Healthcare 4.0 Implementation: Opportunities and Challenges in theHealthcare SectorImplementação do Healthcare 4.0: Oportunidades e Desafios no Setor da SaúdeEduardo de Siqueira CorreaORCID: https://orcid.org/ 0000-0001-9757-6660Universidade Nove de Julho, BrasilE-mail: [email protected] Cardoso SátyroORCID: https://orcid.org/ 0000-0002-0201-222XUniversidade Nove de Julho, BrasilE-mail: [email protected] Ferreira da SilvaORCID: https://orcid.org/0000-0001-6482-8729Universidade Nove de Julho, BrasilE-mail: [email protected] Luiz MartensORCID: https://orcid.org/0000-0003-1242-8795Universidade Paulista, BrasilE-mail: [email protected]é Celso ContadorORCID: https://orcid.org/ 0000-0003-4695-3379Universidade Paulista, BrasilE-mail: [email protected] Healthcare 4.0 é a aplicação dos princípios da Indústria 4.0 na área da saúde, permitindo a personalizaçãoem tempo real do atendimento aos pacientes. Embora tenha ganhado relevância nos últimos anos devidoaos benefícios da Indústria 4.0, o conceito ainda é pouco conhecido por profissionais do setor de saúdebrasileiro e internacional. Usando o método de revisão da literatura e pesquisa de levantamento com 26especialistas em Healthcare 4.0, este trabalho tem como objetivo identificar as oportunidades e desafios emprojetos de implementação do Healthcare 4.0 no setor de saúde do Brasil. A relevância deste estudo é aidentificação das principais oportunidades encontradas: tecnologia digital facilita a coleta de dados dospacientes; a implementação estratégica do Healthcare 4.0 pode trazer vantagens competitivas àorganização; e os principais desafios: a necessidade de capacitação digital dos profissionais de saúde parao Healthcare 4.0, e a necessidade de motivar todos os envolvidos para a adoção do Healthcare 4.0,contribuindo para a teoria. A contribuição prática é ajudar os profissionais da área da saúde envolvidos acompreenderem os pontos relevantes para projetos de implementação do Healthcare 4.0 bem-sucedidos.Palavras-chave: Healthcare 4.0; Indústria 4.0; Oportunidades; Redes; Projetos164ABSTRACTHealthcare 4.0 is the application of Industry 4.0 principles in healthcare, enabling real-time personalizationof patient care. Although it has gained relevance in recent years due to the benefits of Industry 4.0, theconcept is still little known by professionals in the Brazilian and international health sector. Using theliterature review method and survey research with 26 experts in Healthcare 4.0, this study aims to identifyopportunities and challenges in Healthcare 4.0 implementation projects in the health sector in Brazil. Therelevance of this study is the identification of the main opportunities found: digital technology facilitatesthe collection of patient data; the strategic implementation of Healthcare 4.0 can bring competitiveadvantages to the organization; and the main challenges: the need for digital training of healthcareprofessionals for Healthcare 4.0, and the need to motivate everyone involved to adopt Healthcare 4.0,contributing to theory. The practical contribution is to help the healthcare professionals involved tounderstand the relevant points for successful Healthcare 4.0 implementation projects.Keywords: Healthcare 4.0; Industry 4.0; Opportunities; Networks; Projects

Innovations in Healthcare SectorConnected to Industry 4.0Zuzana Papulova, Silvester KrcmeryDepartment of Strategy and Entrepreneurship, Faculty of Management Comenius University inBratislava, [email protected]. With the development of the 4th Industrial Revolution, we can expectchanges that could transform the very essence of humanity and every aspect oflife in our planet. The 4th Industrial Revolution has already undoubtedly im-pacted a lot of sectors and industries along with healthcare. The purpose of thepaper is to introduce the Healthcare 4.0 and evaluate trends and challenges com-ing with innovations of Industry 4.0 in the selected sector of healthcare. Numer-ous studies have come to conclusions that trends like digitalization, telemedicineor artificial intelligence could improve healthcare quality for patients and in-crease the efficiency and effectiveness of healthcare management. The Industry4.0 will substantially change the healthcare in a relatively short time. The valueof this paper is the investigation of the applicability, the challenges and the op-portunities of the 4th industrial revolution paradigms in the healthcare sector.Moreover, it provides an insight into the current state of healthcare in the contextof Industry 4.0. The intention is to present possibilities coming with Industry 4.0to improve healthcare services and to ensure and increase the safety of patients,the quality of life and other healthcare activities. As we can already learn fromprevious industrial revolutions, it is reasonable to expect that the Fourth Indus-trial Revolution will bring many opportunities, benefits, and promise to transformhealth and healthcare in medicine to become even more interconnected, moreprecise, and more democratic, with significantly improved human outcomes.Keywords: Healthcare, Industry 4.0, Innovations.IntroductionAt present, there are often divergent views and discussions about the 4th IndustrialRevolution. In many sectors, companies are actively preparing for changes related tothis revolution, the dynamics of the environment, and this is not different in healthcare,where we can also speak about the so-called Healthcare 4.0, Health 4.0 or eHealth. Thistechnological revolution will bring a number of trends that will fundamentally changethe way organization in healthcare works, such as the application of communicationtools for patients and medical teams to intensify the transfer of treatment from hospitalto home without interrupting outpatient services

Healthcare 4.0: Trends, Challenges and BenefitsFull PaperMati Ur RehmanSchool of BusinessSwinburne University of TechnologyMelbourne, AustraliaEmail: [email protected] Eslami AndargoliSchool of BusinessSwinburne University of TechnologyMelbourne, AustraliaEmail: [email protected] PoustiSchool of BusinessSwinburne University of TechnologyMelbourne, AustraliaEmail: [email protected] Fourth Industry Revolution, known as Industry 4.0, refers to the forces that are transformingindustry, including the healthcare industry, where it has been termed Healthcare 4.0. Though laggingother industries in the adoption of new innovative technologies, the healthcare industry is embracingthe potential benefits that arise from new innovative technologies. New trends revealed both in theacademic literature and by industry practice show that researchers and practitioners are becoming moreaware of the benefits technology can bring to an industry as complex as the healthcare industry. Theobject of the study is to identify the challenges, trends and gaps in the existing body of research withregard to Healthcare 4.0. In this study, a systematic literature review on Healthcare 4.0 research paperswas conducted to identify trends, challenges and the perceived benefits that may arise from it. This paperfound that there is a need to conduct more empirical studies in this area. It, further, identified the needto implement practical procedures in the industry to get feedback from patients and healthcareparticipants in order to promote the adoption of new Healthcare 4.0 technologies.Keywords: Health 4.0, Industry 4.0, healthcareAustralasian Conference on Information Systems Rehman, Andargoli & Pousti2019, Perth Western Australia Healthcare 4.05571 INTRODUCTIONIndustry 4.0 is changing all segments of the industry (Pang et al. 2018). Starting mainly with a focus onthe manufacturing sector, it is now affecting other industries, such as healthcare, where it has beencalled Healthcare 4.0 (Chung and Kim 2016). The research was conducted using a systematic literaturereview of healthcare research articles to identify the trends, challenges, and perceived benefits inHealthcare 4.0.The healthcare industry has already experienced several waves of technological change, starting withHealthcare 1.0, where doctors kept patient records manually (Hathaliya et al. 2019). Healthcare 2.0followed, where paper-based manual records were replaced by electronic record (Hathaliya et al. 2019).Healthcare 3.0 advanced to the point where wearable devices were introduced (Hathaliya et al. 2019).The key technological characteristic that individuates Healthcare 4.0 from its predecessors is that a largenumber of devices of varying types communicate with each other (a) to monitor a patient’s health and(b) to conduct other health-related activities driven by Internet of Things (IoT) , Cyber-physical Systems(CPS) and Internet of Services (Chung and Kim 2016). Pang et al. (2018) defines Healthcare 4.0 as acombined application of IOT, artificial intelligence, robotic, and intelligent sensing in healthcare inorder to transform its value chain. It aims at digitising healthcare enterprise and services. Therefore, inthis paper we aim to highlight the implication of this technology for the practice and delivery ofhealthcare services.2 METHODOLOGYThis paper follows the six step approach of Mathiassen et al. (2004) for conducting a systematicliterature review. Firstly, four academic databases, Scopus, Science Direct, PubMed and Web of Sciencewere selected, and then two search categories were used to search them. One focusing on Health andrelated terms, such as ‘Healthcare OR Clinics OR Hospitals OR Pharmacy; and the other focusing onIndustry 4.0 concepts, such as Industry 4.0 OR Healthcare 4.0 OR Care 4.0. Then, after having scannedeach article’s title and abstract, the researchers chose a data set of relevant for a full text review. Then,other relevant articles selected from the reference list of chosen articles in pervious step.The search covered papers published in English to July 2019, which were then filtered according tosteps: (1) duplicates were removed; (2) books, book chapters, and conference papers were eitherremoved or filtered based on their abstract and title; and (3) all the remaining papers were read in detailto identify those papers which focused on Health 4.0. The research process flow is shown in Figure 1

Introduction to the Special Section:Convergence of Automation Technology,Biomedical Engineering, and Health InformaticsToward the Healthcare 4.0Zhibo Pang , Senior Member, IEEE, Geng Yang , Member, IEEE, Ridha Khedri, Member, IEEE,and Yuan-Ting Zhang, Fellow, IEEEAbstract—Industry 4.0 is spilling out from manufacturingto healthcare. In this article, we provide a brief history andkey enabling technologies of Industry 4.0, and its revolu-tion in healthcare—Healthcare 4.0—and its reshaping of thelandscape of the entire healthcare value chain. We discussthe shift in the system design paradigm from open, small,and single loop to closed, large, and multiple loops. We pro-vide the example of a Caregiving Home, and discuss emerg-ing research topics and challenges, including healthcare bigdata, automated medical production, healthcare robotics,and human–robot symbiosis. Relevant papers published inthis special section are also presented.Index Terms—Caregiving Home, convergence, Health-care 4.0, healthcare robotics, human–robot symbiosis,Industry 4.0.I. I NTRODUCTIONTHE FOURTH REVOLUTION of industry (Industry 4.0)is reshaping all the segments of industries. Pulled bygrand social challenges, automation technologies are dramat-ically “spilling out” from traditional scenarios, such as factoriesand workshops, to everyday life. The traditional research areasof biomedical engineering and health informatics for the agingThis work was supported in part by Open Foundation of the StateKey Laboratory of Fluid Power and Mechatronic Systems at ZhejiangUniversity under the Grant GZKF-201703, in part by the FundamentalResearch Funds for the Central Universities, in part by the Open Foun-dation of the State Key Laboratory of Fluid Power and Mechatronic Sys-tems, in part by the Science Fund for Creative Research Groups of theNational Natural Science Foundation of China under Grant 51521064, inpart by NSFC-Zhejiang Joint Fund for the Integration of Industrializationand Informatization under Grant U1509204, and in part by the NaturalSciences and Engineering Research Council of Canada (NSERC) underGrant RGPIN 2014-06115. (Corresponding author: Geng Yang.)Z. Pang is with the ABB AB, Corporate Research, V ¨aster ˚as 72178,Sweden (e-mail: [email protected]).G. Yang is with the State Key Laboratory of Fluid Power and Mecha-tronic Systems, School of Mechanical Engineering, Zhejiang University,Hangzhou 310027, China (e-mail: [email protected]).R. Khedri is with the Department of Computing and Software, Facultyof Engineering, McMaster University, Hamilton, ON L8S 4L8, Canada(e-mail: [email protected]).Y.-T. Zhang is with the Department of Mechanical and Biomedical En-gineering, City University of Hong Kong, Hong Kong (e-mail: [email protected]).Digital Object Identifier 10.1109/RBME.2018.2848518population have gained unprecedented interest from the automa-tion industry. The research landscape in both academia and in-dustry is significantly reshaped with the cross-disciplinary syn-ergy of expertise and the deep convergence of automation tech-nology, biomedical engineering, and health informatics. Thistrend has been driving the rapid development of health engi-neering, an emerging interdisciplinary field for the predictive,preventive, precise, and personalized medicine. More powerfultools from process or factory automation, such as distributedcontrol systems and robotics, are penetrating into biomedicineand healthcare applications [1], [2]. For example, research ac-tivities related to robotics for biomedicine and healthcare havebeen largely intensified in the recent years [3], [4].The goal of this special section is threefold: 1) to reviewthe advancement in the convergence of automation technology,biomedical engineering, and health informatics; 2) to identifythe gap between the state-of-the-art of research and industrialdemands; and 3) to envision the directions for future research.The application scenarios can cover single or multiple scenariosof health engineering, such as primary care, preventive care,predictive technologies, hospitalization, home care, and occu-pational health. We focus on the cross-disciplinary approaches,solutions, and initiatives rather than single disciplinary ones.II. I MPACT OF I NDUSTRY 4.0 TO HEALTHCAREA. Industry 4.0 Basics and Key TechnologiesIndustry 4.0 (also sometimes spelled as Industrie 4.0) is avision for a new industrial revolution put forward by the Com-munication Promoters Group of the Industry–Science ResearchAlliance to further enhance Germsany’s manufacturing industry[5]. Several other countries, such as China and India, followedby articulating similar visions. The current advances in the fol-lowing areas trigger the Industry 4.0 vision.Cyber-physical systems (CPS) refers to the area where sys-tems incorporate computation and physical processes. Thesophistication that is reached in harnessing machine controlthrough computing provides unprecedented efficiency in thephysical processes and gives levels of performance neverreached before. As early as the 1970s, we started to designsystems where we embedded the computing driven control into

Modelling the barriers of Health 4.0–the fourth healthcare industrialrevolution in India by TISMPuneeta Ajmera 1 & Vineet Jain 2Received: 6 February 2019 / Revised: 16 July 2019 / Accepted: 17 July 2019 /# Springer Science+Business Media, LLC, part of Springer Nature 2019AbstractIn healthcare industry, the phenomenon of Industry 4.0 is popular as Health 4.0 where the modern technologies are integratedwith available data along with the use of artificial intelligence. The main objective of this paper is to explore the barriers of Health4.0 application in healthcare sector in India. Fifteen barriers which can affect the adoption of Health 4.0 in the Indian healthcaresector have been identified through extensive literature review and opinions of healthcare industry and academic experts. ATISM(Total Interpretive Structural Modelling) model has been developed to extract the key barriers influencing Health 4.0 adoptionwhich will guide the healthcare managers and decision makers to explore the effect of each barrier on other barriers as well as thedegree of relationships among them. The result shows that lack of top management support, exclusive and skilled workforcerequirement, inadequate maintenance support systems and political support are the major barriers as they have strong drivingpower. Timely action taken by the management to remove these hurdles will not only reduce the cost of medical procedures butalso improve the quality of treatment so that the true potential of Health 4.0 can be utilized.Keywords Industry 4.0 . Health 4.0 . Health 4.0 barriers . Healthcare industry . Healthcare industrial revolution . Total interpretivestructural modelling . MICMAC analysis1 IntroductionThe Industrial Revolution is considered to be one of the mostsignificant landmark in the history which impacted all theaspects of life in one way or the other. Technological advance-ments and industrialization led to the development of highlyautomated and motorized manufacturing processes giving riseto evolution of factory system Kamble et al. (2018). The firstindustrial revolution occurred with the invention of steam en-gine by Thomas Newcomen in the late eighteenth centurywhich led to the use of steam to make machines causing thedevelopment of textile, coal and iron industry. This resulted inurbanization and increased communications and peoplemoved to those cities where they could work as operators infactories. To provide accommodation to these people, housesof cheaper quality were built and community wells were theonly source of drinking water. Facilities for sewage removalwere hardly present. This led to the deterioration of health andspread of diseases like typhoid, cholera, tuberculosis, fever,smallpox and plague etc. Side by side many medical innova-tions were made due to advancement in science and technol-ogy and scientific causes of some diseases were explored. In1796, Edward Jenner was successful in developing smallpoxvaccination. Before this, there was no awareness about thecauses of spread of diseases and remedies were dependentupon several superstitions and speculations. In the 1850s,Louis Pasteur discovered that the causes of disease were mi-croorganisms. Healthcare industry in that era witnessed theinception of modular information system technologies andthat period was known as Health 1.0 (Bodenheimer 1995;Thuemmler and Bai 2017). Second industrial revolution wasanother transition in technology focussing on the extensiveuse of electrical energy, petroleum and steel for creating massproduction. Improved factories and contemporary technolo-gies gave rise to the discovery of microscopes and other med-ical equipment. Simple networking was introduced inhealthcare industry with the evolution of Electronic Health* Vineet [email protected] [email protected] Department of Hospital Administration, Amity Medical School,Amity University Haryana, Gurgaon, India2 Department of Mechanical Engineering, Mewat EngineeringCollege, Palla, District Nuh, Mewat, Haryana 122107, Indiahttps://doi.org/10.1007/s12063-019-00143-xOperations Management Research (2019) 12:129–145Published online: 9 August 2019

ABSTRACTThis study proposes a problem-oriented methodology, using the algebraic operations proposed inthe Quality Function Deployment’s house-of-quality, to prioritise the integration of Industry 4.0 (I4.0)technologies in hospitals, allowing us to account for both the importance of healthcare value chainproblems and the current level of adoption of I4.0 technologies. The proposed method combinesdifferent techniques that aimed at assessing the maturity of organisations regarding specific issuesand indicating improvement opportunities. Our propositions are illustrated through two case studiescarried out in a large Brazilian public hospital and in a private hospital in India, allowing a compar-ative analysis in which we identify similarities and divergences in improvement priorities in eachinstitution. Findings indicate that the proposed method supports the systemic integration of I4.0technologies into healthcare organisations regardless hospital ownership, as digital applications areranked according to their potential to solve the problems prioritised by managers from both casestudies. Digital integration in healthcare organisations has been restricted to specific sectors, depart-ments, treatment or processes. Due to high complexity of hospitals, most of these initiatives havefallen short on results, frustrating managers’ efforts. Thus, our method provides hospitals’ managers,authorities, and governments guidelines to prioritise the digitisation of healthcare organisations