CIC Healthcare Briefing: The network foundation for IoT ... · Data accuracy has long been a challenge for healthcare organisations. The move to a fully-connected, IoT healthcare

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curtail the soaring healthcare cost. All of these lead to a growing urgency to improve the quality of healthcare outcomes, while maintaining the operational efficiency of healthcare organisations.

Pressure reliefA shift is happening. The healthcare in-

dustry is looking to improve internal workflows, while striving for pa-

perless medical information, and delivering a more connected, patient-centric care approach, with easier and secure access to medical information. Con-necting the data held within

healthcare systems, services, and Internet of Things (IoT) devices

to healthcare professionals is vital. With this information, they are able

to deliver an enhanced level of clinical care and patient experience. Personalised and

more intelligent interactions, that draw from a wider pool of internal and external data, raise the prospects for Information and Communication Technology (ICT) infrastructure and services.

BY CIC ANALYSTS

Healthcare is under pressure to transform In our ever more connected world, healthcare organisations are faced with a growing set of pressures, driving them to transform and modernise – both in the way they operate and the way they employ technologies to support their operations.

With longevity and incidences of chronic illnesses on the rise, care delivery needs to juggle sustainability with quality of care. At the same time, the consumer market is transforming expectations and usage of technology in the healthcare space. Care-givers and patients alike increasingly expect instant access to, and transfer of, information, regardless of location and devices used. Greater connectivity presents new security risks and challenges that can expose healthcare’s vulnerabilities. Added to this is the need to meet the heightened regulatory requirements for patient care and safety, and a drive to

The network foundation for IoT and connected healthcare

CICCREATIVE INTELLECT CONSULTING LTD

H E A LT H C A R E S E R I E S


A connected healthcare system that maximises the value offered by digital technologies, application stacks and IoT is based on three important pillars:

1 Investment in the required ICT infrastructure, to create and deliver

noticeable additional value;

2 A pragmatic growth plan that is aligned to the infrastructure required, and that

draws committed support from the leadership teams and key stakeholders;

3 Support from an infrastructure and application technology partner, with

an ecosystem tuned to the challenges and

The promise of connected healthcareThe pressures driving transformation across the healthcare industry are not simply focused on digitising paper-based processes, but also on enabling new approaches to healthcare delivery. These efforts help improve efficiency and excellence, accelerate and enhance decision-making, reduce costs and drive better health outcomes. This can be achieved by:

Better connecting healthcare professionals and patientsBy delivering easier access to medically relevant data, new technologies enable new forms of collaboration among those involved in care delivery and between patients and healthcare professionals. This includes the use of video and audio conferencing tools, e-prescribing and email systems, remote monitoring technologies, as well as online therapies that can be conducted in either synchronous or asynchronous mode. Overall, the potential to improve health outcomes on a personal and a population level is being transformed by a more connected approach.

Increasing the veracity of medical dataData accuracy has long been a challenge for healthcare organisations. The move to a fully-connected, IoT healthcare environment will significantly reduce input errors: having the patient’s details on a mobile device enables the clinician to reliably update a patient’s electronic health record (EHR) at the bedside. Having systems interconnected means that prescribing data can be sent directly to the pharmacy and can be safely dispensed to the right patient. It also means that, where multiple clinicians need to collaborate on a patient’s care, they are all viewing, commenting, and annotating the same record. Location data is used to validate where IoT data is coming from. It prevents hackers trying to insert fake data from medical devices into clinical records. It can also be used by IT operations teams to track where objects, and even people, are inside the medical facility.

ambitions of the healthcare market.

All three make a positive difference at multiple levels – leadership, frontline interactions and within internal clinical and operational workflows.

Against the backdrop of the many demands placed on the healthcare industry, state-of-the-art ICT infrastructure and services can help revolutionise multiple spheres of operations, clinical workflows, and patient experiences and engagement. The first in a series of reports that address the infrastructure opportunities for each of these areas, this report outlines the network foundations for IoT and connected healthcare.

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Easing access to best practices Given the exponential growth of medical knowledge, it is a challenge for doctors to stay up to date in their field of expertise. By providing evidence-based guidance, at the point of care, treatment will reflect best practice of the entire profession. This accelerates the decision-making process and increases its accuracy.

Raising patient involvementWhen patients are better informed about their condition and more involved in getting well, this typically increases their compliance regarding medication intake or

lifestyle choices. With more health insurers adopting client engagement schemes, to incentivise healthier lifestyle choices, such as smoking cessation programmes, alongside healthcare-related apps and wearable sensors to track lifestyle (exercise, diet etc.), patients are taking an increasing interest in – and becoming more educated about – their own health and healthcare.

In this context, connectivity and interoperability, along with mobility and IoT, are essential enablers for developing a more collaborative patient-centred model.

Digital support for a fundamental shift: From healing to preventionDigital transformation represents a fundamental paradigm shift: it is no longer only about healing. With more data available, especially from a populous equipped with tracking and other IoT devices, healthcare is increasingly concerned with preventing sicknesses. This development – referred to as “precision medicine” – takes into account a wider set of constituents that can affect a person’s health, such as genomics, life-style and environmental factors. It also marks a transition from isolated doctor visits to patient-centred care, where the entire care continuum is accountable for patient outcomes.

2 Mobile access to information: Mobility can assist healthcare professionals throughout their daily routines, independent of their location and proximity to a desktop. With medical data at the point of care, mobility provides real-time information and context and improves productivity and patient outcomes.

1 Digital data and paperless processes: EHRs are the cornerstone of a connected healthcare strategy. The coordination and exchange of patient-relevant information between stakeholders enables improved health outcomes and more efficient use of resources.

Healthcare transformation: Key technology trendsTo deliver on these goals, healthcare organisations are investing in a number of key technology areas. However, no matter the area, security and privacy must be a front of mind concern, requiring them to be embedded throughout to allow for end-to-end continuous protection. In this way, an always on approach towards security and privacy will help mitigate the impact from the ever evolving threat landscape and the actions of more versatile threat actors. New areas of technology focus include:

3 Telehealth and remote monitoring: Bridging the physical distance between patients and health professionals with IT, through audio and video communication, email or text messages, provides an alternative to traditional, in-person, patient-doctor encounters. This leads to innovative models of healthcare delivery, such as remote monitoring and diagnostics, permitting early detection of changes in a patient’s well-being.


Why is having a good network so critical for IoT and connected healthcare?To be able to take full advantage of the capabilities that digital technologies and services offer, and, to safely and securely support the exponential growth of IoT devices, the right kind of ICT infrastructure is vital. This infrastructure must be reliable, scalable, secure and intelligent, in order to manage, transport, process and adapt, according to the context of the information traffic it handles.

A connected healthcare strategy needs a network that provides capabilities in several vital areas:

ManagementA key demand of any network is that it can be managed. It is critical that the entire network is visible to management tools – preferably using the same tool throughout.

Monitoring network traffic can highlight unexpected patterns, which quickly point to security or capacity management issues, so that network teams can react. These tools show the type of traffic, where it has come from, and where it is going; helping to identify if data is being moved to insecure locations, such as personal cloud storage.

However, multiple management tools increase the risk of error. A management platform supporting Application Programming Interfaces (API) presents an opportunity for a centralised portal and a coordinated approach for integrating and interoperating with other data collection and control tools. Such an approach offers greater transparency and linkage between healthcare business and clinical operations and the network resources that support them.

Automation and self-serviceAutomation is essential for networks that must adapt and respond to fast-changing information, but also for enabling more sophisticated control and management. Network automation speeds up the provisioning of network resources, for example varying bandwidth when required. It can also provision network access for new medical devices, checking device characteristics and setup, and ensuring that they are connected to the correct network group.

5 Cloud computing: Cloud-based technologies provide a secure, fast and economical way of accessing, storing, and exchanging health information among various healthcare stakeholders and multiple connected devices. The flexibility, scalability and interactivity that cloud computing brings as a central hub of information and data exchange provides greater opportunities for improved diagnostics and care outcomes.

4 Generating insights from data: Cognitive computing combines natural language processing, artificial intelligence (AI), and machine-learning algorithms, to reproduce the behaviour of the human brain. This, combined with analytics, enables new insights from data that can support evidenced-based clinical decision support, personalised medicine, population health management and clinical research, among others.


Automation is crucial for secure operations, especially for administering fixes, ensuring compliance with the latest security policies, and notifying when an issue arises or a policy is breached, so remediation can take place.

The foremost goal of automation and self-service control is to free up IT staff and provide a faster and more efficient and responsive service.

Mobility, mobile networks and location-based supportThe growing dependence on mobile devices – by clinicians and patients alike – and the continued growth in mobile networks (3G/4G/5G) and associated networking protocols (e.g. Bluetooth) means support for these networks is required. Patients expect to be able to use mobile devices to connect to the Internet, especially if they are to spend a large amount of time in the facility. Streaming music and video, as well as making video calls, can consume very large amounts of bandwidth.

Support for the wide range of network technologies enables a variety of engagement experiences and tracking opportunities for both patients and equipment. For example, as with any organisation there are always pressures on the availability and use of equipment. Administration wants to keep control of costs by making sure that assets are fully utilized and accounted for. A hospital has many portable assets. These range from small handheld devices, to wheelchairs, beds, heart monitors or fluid stands, to larger moveable medical equipment. Using tagging and location-based services, equipment can be monitored and tracked in real time. Doing so will allow equipment to be located when needed. More importantly, administrators can be alerted if registered equipment is moved out of the vicinity, either innocently, or as a result of criminal intention. Appropriate and proportionate action can then be taken.

Network infrastructures that are not built to support mobile technologies and location-based services are often responsible for application failures and poor operating performance, impacting frontline staff and patient experience. A common example is where an organisation invests in a mobile app solution, only for it not to work in many locations due to a lack of connectivity – resulting in the user blaming the application.

Connected mobile devices and applications also provide a potential security risk, and have in some cases

been used by hackers to attack healthcare facilities and the services they

deliver. To adequately prevent this, it is important to apply

a structured architecture to the network topology,

ensuring separate physical and logical networks, according to the nature of the traffic they carry. Therefore, a separate network that handles

communication traffic from connecting ‘guest’

mobile devices can mitigate the impact from a security

breach, ensuring that it does not affect important clinical or

administrative functions.

Scale The volume of data produced by healthcare systems has implications for the scale and capabilities of the network, and this will continue over time.

Healthcare is being flooded by a mix of specialist applications, data analytics, accounting, mobile apps and so on. While all can deliver value, each creates its own data volumes and its own bandwidth.

Growing healthcare application traffic requires a stable network, capable of delivering high-quality images, video and audio; segmentation to ensure the right priority; and safeguards to support a diverse mix of data and traffic.


Strategies that support increasing data volumes, particularly with the growth of data from IoT devices, is crucial. This includes being able to push network processing resources out to the edge and closer to the devices.

Security and privacyThe network is a powerful instrument for security, privacy and protection. It can track the movement of information, identify early any vulnerabilities and attacks, and act swiftly and directly to address threats. Network infrastructure has evolved to incorporate security by design, with the ability to segment traffic and operations. Without leveraging this, opportunities for expansion that maintain secure operations could be missed. The loss of trust will have more than just financial ramifications.

A more integrated and connected approach to healthcare increases the challenges around security and data privacy, as more data – from a wider range of sources and from diverse locations – needs to be managed. The myriad of connected devices and equipment adds another layer of security and privacy threats.

Mobile and connected devices are being used by hackers to attack healthcare facilities and internal exploits – unintentional or otherwise – expose the potential for further vulnerabilities. Regional and international privacy regulations, such as the Health

1Medical imaging

systems such as CAT scanners and MRI scanners can generate

petabytes of data per year, which is increasingly being transmitted

and viewed across computer networks.

2Telemedicine data

transferred over public networks will constitute a

significant challenge in terms of incryption, protection and

bandwidth. 3

Personal health data captured by personal health apps and

devices such as blood pressure monitors, glucometers, heart rate monitors, fitness bands

and smart watches.

4Collaboratively-shared data generated by the growth of

multi-discipline teams sharing images and

documents.

5Patient data: Doctors’ and dental practices gather a large amount of data per

patient visit per year. 6Medical equipment data from

devices such as advanced pacemakers, insulin pumps

and other devices in patients’ homes, doctors’ surgeries

and care homes.

7Application data from specialist

applications, as well as data analytics, accounting, ERP, mobile apps and artificial

intelligence/machine learning software.

9Cloud connectivity traffic

caused by data moving between the healthcare location and its

cloud services provider.

8Administrative data

gathered in response to governmental and

regulatory demands.

Healthcare organisations’ IT networks already

support data from a wide range of sources:


Insurance Portability and Accountability Act (HIPAA) and the European Union’s General Data Protection Regulation (GDPR), raise the privacy compliance bar higher.

All these factors necessitate a network infrastructure that is capable of protecting the data it transports and ensuring that it does not go beyond authorised systems and personnel.

AnalyticsICT infrastructure needs to be intelligent to proactively – and in context – surface insights to help secure and protect the organisation and the community it serves.

The ability for deeper analytical insights has grown with the advances in artificial intelligence (AI) technologies, such as machine learning and cognitive computing. Their capability for continual learning helps to anticipate patterns of use and alert when notifiable changes occur. Real-time analytics are a core feature for monitoring, provisioning and securing systems.

Infrastructure with weak analytical support challenges the ability to anticipate vulnerabilities and respond quickly to fast-changing requirements or anomalous behaviours that could result in the exfiltration of sensitive data.

Network design and architectureThe success of a connected healthcare service depends on the underpinning infrastructure. Good design and architecture – along with equipment that can be flexibly configured and extended through software programming – lowers costs, aids security and improves efficiency. This can help reduce complexity – a barrier to growth – as well as address security concerns, by embedding resilience, end-to-end management and governance.

Where infrastructure is already in place, assessments can help identify gaps and weaknesses, leading to the reconfiguration of existing equipment or justifying replacing it with a more advanced solution.

Network design and architecture can be challenging, especially with the speed of technological advancements. However, the alternative creates a real problem for healthcare, reversing all the potential benefits from a robust network architecture.

The network design topology must look to address physical network, quality-of-service and data security requirements. Network management requires that traffic is partitioned into a number of different logical networks. Table 1 and 2, offers a summary overview of the topology to consider.

DATA CENTRE NETWORK

PHYSICAL NETWORKS INSIDE HEALTHCARE FACILITY

CLOUD

MOBILE

TELEMEDICINE

OTHER PUBLIC NETWORKS

Inside the data centre, the network demand means higher bandwidth to deal with current and near-future demands. Higher speeds may require architecture, hardware and cabling changes.Cloud offers provisioning flexibility with the specification of performance SLAs.

WIRED Difficult to redesign and upgrade if future requirements were/are not built in.

WIRELESS A future-proofing option, with the right standards, security, number of access points and segregation of traffic.

Potential for direct connection to provider’s local point of presence

3G / 4G/ 5G and network protocols like Bluetooth

Public and Mobile network support

Healthcare ecosystem partners with potential for direct connections.

TABLE 1 PHYSICAL NETWORK TOPOLOGY CONSIDERATIONS


Clinician access High-priority access to data from multiple sources for the clinician. Can integrate with other hospital systems such as the pharmacy and diagnostic testing.

Life support systems - High-priority access; Record-taking; Medical imaging; Staff access.

Voice over IP (VoIP); Collaboration - sharing of medical data between multiple locations; General Admin - Billing; ERP; Research - partner networks. Data sensitivity may require both logical and physical separation.

Patient data acquisition Newer devices connected to patients are likely to support a wider range of network choices, be smarter and record the data on network storage devices.

Personal healthcare devices Range from traditional devices such as heart monitors and insulin pumps to newer devices such as blood pressure monitors. Data may be transmitted over the public network or stored and uploaded when patient next visits the healthcare facility.

Non-medical IoT Printers, scanners, security cameras, televisions, fridges, systems to record when staff arrive and leave, tags connected to at-risk patients so that they can be tracked - all require different types of network access.Few will have built-in security so need to be carefully categorised and strictly limited to networks where they cannot impact critical or clinical systems.

Patients and visitors with lots of different mobile devices and expect connection to the Internet.Can consume very large amounts of bandwidth.Secure and logically (potentially physically) segregated to limit breach risk and impacting other networks.

CLINICAL

ADMINISTRATIVE

MACHINE TO MACHINE (M2M) AND IOT

PATIENT/GUEST ACCESS

TABLE 2 LOGICAL NETWORK TOPOLOGY CONSIDERATIONS

Where to start for connected healthcare: An assessment-first approach from CiscoCisco, a long-time ICT infrastructure provider for the healthcare sector, with a strong footprint of technology solutions and infrastructure products, supporting healthcare entities across the globe, understands clearly what is at stake for the healthcare community. The company rightly believes that progression in the digital economy is directly linked to the maturity of the underpinning ICT infrastructure. As a result, Cisco has evolved its services and supporting portfolio of network products, to serve the infrastructure needs of the healthcare giver – hospitals, clinics and research networks.

In answering the question of where to start, Cisco identifies an opportunity for maturity assessment.

There are already a number of maturity assessment models in the market, but these typically focus on

appraising generic process maturity, or – even when they specifically target the healthcare industry – take a purely application-based perspective. One such example is the method of measuring the degree to which hospitals have replaced paper-based processes with technology; the Electronic Medical Record Adoption Model (EMRAM), developed by HIMSS Analytics. However, these application and process models miss the ability to understand the underpinning information and communication infrastructure that is required to support their various levels of maturity.

Infrastructure Maturity Assessment – a pioneering starting point Extensive investigation into how different types of healthcare entities mature has led Cisco to pioneer an Infrastructure Maturity Assessment (IMA) model. This IMA model is built upon expert knowledge of the infrastructure required to support digital technologies in delivering optimal operational experience and business value to healthcare organisations.


The assessment feedback provides a realistic baseline of the maturity of a healthcare entity’s existing ICT infrastructure and its capabilities for transitioning to a higher order of service productivity, clinical care quality and patient engagement.

The IMA model offers a different approach to helping healthcare organisations understand the ICT infrastructure required to support and maximise the benefits of application stacks, such as an EHR solution. The same insights can be achieved to determine the ICT infrastructure required to support key technology domains (e.g. Mobility, Security, Collaboration, Network Transport, and Data Centers) or the physical or virtual offerings of important clinical services; whether those services connect clinicians, clinicians and systems, clinicians and patients, or are purely consumer-driven.

Crucially, the IMA highlights the infrastructure capabilities that currently exist, versus the resources and investment needed to transition to a higher quality of service for patient experience and quality and productivity for clinical services. As with many other maturity assessment models, the IMA can help to unearth problems and make a business justification case for addressing gaps and weaknesses. Where it differentiates, is in its ability to provide a clear mapping between a business service or capability and a technical one. The Cisco IMA has been adopted as part of a standards-based model for infrastructure assessment:

IMA GOAL

Identify weakness in ICT infrastructure capabilities

Provide a framework for business case justification for ICT investment

Provide a longer-term road map for digital transformation aligned to the goals and direction of the organisation

Provides a benchmark of the organisations infrastructure performance with an opportunity for wider comparison

Level 1: Administrative – no use of ICT for clinical purposes

Level 2: Tactical – distribution of healthcare entity Information to specific departments

Level 3: Fixed – delivery of information through fixed wired end points throughout healthcare entity

Level 4: Mobile – Information is mobilised for wireless distribution

Level 5: External – Information is available beyond the healthcare entity

Level 6: Integrated – creation of integrated sets of data for cumulative insights

Level 7: Contextualised – customise information for personalised and contextual delivery

Level 8: Orchestrated – the use of contextualised information to drive improved workflows (e.g. through Artificial Intelligence) and the ability to orchestrate to operate infrastructure more easily

Domain: Mobility + sub domains

Domain: Security + sub domains

Domain: Collaboration + sub domains

Domain: Transport + sub domains

Domain: Data Center + sub domains

Virtual and Local Clinical Services:

Clinician to System services

Clinician to Clinician services

Clinician to Patient services

Consumer Drive

An understanding of maturity level for Digital Transformation

Map of the infrastructure capability to support key domains and clinical services and application stack models such as the EMRAM from HIMSS

A business value viewpoint for patient experience, clinical quality and productivity

Guidance for identifying the right ecosystem of partners for strategic and tactical support

Strategic roadmap development for aligning the transformation maturity of individual entities with group-wide goals

IMA LEVELS AND CAPABILITIES DOMAIN AND CLINICAL SERVICES COVERAGE

SELECTION OF VALUE DELIVERED


Cisco Digital Network Architecture (DNA) for a connected healthcareLike many other ICT providers, Cisco recognises the challenges facing organisations looking to transform their ICT estate to support innovations and digital capabilities. Complexity, costs, fragmentation and security all have a bearing on their ability to progress. Skill shortages, scale of service delivery and a need to respond faster and more intelligently to the needs of the workforce, suppliers and clients alike, add to the challenges of operating in a climate of changing market forces. The network is the backbone of any IT estate, and ‘Network Intuitive’ heralds a transition to the intent-based networking that lies at the heart of Cisco’s Digital Network Architecture (DNA).

Cisco DNA for Healthcare leverages advances in Cisco’s network infrastructure products (switches, routers, wireless and applications) and virtualised functions, that enable immediate support for a range of digital technologies and application services. The DNA infrastructure and application portfolio provides an

end-to-end platform for digitally connecting patients and healthcare teams and delivering the core business value metrics for the healthcare industry. For Cisco, DNA represents the company’s vision for digital-ready infrastructure and the wider industry transition towards: open, programmable, software-driven hardware; policy-based automation and segmentation; built-in security that proactively and contextually protects; and real-time business insights.

Cisco DNA delivers an intent-based network that focusses on: simplifying network design, build and management; enhancing the ability to predict, adapt and secure clinical workflows and operations; and protecting internal and external interactions and connected devices and equipment. A full list of the associated products and specific capabilities can be found at Cisco DNA for Healthcare.

The table below highlights the core solutions supporting Cisco DNA for Healthcare, along with some of the overall features and the value added benefits for healthcare entities.

CAPABILITY CISCO SOLUTIONS KEY FEATURES VALUE ADD BENEFITS FOR HEALTHCARE

Insights and Analytics

Automation and Assurance

Security and Compliance

Virtualization

DNA Ready Infrastructure

● Cisco Connected Mobile Experiences

● DNA Analytics and Assurance

● Meraki Location Analytics

● Security analytics

● DNA Center

● SD-Access

● Meraki Dashboard

● Cisco SD-WAN

● Meraki SD-WAN solution

● Enterprise Network Security

● Meraki Security Appliances

● Enterprise NFV

● Meraki DNA products

Network design, build and management strategy

Software driven configuration

Cloud support

Context and intent based networking

Faster flexible deployment

Adaptable, automatically responding to new digital requirements

Simplifying network management using automation and network virtualization

Centralized management and monitoring

Detect malicious patterns in encrypted traffic

Intelligent sensor and profiling with deep network visibility

Automated device deployment and provisioning of multiple devices

Policy driven operation for improved security

Digitally connect patient and healthcare teams

Automatically Identify critical healthcare equipment and placing them in secure segments

Lower costs and reduce risk

Bring your own device (BYOD) support

Analytics to improve workflows and patient outcomes

Continuous monitoring services


ConclusionThe growing collaboration between medicine and information technology is responsible for improving and saving countless lives all around the world. With healthcare transformation, comes the opportunity for clinicians to practice in new ways. For instance, they can incorporate insights from data into their treatment plans, conduct virtual visits with their patients, and receive alerts from remote patient monitoring devices that can trigger a specific response.

ICT infrastructure is the foundation for exploiting digital technologies that propel efficiency and excellence in healthcare operations – from clinical workflows, partner and patient engagement, to administrative operations. Without it, the barriers to improvement and progression become insurmountable.

other reports in this series:To learn more about connected healthcare and Cisco’s offerings in this area, please see the CIC Briefing Note: Security priorities for IoT and connected healthcareCIC Briefing Note: Streamlining clinical experiences in IoT and connected healthcare CIC Briefing Note: Progressing the patient experience in IoT and connected healthcare

Creative Intellect Consulting is an analyst research, advisory and consulting firm focused on software development, delivery and lifecycle management across the Software and IT spectrum along with their impact on, and alignment with, business. Read more about our services and reports at www.creativeintellectuk.com

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CIC ANALYSTS Bola Rotibi, Research Director; Cornelia Wels-Maug, Principal Healthcare Analyst; Ian Murphy, Principal Analyst; Clive Howard, Principal Analyst.

https://engage2demand.cisco.com/LP=9699



CIC Healthcare Briefing: The network foundation for IoT ... · Data accuracy has long been a challenge for healthcare organisations. The move to a fully-connected, IoT healthcare

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