title: A Software Framework for Remote Patient Monitoring by Using Multi-Agent Systems Support.
abstract: BACKGROUND
  Although there have been significant advances in network, hardware, and software technologies, the health care environment has not taken advantage of these developments to solve many of its inherent problems. Research activities in these 3 areas make it possible to apply advanced technologies to address many of these issues such as real-time monitoring of a large number of patients, particularly where a timely response is critical.
  
  
  OBJECTIVE
  The objective of this research was to design and develop innovative technological solutions to offer a more proactive and reliable medical care environment. The short-term and primary goal was to construct IoT4Health, a flexible software framework to generate a range of Internet of things (IoT) applications, containing components such as multi-agent systems that are designed to perform Remote Patient Monitoring (RPM) activities autonomously. An investigation into its full potential to conduct such patient monitoring activities in a more proactive way is an expected future step.
  
  
  METHODS
  A framework methodology was selected to evaluate whether the RPM domain had the potential to generate customized applications that could achieve the stated goal of being responsive and flexible within the RPM domain. As a proof of concept of the software framework's flexibility, 3 applications were developed with different implementations for each framework hot spot to demonstrate potential. Agents4Health was selected to illustrate the instantiation process and IoT4Health's operation. To develop more concrete indicators of the responsiveness of the simulated care environment, an experiment was conducted while Agents4Health was operating, to measure the number of delays incurred in monitoring the tasks performed by agents.
  
  
  RESULTS
  IoT4Health's construction can be highlighted as our contribution to the development of eHealth solutions. As a software framework, IoT4Health offers extensibility points for the generation of applications. Applications can extend the framework in the following ways: identification, collection, storage, recovery, visualization, monitoring, anomalies detection, resource notification, and dynamic reconfiguration. Based on other outcomes involving observation of the resulting applications, it was noted that its design contributed toward more proactive patient monitoring. Through these experimental systems, anomalies were detected in real time, with agents sending notifications instantly to the health providers.
  
  
  CONCLUSIONS
  We conclude that the cost-benefit of the construction of a more generic and complex system instead of a custom-made software system demonstrated the worth of the approach, making it possible to generate applications in this domain in a more timely fashion.
authors.affiliation: Department of Informatics, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil.
authors.forename: Chrystinne Oliveira
authors.identifier: http://orcid.org/0000-0002-8623-9500
authors.initials: CO
authors.lastname: Fernandes
authors.affiliation: Department of Informatics, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil.
authors.forename: Carlos José Pereira De
authors.identifier: http://orcid.org/0000-0001-9669-2352
authors.initials: CJ
authors.lastname: Lucena
keywords: biometric sensors; eHealth systems; remote patient monitoring