data processing phase can be utilized by medical teams for any necessary patient‐related decision‐making, and this analytical information can also be used to activate the actuators. This stage is executed via the business and application layers.

The literature [36, 68, 69, 70] shows that patient use of technology is classified under one of these categories. Gathering information: Technologies such as IoT are used to collect patient data [55], and artificial intelligence (AI) and machine learning (ML) are increasingly used in healthcare predictive analytics for data collection [71]. These tools aid in collecting and processing vast volumes of data to make accurate predictions, assessments, and diagnoses, which can improve healthcare outcomes. Creating connection: The exponential growth of technology in healthcare has improved the ability to store, share, and analyse health information [68]. This development has enhanced provider capacities and patient access, fostering linkages between patients, healthcare providers, and other industry players [36]. Sharing information: the use of technology in healthcare necessitates the sharing of health information, which is essential for the coordination, collaboration, and decision‐making of healthcare practitioners [72, 73].

However, patients must consider all types of use in one model regarding patient engagement. In other words, the patient should have the belief and ability to use innovative technology such as (IoT‐RMS) to gather their data automatically and create a sustainable connection between them and the healthcare provider. Lastly, a patient must have an interest in sharing information through technology. Figure 5 shows the relation between the architecture of IoT healthcare and the RMS phases considering technology use.

FIGURE 5.

The correlation between the architecture of IoT healthcare and the RMS phases considering technology use.

The following part explains how IoT‐RMS might enhance patient engagement and introduces the capability of IoT‐RMS with patient engagement. We examine the sequential stages of remote monitoring systems in connection to the architectural framework of IoT and relevant technological use based on the fundamental understanding of patient engagement definitions and stages. By merging these components, we seek to elaborate on how IoT‐RMS enhances patient engagement in healthcare settings. This part offers a scholarly analysis of how patient engagement, technological infrastructure, and the use of IoT‐RMS are interconnected, aiming to promote knowledge in healthcare technology and patient‐centred treatment.

3.5. IoT‐RMS and patient engagement

As patients have greater access to healthcare options and data, the importance of patient engagement for individuals has expanded. Organizations must keep patients engaged in boosting experience and retaining current patients [74]. Patient engagement is becoming more reliant on technology [13]. The appropriate technology can promote patient engagement by providing access to critical information [4]. Understandably, patients anticipate new technology from their doctors as new technology becomes more integrated into their daily lives [75].

One of the principles of IoT‐RMS is its ability to increase patient engagement by providing individuals with the means and the motivation to take a more significant interest in enhancing their health. IoT‐RMS improves engagement by reducing access obstacles, enables better accessibility for remote patients to engage actively in their care team, and enables more timely care by collecting real‐time data [76].

IoT‐RMS is an effective method for increasing patient engagement to gain greater control over health‐related decisions and actions. However, there is a need for more sophisticated analysis research on long‐term engagement with specific interventions [77].

According to the previous literature about patient engagement, this process is divided into three main phases: enabling the patient, involvement with the patient, and empowering the patient. Figure 6 illustrates the relationship between IoT‐RMS and patient engagement phases.

FIGURE 6.

The integration of patient engagement and IoT‐RMS stages.

The Enablement phase focuses on setting up the fundamental behaviours and technology required for patient participation. The Perception and Networking layer enables motivation and technological acceptance. The layers are accountable for the primary data creation via sensors, wearables, and cell phones. Integrating technological acceptability at this level emphasizes the crucial role of patients adopting IoT devices, aligning with collecting information. Transitioning to the Involvement phase involves continuous monitoring, indicating an engaged and constant procedure. This aligns with the Middleware layer of IoT, which is essential for data processing, analysis, and establishing connections across various healthcare entities. Highlighting data analysis and establishing linkages strengthens the idea of patients actively participating and consistently engaging in healthcare. The Empowerment phase demonstrates the final objective of patient engagement: empowering patients to be connected, make decisions, and self‐manage their health. This is associated with the Application/Business layer, which handles information consumption. Patients here can access and control information, share it, and receive status notifications, which helps empower them through information sharing.

4. DISCUSSION

Integrating IoT‐RMS in patient care offers a transformative approach to the conventional stages of patient engagement: enablement, involvement, and empowerment. The analysis of the enablement phase shows that while traditional models have provided resources and knowledge for patient participation, IoT‐RMS elevates this phase through technology that can tailor patient education and motivation to an individual's specific needs and behavioural patterns. In the involvement phase, IoT‐RMS potentially shifts the paradigm from intermittent to continuous patient‐provider interaction. This constant monitoring capability supports informed decision‐making and enhances the depth and quality of patient engagement by utilizing real‐time data and feedback loops. As the culminating phase of patient engagement, empowerment reaches new heights with IoT‐RMS by enabling patients to take a proactive stance in managing their health. IoT technologies can facilitate informed decision‐making and self‐management by providing actionable insights and personalized health metrics. This can result in a more nuanced form of empowerment, where patients are not merely deciding on pre‐determined options but are actively contributing to the design of their care plans. IoT‐RMS can, therefore, redefine patient engagement by offering a more nuanced and continuous interaction with health technology, creating a dynamic, feedback‐driven approach that aligns more closely with individual patient needs and adaptive healthcare goals.

IoT technology may be strategically aligned with several stages of patient engagement by leveraging its layered design to cater to each phase's distinct requirements and objectives: Enablement, Involvement, and Empowerment.

Enablement: IoT technology is a facilitator in the early stage of patient involvement, utilizing its Perception and Networking layers. Data collection via sensors, wearables, and cell phones is essential. These gadgets promote motivational behaviours and technological adoption by collecting information, which paves the way for more involvement. They establish the basis by providing patients with the tools to actively engage in their health by incorporating health‐related information.

Involvement: The Middleware layer of IoT is crucial during the Involvement phase. It enables data processing, from simple collecting to advanced analysis, and establishes essential linkages. It allows for continuous monitoring and engagement by integrating and interpreting health data from many sources, which can inform and impact patient behaviour and interaction with healthcare practitioners. This layer is crucial for establishing a cohesive healthcare ecosystem that enables more efficient collaboration between patients and providers.

During the Empowerment phase, the Application/Business layer utilizes and applies information. Patients can use this stage to obtain and manage their health information, participate in shared decision‐making, and take care of their health through self‐care activities with the help of the IoT framework. Granting access to health information and immediate status notifications empowers patients to actively engage in managing their health, resulting in more independence and enhanced health results.

5. LIMITATION AND FUTURE RESEARCH

In the process of our literature review and narrative analysis, we encountered several challenges that warrant discussion: There is a potential for selection bias due to the subjective nature of article inclusion. We aimed to reduce this by utilizing a group consensus method throughout the review process. Furthermore, we acknowledge the risk of publication bias because of not including grey literature, which may contain pertinent unpublished studies or negative results. Likewise, this review may be limited by not incorporating all existing tools for assessing bias, which primarily focuses on methodology rather than outcomes.

6. CONCLUSION

This research highlights how technology can enhance patient engagement through the capability of IoT‐RMS and identifying patient engagement stages of enablement, involvement, and empowerment. We witness a seamless integration of perception, networking, middleware, and application/business layers through a structured approach involving data generation, processing, and consumption. This integration fosters individual freedom in information handling and promotes a culture of active participation where technology is not just a tool for supporting traditional forms of engagement but rather a means for patients to actively interact, comprehend, and integrate technology into their health management practices. This research envisions a future where empowered users can efficiently and effectively navigate information ecosystems, representing a substantial advancement in user‐centric technology adoption.

AUTHOR CONTRIBUTIONS

Khalad Agali: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization; writing—original draft. Maslin Masrom: Conceptualization; data curation; methodology; supervision; validation; writing—review & editing. Fiza Abdul Rahim: Conceptualization; formal analysis; funding acquisition; methodology; validation; writing—review & editing. Yazriwati Yahya: Conceptualization; formal analysis; funding acquisition; methodology; validation; writing—review & editing.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Agali, K. , Masrom, M. , Abdul Rahim, F. , Yahya, Y. : IoT‐based remote monitoring system: A new era for patient engagement. Healthc. Technol. Lett. 11, 437–446 (2024). 10.1049/htl2.12089

DATA AVAILABILITY STATEMENT

The data supporting the findings of this systematic review are available from the corresponding author. The data were collected from various databases, ensuring a comprehensive review. All relevant data have been archived in public repository [my‐public‐repo] and can be accessed at https://github.com/Khaled7011/my‐public‐repo.git.