Modeling an Integrated Network for Remote Patient Monitoring, Based on the Internet of Things for a More Preventive and Predictive Health System in West Africa

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This review of the literature revealed that the challenges of health surveillance are very topical.Most of the work has not been in favor of a particular health system from a country, region, or area depending on its configuration but has shown there is an opportunity presented by technological progress to aid in monitoring several aspects of a patient's state of health including managing patient data, 1,2 WBAN networks and architecture, security in health data management systems and many other areas. 3,4All of militated in favor of the results obtained.

RELATED WORK
A total of 128 articles between 2010 and 2019 were found, with an emphasis on research between 2014 and 2016.The 128 articles were then sorted to rank those that best met the criteria of research.In the end, 34 articles were excluded and 94 were included as the subject of our study.The results are shown in Table 1.
The IoT is of great potential interest for medical applications and healthcare.Many technologies are related to IoT.Technologies such as wireless medical body sensors, advanced healthcare systems, wearable sensors, cloudbased platform for wireless transfer, storage, and display of clinical data (see Table 2, in appendix) carry particular interest.In conclusion, we note that the challenges of any medical surveillance system lie in the proper design of the network architecture.In light of this, our work aims to model an integrated patient monitoring network (RIMP) in the West African health system, based on the IoT.This article presents the methodology adopted for the work, the results obtained, and the analysis, discussion, and perspectives envisaged.

RESULTS
Despite the specificities observed in each country, the health pyramid of West African countries generally includes first-level structures (dispensaries, health huts, etc.), so-called reference structures (general hospital), specialized structures (dedicated to a disability or illness), and university hospitals.In principle, so-called primary health care is the foundation of health systems, whose national health development programs (PNDS) stipulate that the structures responsible for it must cover n thousands of inhabitants in a given geographical area [Org].Such a health pyramid has enormous advantages for mastering health data from scratch when it comes to diagnosis and care, so it has a modern remote monitoring architecture.For better monitoring of patients in African health systems, we propose an architecture integrating the different levels of each health system facilitated by a cloud of technocentres from remote monitoring networks.This would include surveillance centers allowing centralized accessible health information.

IoT Architecture of an Integrated Patient Monitoring Network
Several physiological parameters can be monitored Sixteen different groups of physiological parameters can be monitored using IoT sensors placed at 17 different locations on the patient's body.5 Figure 1 shows an outline of some of the physiological parameters ( The IoT architecture of the Integrated Patient Monitoring Network shows the interaction of the different IoT components of our system and its network and computer technologies.The different IoTs in this architecture include intelligent medical sensors of different sizes and types that monitor patient health parameters and also process and record the raw data from the sensors.The transceiver modules of the medical sensors communicate with the base stations via a wireless interface.The most

INTRODUCTION
The current challenges and goals of information and communication technologies (ICTs) are to provide effective and efficient healthcare.One of the latest advances in ICTs is the Internet of Things (IoT) providing global connectivity and management of sensors, devices, users, and information.The IoT concept provides the ability to search for information about a tagged object or person by browsing Internet addresses or a database entry that matches a particular active Radio Frequency Identification (RFID) with a detection function.In the last decade, wireless medical sensors, smartphones, and other mobile devices have attracted growing interest as tools that can be used for personal healthcare, and monitoring activities and physical condition.
Some research has been done on the clinical applications of these technologies in remote healthcare surveillance architectures for long-term management, registration, and clinical access to patient physiological information Based on these current technological advancements, it is easier to plan or schedule your physical examination, which is preceded by a period of a few days of continuous monitoring of your physiological state with less expensive wireless medical sensors.During this monitoring, wireless medical devices continually record signals correlating with the patient's important physiological parameters and sends them to a database of medical records.This scenario allows the medical professional (doctor and other) to have more information about the patient's state of health before the next appointment.Using this information and making it available to health professionals who also have access to a vast body of observational data for other individuals, the medical professional can make a better diagnosis and recommend appropriate treatment regarding early intervention and particularly effective lifestyle changes that can improve the patient's quality of health.These technological advances have a transformative impact on global health systems by dramatically reducing health costs and improving the speed and accuracy of diagnostics.
The vision presented previously from the technological point of view has been available for some years now in several sanitary systems around the world not within the African health systems and especially West Africa despite the technology already on hand.The West African health system presents for the most part the same configuration and structuring inherited from their time as colonies.
In this article, we are particularly interested in modeling an architecture that takes into account the current structure of West African health systems while implementing the healthcare surveillance architecture.

METHODOLOGY
It is very important to choose the appropriate techniques and methods in the literature search and data analysis.To ensure the integrity of the data, the means used to perform the analysis will depend on the information provided by the various search engines such as Google Scholar and scientific databases such as PubMed, Wiley, NCBI, IEEE Xplore, Scopus, and Web of Science.Google Scholar and IEEE Xplore are the two most used in our research.
The keywords used for data collection were: "IoT and Health Surveillance", "Internet of Things and Health System", "Remote Patient Monitoring with IoT".These three combinations of keywords were used on Google Scholar for the documentary review.
Mots-clés -Modélisation, Réseau Intégré, Internet des objets, Système de santé, Technocentre.make it possible to know any health antecedent of a patient wherever they are.This multifunctional health card will also allow the payment of the patient's health services since it integrates a virtual account.The patient's localization feature will be integrated with the patient's CISU-P card to find it through GPS on an integrated platform.This feature will allow a patient's hospitalization to be known in real time.More interesting in this architecture is that the position of the patient is known even outside of the hospital in real time as long as they have the health card on them.The architecture of the platform integrates all the entities (surgery, medicine, emergency, laboratory ...) of the hospital so that the patient record can be seen by all (except for any access restrictions added as required).

DISCUSSION
Faced with the challenges of the West African health systems and in particular, the Beninese health system, which are (i) to provide quality health care to a growing population, (ii) to optimize the availability of health care personnel, and (iii) to utilize patient health data in a more predictive health system; we proposed in this work an integrated IoT architecture for patient monitoring and the functional architecture of the hospital platform whose implementation could revolutionize the West African health systems in general and Benin in particular.The implementation of this solution would go through several stages: first, choosing a health zone in Benin that has village, district, and communal health centers, departmental hospitals, and university hospitals.Once the expected positive results in this first zone were confirmed we would consider the extension of the architecture to other health zones.
Constraints of WBAN networks (i.e., scalability, quality of service [QoS], energy consumption, wireless technology) will have to be taken into account. 6,7There is a large amount of work in the literature that deals with the application of WBANs in a healthcare setting. 8,9This research outlines the characteristics and requirements of the medical application of WBANs as well as the characteristics and design factors.
Another consideration in the design of WBAN networks involves security requirements (WBAN and traditional networks have the same security requirements). 10,11owever, this does not present a functional issue for the architecture of the hospital platform, which is the focus of our work.Moreover, we can see that the multitude of work in the literature does not consider a global architecture of a health system but often speaks of service architecture, while at the security level the security of patient and billing data will be considered when implementing the proposed solutions.Security threats or attacks, such as modifying and eavesdropping on medical data, detecting and locating activities, and hacking into security systems and alarms, can occur and must be taken into account. 10,11lso, data flow and network capacity are also among the parameters that have an impact on system performance.In this scenario, the choice of high-speed wireless technology offers advantages to meet the scalability of the network and increase the number of people being monitored.On the other hand, other technologies allow for lower power consumption, but have higher delays (production) and/ or lower transfer rates.The technology chosen will therefore be a compromise between throughput and energy consumption.As several technologies are used in patient monitoring architectures to provide multiple services 9,12 we started to identify all technologies used within the different services.On this basis, our work extends this knowledge by proposing the essential characteristics of any monitoring system adapted to the Beninese health system as well as the different possible positions where the sensors could be placed on a patient's body as mentioned in our previous work. 5,13

CONCLUSION
In this work, we modeled West African health systems by proposing an IoT architecture for patient monitoring and the functional architecture of the hospital platform.This model incorporates the CIUS-P which allows the patient information to be available in all areas across the West African health system.This architecture will allow the West African health system to respond to health challenges and provide data for better health forecasting.Future work will allow this architecture to be implemented in Benin to analyze its effect and any limitations.The implementation will occur through the choice of a health zone in Benin and take advantage of the unique identification database of the population set up, the project to interconnect all the health systems in Benin, the national data center, and powerful base stations will act as data aggregators, well nodes, or gateways to servers.The different IoT Gateways work with the different types of devices and associated network protocols to provide overall connectivity.
The integrated IoT patient monitoring architecture is made up of several levels.The first level is the IoT sensor level, which fits the patient with several sensors to measure the desired physiological parameters (EMG, ECG, blood pressure, heart rate...).The second level of the architecture shows the connectivity elements.This level shows the symbols of the different communication networks used to route the data collected by the sensors to the treatment centers.Depending on the application, wifi, Bluetooth, or zigBee can be used to route measured physiological data to the sensor nodes and then to the treatment centers called here technocenters.Technocenters are data processing centers available at all levels of the health system including those in village health centers, district health centers, communal health centers, departments, and zones at the national level.These technocentres are interconnected through a network.To allow different requests from users of the network including healthcare providers, the healthcare administrator and the patients, we are implementing a DNS service so the users can successfully request the data from the closest server with a different zone access from the internal and external users of the network.The patient's personal digital devices (PDAs) will allow healthcare providers to capitalize on the capabilities in smartphones that patients already carry.Since these smartphones can be connected to the Internet through their GSM network, it would be enough to install eHealth applications allowing the patient's phones to receive and send the necessary information to and from the treatment center.Recommendations could easily be made for these smartphones regarding their specific characteristics as needed.

Functional Architecture of the Hospital Platform
We propose the functional architecture of the hospital's platform detailed in Figure 2 to enable the West African health system to monitor patients effectively.
The functional architecture of the hospital platform that we propose takes into account several aspects for the monitoring and the traceability of the patient inside and outside the hospital.We propose the use of the Country Unique Patient Health Identification (CIUS-P) for patients in the West African health system.This will allow a patient in Benin or any other African country to have a unique identity card from his country of origin.This new health card will make it possible for any hospital in the African health system to have access to the patient file and will

N°Ref.
Aspect covered 1 [14]   Put in place a solution to address drug issues based on IoT technologies like smartphones and the Web to support ubiquitous access, 6LoWPAN technology for ubiquitous patient data collection, sensors and hospitals, RFID / NFC (Near Field Communication) and barcode identification technologies.
2 [15]  Propose IoT Communication Framework as Primary Tool for Healthcare Applications Spread Around the World.They presented the IoT protocol stack and the benefits it brings to health care scenarios.
3 [16]  Proposed a cooperative approach of IoT to improve the monitoring and control the health of rural and poor human health parameters.

[17]
Analyze the possibility and related issues of providing advanced services for human health management in the real world of medical technology on IoT.
A new architecture for health services based on ISO / IEEE 11073 on the IoT platform.The proposed architecture meets oneM2M and ISO / IEEE 11073.Standards with a stack of protocols for constrained healthcare devices on the BLE network.

[53]
A cooperative key establishment protocol to create a secure end-to-end connection for resource-limited sensor nodes with any remote server or entity.Security analysis and performance appraisals prove to be a considerable improvement in security as well as protocol resilience against known attacks and security breaches.

[54]
A cloud-integrated Health IoT monitoring framework, where health data is watermarked before being sent to the cloud for secure, high-quality, health monitoring.

[55]
A new user-oriented world of IoT.In this world, users are empowered by their ability to control access to the data that has been knowingly or unknowingly generated and belongs to them.This data can be requested by other users and organizations to be analyzed collectively and potentially bring value to society.
Ahouandjinou, Medenou, Pecchia, Houessouvo, Jossou: Modeling an Integrated Network for Remote Patient Monitoring, Based on the Internet of Things for a More Preventive and Predictive Health System in West Africa , Pecchia, Houessouvo, Jossou: Modeling an Integrated Network for Remote Patient Monitoring, Based on the Internet of Things for a More Preventive and Predictive Health System in West Africa

FIGURE 1 .
FIGURE 1. IoT architecture of an integrated patient monitoring network.

FIGURE 2 .
FIGURE 2. Functional architecture of the hospital platform.

Modeling an Integrated Network for Remote Patient Monitoring, Based on the Internet of Things for a More Preventive and Predictive Health System in West Africa the
Ahouandjinou, Medenou, Pecchia, Houessouvo, Jossou: availability of the GPRS network of GSM networks in the various health zones in Benin.