Internet of Things and Artificial Intelligence in Healthcare During COVID-19 Pandemic—A South American Perspective

The shudders of the COVID-19 pandemic have projected newer challenges in the healthcare domain across the world. In South American scenario, severe issues and difficulties have been noticed in areas like patient consultations, remote monitoring, medical resources, healthcare personnel etc. This work is aimed at providing a holistic view to the digital healthcare during the times of COVID-19 pandemic in South America. It includes different initiatives like mobile apps, web-platforms and intelligent analyses toward early detection and overall healthcare management. In addition to discussing briefly the key issues toward extensive implementation of eHealth paradigms, this work also sheds light on some key aspects of Artificial Intelligence and the Internet of Things along their potential applications like clinical decision support systems and predictive risk modeling, especially in the direction of combating the emergent challenges due to the COVID-19 pandemic.

Introduction

Recent years have seen a tremendous surge in domains like the Internet of Things (IoT). The area of healthcare has always been one of the principal application domains of applied IoT. Clubbed with recent advances in Artificial Intelligence (AI) and Machine Learning, eHealth has emerged to new heights in recent times. With the approach of the COVID-19 pandemic, the entire healthcare sector across the world has received shudders from multifarious aspects, including its capacity and deliverability, promptness in response, connected information and analysis. IoT and AI applied to healthcare makes the domain of eHealth largely transdisciplinary, and especially during the times of COVID-19 pandemic, has opened new frontiers of challenges. On one hand, the aspect of eHealth has been fortified in South America during the pandemic by fast development of virtual healthcare solutions. On the other hand, technological areas like IoT and AI have received a strong push to provide fast and efficient healthcare services especially in the perspective of COVID-19, often to automate and facilitate several tasks of the healthcare personnel.

This work is focused on highlighting some of the key aspects of IoT and AI in healthcare related to the domain of South America, especially relevant during the times of COVID-19 pandemic. The principal aspects of eHealth services during COVID-19 in South America have been illustrated, followed by a country-wise review of the state-of-the-art tools and solutions like mobile apps and virtual consultations. Overall, an enormous technological response in healthcare in the South American domain has been noted during the COVID-19 pandemic.

Key Issues in Healthcare Services During COVID-19 Pandemic

With the advent of COVID-19, the entire healthcare system in many countries across the world faced the tremendous pressure of the newly infected patients. Added to the pressure was the extremely critical protocols (1) of water, sanitation, hygiene, and waste management, maintaining which implied new challenges in handling patients in the hospitals and healthcare centers. However, these challenges during the times of pandemic opened new possibilities for IoT and AI in the domain of healthcare. IoT is basically an interconnection of different objects, mostly heterogenous, to share important data among each other, aiming to provide more efficient services to the users. Artificial Intelligence on the other hand contributes significantly in making sense of the huge data accumulated from various sources by processing it and applying intelligent analytics to get deeper insights, in addition to providing smart services to the stakeholders. Since the inception of the COVID-19 pandemic, the healthcare sector in the entire South America faced several challenges, the principal ones being the shortage of human resources in essential healthcare services, arrangement of treatments for usual patients, and suddenly surged demand of specific medical supplies.

Healthcare Personnel

The crisis occurred due to the COVID-19 pandemic resulted in a shortage of available medical staff to treat the usual patient population. Due to the shortage, special efforts were taken by several countries to address the sudden surge in the need of physicians in the healthcare system. Several South American countries like Argentina, Uruguay, Chile and Venezuela have formed cooperation between the university faculties of medicine and state healthcare authorities to invite and engage medical students in the combat of COVID-19 on one hand, and summoned retired physicians to join the existing healthcare staff during the pandemic (2–7). For example, in Uruguay, retired physicians were invited for voluntary participation in the follow-up of patients under home-quarantine through tele or videoconference. Also, there has been a movement of physicians between countries to handle the shortage of healthcare staff due to the pandemic's effect on the healthcare system (8).

Patient Follow-Up

Due to the added risk of contamination and to reduce gatherings in hospitals and healthcare centers, the aspect of remote healthcare especially for the existing non-critical patients stood highly important. Also, to free up healthcare resources for the critical COVID-19 patients, most of the non-critical patients with other diseases were advised to avoid hospital visits (9). Clearly, this involved a disruption in the usual treatment and follow-up of the existing non-COVID patients, leading to newer challenges in maintaining a necessary level of treatment and follow-up on one hand, and keep provisions for COVID-19 patients on the other hand.

Medical Resource Shortage

Due to non-uniform geographical distribution of the COVID-19 cases, there has been frequent need of sharing and interprovincial transportation of medical supplies among different healthcare facilities in a dynamic manner based on the progression of COVID-19 cases, to avoid shortage at a specific facility with high demand. To avoid the shortage of essential medical devices like respirators and rapid test kits, several collaborations have been established between academia and industry, for the development of devices like artificial respirators or UV-based sterilizing devices (10, 11).

Principal Applications of IoT and AI in Virtual Healthcare—South American Perspective

The application domain of Artificial Intelligence in healthcare is extremely wide. In addition to intelligent analytics and decision-making, AI and IoT have specific advantages in eHealth during the emergent situations due to COVID-19. Especially in South America, where challenges in healthcare are multifarious like inequalities in healthcare access, healthcare quality, demographic and epidemiological changes in the population (12), the situation due to COVID-19 created a substantial pressure on the healthcare system. But this opened a vast potential for applying eHealth, making the relevance of IoT and AI paramount. Especially in the perspective of COVID-19, several aspects of eHealth using IoT and AI can be applied for improved treatment and monitoring and better management of healthcare services during the pandemic times.

Virtual Consultations and Remote Monitoring With IoT Devices

To avoid the hospital visits and reduce the conglomeration of non-critical patients in healthcare facilities during COVID-19, several South American countries have started virtual consultation systems through their public healthcare system (Table 1). On one hand, some countries enhanced their existing telehealth platforms, and on the other hand, dedicated virtual consultation channels were opened attributed to the pandemic. It is mostly performed through telephone calls or videoconferencing or even through messages, but without an extensive usage of remote monitoring devices.

TABLE 1

Table 1. State of virtual consultations during COVID-19 in South America.

However, the system of virtual consultation is primarily built on the foundation of verbal reporting of the symptoms by the patient and the physician's diagnoses based on that. A key to efficient diagnosis is the knowledge of different health indicators in addition to the detailed symptoms reported by the patient. But through telephone calls or videoconferencing, this stands as a substantial challenge, as in virtual consultations, the physician has to entirely depend on the reported symptoms. Also, it raises the possibilities of patients lacking confidence in the diagnosis since it is prepared without any precise knowledge of the health indicators.

IoT-eHealth devices hold the potential to play a significant role in this area. It aims at monitoring patients remotely from their homes using smart healthcare devices, to avoid or minimize their hospital visits on one hand, and to provide more accurate health-information to the physicians before or during virtual consultations. IoT-eHealth devices are usually capable of measuring several health parameters like heart rate, blood pressure, temperature, blood glucose etc. right from the patient's home and send summarized information to the medical personnel, to facilitate their diagnosis and treatment. For example, significant surge has been seen in the usage of devices like pulse oximeters in the COVID-19 scenario, to monitor blood oxygen levels (SpO₂) at home itself. Especially during the times of COVID-19, the usage of smart healthcare devices through IoT platforms is proposed, as it ensures better visibility of the patients' health to the physicians during the virtual consultations and also facilitates more accurate and efficient treatment.

Early Detection, Diagnosis, and Management Using Artificial Intelligence

Due to the COVID-19 pandemic, almost all the countries in South America faced an enormous load in the healthcare system. This involved scarcity of resources like medical staff, or even space in hospital and healthcare facilities. This opened a strong need to automate the basic decision-making processes for providing advice to the patients (35–38). AI plays an important role in this aspect, especially supporting physicians in early detection of COVID-19 cases by quickly analyzing irregular symptoms and other suspicions and thus alert the respective stakeholders like the patients and healthcare authorities (39).

Almost all the countries in South America have developed mobile applications and web-platforms to analyze the symptoms provided by people and matching it with predesigned decision trees, to provide specific advice related to COVID-19 (Table 2). Using IoT-eHealth devices counts more significant in this domain because of its more precision in reporting health indicators remotely and its potential in facilitating the automated decision-making process through. Since the quality of input health-data to the intelligent models through smart eHealth devices would be better than just self-reporting of symptoms, the advice would be more specific, personalized and efficient. Clinical decision support systems hold the potential to provide fast and automatic primary responses to the patients based on the health-data obtained (Figure 1), saving significant resources like time and personnel in the rush-hours and times of pandemic.

TABLE 2

Table 2. Mobile and web-apps in South America for early detection of COVID-19.

FIGURE 1

Figure 1. Clinical decision support system.

Connected Electronic Health Records (EHRs)

The advantage of the electronic health-data acquired by the IoT-eHealth devices lies in its transferability and processability. The IoT offers a sharing platform so that the EHR collected from the patients' eHealth devices can be shared across multiple heterogeneous devices, and across health networks in an easily accessible way to the healthcare providers. In South America, several countries have developed models for shareable EHR, enabling seamless exchange of EHR between healthcare providers as well as administrative entities. Primarily it deals with electronic versions of medical reports, physician's prescriptions and other information of patients stored online, making it easy to access for the patients avoiding visits to healthcare facilities and also for the healthcare personnel to provide remote treatment more efficiently. With the advent of COVID-19, the need of sharing health-data has increased significantly, in order to share important aspects of the disease outbreaks, compare symptoms across different regions and healthcare facilities and to understand the comprehensive scenario. IoT supports this scenario through multilayered sharing of EHR among different stakeholders, to provide comprehensive support to the patients.

Especially during the times of COVID-19, shareable and comprehensively accessible EHR enables to design a detailed risk-profiling of the population in almost real-time, using clustering algorithms. Also, it helps in deciphering the health-trend of the population mostly through supervised predictive models, strongly important in day-to-day planning and decisions on healthcare services during the pandemic.

Priority Scheduling of Patients

After the first effect of COVID-19 pandemic, as several healthcare facilities started opening for usual healthcare services in different South American countries, one of the key challenges is to manage the huge list of waiting patients who had to avoid visits the hospitals during the times of lockdown. The handling of patient-queues and priority lists is important, as delays in patients with potential risk could be fatal and due to limited resources of healthcare facilities, prioritization should be done efficiently and accurately. AI can process the comprehensive health-data of patients, including the previous hospital visits, laboratory results and interim treatments or complications, and use machine learning to train models and generate priority lists of patients to facilitate the medical staff in attending usual patients after lockdown.

Resource Sharing and Policymaking

AI plays a significant role in resource optimization. Especially in the crisis of resources and medical supplies in the times of COVID-19 pandemic, applying unsupervised learning techniques like clustering is useful to identify the key clusters and overall situation of resources across different centers, followed by distribution algorithms to share the resources efficiently. It is useful in different aspects of policymaking in emergency situations. Also, it can be used to predict the shortage of resources and supplies with considerable anticipation, giving enough time to organize the transfer and management of resources in combating the shortage.

Conclusion

The domain of healthcare has been one of the fastest adopting sectors for IoT and AI (40–47). Especially in the times of COVID-19 pandemic, the entire healthcare sector faced new challenges. In this context, several opportunities for application of IoT and AI have been discussed pertaining to a South American perspective. It includes efficient virtual consultations and remote monitoring of patients, intelligent diagnoses, sharing EHRs, and priority scheduling for patients. Several countries in South America face challenges in areas like digital-divide and disparity in population having access to digital technologies toward healthcare. Apart from that, despite having other challenges like limited power in handling big data, interoperability of health-data among heterogeneous stakeholders, and lack of unified implementational structure for eHealth, AI and IoT put forward immense potential in the healthcare sector, especially during and after the COVID-19 pandemic.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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