Healthcare and the Internet of Medical Things: Applications, Trends, Key Challenges, and Proposed Resolutions

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The paper systematically reviews the Internet of Medical Things (IoMT) within the healthcare sector, focusing on the various applications, key challenges, and proposed technical resolutions derived from existing literature and published articles. The paper seems interesting but has several concerns:

 

1. The author should revise the abstract and introduction.  The research question, motivation, and contributions need to clearer.
2. The structuring and formatting of paper need to improve.
3. Equations mentioned throughout the paper should be presented mathematically. Authors can use any tool to write the equations.
4.  Related work should be expanded some more relevant articles, such as (https://doi.org/10.1016/j.jobcr.2021.11.010),(10.1109/JIOT.2020.3006523), (https://doi.org/10.1016/j.jnca.2021.102975), (https://doi.org/10.1002/spy2.235), should be added.
5. Subheading on pages number 2 and 4 seems the same (Research Methodology).
6. The paper needs to discuss the limitations or potential challenges of the proposed approach.

Comments on the Quality of English Language

1. Careful attention is needed to address English grammar issues throughout the paper. 

Author Response

Comments 1: The paper systematically reviews the Internet of Medical Things (IoMT) within the healthcare sector, focusing on the various applications, key challenges, and proposed technical resolutions derived from existing literature and published articles. The paper seems interesting but has several concerns: The author should revise the abstract and introduction.  The research question, motivation, and contributions need to clearer.

Responses 1: I agree and appreciate your guidance. The abstract has been revised to clearly articulate the research question, motivation, and contributions. Below is the paragraph that has been incorporated into the new version of the manuscript.

Revised Abstract

In recent years, the Internet of Medical Things (IoMT) has become a significant technological advancement in the healthcare sector. This systematic review aims to identify and summarize the various applications, key challenges, and proposed technical solutions within this domain, based on a comprehensive analysis of existing literature. The review highlights diverse applications of IoMT, including mobile health (mHealth) applications, remote biomarker detection, hybrid RFID-IoT solutions for scrub distribution in operating rooms, IoT-based disease prediction using machine learning, and efficient sharing of personal health records through searchable symmetric encryption, blockchain, and IPFS. Other notable applications include remote healthcare management systems, non-invasive real-time blood glucose measurement devices, distributed ledger technology (DLT) platforms, ultra-wideband (UWB) radar systems, IoT-based pulse oximeters, accident and emergency informatics (A&EI), and integrated wearable smart patches. Key challenges identified include privacy protection, sustainable power sources, sensor intelligence, human adaptation to sensors, data speed, device reliability, and storage efficiency. Proposed mitigations encompass network control, cryptography, edge-fog computing, and blockchain, alongside rigorous risk planning. The review also identifies trends and advancements in IoMT architecture, remote monitoring innovations, integration of machine learning and AI, and enhanced security measures. By addressing current limitations and suggesting future research directions, this work aims to advance scientific understanding of IoMT in healthcare.

Revised Introduction

The advancement of technology within medical systems is crucial for pioneering new approaches to illness prevention and treatment, while also enhancing resilience during public health emergencies. Technological innovations are anticipated to significantly improve the effectiveness and capacity of medical systems, thereby bolstering public health outcomes [1].. A particularly promising area of technological advancement in healthcare is the Internet of Medical Things (IoMT).

The Internet of Medical Things (IoMT) constitutes a network of interconnected systems and devices designed to collect, process, and disseminate health data [2]. This transformative technology revolutionizes healthcare delivery by enabling remote patient monitoring, diagnosis, and treatment. IoMT applies the principles of the Internet of Things (IoT) specifically within the medical domain, addressing the unique needs and challenges of the healthcare industry [3].

By leveraging IoMT, medical systems can establish comprehensive information platforms that interconnect various smart devices, including hospital assets, medical examination tools, and wearable sensors. These devices serve as foundational nodes in the IoMT network, continuously gathering and generating health data, which is then transmitted to centralized servers for further processing and analysis. The insights derived from this data are pivotal in informing medical professionals’ decision-making processes [4].

In recent years, IoMT has garnered significant attention and adoption across diverse fields within healthcare, including illness detection, remote health monitoring, smart hospitals, and the tracking of infectious diseases. This widespread adoption underscores the transformative potential of IoMT in revolutionizing healthcare delivery and improving patient outcomes [5] .

Despite the growing interest and adoption of IoMT, there is a notable gap in the literature regarding how IoMT specifically addresses the challenges and requirements of the healthcare industry. While existing studies provide a general overview of IoMT and its various applications, they often lack a detailed exploration of how IoMT meets specific healthcare needs. This paper aims to bridge this gap by focusing on the following aspects:

1. Specific Challenges in Healthcare Systems: Identifying the limitations and challenges within current healthcare systems that IoMT aims to overcome, such as data privacy, power sustainability, sensor intelligence, and device reliability.
2. Unique Features of IoMT: Highlighting the unique capabilities of IoMT that make it well-suited for addressing these challenges, including its ability to provide continuous health monitoring, real-time data processing, and integration of advanced technologies like machine learning and AI.
3. Practical Implementation and Impact: Providing concrete examples and case studies that illustrate the practical implementation and impact of IoMT in real-world healthcare settings. This includes detailed examinations of IoMT applications in remote health monitoring, smart hospitals, and disease tracking.

By elaborating on these aspects, this paper aims to provide a comprehensive understanding of IoMT’s significance and potential contributions to the healthcare sector, thereby addressing the existing gap in the literature. Through detailed analysis and case studies, we seek to demonstrate how IoMT can effectively transform healthcare delivery and improve patient outcomes.

Comments 2: The structuring and formatting of paper need to improve.

Responses 2: Thank you for your feedback regarding the structuring and formatting of the paper. We have used the journal’s template and benchmarked our paper against systematic reviews published in previous issues. Could you please specify which section or sections you recommend we amend? We would be more than glad to make the necessary improvements.

Comments 3: Equations mentioned throughout the paper should be presented mathematically. Authors can use any tool to write the equations.

Responses 3: Thank you for your input. Upon reviewing the entire paper, we did not identify any equations in any section. We would be glad to make amendments if you could kindly point out the specific location. Thank you immensely.

Comments 4: Related work should be expanded some more relevant articles, such as (https://doi.org/10.1016/j.jobcr.2021.11.010),(10.1109/JIOT.2020.3006523), (https://doi.org/10.1016/j.jnca.2021.102975), (https://doi.org/10.1002/spy2.235), should be added.

Responses 4: Thank you for the shared journals, all have been incorporated where appropriate and further additional academic references were added as highlighted in the manuscript.  

Comments 5: Subheading on pages number 2 and 4 seems the same (Research Methodology).

Responses 5: All sub-headings were reviewed and re-numbered across the entire paper and the duplicate ‘Research Methodology’ typo was removed.

Comments 6: The paper needs to discuss the limitations or potential challenges of the proposed approach.

Responses 6: In the dedicated section titled ‘3. Research Limitation and FRA’ the following additional paragraphs were added and highlighted in the manuscript

There is also a pressing need to address cybersecurity concerns within IoMT systems. Ensuring the privacy and security of patient data is paramount, given the sensitive nature of health information and the increasing frequency of cyber-attacks. Developing robust encryption methods and secure communication protocols for IoMT devices and networks is essential.

Furthermore, interoperability standards for IoMT devices and systems must be established to ensure seamless integration and communication between different healthcare technologies. This would facilitate a more cohesive and efficient healthcare delivery system, improving patient outcomes and operational efficiency.

Additionally, research into the scalability of IoMT solutions is crucial. As the number of connected medical devices grows, it is important to ensure that IoMT systems can handle increased data volumes and maintain performance levels. Exploring advanced data processing and storage solutions, such as cloud computing and edge computing, could provide valuable insights into managing the scalability of IoMT infrastructures.

Finally, the impact of IoMT on healthcare policy and regulation warrants further investigation. Understanding how emerging technologies influence healthcare laws, ethical considerations, and regulatory frameworks will be vital in shaping the future landscape of IoMT in healthcare. By addressing these multifaceted challenges, future research can pave the way for more effective and sustainable IoMT implementations, ultimately enhancing patient care and health outcomes.

Comments 7: Comments on the Quality of English Language. Careful attention is needed to address English grammar issues throughout the paper. 

Responses 7: The spelling and grammar of the entire paper were meticulously reviewed to enhance its overall quality.

Reviewer 2 Report

Comments and Suggestions for Authors

This paper presents a comprehensive review of the Internet of Medical Things (IoMT) and its various applications, challenges, and proposed solutions in the healthcare sector. The study systematically reviews existing literature, identifies key applications such as mobile health (mHealth), remote biomarker detection, and IoT-based disease prediction, and addresses significant challenges including privacy protection, sustainable power sources, and data management. Despite the manuscript's strengths, it does contain several areas that require improvement. Below, I provide detailed comments and suggestions to help the authors enhance the quality and impact of their work.

1-     The article provides an extensive overview of various IoMT applications, but it fails to delve into the specifics of their real-world implementations and effectiveness. Without detailed case studies or practical examples, the discussion remains too abstract, making it difficult for readers to grasp the actual impact of these technologies on healthcare outcomes. Including concrete examples of how IoMT solutions have been successfully deployed in healthcare settings would greatly enhance the manuscript's credibility and provide valuable insights for practitioners and researchers alike.

2-     While the manuscript acknowledges the importance of privacy and security in IoMT applications, it does not adequately explore the existing technologies and strategies designed to address these challenges. The brief mention of blockchain and encryption methods lacks depth and fails to provide a comprehensive understanding of how these solutions can be practically implemented to protect sensitive health data. A more thorough examination of current privacy and security practices, along with comparisons and case studies, would significantly strengthen the discussion and offer actionable recommendations for enhancing data protection in IoMT systems.

3-     The literature review in the article is confined to publications from 2020 to 2023, which limits the breadth of historical context and may exclude significant earlier research and developments in the field of IoMT. This narrow scope can result in an incomplete understanding of the evolution and progression of IoMT technologies. To provide a more comprehensive review, it would be beneficial to include relevant studies from earlier years, highlighting key advancements and foundational research that have shaped the current state of IoMT. Expanding the literature review to cover a broader timeframe would offer a more robust and well-rounded perspective on the subject.

4-     The article predominantly relies on qualitative descriptions of IoMT applications and challenges without incorporating sufficient quantitative data to substantiate its claims. The absence of statistical data on adoption rates, effectiveness, and cost-benefit analyses weakens the manuscript's ability to provide empirical evidence for its assertions. Integrating quantitative analysis would not only bolster the credibility of the findings but also offer readers a more precise understanding of the impact and feasibility of IoMT solutions in healthcare settings.

5-     Interoperability is a critical factor in the successful implementation of IoMT systems, yet the article does not adequately address the challenges and solutions related to the seamless integration of diverse devices and systems. The lack of focus on interoperability issues such as standardization, compatibility, and data exchange protocols leave a significant gap in the discussion. Addressing these aspects in detail, along with proposing strategies to overcome interoperability barriers, would provide a more comprehensive guide for the deployment of IoMT technologies.

6-     The manuscript does not sufficiently explore the user experience and acceptance of IoMT technologies among healthcare professionals and patients. Understanding the perspectives and concerns of end-users is crucial for the successful adoption of any new technology. The article should include a discussion on the usability, accessibility, and potential resistance to IoMT systems, supported by user feedback and case studies. Highlighting user-centric design principles and strategies to enhance user engagement would significantly enrich the content.

7-     The article lacks a thorough examination of the scalability and sustainability of IoMT solutions. While it touches upon various applications and challenges, it does not delve into the practical aspects of scaling these technologies across different healthcare environments or ensuring their long-term sustainability. Discussing factors such as infrastructure requirements, cost implications, maintenance, and scalability strategies would provide a more realistic and actionable framework for healthcare providers considering IoMT implementation. Including examples of successful large-scale deployments and lessons learned from these experiences would also add substantial value.

8-     While the manuscript provides a broad overview of IoMT applications, it misses the opportunity to integrate several key pieces of research that could significantly enrich the discussion. Specifically, the studies “Internet of Medical Things (IoMT) optimization for healthcare: A deep learning-based interference avoidance model”, “Deep transfer learning-based fall detection approach using IoMT-enabled thermal imaging-assisted pervasive surveillance and big health data”, and “Healthcare diagnostics with an adaptive deep learning model integrated with the Internet of medical Things (IoMT) for predicting heart disease” offer valuable insights and findings that are directly relevant to the topics covered in the manuscript. These studies provide advanced methodologies, detailed case analyses, and comprehensive reviews of IoMT technologies and their implications in healthcare.

While the manuscript has significant potential and offers valuable insights into the applications, challenges, and proposed resolutions for IoMT in healthcare, it requires addressing several critical issues to enhance its quality and impact.

Comments on the Quality of English Language

Based on the review of the manuscript, the quality of the English language appears to be generally good, with clear and coherent descriptions of IoMT applications and challenges. However, there are a few areas where improvements could be made to enhance readability and clarity. 

Author Response

Comments 1: This paper presents a comprehensive review of the Internet of Medical Things (IoMT) and its various applications, challenges, and proposed solutions in the healthcare sector. The study systematically reviews existing literature, identifies key applications such as mobile health (mHealth), remote biomarker detection, and IoT-based disease prediction, and addresses significant challenges including privacy protection, sustainable power sources, and data management. Despite the manuscript's strengths, it does contain several areas that require improvement. Below, I provide detailed comments and suggestions to help the authors enhance the quality and impact of their work. The article provides an extensive overview of various IoMT applications, but it fails to delve into the specifics of their real-world implementations and effectiveness. Without detailed case studies or practical examples, the discussion remains too abstract, making it difficult for readers to grasp the actual impact of these technologies on healthcare outcomes. Including concrete examples of how IoMT solutions have been successfully deployed in healthcare settings would greatly enhance the manuscript’s credibility and provide valuable insights for practitioners and researchers alike.

Responses 1: A dedicated section titled ‘2.2 Case Studies of Healthcare IoMT Implementations’ has been added and highlighted in the manuscript, addressing your suggestion. This addition has significantly enhanced the manuscript’s credibility and provided valuable insights for practitioners and researchers. The hospitals that have successfully implemented IoMT are listed in Table 2 alongside additional academic reference to support the outcomes of each case study.

Comments 2: While the manuscript acknowledges the importance of privacy and security in IoMT applications, it does not adequately explore the existing technologies and strategies designed to address these challenges. The brief mention of blockchain and encryption methods lacks depth and fails to provide a comprehensive understanding of how these solutions can be practically implemented to protect sensitive health data. A more thorough examination of current privacy and security practices, along with comparisons and case studies, would significantly strengthen the discussion and offer actionable recommendations for enhancing data protection in IoMT systems.

Responses 2: Thank you for your valuable feedback on our manuscript. We have re-written the section on privacy and security in IoMT applications to address your recommendations. The revised section now provides a comprehensive exploration of existing technologies and strategies designed to tackle these challenges. We have expanded our discussion on blockchain and encryption methods, offering an in-depth analysis of their practical implementations for safeguarding sensitive health data. Additionally, we have included a thorough examination of current privacy and security practices, supplemented with comparisons and relevant case studies. These enhancements aim to provide actionable recommendations for improving data protection in IoMT systems.

Comments 3: The literature review in the article is confined to publications from 2020 to 2023, which limits the breadth of historical context and may exclude significant earlier research and developments in the field of IoMT. This narrow scope can result in an incomplete understanding of the evolution and progression of IoMT technologies. To provide a more comprehensive review, it would be beneficial to include relevant studies from earlier years, highlighting key advancements and foundational research that have shaped the current state of IoMT. Expanding the literature review to cover a broader timeframe would offer a more robust and well-rounded perspective on the subject.

Responses 3: The literature review was expanded to cover 2004 and 2024. All identified articles are reflected as appropriate.

Comments 4: The article predominantly relies on qualitative descriptions of IoMT applications and challenges without incorporating sufficient quantitative data to substantiate its claims. The absence of statistical data on adoption rates, effectiveness, and cost-benefit analyses weakens the manuscript's ability to provide empirical evidence for its assertions. Integrating quantitative analysis would not only bolster the credibility of the findings but also offer readers a more precise understanding of the impact and feasibility of IoMT solutions in healthcare settings.

Responses 4: Thank you for your feedback. This paper is a systematic literature review, which inherently focuses on synthesizing existing qualitative descriptions of IoMT applications and challenges. We acknowledge the importance of incorporating quantitative data, such as adoption rates, effectiveness, and cost-benefit analyses, to substantiate claims and enhance empirical evidence. Recognizing this, we have identified the integration of quantitative analysis as a crucial area for future research. This will not only bolster the credibility of findings but also provide a more precise understanding of the impact and feasibility of IoMT solutions in healthcare settings.

Comments 5: Interoperability is a critical factor in the successful implementation of IoMT systems, yet the article does not adequately address the challenges and solutions related to the seamless integration of diverse devices and systems. The lack of focus on interoperability issues such as standardization, compatibility, and data exchange protocols leave a significant gap in the discussion. Addressing these aspects in detail, along with proposing strategies to overcome interoperability barriers, would provide a more comprehensive guide for the deployment of IoMT technologies.

Responses 5: The following paragraph was added to the manuscript to address this point. Thank you for your insight.

Furthermore, interoperability standards for IoMT devices and systems must be established to ensure seamless integration and communication between different healthcare technologies. This would facilitate a more cohesive and efficient healthcare delivery system, improving patient outcomes and operational efficiency [110]. Interoperability is a critical factor in the successful implementation of Internet of Medical Things (IoMT) systems, as it ensures seamless integration and communication among diverse medical devices and systems. The primary challenges in achieving interoperability include standardization, compatibility, and data exchange protocols [111]. To address these issues, the adoption of universally accepted standards is essential, enabling devices from different manufacturers to work together harmoniously. Compatibility can be enhanced through the development of middleware solutions that bridge the gaps between disparate systems, facilitating smooth data flow [112]. Robust data exchange protocols, such as HL7 and FHIR, should be implemented to ensure secure and efficient communication of medical data [113]. Furthermore, fostering collaboration among stakeholders, including device manufacturers, healthcare providers, and regulatory bodies, is crucial for establishing a cohesive framework that supports interoperability [114]. By focusing on these strategies, the deployment of IoMT technologies can be more effective, leading to improved patient outcomes and streamlined healthcare operations.

Comments 6: The manuscript does not sufficiently explore the user experience and acceptance of IoMT technologies among healthcare professionals and patients. Understanding the perspectives and concerns of end-users is crucial for the successful adoption of any new technology. The article should include a discussion on the usability, accessibility, and potential resistance to IoMT systems, supported by user feedback and case studies. Highlighting user-centric design principles and strategies to enhance user engagement would significantly enrich the content.

Responses 6: A new section “2.6 User Experience and Acceptance of IoMT Technologies” has been added to the manuscript addressing all aspects of the feedback.

Comments 7: The article lacks a thorough examination of the scalability and sustainability of IoMT solutions. While it touches upon various applications and challenges, it does not delve into the practical aspects of scaling these technologies across different healthcare environments or ensuring their long-term sustainability. Discussing factors such as infrastructure requirements, cost implications, maintenance, and scalability strategies would provide a more realistic and actionable framework for healthcare providers considering IoMT implementation. Including examples of successful large-scale deployments and lessons learned from these experiences would also add substantial value.

Responses 7: A new section “2.3 Critical Factors for a successful IoMT implementation” was added to address this point.   

Comments 8: While the manuscript provides a broad overview of IoMT applications, it misses the opportunity to integrate several key pieces of research that could significantly enrich the discussion. Specifically, the studies “Internet of Medical Things (IoMT) optimization for healthcare: A deep learning-based interference avoidance model”, “Deep transfer learning-based fall detection approach using IoMT-enabled thermal imaging-assisted pervasive surveillance and big health data”, and “Healthcare diagnostics with an adaptive deep learning model integrated with the Internet of medical Things (IoMT) for predicting heart disease” offer valuable insights and findings that are directly relevant to the topics covered in the manuscript. These studies provide advanced methodologies, detailed case analyses, and comprehensive reviews of IoMT technologies and their implications in healthcare.

Responses 8: Thank you for the suggested articles; indeed, they provided valuable insight that was incorporated into the manuscript.

Comments 9: While the manuscript has significant potential and offers valuable insights into the applications, challenges, and proposed resolutions for IoMT in healthcare, it requires addressing several critical issues to enhance its quality and impact. Comments on the Quality of English Language. Based on the review of the manuscript, the quality of the English language appears to be generally good, with clear and coherent descriptions of IoMT applications and challenges. However, there are a few areas where improvements could be made to enhance readability and clarity. 

Responses 9: The spelling and grammar of the entire paper were meticulously reviewed to enhance its overall quality.

Reviewer 3 Report

Comments and Suggestions for Authors

The paper "Healthcare IoMT: Applications, Trends, Key Challenges, and Proposed Resolutions" provides a comprehensive and systematic review that evaluates the impact and challenges of the Internet of Medical Things (IoMT) in healthcare. The authors have thoroughly explored a broad spectrum of IoMT applications, such as mobile health apps, remote biomarker detection, and wearable devices for glucose monitoring, highlighting their significance in enhancing healthcare delivery.

 The abstract provides a detailed overview of the study's scope, including IoMT applications, key challenges, and proposed resolutions. It effectively sets the stage for the reader by highlighting the systematic review approach and the various IoMT applications. Please include novel contributions of your study compared to existing literature.

The authors do well to introduce IoMT's core components and its potential to transform the real-world applications. Nonetheless, the identified gap regarding detailed exploration of IoMT's specific challenges and solutions could have been elaborated further to justify the study's necessity.

 The research aims and objectives are well defined, providing a structured approach to the review. The three major objectives, namely, identifying applications, challenges, and resolutions are explained well.

 The methodology section outlines a systematic review approach, adhering to PRISMA guidelines, which is commendable for ensuring transparency and reproducibility. The use of the Scopus database and specific keyword strategies is appropriate for capturing relevant literature. The inclusion and exclusion criteria are well-defined, ensuring that the selected articles are intact with the research objectives. It would be better if the authors provide more details on how the authors extracted and analyzed patterns from the selected.

One area for improvement is the depth of analysis in each application. While the paper lists numerous applications, it often lacks a critical assessment of their current state, and practical challenges in real-world implementation. Including case studies or real-world examples could provide better understanding of these applications and their impact.

The discussion on key challenges is thorough, covering issues such as privacy protection, sustainable power sources, and data speed and reliability. The proposed resolutions, including blockchain, edge-fog computing, and homomorphic encryption, are relevant and well-established in current technological advancements.

The comparative analysis with previous studies is a strong point of the paper, highlighting advancements in IoMT architecture, remote monitoring, and integration of AI and machine learning.  But still, this analysis could be enriched by a more explicit discussion on how the findings of this review can be interpreted into practical recommendations for stakeholders, including healthcare providers, technology developers, and policymakers.

The conclusion effectively summarizes the paper's key findings and reinforces the importance of IoMT in healthcare. It reiterates the identified challenges and proposed solutions, providing a cohesive end to the review. However, the conclusion could be strengthened by highlighting the practical implications of the study's findings and offering more concrete recommendations for future research and practice.

Overall, this paper makes a valuable contribution to the field of IoMT in healthcare by systematically reviewing its applications, challenges, and potential solutions. The thorough methodology and comprehensive scope are commendable. However, the paper could be improved by including the above suggestions in the respective sections. Addressing these areas would enhance the paper's quality and practical relevance, making it an even more better resource for researchers and practitioners in the field.

Comments on the Quality of English Language

I advice the authors to sincerely go through the manuscript for typos and other grammatical issues. 

Author Response

Comments 1: The paper "Healthcare IoMT: Applications, Trends, Key Challenges, and Proposed Resolutions" provides a comprehensive and systematic review that evaluates the impact and challenges of the Internet of Medical Things (IoMT) in healthcare. The authors have thoroughly explored a broad spectrum of IoMT applications, such as mobile health apps, remote biomarker detection, and wearable devices for glucose monitoring, highlighting their significance in enhancing healthcare delivery. The abstract provides a detailed overview of the study's scope, including IoMT applications, key challenges, and proposed resolutions. It effectively sets the stage for the reader by highlighting the systematic review approach and the various IoMT applications. Please include novel contributions of your study compared to existing literature.

Responses 1: The following was added to the abstract. This review makes several novel contributions compared to existing literature 1) a comprehensive categorization of IoMT applications, extending beyond traditional use cases to include emerging technologies such as UWB radar systems and DLT platforms. 2) an in-depth analysis of the integration of machine learning and AI in IoMT, highlighting innovative approaches in disease prediction and remote monitoring. 3) a detailed examination of privacy and security measures, proposing advanced cryptographic solutions and blockchain implementations to enhance data protection. 4) identification of future research directions, providing a roadmap for addressing current limitations and advancing the scientific understanding of IoMT in healthcare.

Comments 2: The authors do well to introduce IoMT's core components and its potential to transform the real-world applications. Nonetheless, the identified gap regarding detailed exploration of IoMT's specific challenges and solutions could have been elaborated further to justify the study's necessity. The research aims and objectives are well defined, providing a structured approach to the review. The three major objectives, namely, identifying applications, challenges, and resolutions are explained well.

Responses 2: Thank you for this feedback; the manuscript now hosts the following elaboration around the gap and objectives.  

Despite the growing interest and adoption of IoMT, there is a notable gap in the literature regarding how IoMT specifically addresses the challenges and requirements of the healthcare industry. While existing studies provide a general overview of IoMT and its various applications, they often lack a detailed exploration of how IoMT meets specific healthcare needs. This paper aims to bridge this gap by focusing on the following aspects:

1. Specific Challenges in Healthcare Systems: Identifying the limitations and challenges within current healthcare systems that IoMT aims to overcome, such as data privacy, power sustainability, sensor intelligence, and device reliability.
2. Unique Features of IoMT: Highlighting the unique capabilities of IoMT that make it well-suited for addressing these challenges, including its ability to provide continuous health monitoring, real-time data processing, and integration of advanced technologies like machine learning and AI.
3. Practical Implementation and Impact: Providing concrete examples and case studies that illustrate the practical implementation and impact of IoMT in real-world healthcare settings. This includes detailed examinations of IoMT applications in remote health monitoring, smart hospitals, and disease tracking.

By elaborating on these aspects, this paper aims to provide a comprehensive understanding of IoMT’s significance and potential contributions to the healthcare sector, thereby addressing the existing gap in the literature. Through detailed analysis and case studies, we seek to demonstrate how IoMT can effectively transform healthcare delivery and improve patient outcomes.

Comments 3: The methodology section outlines a systematic review approach, adhering to PRISMA guidelines, which is commendable for ensuring transparency and reproducibility. The use of the Scopus database and specific keyword strategies is appropriate for capturing relevant literature. The inclusion and exclusion criteria are well-defined, ensuring that the selected articles are intact with the research objectives. It would be better if the authors provide more details on how the authors extracted and analyzed patterns from the selected.

Responses 3: Thank you for your feedback, this section is reflected in the methodology section.

To extract and analyze patterns from the selected articles, we employed a multi-step approach. Initially, two independent reviewers used a standardized data extraction form to capture key information from each study, including study design, sample size, methods, and outcomes. This process ensured consistency and minimized bias. Subsequently, we conducted a thematic analysis to identify recurring themes and patterns across the studies. This involved coding the data and grouping similar concepts to uncover common trends. We also used statistical tools, such as meta-analysis, where applicable, to quantify patterns and relationships. Throughout the process, any discrepancies between reviewers were resolved through discussion or consultation with a third reviewer, ensuring the reliability and robustness of our findings.

Comments 4: One area for improvement is the depth of analysis in each application. While the paper lists numerous applications, it often lacks a critical assessment of their current state, and practical challenges in real-world implementation. Including case studies or real-world examples could provide better understanding of these applications and their impact.

Responses 4: A new section 2.2. Case studies of Healthcare IoMT implementations was added to the manuscript.

Comments 5: The discussion on key challenges is thorough, covering issues such as privacy protection, sustainable power sources, and data speed and reliability. The proposed resolutions, including blockchain, edge-fog computing, and homomorphic encryption, are relevant and well-established in current technological advancements.

Responses 5: Greatly appreciate the feedback.

Comments 6: The comparative analysis with previous studies is a strong point of the paper, highlighting advancements in IoMT architecture, remote monitoring, and integration of AI and machine learning.  But still, this analysis could be enriched by a more explicit discussion on how the findings of this review can be interpreted into practical recommendations for stakeholders, including healthcare providers, technology developers, and policymakers.

Responses 6: Thank you for your feedback. A dedicated section ‘3. Practical Implications’

For healthcare providers, these recommendations could focus on implementing the latest IoMT technologies to enhance patient care and streamline operations. For technology developers, insights from the review could guide the development of more robust and user-friendly IoMT solutions that address current gaps and challenges. Policymakers could use the findings to formulate regulations and standards that ensure the safe and effective deployment of IoMT systems, promoting innovation while safeguarding public health. Providing such practical recommendations would not only strengthen the paper but also facilitate the real-world application of its findings.

Comments 7: The conclusion effectively summarizes the paper's key findings and reinforces the importance of IoMT in healthcare. It reiterates the identified challenges and proposed solutions, providing a cohesive end to the review. However, the conclusion could be strengthened by highlighting the practical implications of the study's findings and offering more concrete recommendations for future research and practice.

Responses 7: Thank you for your feedback. A dedicated section ‘3. Practical Implications’ is now in the manuscript and section ‘4. Research Limitation and Future Areas of Research’ offer more concrete recommendations.

Comments 8: Overall, this paper makes a valuable contribution to the field of IoMT in healthcare by systematically reviewing its applications, challenges, and potential solutions. The thorough methodology and comprehensive scope are commendable. However, the paper could be improved by including the above suggestions in the respective sections. Addressing these areas would enhance the paper's quality and practical relevance, making it an even better resource for researchers and practitioners in the field.

Responses 8: Thank you for all your insights which were reflected promptly in our manuscript.

Comments 9: Comments on the Quality of English Language. I advice the authors to sincerely go through the manuscript for typos and other grammatical issues. 

Responses 9: The spelling and grammar of the entire paper were meticulously reviewed to enhance its overall quality.