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Analysis of Industry 4.0 Technologies Applied to the Health Sector: Systematic Literature Review

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DOI: 10.1007/978-3-030-14730-3_73
5 authors, including:
Franco da Silveira
Italo Rodeghiero Neto
Universidade Federal do Rio Grande do Sul
Universidade Federal do Rio Grande do Sul
Filipe Molinar Machado
Marcelo Pereira da Silva
Universidade Regional Integrada do Alto Uruguai e das Missões
Universidade Federal do Rio Grande do Sul
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Analysis of Industry 4.0 Technologies
Applied to the Health Sector: Systematic
Literature Review
Franco da Silveira, Italo Rodeghiero Neto, Filipe Molinar Machado,
Marcelo Pereira da Silva and Fernando Gonçalves Amaral
Abstract The health sector is possibly the sector most in need of an adequate
technological convergence of factors of the Fourth Industrial Revolution. Health 4.0
can be understood as the set of technological procedures emerging from the
physical, biological and digital worlds that seeks to improve the efficiency and
effectiveness of health processes and professionals with guidelines for transforming
data into useful and accessible information. However, systematizing and qualitatively describing the contributions of industry 4.0 in the context of the health sector
is a complex task. This article presents an analysis of industry 4.0 related to the
health sector and their descriptive characteristics. As a complement, it discusses the
perspectives for the greater use of technology in the health area. In methodological
terms, a Systematic Bibliographic Review was applied in the context of industry 4.0
with emphasis on terms referring to health issues in two international databases
(Science Direct and ISI Web of Science). The research is classified as descriptive
and qualitative, of an exploratory nature. As a result, the main technologies that are
part of Health 4.0 have been identified in the literature and should be adopted to
avoid future problems with patients. The results obtained contribute to narrowing
the gap of information about industry 4.0 in the health sector.
Keywords Industry 4.0
Health 4.0 Emerging technologies
F. da Silveira I. R. Neto M. P. da Silva (&) F. G. Amaral
Federal University of Rio Grande do Sul (UFRGS), Porto Alegre,
Rio Grande do Sul, Brazil
e-mail: [email protected]
F. da Silveira
e-mail: [email protected]
I. R. Neto
e-mail: [email protected]
F. G. Amaral
e-mail: [email protected]
F. M. Machado
Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
e-mail: [email protected]
© Springer Nature Switzerland AG 2019
P. M. Arezes et al. (eds.), Occupational and Environmental Safety and Health,
Studies in Systems, Decision and Control 202,
F. da Silveira et al.
1 Introduction
Industry 4.0 is combined with intelligence in data processing [1]. The recently
proposed concept of Industry 4.0 represents the fourth industrial revolution, which
is defined as a new level of organization and control over the product lifecycle value
chain, with an emphasis on customer requirements that become more individualized
[2]. The term “Industry 4.0” emerged in Germany in 2011 through the integration
between associations of business representatives, politicians and academic
researchers who sought to promote the idea as an approach to strengthen the
competitiveness of German manufacturing industry [3] and bridging the boundaries
between the digital, physical and biological worlds [4].
In health, the principles of Industry 4.0 incorporate the digitization of clinical,
medical and laboratory data, implementing the automation of several manual processes used in hospital and general health environments [5]. However, services in
the health sector always present challenges, since different diseases can be developed over the years [6]. Thus, to improve the efficiency and speed of physicians, to
explore patient data in hospitals, to enable optimization of resources and to minimize deterioration of the patient’s health [7], real-time communication technologies
[8], Big Data, human-machine cooperation, remote sensing, process monitoring and
control, stand-alone equipment and interconnectivity [9] are becoming very active
and responsible for positive impacts on health and safety management [10].
In this context, the term “health 4.0”, developed by the Aliança Brasileira da
Indústria Inovadora de Saúde (ABIIS) stands out from the characteristics of
industry 4.0, which proposes an interaction between technology and human beings
in the health sector. In Health 4.0, the possibilities of collaborative partnerships
among actors in the same value chain, who can share the coordinated planning of
production and distribution, in an agile and effective way to the needs of users, are
facilitated. The work is developed with adequate inventories to avoid delays or
unavailability of products and there is a fast response to the demands of the end
users and an efficient control in the transaction of patient data in hospitals [11].
However, understanding how to perform data digitization, interconnectivity
between machines and commands, more efficient databases, and, in particular,
greater autonomy of patients in relation to their own health is a complex task [12].
Exploring technology-driven initiatives that make life easier for human beings
will be a research trend. Thus, this article presents an analysis of industry 4.0 related
to the health sector and their respective characteristics in Brazil. As a complement,
this research seeks to verify the perspectives for the use of technology in the health
area. It should be emphasized that although the study presents an analysis of
industry 4.0 in the health sector, it is not the objective of the research to define
rigorously the semantics and syntax of the Brazilian context. The proposed results
of the analysis demonstrate which perspectives should be adopted in the health
sector, facilitating the dissemination of knowledge regarding Health 4.0.
The main contribution of the article to the literature is the identification of
qualitative and exploratory health variables for an analysis and adaptation of
Analysis of Industry 4.0 Technologies Applied to the Health …
technologies that can be used in hospitals. The propositions and reflections raised
did not contribute to subsidize the scientific research on the subject, which can give
continuity to this study.
2 Methodology
To carry out the initial stage of the research, it was necessary to develop the
formulation of the research problem and its delimitation of context, focused on the
interface between industry 4.0 and the Brazilian health sector. The general and
specific objectives of the work were then elaborated. In the third stage, the theoretical study was made. To carry out the theoretical part of the research, the method
of Systematic Literature Review (SLR) was selected. The SLR methodology uses as
a data source the existing literature on a given theme, selects and evaluates contributions, analyzes and synthesizes data [13]. In addition, it describes the evidence
in order to allow clear conclusions about the topics that are already known, as well
as what is unknown about the subject matter [13, 14]. The analysis (fourth stage of
the research) is characterized as theoretical-conceptual and objective to present the
main technologies that contextualize health 4.0, in order to analyze their
The scope of the literature review includes articles published in journals and
journals that deal with the context of industry 4.0, with emphasis on aspects related
to the health sector. The databases used were Science Direct and ISI Web of
Science due to the breadth of these bases and relevance to the areas of knowledge
covered by this research (industry 4.0, health 4.0, healthcare, health technologies
and related areas). To perform the advanced searches in the databases, it was
necessary to make use of logical operators. Subsequently, it was necessary to
establish the keywords (without quotes and without refinement by area of knowledge) to be used in the theoretical survey in the databases. After the searches, the
refinement of the survey considered the period between 2011 and 2018 in the
databases. The search procedure was carried out between June 20 and July 10,
2018. Only papers written in English and documents such as “article”, “review” or
books and book chapters were selected.
The keywords used by the authors fall into the following two categories: (i) industry-related keywords 4.0, such as: industry 4.0, cyber-physical systems, Cloud
Computing (CC), Internet of Things (IoT); and (ii) health related keywords such as:
health, smart hospitals, Smart Healthcare, Healthcare Services. For the files available in full, it was necessary to perform a complete reading and their references
were observed to ensure that other works have not been detected in the original
survey. After applying the filtering based on the previously explicit criteria, 178
articles were identified.
The articles that had only relation with the industry 4.0 in the title were
excluded, for a total of 105. Subsequently, the abstracts that considered the
established terms were evaluated and 30 other papers were excluded, which
F. da Silveira et al.
emphasized the concept of industry 4.0 and did not mention the health sector.
Finally, another filtering was carried out with emphasis on the introduction and
conclusion, being excluded respectively another 33 works. Thus, 10 research papers
were selected as containing more details about the technologies of industry 4.0 that
are being used in health.
The research sought to select different approaches of the technologies, with the
purpose of demonstrating the evolution and the progress of the health sector from
research in universities and companies. In addition, it sought to present the state of
the art and analysis of gaps of different levels of integration components, analyzing
different proposals existing in the literature.
3 Results
Industry Technologies 4.0 Used in the Health Sector
Technological innovations have driven the health sector to an unprecedented level.
Different medical devices, many of them portable, are being sold in the consumer
market to provide a healthier lifestyle for society [15]. Some of the technologies
relate to Cloud Computing (CC) and Internet of Things (IoT). These are platforms
that provide alternatives to medical support through the solution of various problems in health applications, with intelligent hospitals, drug control and remote
medical services [6, 8]. In addition, with cyber-physical systems, they can interconnect with a combination of softwares, sensors, processing and communication
technologies that together play an important role in decision making by providing
accurate and momentous information [3].
With the interconnection of hospitals, people and systems provide real dynamics
with optimized time and self-organized with respect to the patient’s condition.
Industry 4.0 technologies that present similarities in the use of the health sector
should also develop new paradigms on occupational health and safety management,
as safer equipment is needed to operate and work environments and practices with
better control and management [10]. For Chang [16], another technology that
should facilitate the exploration of areas that can not be easily reached by traditional
means of medicine is computational intelligence, which includes simulations of
genes and proteins related to the development and immunity of cancer.
As in the context of industry 4.0, the literature does not present a unique way of
naming health technologies 4.0. The classifications used in the literature are often
incompatible with each other, since they classify the same technologies into different categories [17]. As a way of contributing to this diversity of health technology classification 4.0, this work uses the functionalities of technologies as a way
of categorizing them. In Table 1 are the main technologies found in the literature
that contemplate the principles of industry 4.0 and that are commonly used in the
health sector. To facilitate the understanding, it was necessary to present the
Pang et al.
Internet ofThings
Home health services based on IoT to solve
problems caused by population aging
et al. (2014)
Internet ofThings
et al. (2015)
Internet ofThings
Support IOT-based communications between
devices and health services in an
event-driven manner
Identification by radiofrequency, wireless
sensor network and intelligent mobile
technologies of patients’ physiological
Zhang et al.
Wearable Devices
and Smartphones
Continuous monitoring of health conditions,
remotely diagnose phenomena and share
health information in real time
et al. (2017)
Cloud Computing
(CC) e Internet of
Things (IoT)
et al. (2017)
Cloud Computing
The integration of technologies provides a
solution to various problems in health
applications, drug control and distance
medical services
Intelligent systems based on cloud
environment for hospital health services
Propose a business-technology developed in
co-design that realizes an integration of
devices and services of home health attention
Describe the platform developed, with
emphasis on reliability aspects, including
availability, scalability and security
To propose a new intelligent architecture,
with IoT recognition, for automatic
monitoring and tracking of patients, people
and biomedical devices inside hospitals and
nursing institutes
Investigate the security and privacy
protection of multifunctional wearable
devices and the widespread use of
smartphones, including aggregation of
privacy data that preserves privacy, secure
health data processing, and detection of
Present a new concept of CC and IoT
integration for health applications
Improve scheduling of tasks and reduce
stakeholder engagement time (patients,
doctors, nurses, for example) and maximize
resource utilization in clouds
Analysis of Industry 4.0 Technologies Applied to the Health …
Table 1 Technologies developed in Industry 4.0 used in the Health Sector
Table 1 (continued)
et al. (2017)
Big Data e Smart
Evaluate Big Data technologies and
intelligent systems focusing on
state-of-the-art advanced health systems
Costa et al.
Mshali et al.
Internet of Health
Things (IoHT)
Health Monitoring
Systems (HMS)
Big Data and Smart Healthcare systems
independently attract great attention from the
academia and industry and can streamline
healthcare industry perspectives
Intelligent monitoring of vital signs on
hospital wings through IoT
Provide timely electronic health services for
individuals who wish to maintain their
et al. (2018)
Internet of Things
Describe the possibilities of IoT in the scope
of vital signs monitoring by hospital wards
Present a review of intelligent health
monitoring and health care systems for
individuals, especially for the elderly and
Explore the concept of Cloud Computing in
Healthcare IoT systems, forming an
intermediate layer of intelligence distributed
geographically between the sensors and the
Develop health solutions with smarter and
predictive capabilities for both daily living
(home/office) and hospitals using IoT and the
strategic position of such gateways
F. da Silveira et al.
Analysis of Industry 4.0 Technologies Applied to the Health …
description of each technology to verify its function and, from the objective of this
article, what they seek to improve in the hospitals and in the health topic in general.
4 Discussions
According to Liang [18] there are other devices such as wearable ones that are
developing widely and can be used to provide continuous medical care, such as
monitoring of physiological parameters for health care through remote monitoring.
These are wristwatches, bracelets, rings and smart haircuts that fit as ubiquitous
products and use mobile networks (WIFI) and computer servers that are responsible
for collecting health information detected by such products [18–20]. In addition,
they process the data to properly monitor and diagnose integrity and allow social
interactions with users, so that no errors result [20, 21].
For Costa [7], patient data are collected manually in hospitals from stand-alone
medical devices, including vital signs. Such data are sometimes stored in electronic
spreadsheets, not being part of patients’ electronic records, and therefore it is difficult for those in the hospital to combine and analyze. Thus, one solution to
overcome these limitations is the interconnection of medical devices via the Internet
using a distributed platform, IoT. This approach allows data from different sources
to be combined to better diagnose the patient’s health status and identify possible
anticipatory actions [7].
According to Elhoseny [5], the adoption of the CC and IoT paradigm in health
can significantly improve health services and contribute to their continuous and
systematic innovation in a Big Data environment as industry applications 4.0.
However, the resources required to manage this data in a Cloud-IoT environment
are still challenging. In addition, connectivity and the analysis of information are
the major pillars of this future transformation. Connectivity because the patient will
carry all his medical history with greater data security, which is allowed by the
blockchain, the same that brought Bitcoin to life. And information analysis because
an artificial intelligence makes it possible to process information much faster than a
human being. This repetition of comparisons allows the evaluation between
causalities to respond in a preventive way to a patient at risk. Understanding the
variables that signal an increased patient risk is only possible with this intelligence
at hand.
5 Conclusion
The objective of this article was to present an analysis of industry 4.0 related to the
health sector and their respective characteristics. As analyzed in the research, in the
health sector, health technologies should be adopted that include the principles of
industry 4.0 to improve data digitization, interconnectivity between machines and
F. da Silveira et al.
commands, more efficient databases and, health. The main technologies identified
in the literature and also in the interviews refer to the CC and IoT developed for
hospitals, as they seek to support communication between devices and health
In addition, the article contributed to health professionals seeking to better
understand definitions and concepts related to health 4.0, also providing researchers
and stakeholders with a study on the subject. The description of the results was
focused and critical, structured, as far as possible, for the expansion of knowledge
about industry 4.0, given its relevance and relevance in the health sector, which are
necessary to perform the interconnection of hospitals, people and systems to provide real dynamics with optimized time and self-organized with respect to the
patient’s condition.
As future steps, it is suggested to carry out research that deepens the field of
health knowledge 4.0, such as: (i) analyze how developed countries are developing
the health value chain 4.0; (ii) verify how the development of products by Brazilian
companies in the health sector should be in the coming years; (iii) conducting a case
study in a hospital that covers all the characteristics of a 4.0 industry; and
(iv) identify how smart hospitals are empowering employees, while increasing new
technologies annually in the control of patient data.
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