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

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

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

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

Industry 4.0 Applications for Medical/Healthcare ServicesShuva Paul 1,* , Muhtasim Riffat 2 , Abrar Yasir 2, Mir Nusrat Mahim 2, Bushra Yasmin Sharnali 2,Intisar Tahmid Naheen 2, Akhlaqur Rahman 3 and Ambarish Kulkarni 4



Citation: Paul, S.; Riffat, M.; Yasir, A.;Mahim, M.N.; Sharnali, B.Y.; Naheen,I.T.; Rahman, A.; Kulkarni, A.Industry 4.0 Applications forMedical/Healthcare Services. J. Sens.Actuator Netw. 2021, 10, 43.https://doi.org/10.3390/jsan10030043Academic Editors: Igor Bisio andClaudio SavaglioReceived: 20 March 2021Accepted: 24 June 2021Published: 30 June 2021Publisher’s Note: MDPI stays neutralwith regard to jurisdictional claims inpublished maps and institutional affil-iations.Copyright: © 2021 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).1 Georgia Institute of Technology, Atlanta, GA 30332, USA2 Department of Electrical Engineering and Computer Science, North South University,Dhaka 1229, Bangladesh; [email protected] (M.R.); [email protected] (A.Y.);[email protected] (M.N.M.); [email protected] (B.Y.S.);[email protected] (I.T.N.)3 School of Industrial Automation, Engineering Institute of Technology, Melbourne, VIC 3000, Australia;[email protected] School of Engineering, Swinburne University of Technology, Hawthorn, Melbourne, VIC 3122, Australia;[email protected]* Correspondence: [email protected]: At present, the whole world is transitioning to the fourth industrial revolution, or Industry4.0, representing the transition to digital, fully automated environments, and cyber-physical systems.Industry 4.0 comprises many different technologies and innovations, which are being implementedin many different sectors. In this review, we focus on the healthcare or medical domain, wherehealthcare is being revolutionized. The whole ecosystem is moving towards Healthcare 4.0, throughthe application of Industry 4.0 methodologies. Many technical and innovative approaches have hadan impact on moving the sector towards the 4.0 paradigm. We focus on such technologies, includingInternet of Things, Big Data Analytics, blockchain, Cloud Computing, and Artificial Intelligence,implemented in Healthcare 4.0. In this review, we analyze and identify how their applicationsfunction, the currently available state-of-the-art technologies, solutions to current challenges, andinnovative start-ups that have impacted healthcare, with regards to the Industry 4.0 paradigm.Keywords: cloud computing method; artificial intelligence; IoT; blockchain; healthcare 4.0;industry 4.01. IntroductionScience and technology have been advancing in many ways, impacting almost everysector of human life. Advanced electrical power generation, transmission, and distributionsystems (i.e., smart grids), as well as advanced healthcare, education, roading, and trans-portation, and so on, are making daily life more efficient and easy [ 1 ]. The use of MachineLearning (ML) in different sectors has helped to operate multiple interconnected industriesin parallel [ 2– 6]. Industry 4.0, or the fourth industrial revolution, describes the conversionand development of industrial manufacturing through the digitization of new technologies.The idea of the industrial revolution has varied from decade to decade; presently, thereexists global competition between industrial manufacturers. In response, Industry 4.0has added a new dimension where, with the help of new technologies, the industrialmarket has hit a new level, the likes of which has not been seen before. The industrialinternet concept was introduced in 2012 [7 ], with a close-fitting mixture of both digitaland physical worlds adjoining Big Data with the Internet of Things (IoT). This thoughtdescribes many widespread ideas about Industry 4.0. Experts have estimated that around46% [ 8] of the global economy could benefit from the industrial internet. The industrialrevolution can be presented or divided into four revolutions. The first industrial revolution,known as Industry 1.0, began with mechanical efficiency in the late 1800s [ 9 ] and involvedthe manual use of mechanical tools, mostly in the textile industry. The second revolution’s

The Future of Healthcare with Industry 5.0: PreliminaryInterview-Based Qualitative AnalysisJuliana Basulo-Ribeiro and Leonor Teixeira *Department of Economics, Management, Industrial Engineering and Tourism (DEGEIT), Institute of Electronicsand Informatics Engineering of Aveiro (IEETA), Intelligent Systems Associate Laboratory (LASI), University ofAveiro, 3810-193 Aveiro, Portugal; [email protected]* Correspondence: [email protected]; Tel.: +351-234370361Abstract: With the advent of Industry 5.0 (I5.0), healthcare is undergoing a profound transformation,integrating human capabilities with advanced technologies to promote a patient-centered, efficient,and empathetic healthcare ecosystem. This study aims to examine the effects of Industry 5.0 onhealthcare, emphasizing the synergy between human experience and technology. To this end,6 specific objectives were found, which were answered in the results through an empirical studybased on interviews with 11 healthcare professionals. This article thus outlines strategic and policyguidelines for the integration of I5.0 in healthcare, advocating policy-driven change, and contributesto the literature by offering a solid theoretical basis on I5.0 and its impact on the healthcare sector.Keywords: Industry 5.0; technological innovation; digital health; generation Z; digital transformation1. IntroductionAs we enter a new era defined by Industry 5.0 (I5.0), we witness a symbiosis betweenhuman capabilities and technological innovations, reshaping the healthcare ecosystem onan unprecedented scale [1 ,2 ]. The importance of this topic lies in its ability to radicallytransform not just the existing healthcare systems but also to fundamentally reinvent thehealthcare model [1, 3]. As mentioned by Gomathi and Mishra [4], “Industry 5.0 is predictedto revolutionize the healthcare sector”.This way, the concept of “Industry 5.0” is gaining traction as a model that blendstechnology, machinery, and human input, being an evolution of Industry 4.0. This ap-proach (I5.0) is increasingly relevant to the healthcare industry as well, where it is knownas “Healthcare 5.0”. It introduces a paradigm where technology not only supports butamplifies human competence, promoting unprecedented collaboration between doctors,patients, and machines. In this context, Healthcare 5.0 leverages advanced technologies totransform patient care, healthcare services, technologists, and the overall patient experience,bringing significant benefits to the healthcare sector [2–6].The I5.0 revolution advocates for the actualization of sustainable practices and theharmonization of technology with human values and is viewed as a progressive stridetoward fulfilling sustainable development goals [ 5, 7]. The Sustainable Development Goalsare “an integrated framework of human, social, and environmental development objec-tives that include 17 goals” [ 8 ]. I5.0 in healthcare carries the transformative potential toadvance the Sustainable Development Goals (SDGs), especially SDG 3, which focuses onensuring healthy lives and promoting well-being for all ages [ 9]. By integrating smarttechnologies, I5.0 can revolutionize patient care, making health services more accessible andpersonalized, thereby directly contributing to the goal’s fulfillment [1 ]. The ripple effectsof such advancements also help in achieving SDG 8, as I5.0 technologies can create newjob opportunities and promote sustained, inclusive economic growth within the differentsectors, among which the healthcare sector is included [ 9, 10 ]. The impact of I5.0 on healthwithin the framework of SDG9 is addressed through an emphasis on collaboration betweenFuture Internet 2024, 16, 68. https://doi.org/10.3390/fi16030068 https://www.mdpi.com/journal/futureinternet