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com

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ICT Express xxx (xxxx) xxx
www.elsevier.com/locate/icte

Utilization of mobile edge computing on the Internet of Medical Things: A

survey
Ahmed I. Awada , Mostafa M. Foudab , Marwa M. Khashabaa , Ehab R. Mohameda , Khalid
M. Hosnya ,∗
a Department of Information Technology, Faculty of Computers and Informatics, Zagazig University, 44519 Zagazig, Egypt
b Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA

Received 17 March 2022; received in revised form 27 April 2022; accepted 11 May 2022
Available online xxxx

Abstract
Internet of Things (IoT) enables different smart environment objects to communicate without involving humans. Recently, IoT has started a
new challenge within the healthcare sector called the Internet of Medical Things (IoMT). The huge amounts of data generated by IoMT entities
need to be analyzed in real-time to improve the performance and quality of service of the IoMT applications. Mobile Edge Computing-enabled
5G system is shown as a successful paradigm to address such an obstacle. Numerous frameworks are introduced in literature based on this
idea. This paper presents a thorough discussion of MEC-based IoMT healthcare systems.
© 2022 The Author(s). Published by Elsevier B.V. on behalf of The Korean Institute of Communications and Information Sciences. This is an open
access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: MEC; Cloud computing; IoMT; Smart healthcare; 5G; Microservices; TinyML; DevOps; WBAN; Big data; Blockchain

1. Introduction has saved a lot of time for the caregivers to take care of patients
instead of recording their body parameters manually.
Health is the most important thing for all of us; there-
IoMT was a powerful technology during the covid-19 out-
fore, researchers from various fields are trying to do their
break [4]. It enabled the remote detection, diagnosis, mon-
best to improve the traditional healthcare system. Healthcare
itoring, and treatment of patients, which helped reduce the
recently used Information and Communication Technologies
spread of this virus. Data from different patients are collected
(ICT) to design smart systems that accelerate the process
and analyzed automatically, and the results are stored in the
of abnormality detection in human bodies and furnish an
cloud to instantly extract more knowledge and statistics about
accurate and effective treatment. Ranging from data collection
the virus. It also helped in providing the healthcare anywhere
to diagnosis, the Internet of medical things (IoMT) has au-
and any time. It enabled caregivers to service more than one
tomated the overall healthcare system processes [1–3]. IoMT
patient simultaneously, saving many lives. The IoMT-enabled
expresses the Internet of things (IoT) devices used in the
smart healthcare system will effectively improve the traditional
medical healthcare systems. Therefore, we will use both terms
healthcare systems that require a caregiver for each patient,
interchangeably during this study. IoMT has translated the
which cannot meet the rising numbers of patients.
traditional healthcare systems into smart healthcare systems.
Governments and public sectors face substantial challenges
IoMT sensors gather patient data such as pulse rate, body
due to the rising number of chronic disease patients, catas-
temperature, glucose, blood pressure, oxygen, etc., and share
trophe management, and emerging epidemiological risks such
them with doctors, patients’ relatives, or nearest caregivers in
as COVID-19. These challenges encouraged the evolution
these smart systems. The automation of healthcare operations
of IoMT devices to meet these needs. It is estimated that
∗ Corresponding author. connecting devices will be more than one trillion by 2025 [5].
E-mail addresses: ahmedawd622@gmail.com (A.I. Awad), The ever-growing number of IoMT entities naturally generates
mfouda@ieee.org (M.M. Fouda), marwamkhashaba@gmail.com large amounts of big data [6–8], which must be processed in
(M.M. Khashaba), ehab.rushdy@gmail.com (E.R. Mohamed),
real-time. Big data produced from IoMT entities needs to be
k_hosny@yahoo.com (K.M. Hosny).
Peer review under responsibility of The Korean Institute of Communica- analyzed effectively to get valuable results for the caregivers
tions and Information Sciences (KICS). and community. Processing big data on IoMT devices is
https://doi.org/10.1016/j.icte.2022.05.006
2405-9595/© 2022 The Author(s). Published by Elsevier B.V. on behalf of The Korean Institute of Communications and Information Sciences. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: A.I. Awad, M.M. Fouda, M.M. Khashaba et al., Utilization of mobile edge computing on the Internet of Medical Things: A survey, ICT Express (2022),
https://doi.org/10.1016/j.icte.2022.05.006.
A.I. Awad, M.M. Fouda, M.M. Khashaba et al. ICT Express xxx (xxxx) xxx

impossible in real-time because of their limited computing systems. Section 4 discusses MEC-IoMT applications from the
and storage capabilities. The first solution was centralized literature. In Section 5, the advantages of applying MEC in the
cloud computing [9,10], with excellent computing and stor- IoMT applications. Section 6 discusses the key ICT enablers
age recourses. But processing data on cloud servers incurred for improving the efficiency of IoMT systems. Security and
considerable delays since sending data to the cloud depends privacy challenges of the system are explored in Section 6.
on network bandwidth and congestion. Finally, we concluded our work in Section 7.
Transmission of data to be analyzed on the cloud can cause
the death of some persons. One more practical solution is 2. Comparison with related works
to process time-sensitive data near patients, which can be
Applying edge computing is a crucial component of IoT
the network edge. This solution requires distributing small
healthcare systems. This study will discuss the technical issues
cloud servers at the network edges or base stations in mobile
relevant to applying mobile edge computing in the IoMT
networks. Mobile Edge Computing (MEC) is a new paradigm
healthcare systems and integrating cloud computing through
that brings cloud servers to the edge of mobile networks to
the 5G network. The main components and applications of
enable real-time subscriber and IoT data processing. European
5G MEC-based IoMT healthcare systems were determined by
Telecommunications Standards Institute (ETSI) announced the
examining the literature and surveying the current architecture.
first release of MEC in 2014 [11], and later in 2018, it was
The authors in [14] reviewed the use of big data, Machine
renamed Multi-access Edge Computing [12]. MEC does not
Learning (ML), Deep Learning (DL), and blockchain in edge-
replace cloud computing. Instead, it will be integrated to
based IoT healthcare. Still, they did not provide the main
improve the performance of IoMT systems.
issues of implementing mobile edge computing in the smart
Burgeoning IoMT technology presents several novel so-
healthcare system, and the study also did not discuss the
lutions and further growth chances, particularly for innova-
integration with 5G technology. Study [15] presented a good
tive ideas in the healthcare sector. Recent advancements in
review about integrating ICT technologies like 5G, Artificial
communication technologies and protocols also aided us im-
Intelligence (AI), MEC, and Big Data. Still, it does not dis-
mensely [13]. Most of the work is done in the physical,
cuss the processing model in MEC-based IoMT Healthcare
network, and link layers. Aside from that, protocols at the
architecture and does not include the recent advancements in
highest network levels are essential for effective data gathering
Wireless Body Area Network (WBAN). Abdellatif et al. [16]
and exchange. There are several applications, processes, and
discussed the MEC-based smart healthcare architecture but did
designs for selection in the healthcare industry. Network engi-
not discuss the system’s key enablers and integration with
neering and applications, device design, security and privacy
5G and IoMT sensors. The study also lacked the discussion
problems, and latency optimization are all continuing ad-
and review of the system components in detail. Many other
vancements in IoT healthcare research. In addition, numerous
papers [17–21] discussed the role of IoT smart healthcare
IoMT recommendations and policies have been established in
systems, referring to edge/fog computing as promising tech-
healthcare in several countries and organizations worldwide.
nologies for improving the performance of these systems. Still,
However, even though a significant amount of research has
the technical implementation details, recent ICT key enablers,
been done on IoT, there is still a significant need for more
security and privacy challenges, and data processing taxonomy
study in the healthcare industry. This survey paper looks at
of the MEC-based IoMT smart healthcare architecture are not
a variety of smart healthcare challenges and trends. In this
covered in the literature.
regard, this paper makes the following contributions:
1. The overall fifth Generation (5G) MEC-based IoMT 3. Life cycle of data processing in the 5G MEC-based
healthcare system architecture with a discussion of the IoMT systems
implementation details is introduced.
The standard distributed computing nowadays is the client–
2. From data collection until diagnosis, a taxonomy of
server computing paradigm. It uses a client-side to initiate
data processing in the system, from data collection until
server requests and a remote server-side to manipulate them,
diagnosis, is presented and discussed.
allowing software developers to utilize centralized computing
3. A table of literature studies that relate to this paper topic
and storage resources. It has become the main driver for
is provided.
the appearance of cloud computing. The emergence of MEC
4. The advantages of utilizing MEC in the IoMT systems
improved this environment by introducing an intermediate
are provided.
element at the network edge, which led to a new software
5. An overview of the recent ICT key enablers for im-
development model with three locations: Client, Edge Server,
proving the efficacy of smart healthcare systems is
and Cloud Server. The client location can be a smartphone or
provided.
other IoT device. Modern development paradigms such as Mi-
6. Security and privacy challenges are discussed with pos-
croservices, serverless computing, and DevOps make it easier
sible solutions from the literature.
to adapt to this model [22]. However, for MEC applications,
The following sections are organized as follows: Section 2 application developers need to distinguish features of their ap-
provides a comparison with related works. Section 3 presents plications that require processing at each of the three locations.
the life cycle of data processing in the 5G MEC-based IoMT They should determine what features should be processed on
2
A.I. Awad, M.M. Fouda, M.M. Khashaba et al.
Fig. 1. 5G MEC-based IoMT healthcare system architecture.
an IoMT device/smartphone, what features to process on MEC
and the features that do not require high computing power or
high latency and can therefore, be deployed at cloud location.
The architecture shown in Fig. 1 represents 5G IoMT-
enabled smart healthcare systems that employ mobile edge
computing servers as a middle-ware layer. This architecture
includes four layers: The sensing layer mainly for data acqui-
sition, the communication layer for computational offloading
of tasks, the MEC layer for edge processing, and the cloud
layer for remote processing and storage.
It represents the end-to-end operation of the MEC-based
smart healthcare system. Firstly, data is collected using differ-
ent medical sensors or IoMT devices. Because of the poor pro-
cessing and storage capabilities of IoMT devices, heavy data
processing is passed to a more powerful computing device.
Depending on the offloading decision, the devices employed
for further processing the gathered data could be MEC or
cloud computing servers or the IoMT device itself in the
case of lightweight tasks with tiny machine learning tools.
In the 5G structure, the data generated by IoMT sensors is
transmitted to multi-interface base stations or gNB [23] that
employ MEC. Finally, processing healthcare data can be used
to make appropriate decisions or another analytical process.
We divided the operation of the MEC-based smart health-
care system into four layers, as shown in Fig. 1, to better
explain the system’s architecture. This section will explain the
work done in each layer of the system. The layered explanation
will also enable the reader to imagine the flow of events
performed in the system.
3.1. Sensing layer
IoT is a promising ICT paradigm that enables different
smart environment objects to communicate without humans
[24]. In the IoT world, physical items (sensors, actuators, home
appliances, and so on) are connected to the Internet and can
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ICT Express xxx (xxxx) xxx
interact intelligently [25]. Smart homes [26], smart cities [27],
vehicle sensors, and smart agriculture [28] are just a few of
the applications where IoT is being used to build and develop
intelligent devices to save energy and personnel.
IoT technologies are also used in the healthcare field
to achieve a more inventive future and are referred to as
IoMT [29]. In a sophisticated health-tech environment, the
IoMT sensors improve the quality and efficiency of real-time
diagnosis [30]. The IoMT devices made it possible to provide
healthcare anywhere and at any time.
There are many uses of IoMT sensors in the medical
environment. The first use is in WBAN, also known as Body
Area Sensor Network (BASN), an IoT network connected
to the human body that senses to monitor any critical or
periodic occurrences [31]. It comprises a set of wireless med-
ical sensors situated in specific places of the human body
to measure physiological variables such as heartbeat, body
temperature, insulin and oxygen ratios in blood, and blood
pressure [32]. The IoMT devices capture medical data and pass
it to a local node such as a Personal Data Assistant (PDA),
smartphone, or nearest node to an access point or base station
for transmission [33–35]. The local node can perform data
analysis using tiny machine learning and other lightweight
processing tools, then upload the necessary data only to the
MEC server or the cloud. The result of the analysis is sent to
a coordinator (medical specialists, healthcare researchers, doc-
tors, pharmacies, ambulances, physicians, or patients’ families)
via a gateway [36]. Sensor data and other process choices are
collected using smartphones or PDA devices [37].
Table 1 shows a list of medical sensors used to collect data
from the human body [38,39]. There are many other WBAN
sensors in the healthcare industry, but we have mentioned the
basic sensors used in the literature.
The second use of IoMT sensors, such as a smart camera,
is in public places and smart roads to detect emergency cases
and accidents and signal the nearest emergency services or
caregiver [40].
A.I. Awad, M.M. Fouda, M.M. Khashaba et al. ICT Express xxx (xxxx) xxx

Table 1 mentioned. In [48], the authors reviewed the proposed machine

Standard WBAN sensors. learning-based methodologies for task offloading in MEC.
Medical sensor Description After capturing and collecting data at the local node, the
Blood Pressure A non-invasive sensor for measuring local node can take the offloading decision based on the
Sensor blood pressure in humans. The profitability of the offloading in terms of energy consumption,
oscillometric method assesses systolic,
latency, and cost of processing [49]. The decision can be one
diastolic, and mean arterial pressure.
of the following three [50].
GPS Stands for a global positioning system,
and it is a sensor that provides position, 1. Local execution: the local node or User Equipment
velocity, and timing information. (U.E.) can execute its tasks locally.
Accelerometer Reports proper acceleration (the rate of 2. Offloading to MEC: offloading tasks to one or more
change of velocity). MEC servers.
Pressure sensor Absolute and gauge pressure 3. Offloading to cloud computing: this decision can be
measurement taken by the local node or MEC.
Pulse Oximeter It is worn on a fingertip and employs
laser beams to calculate blood oxygen The MEC also can offload some tasks to centralized cloud
saturation (spo2) and pulse rate. servers to benefit from the powerful capabilities of the cloud
Respiration Report chest expansion and contraction. servers [51]. Computational tasks from the same healthcare
Sensor application running on different MEC can be offloaded to the
Glucose Sensor Blood sugar measurement. cloud for further processing. For this reason, the cloud can
Temperature Measuring body temperature.
maintain a priority queue for processing these computation
Sensor tasks, which is the same for the tasks offloaded to MEC. This
EEG Sensor EEG stands for Electroencephalogram,
research area still needs more stable solutions.
and it is used for brain activity
measurement. 3.3. MEC layer
ECG Sensor Stands for an Electrocardiography sensor
and is used to collect the electrical MEC provides a decentralized computing environment pla-
activity signals of heartbeats. ced at the mobile network edge [52]. It can deploy health-
EMG Sensor EMG stands for Electromyography sensor care applications to store and process content in proximity
and measures electrical signals generated to mobile subscribers and IoT devices [53]. It is an interme-
by body muscles during motion.
diary technology between IoMT and cloud computing [54].
Thermometer It is a device that measures the MEC can be used for local caching to reduce remote cloud
temperature of objects.
requests [55]. It compensates for the poor processing and
Motion Sensor Detection of nearby people or objects storage capabilities of IoMT entities and avoids the trans-
motion.
mission of data on the public Wide Area Network (WAN).
It is a promising paradigm for the real-time healthcare data
processing produced from IoMT devices. Authors in [56] have
The third use is in-home care to monitor elderly people utilized MEC to deploy a trained breast cancer diagnostic deep
and persons with chronic diseases through smart wearable learning model to overcome bandwidth limitation problems
sensors [24]. and the lack of all-time available skilled doctors. With the
Another use of IoMT sensors is in the hospital management aid of a local edge server, Authors in [57] have developed a
systems to monitor the status of hospital resources (human re- privacy-preserved diagnostic model for healthcare data.
sources, medical devices, hospital rooms, room beds, etc.) [41– Fig. 2 shows the abstract architecture of the MEC server in
43]. the healthcare environment. MEC server platform consists of
the following essential components [11,51]:
3.2. Communication layer 1. MEC hosting infrastructure: refers to the physical
hardware resources and virtualization layer. It includes
The communication layer involves transmitting data and the connection to the Radio Access Network (RAN)
tasks to the nearby MEC servers through Wireless area net- base station (gNB). Virtual Machines (VMs) are used to
works. Transferring resource-intensive tasks such as big data deploy and run MEC healthcare software from vendors,
analytics tasks to MEC servers for processing [44]. service providers, and third parties. This component is
Many technical publications in the literature examine the managed by MEC hosting infrastructure management
topic in depth to propose novel techniques for optimizing task system.
offloading to MEC servers in the healthcare industry [45– 2. The MEC app platform management system man-
47]. These technical publications primarily offered methods ages the MEC application platform. It offers a set
based on game theory, machine learning, mathematics, model- of intermediary services to the healthcare applications
based, heuristic-based, or a hybrid form of the techniques deployed on the MEC server:
4
A.I. Awad, M.M. Fouda, M.M. Khashaba et al.
Fig. 2. The MEC architecture.
2.1. Infrastructure services: contain two primary
services: communication services that allow apps
running on a single MEC server to interface
with application-platform services (through well-
defined (Application Programming Interfaces
(APIs)) and with one another (via a service-
specific API). Lastly, the Service registry repre-
sents a service catalog that shows the services
available on the MEC server.
2.2. Radio Network Information Services (RNIS):
provides permitted apps with network context in-
formation such as cell identification (cell-id), lo-
cation of the subscriber, cell load, and throughput
guidance.
2.3. Traffic Offload Function (TOF): Prioritizes traf-
fic and directs a policy-based stream of user data
to and from apps permitted to receive it.
3. MEC applications: The healthcare applications are
deployed in this layer and managed by the application
management system. There is an on-premises instan-
tiation of Virtual Network Function (VNF) for each
service request to prepare data for the healthcare app
to return the result to the device and destroy it after its
operation [58]. This VNF is also used to keep privacy
for users. After the VNF decides on the target healthcare
application, it prepares the data and then passes the
cleaned data to the intended application. There should
be a VPN on the link between MEC and the cloud
to maintain high-level security for the data on the
network [59]. Many papers in the literature worked
on the integration of MEC with Network Function
Virtualization (NFV) [60–62].
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ICT Express xxx (xxxx) xxx
3.4. Cloud layer
Cloud computing refers to supplementing various IT ser-
vices over the Internet on demand. Servers, storage, databases,
networking, software, analytics, and intelligence are examples
of these services [63]. Cloud computing is a popular choice
among individuals and businesses, including cost savings,
high availability, increased productivity, speed and efficiency,
improved performance, and security [64]. Cloud computing
is utilized in the healthcare sector to handle operations that
require a lot of processing power and to store massive data
generated by IoMT devices.
Cloud computing, unlike a microcontroller, is not a sin-
gle technology chip. It is a system in which cloud com-
puting providers provide their consumers with three cloud
services [65]:
i. Software-as-a-service (SaaS): SaaS is a means of dis-
tributing software applications via the Internet on a
pay-as-you-go or on-demand basis. The software ap-
plication, underlying infrastructure, and maintenance
operations are hosted and managed by cloud providers
through SaaS. Cloud users utilize a web browser to
access the application via the Internet. Third parties are
permitted to use the cloud to install their applications
remotely.
ii. Infrastructure-as-a-service (IaaS): IaaS is a pay-as-
you-go service that provides computer hardware (pro-
cessing, memory, network, storage, server/virtual ma-
chine, and data center) to customers.
iii. Platform-as-a-service (PaaS): PaaS refers to delivering
an on-demand cloud-based environment for developing,
testing, delivering, and managing software applications.
PaaS allows developers to quickly create web or mobile
apps without worrying about setting up or managing the
underlying infrastructure of servers, storage, network,
and databases needed for development.
iv. Function-as-a-Service (FaaS): FaaS is a new cloud
computing service that abstracts application developers
from complicated infrastructure for building, deploying,
and launching Microservices applications [66]. FaaS is
an event-driven computing paradigm in which applica-
tion code runs only in response to events or requests.
FaaS platforms are the most common kind of serverless
computing, which is the recent concept in this area to
remove servers from the developer’s worries [67]. FaaS
offers obvious advantages: users do not have to manage
servers or resources; instead, they send their code to the
cloud, which is processed and performed on demand.
Even better, customers only pay for individual invoca-
tions of such functions, with millisecond execution time
considered [68].
Centralized cloud computing receives computing-intensive,
time-insensitive tasks for processing. It also stores statistics
from all MEC servers, such as the numbers of people infected
with some diseases and locations of some pandemics. It also
stores the data needed for the processing, such as the features
A.I. Awad, M.M. Fouda, M.M. Khashaba et al.
Fig. 3. Advantages of adopting MEC in the smart healthcare system.
of sample images required for recognizing a specific disease.
The information that is extracted from processing the sensed
data can be used in different ways:
• Displayed for a physician for diagnosis.
• Further processed to extract some statistics.
• Used in scientific research.
4. MEC in IoMT-enabled smart healthcare systems
Many researchers tried to utilize MEC in healthcare appli-
cations. The authors target many healthcare applications and
diseases. They especially concentrated on the following issues:
1. Security and privacy of the patient data.
2. Latency of the diagnosis and treatment operations.
3. Energy consumption of the IoMT devices.
4. Usage cost of the server resources.
5. Decentralizing the healthcare environment by providing
healthcare services anywhere and anytime.
6. Accuracy of the results.
Table 2 contains a list of papers from the literature that
focuses on using MEC in IoMT-enabled smart healthcare
applications.
5. Advantages of applying MEC in IoMT-enabled smart
healthcare systems
MEC comes with characteristics [11] that can enhance the
healthcare system. These advantages can be summarized as
shown in Fig. 3. In this section, we will briefly discuss the
essential advantages that were considered a requirement for
the smart healthcare system before the appearance of MEC.
5.1. Optimization of latency
The latency is commonly expressed as a Round Trip Time
(RTT), or the time it takes for network packets to go from point
A to point B and return. MEC reduces latency by bringing
computing power to close locations to mobile subscribers
in mobile networks. This benefit can help in saving many
people’s lives.
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5.2. Location awareness
Since MEC is installed on the edge of the network (base
station in cellular system) [83], it can utilize low-level signal-
ing information to discover the location of connected devices.
This property can help the patients and caregivers. It can
help patients discover the nearest caregiver, such as hospitals,
physicians, ambulances, or even a patient’s relative. It can
also help the caregiver know the Surrounding people with
infectious epidemic diseases [84,85].
5.3. Energy efficiency
Many types of research have been done to minimize the
energy consumption of IoMT devices using MEC. In [34,35],
the authors worked on optimizing data transfer using clustering
and other technologies such as fuzzy logic to determine the
nearest edge node/nodes to collect and send the data to the
MEC.
5.4. Pushing intelligence to network edge
Depending on the central cloud to provide the intelligence
to Wireless Body Area Sensor Network (WBSN) will cause
significant delays since sending data to the cloud depends on
network bandwidth and congestion, which lead to erroneous
results for patients [86]. On the other hand, the shortage of
IoMT devices capabilities such as storage, processing, and
the battery will limit the evolution of the healthcare sys-
tem, so they are considered only simple data collectors [87].
Therefore, the solution is MEC. Heavy processing tasks are
offloaded to the MEC, which should be integrated with the
central cloud nor replaced [88].
6. Key ICT enablers for improving the efficiency of
MEC-enabled IoMT systems
This part will provide a brief discussion of the fundamental
ICT enablers for improving the efficiency of smart healthcare
systems. As shown in Fig. 4, we present nine Technologies
that can effectively improve the smart healthcare sector ap-
plications’ performance. We have discussed IoMT, MEC, and
cloud computing in Section 3.
6.1. 5G
5G represents the network core for the IoMT-enabled MEC
applications, as shown in Fig. 1. 5G is the recent generation of
mobile networks. In contrast to Fourth Generation Long Term
Evolution (4G LTE) networks, the next generation 5G wireless
telecommunications systems requirements can be summarized
as [89]:
i. Extremely high bandwidth (typically of Gigabits per
second (Gbps)): from 1 to 10 Gbps data rates in mo-
bile networks, nearly ten times greater than pre 5G
networks.
A.I. Awad, M.M. Fouda, M.M. Khashaba et al. ICT Express xxx (xxxx) xxx

Table 2
Literature review for MEC in IOMT applications.
Author Contribution Year Simulation\ Simulation data Advantages Limitations
Evaluation tool

Single, Tshiamo Proposed 5G-based smartphone healthcare 2018 Open source An ElectroEncephaloGram (EEG) • Tried to reduce energy • Ignored task dependency.
Hu, Yim Fun portal for smart healthcare equipment Edgecloudsim gadget connected to the person’s consumption on a • It is a single objective
Ali et al. [69]. called IEE5GG. simulation tool smartphone is used to track their smartphone by offloading problem.
brain activity while they are on the some application tasks to
move. MEC.

Alabdulatif, Abdulatif Created a secure Edge of Things (EoT) 2019 Google Cloud Real heart disease dataset from the • Reserved patient data • Did not handle the
Khalil, Ibrahim platform for smart health observation that Platform (GCP). University of California Irvine’s privacy through fully missing values in IOT
Yi et al. [70]. can collect, monitor, and analyze (UCI) Machine Learning Repository. homomorphic encryption. collected data.
biosignal data in real-time. • Reduced latency by
adopting EoT.

Muhammad, Ghulam Introduced a smart healthcare system for 2019 python TUH EEG Abnormal Corpus v2.0.0. • Run the preprocessing • All processing is done on
Alhamid et al. [71]. discovering pathology using deep learning, step on the network edge to a remote cloud.
MEC, and cloud computing. reduce sent data to the
cloud.

Hossain, M. Shamim Proposed smart healthcare framework for 2020 Python TensorFlow Temple University Hospital (TUH) • Benefited from the • The number of subjects
Muhammad, Ghulam detecting pathology in EEG signals. The library abnormal EEG corpus v2.0.0 was location awareness property used in the experiment is
[72]. system enables the integration of MEC, of the MEC to notify relatively low.
cloud, Software Defined Networks (SDN), nearby caregivers for
Network Slicing (NS), and a deep patients.
learning architecture in the form of a • Reduced sent data to the
Convolutional Neural Network (CNN) cloud.
model.

Uddin, Md Zia [73]. Depends Recurrent Neural Network (RNN) 2019 Real experiment MHEALTH public dataset • Utilized local edge server • All data processing is
to forecast human activity. It used a set with graphical processing done on the local edge.
of wearable sensors to collect data and unit (GPU).
transfer it to an edge device for
processing.

Sodhro et al. [74]. Proposed a window-based Rate Control 2019 MATLAB “Navigation to the Uterine Horn” is • Improved quality of • Two-tier architecture with
Algorithm (w-RCA) to improve the an 8-minute pre-recorded medical service for data transmission all processing is done on
quality of service in healthcare systems media feed. to MEC. the server.
(m-QoS).
An 8-minute medical video stream
transmission across 5G networks uses a
MEC-based smart healthcare system that
considers network factors such as
Peak-to-Mean Ratio (PMR), standard
deviation, delay, and jitter.

Han, Tao For edge-computing based IoMT systems,
Zhang et al. [34]. a Clustering Model for Medical
Applications (CMMA) was developed for
cluster head selection to enable effective
communication in energy usage.
2019 MATLAB random • Reduced dissipation at • IoMT devices were used
IoMT devices by selecting a only for data acquisition.
cluster head near the MEC.

Ali et al. [75]. The authors developed a deep learning 2020 Python Keras library EEG signals from a single channel • The latency is enhanced • A small set of data was
model for epileptic seizure detection using with no artifacts and a duration of by adopting the MEC layer. used for training the model.
MEC. 23.6 s. • MEC is only used for
preprocessing.

Sellam, V. Developed the Fuzzy Clustering IoMT 2021 MATLAB random • Used fuzzy logic to • IoMT devices were used
Kannan et al. [35]. (FC-IoMT) technique, a fuzzy logic-based reduce dissipation at IoMT only for data acquisition.
clustering technique for IoMT applications devices by selecting a
leveraging MEC. The FC-IoMT technique cluster head near the MEC.
selects Cluster Heads (C.H.s) depending
on five input factors to reduce energy
consumption in the IoMT system.

Olokodana et al. [76]. The standard kriging approach presented a
real-time seizure detection model in an
edge computing context.
2020 Real implementation: Two datasets are used: • The latency is enhanced • IoMT devices were used
A single-board Dataset 1: collected from 5 healthy by adopting the MEC layer. only for data acquisition.
computer subjects and five epilepsy patients by
(Raspberry) was the University of Bonn in Germany.
used as a client, Dataset 2: collected from 22 patients
and a personal at the Children’s Hospital Boston
computer was used (CHB) associated with MIT.
as the server

Ning, Zhaolong Developed a MEC-based 5G health 2021 MATLAB Through attached body sensors, N = • Minimize cost and latency. • Cloud is only used for
Dong et al. [77]. monitoring system in smart homes for 30 patients generate health monitoring final reports storage.
IoMT to minimize the system-wide cost. packets. Five edge servers = K

S. Raj, Jennifer [78]. Developed a framework to optimize the 2021 Real experiment. Real dataset from elderly adults. • Depended on a real • Did not add the cloud to
edge cooperative network for improving dataset collected from the cooperation network.
the efficacy of edge computing tasks. elderly persons to show the
model’s efficiency.

Xiao Zheng et al. [79]. Developed a Federated Transfer Learning 2021 Python Public human action recognition or • Privacy-preserving. • A fewer number of
method (FT-IoMT) based on IoMT that (UCI) smartwatch dataset. • Personalized results. subjects were used in the
reduces the number of rounds between experiment.
the participant and the server while
maintaining accuracy from the system’s
perspective.

Yu Qiu et al. [80]. Considering the QoS need, power limit, 2021 MATLAB Assumed parameters for the • Formulated an • Ignored cost of server
and wireless front haul constraint, the simulation. optimization problem to resources usage.
authors examined the cost minimization minimize the cost and
issue for healthcare monitoring in fog energy of healthcare apps.
computing-based IoMT (FogC-IoMT).

Dawid Połap et al. [81]. Presented a federated learning approach 2020 Python Tuberculosis Chest X-ray Image Data • Utilized blockchain • Latency increased
that combines decentralized learning with Sets. technology with federated
blockchain-based security and a suggestion learning to provide a more
for training intelligent systems with secure and personalized
distributed and locally-stored data for all results model.
patients. • IoMT devices are used
for clearing private data.

Dong, Peiran, et al. This study aims to research an edge 2020 MATLAB Random data. • System-wide cost is • No cooperation among
[82]. computing-based healthcare system in minimized. nearby MECs.
IoMTs to lower system-wide costs. • All processing is done on
MEC.

7
A.I. Awad, M.M. Fouda, M.M. Khashaba et al.
Fig. 4. Key enablers for intelligent healthcare systems.
ii. Extremely low latency: 1 ms round trip time, which is
also almost ten times minimization from 4G’s latency,
definitely improving users’ perceived QoS.
iii. An enormous increase in base station’s capacity: in-
creasing the number of connected devices to base sta-
tions allows thousands of IoT devices to be connected.
iv. Availability: 5G anticipates a network that is always
available.
v. Minimization of Energy consumption: nearly 90% re-
duction in energy usage is claimed by 5G technology.
Standard bodies are already considering green technol-
ogy development. With 5G wireless’s high data rates
and widespread connectivity, this will be even more
critical.
The 5G is developed using Network Softwarization ideas to
meet the above objectives. As a result, modern network ideas
such as SDN, NFV, cloud computing, MEC, and NS will be
adopted by 5G mobile networks [90,91].
NFV presents a revolutionary way to create, deploy, and
manage networking services. Through the virtualization layer,
NFV replaces network appliances such as load balancers
and firewalls with VNFs that run on a single device. The
SDN idea suggests isolating network devices’ control and
data planes [92]. Whether it is managed inside a network
operating system by a centralized logic, SDN-based networks’
network control logic and intelligence are spitted separately
from routers and switches. This notion aims to isolate network
services from proprietary hardware to be run as software
instances. The NS concept relies on network virtualization
to separate single network connections into numerous inde-
pendent virtual connections that supply various resources to
different types of traffic, improving the 5G Network’s support
for different traffic classes [93].
6.2. Big data
The Evolution of IoMT devices has brought many benefits
to the traditional healthcare systems. However, it has produced
enormous quantities of big data that need to be analyzed
to improve the usability of the IoMT-enabled systems [94].
Furthermore, the distributed biomedical services that deal with
8
ICT Express xxx (xxxx) xxx
big data, such as handling massive and exponentially increas-
ing genomic data, are needed for big data and other ICT
technologies in the healthcare sector [95].
The concept of “big data” encompasses the massive vol-
umes of data that must be handled and stored and the data’s
nature [96]. The term “Big Data” refers to a large amount
of structured, semi-structured, and unstructured data that is
defined by the “5 Vs”. [97,98]:
i. Volume: this characteristic refers to the large sizes of
data (in Exabyte’s or Zettabytes) generated, collected,
transmitted on a network, and analyzed, such as the
data generated from the IoMT sensors in the healthcare
sector.
ii. Velocity: relates to how quickly data is generated and
transferred for further processing. Processing such vast
amounts of real-time data necessitates advanced analyt-
ics tools [99,100].
iii. Variety: is a concept that relates to the many types
and forms of data acquired by handheld devices. Text,
image, video, and audio can all be used to store data.
Structured, semi-structured, and unstructured data are
all possibilities.
iv. Veracity: refers to the validity, quality, reliability, trust,
and consistency of the data.
v. Value: refers to the revenue from analyzing data.
6.3. TinyMl
Machine Learning (ML) is the ground-breaking paradigm
that will enable the next generation of MEC-based smart
healthcare applications [101]. ML allows us to infer impor-
tant information and knowledge from massive amounts of
previously unobservable data to the human eye.
Tiny machine learning (TinyML) is a new IoT prospect
that calls for putting the ML algorithm within the IoT device,
thanks to rapid advancements in the shrinking of low-power
embedded devices and ML algorithms [102]. TinyML frame-
work aims to deliver low latency, low energy consumption,
efficient bandwidth use, data security, privacy, and cost sav-
ings [103]. Table 3 contains the common tinyML libraries in
the MEC-based IoT applications according to [104].
6.4. Blockchain
Blockchain is a distributed, immutable, and public database
[105]. It is based on the peer-to-peer network model, where
no single centralized node controls the transaction informa-
tion. Transactions records are stored in a chain of blocks
access to all blockchain network nodes responsibly and se-
curely [106,107]. Blockchain validates the authenticity of
transaction information via consensus procedures and encryp-
tion techniques, ensuring that connected blocks are resis-
tant to modifications and alterations [108,109]. The modern
mechanisms are distributed. Blockchain technology offers de-
pendable answers to healthcare system security and reliability
problems [110]. Due to security concerns and information
A.I. Awad, M.M. Fouda, M.M. Khashaba et al.
Table 3
Common TinyMl libraries in MEC-based IoT applications.
TinyML library Description
TensorFlow Lite It is an open-source machine learning
(TFL) framework that supports edge-aware
learning inference on mobile and IoT
devices.
uTensor It is a free embedded learning framework
that allows rapid prototyping and
deployment to IoT edge devices.
Edge Impulse It is a cloud service for building machine
learning models for TinyML-enabled
edge devices.
PyTorch Mobile It is part of the PyTorch ecosystem,
which intends to assist all aspects of
machine learning model development,
from training to deployment on mobile
devices.
Embedded Microsoft created the ELL to assist the
Learning TinyML environment for embedded
Library (ELL) learning. It currently supports picture and
audio classification. Raspberry Pi,
Arduino, and microbit platforms are all
supported. Because the models used in
these devices are Internet agnostic, no
cloud access is necessary.
misuse, patient information and other healthcare data should
not be provided to malicious third parties. Blockchain and
smart contracts will likely provide optimistic solutions for
protecting healthcare data shortly [111,112].
6.5. DevOps
DevOps is a set of techniques (plan, implementation, in-
stallation, test, and supervision) for developing, deploying,
and testing software updates fast and reliably by allowing
developers, operators, and testers to communicate more effi-
ciently [113]. DevOps is a software development methodology
based on agile and lean principles [114]. DevOps is an integral
approach to IoT application development teams to effectively
collaborate their ideas to generate reliable, error-free, com-
pelling software, especially in healthcare. The authors define
fast and continuous monitoring feedback of IoT system avail-
ability activity (F&CF availability) [115]. It supports auto-
matic and continuous monitoring feedback from operations to
develop IoT system availability.
6.6. Microservices
The term “Microservices” was initially used at a software
architecture workshop in May 2011 to describe a shared
architectural approach that the workshop attendees had been
experimenting with [116]. With this Microservice Architecture
(MSA), the application is designed by separating business
logic into a collection of small, discrete, and loosely con-
nected Microservices that can be developed, deployed, tested,
and independently communicated via well-defined application
APIs [117], MSA style main characteristics are [118]:
9
ICT Express xxx (xxxx) xxx
• As the name Microservice implies, small-sized services
mean that each service can perform a single business
capability.
• Autonomous: each service contains all required data for
its execution.
Individual Microservice can be deployed, migrated, and with-
drawn on demand during runtime, giving MSA more flex-
ibility and scalability than a monolithic design [119]. By
combining MSA and MEC, proximity services for nearby
mobile users can be provided with minimal delay. The MSA
is enabled with the serverless computing cloud model or
FaaS, which dynamically provisions computing resources with
their configuration and management at run time [120]. Xi-
ang He et al. [121] created a programming framework for
Microservices (EPF4M) and infrastructure for self-adaptive
Microservice systems (EI4MS) for the cloud–edge context.
In [122], the authors presented an MSA-style framework for
edge computing methods. The integration of MSA style with
MEC in healthcare applications has not been researched, so
we wish to open this research challenge to ICT researchers.
7. Security and privacy challenges
Healthcare is a field where technology infrastructure must
provide high security and privacy [123]. Industry 4.0 de-
sign principles (interoperability, virtualization, decentraliza-
tion, real-time capability, service orientation, and modularity)
are applied to the medical domain in Healthcare Industry 4.0.
The main challenge was preserving the security and privacy of
the healthcare data [124]. The key objectives for guaranteeing
the security and privacy of IT-based hospitals are maintaining
doctor–patient confidentiality and protecting the MEC server
from physical and cyberattacks aimed at unethical uses of
healthcare data. Furthermore, because of the importance of
time in the proposed setting, hindering service assaults aimed
at delaying services have a more significant impact. As a
result, protecting communication protocols with the appropri-
ate level of cryptographic primitives is critical [125]. Authors
in [126] proposed a deep learning-based system model to
safeguard the MEC environment from cyberattacks.
7.1. Security of the system
Smart healthcare systems based on MEC servers can sup-
plement standard healthcare treatments flexibly and effec-
tively. Due to the restricted computing, storage, and energy
capacity of medical sensors, which cannot match the com-
putational demands of traditional cryptographic approaches,
lightweight cryptographic algorithms must be created for this
environment [127,128].
The security model applied in any IoT environment should
satisfy the three components of the Confidentiality, Integrity,
and Availability (CIA) triad [129].
• Confidentiality: ensure that the patient’s data is en-
crypted except for users with permission.
• Integrity: protecting patient data from any modification
by third parties.
A.I. Awad, M.M. Fouda, M.M. Khashaba et al.
• Availability: ensure that the medical data is available to
its users.
According to Pirbhulal et al. [130], there are many threats in
WBAN, including:
i. Eavesdropping: it can be done by the attacker on the
communication link between the sensor node and the
MEC to see patients’ medical data.
ii. Traffic analysis: the attacker tries to analyze the net-
work traffic to deduce the packet’s contents.
iii. Data Modification: the attacker alters the packet’s con-
tent, producing terrible results while analyzing these
medical data.
iv. Distributed Denial of Service (DDoS attack): DDoS
attacks typically function by flooding a targeted ma-
chine (MEC) or WBAN network with request packets
until regular traffic cannot be processed, resulting in
denial-of-service to authenticated users.
v. Replaying: the attacker captures the traffic and commu-
nicates to its original destination, acting as the source.
7.2. Privacy of the system
Protecting the privacy of the patient’s data is one of the
most critical issues since medical data can contain private
information about the patient, and many criminals can seek
to uncover this data for many reasons. Many literature papers
have focused on providing privacy for our smart healthcare
system [131–133]. The use of NFV in the healthcare model
with effective encryption technology can help preserve user
data privacy.
7.3. Proposed solution
In addition to the common cryptographic techniques, bloc-
kchain is one of the most common techniques researchers
have used to assure healthcare systems’ privacy and security.
Blockchain technology increases the complexity of crypto-
analysis while reducing the cryptographic overhead on the
data. Enhanced authentication procedures and security meth-
ods based on blockchain technology are promising approaches
to safeguard the healthcare environment [134].
8. Conclusion and future work
This paper surveyed recent advances in the utilization of
mobile edge computing in the IoMT. We tried to summarize
the state-of-the-art IoT healthcare systems that depend on
mobile edge computing for their processing. We first discussed
the data processing lifecycle in the 5G IoMT-enabled MEC
healthcare systems. For simplified presentation, the general
operation of the system is divided into four layers: sensing
layer, communication layer, MEC layer, and cloud layer. The
papers of literature related to the paper topic are presented
with a brief analysis of their cons and pros. The advantages
of adopting MEC in the IoMT applications are summarized.
Then key ICT Enablers for enhancing the effectiveness of
10
ICT Express xxx (xxxx) xxx
these systems are introduced with a brief discussion. The
paper discussed the security and privacy issues of the system
and possible solutions for the security and privacy challenges.
There are many open research areas in this field, such as han-
dling big data generated from IoMT devices in the real-time,
improvement of the accuracy of the system in the different
healthcare applications, optimization of the computational of-
floading strategies to minimize the overall system cost in terms
of energy consumption of IoMT devices, latency, and cost
usage of server resources, proving more stable solutions for
the security and privacy challenges.
Declaration of competing interest
The authors declare that they have no known competing
financial interests or personal relationships that could have
appeared to influence the work reported in this paper.
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