Introduction
A smart city represents a dynamic urban landscape that harnesses the power of technology and data-driven approaches to elevate the well-being and prosperity of its inhabitants [
1,
2]. By seamlessly integrating cutting-edge technologies like sensors, the Internet of Things (IoT), automation, and artificial intelligence with various infrastructure systems, smart cities create a sustainable and highly efficient urban environment [
3]. At its core, the main objective of a smart city is twofold: to optimize resource utilization and to enhance the quality of services and safety for its residents [
4]. This vision is centered around a sophisticated information and communication technology system, acting as the backbone for seamless data collection, analysis, and distribution [
5]. Through this interconnected infrastructure, smart cities can achieve intelligent decision-making and efficient resource management, creating a sustainable and improved urban living experience for their residents [
2,
6,
7]. In addition to their technological advancements, smart cities actively involve their inhabitants in identifying challenges and collaboratively proposing solutions [
8]. Through the strategic use of technology, they empower residents to play a meaningful role in the city’s development, fostering a stronger sense of community ownership and cohesion [
9]. At the heart of smart cities is a firm commitment to sustainability, efficiency, and cooperation [
10]. By prioritizing these elements, smart cities strive to enhance the quality of life for all residents while ensuring long-term economic growth in urban areas. Through continuous innovation and data-driven solutions, smart cities present a promising vision for the future, where urban life is redefined, and the potential for positive societal impact is maximized.
Numerous countries have achieved success in establishing smart cities that harness innovative technologies and data-driven approaches to enhance the well-being of their residents. Singapore, the Netherlands, and South Korea stand out as prominent examples in this domain [
11]. Singapore, in particular, stands out as one of the most advanced smart cities globally, employing an array of technologies like sensors, analytics, and automation to enhance public transport efficiency, smart waste management, and environmental sustainability [
12]. Amsterdam, the capital of the Netherlands, has made significant strides in environmental sustainability through projects involving electric vehicles and smart grid systems [
13]. Additionally, the city has implemented sophisticated systems to monitor air pollution and waste levels, contributing to its reputation as a forward-thinking smart city. Seoul, the capital of South Korea, is another trailblazer in the realm of smart cities in Asia. Leveraging advanced technologies like the Internet of Things and big data, Seoul has made considerable progress in improving energy management, telemedicine, and e-government services [
14]. These examples highlight how innovative solutions in smart cities have resulted in more sustainable, efficient, and livable urban environments worldwide. However, it is important to note that developing countries are also striving to create smart cities within their boundaries. Nevertheless, they face unique challenges in this endeavor [
15]. Limited resources, infrastructural deficiencies, low technology adoption, and other factors present considerable obstacles for creating smart cities in these regions [
16].
Despite the challenges, developing countries’ efforts to build smart cities are commendable and indicative of their determination to improve the lives of their residents through technological advancements. As technology becomes more accessible and innovative solutions are tailored to suit local needs, the potential for smart cities to flourish in developing nations grows, offering the promise of sustainable, inclusive, and prosperous urban environments for the future.
One of the key areas for smart city innovation is healthcare [
17], where cities use a variety of technological tools and processes to improve access to care, improve patient outcomes, reduce costs, and increase efficiency. As urban populations continue to grow and healthcare demands increase, the smart city approach to healthcare is likely to become increasingly important in the coming years, offering new opportunities for both patients and healthcare providers [
18].
The current body of research on the holistic impact of smart cities on healthcare delivery, especially in developing nations, remains insufficient and warrants further investigation. Through a comprehensive literature review, we aim to address the following research questions: (1) How can smart cities enhance healthcare delivery? (2) What are the technological tools employed by smart cities in advancing healthcare services? (3) What are the key indicators of a smart city’s healthcare capabilities, particularly in developing countries? To pursue these inquiries, we conducted a meticulous search using a well-structured strategy across reputable databases, namely PubMed, OVID, EMBASE, Web of Science, and Scopus. The search encompassed articles published up to November 2022 to ensure a comprehensive review of the relevant literature on the subject matter.
Materials and methods
Our study involves a comprehensive literature review focused on examining the components and indicators related to Smart City applications in healthcare delivery. While preparing this manuscript, we have partially followed the PRISMA-ScR checklist, and the preferred reporting of systematic reviews as outlined by [
19]. We have followed specific elements of the PRISMA-ScR checklist, such as:
1.
Structured Summary: Including background, objectives, eligibility criteria, evidence sources, diagramming methods, and conclusions related to the review questions and objectives. This helps provide a concise overview of the review.
2.
Stating Questions and Objectives: Clearly stating the questions and objectives that were raised in the review, with reference to their key elements. This helps readers understand the focus of the review.
3.
Summarizing Main Results: Providing a summary of the main results obtained from the review. This helps readers quickly grasp the key findings.
4.
Interpretation of Results: Providing a general interpretation of the results according to the questions and objectives of the review. This helps provide context and meaning to the findings.
5.
Potential Implications: Discussing potential implications of the review findings. This helps identify the practical implications and applications of the research.
It is worth noting that this manuscript has not been previously registered in PROSPERO or any equivalent database. We would like to clarify that the manuscript for this literature review has not been registered in PROSPERO or any equivalent database. While registration in PROSPERO is more commonly associated with systematic reviews, we made a conscious decision not to register this particular review. This decision was based on the scope of our review, which does not strictly adhere to the eligibility criteria of PROSPERO, and the feasibility within the constraints of our project. We assure readers that the rigorous methodology employed in our literature search and selection process, as well as the transparent reporting of our findings, are designed to address any concerns related to credibility.
Inclusion and exclusion criteria
The study selection process involved specific inclusion criteria to identify relevant studies from the database. The following criteria were applied:
1) The article had to be either an original article or a short article published in English within a peer-reviewed journal. As a result, reports, letters to the editor, review articles, and meta-analyses were excluded from consideration. The rationale for excluding reports (often lack sufficient detail and rigor in methodology compared to peer-reviewed articles), letters to the editor (typically present opinions, comments, or responses to previously published articles, rather than original research), review articles (our aim was to focus on original research studies), and meta-analyses (often have their own inclusion and exclusion criteria, which may differ from ours).
2) The article had to focus on healthcare or smart health. Thus, articles solely addressing smart cities without any relevance to healthcare were excluded from the review.
By applying these criteria, we ensured that the selected studies were directly related to healthcare in the context of smart cities, providing a targeted and focused analysis for our research.
Databases and search method
PubMed, OVID, EMBASE, Web of Science, and Scopus databases were searched for studies. In our search, we applied a date restriction from January 1, 2010, to November 2022. This timeframe was chosen to capture the most recent literature relevant to our research objectives. However, we did not impose any restrictions based on the start date of our search. This study used broad search terms and conducted a nested search [
20]. To develop a comprehensive search strategy, we used a combination of keywords and controlled vocabulary terms (MeSH terms in PubMed) related to our research topic. The search terms included variations and synonyms to ensure maximum coverage. Here is an example of the search string used in PubMed: (“healthcare” OR “smart health”) AND (“technology” OR “digital health” OR “eHealth”) AND (“impact” OR “effectiveness” OR “outcomes” OR “evaluation”) AND (“Smart City” OR “Smart” OR “Smart-city” OR “Smart-cities”). By including relevant keywords and combining them using Boolean operators, we aimed to capture articles that focused on the impact, effectiveness, and evaluation of healthcare or smart health technologies. The specific search terms and string varied slightly for each database but followed a similar structure.
Study selection
We conducted a two-step study selection process to identify articles that met our inclusion criteria. In the first step, two independent reviewers (HR.S. and Z.M.) screened the titles and abstracts of the identified articles to assess their relevance to our research question and inclusion criteria. Any disagreements between the reviewers were resolved through discussion and consensus. In cases where disagreements between the two reviewers persisted, a third reviewer (M.H.) was consulted as an arbitrator. The third reviewer carefully reviewed the articles in question and provided their input to reach a consensus. This process ensured that the final selection of articles was based on collective agreement.
Study quality appraisal
The quality of included reviews was assessed by two researchers (HR.S. and Z.M.) using the CASP Systematic Review Checklist [
21] (Appendix 1). We resolved any disagreements through discussion and agreed on the quality of the study.
Discussion
Regarding the first research question (i.e., How can smart cities improve healthcare), four key aspects of application emerged as significant contributors: (1) Increasing access to healthcare (4 articles); (2) Improving patient outcomes (5 articles); (3) Smart cities using technology to enhance patient health outcomes (3 articles); (4) Increased efficiency (4 articles) Overall, smart cities are at the forefront of healthcare innovation, driving advancements in access, patient outcomes, cost reduction, and efficiency. The conclusive findings highlight enhanced patient experiences and the seamless integration of technology into healthcare delivery, indicating a promising trajectory for the future of healthcare in smart cities.
Regarding the second research question (i.e., Technologies used by a smart city in providing healthcare), the review identified seven crucial and practical aspects, supported by the following number of articles: (1) Internet of Things devices (4 articles); (2) Wearable devices (3 articles); (3) Artificial Intelligence (5 articles); (4) Telemedicine (4 articles); (5) Electronic Health Records (4 articles); (6) Mobile Health (10 articles); (7) Biometric sensors (3 articles).
These technologies showcase the significant role of innovation in smart cities, highlighting their potential to revolutionize healthcare delivery and improve patient outcomes through cutting-edge applications and solutions.
Regarding the third research question (i.e., What are the indicators of a smart city for healthcare in a developing country), the review identified seven essential and functional aspects, supported by the following number of articles:1. Accessible and affordable healthcare (3 articles); 2. Digital healthcare infrastructure (4 articles); 3. Healthcare facilities (5 articles); 4. Public health awareness (5 articles); 5. Emergency Response Services (3 articles); 6. Research and Development (4 articles); 7. Community involvement (2 articles).
These indicators provide valuable insights into the key areas that a smart city in a developing country should prioritize to enhance healthcare accessibility, quality, and overall public health outcomes. By focusing on these aspects, a smart city can effectively address the unique challenges faced by developing nations, leading to improved healthcare services and better health outcomes for its residents.
Smart city technology plays a crucial role in enhancing healthcare by improving access, efficiency, and quality [
60]. Among the effective technologies, data analysis and IoT sensors enable the monitoring of community health, with predictive analysis aiding in early diagnosis and interventions [
61]. An essential indicator for a smart city in healthcare delivery involves the seamless collection and integration of data from diverse sources, including electronic health records, wearable devices, social media, and environmental sensors [
24,
50]. To ensure data security and protect individuals’ personal information, data governance and privacy regulations must be implemented, while addressing ethical and regulatory issues such as bias, transparency, and accountability [
53]. Additionally, a critical infrastructure in developing a smart city for healthcare is the adoption of telemedicine and virtual care [
47,
49]. The COVID-19 pandemic accelerated this transition, showcasing the high functionality of these digital health technologies and their potential to improve access to care [
49]. By embracing these advancements, smart cities can advance their healthcare capabilities, providing more efficient, accessible, and patient-centered services for their communities.
Engaging healthcare providers, patients, policymakers, and technology developers in smart cities is crucial for aligning healthcare technology with community needs and values [
33,
45,
59]. Adopting a multidisciplinary strategy encompassing technical feasibility, social impact, economic viability, and environmental sustainability is essential [
29,
42]. By fostering collaboration among diverse stakeholders, smart cities can create healthcare solutions that are not only innovative and efficient but also responsive to the unique requirements and aspirations of their communities.
A smart city’s success relies on a robust digital infrastructure, underpinned by a strong and stable internet connection. For developing countries, investing in broadband connectivity is imperative to enable residents’ access to essential digital services like e-government, e-health, and e-education [
62]. Moreover, these countries must prioritize resident participation in health-oriented policies to ensure the effective implementation of smart city initiatives [
63]. Smart cities offer residents a unique opportunity to collaborate with local governments, actively participating in decision-making and urban planning endeavors [
59]. Developing countries should emphasize resident engagement to ensure their smart city programs cater to the needs of their residents, accurately reflecting their aspirations and empowering them to take an active role in project planning and implementation [
15]. By doing so, these countries can develop a unique and tailored approach that best addresses their existing challenges and priorities, while adhering to global smart city standards. In this way, they can effectively leverage smart city technologies to enhance the overall quality of life for their residents and foster sustainable urban development.
Smart city technology has brought about a transformative impact on healthcare delivery, significantly enhancing access, efficiency, and the overall quality of care. Policymakers play a crucial role in the successful implementation of healthcare-related smart city initiatives, ensuring that data and technology are used ethically to safeguard patient privacy and data security. The integration of machine learning algorithms has enabled the analysis of vast healthcare data, enabling the identification of patterns and early signs of diseases for proactive interventions. Furthermore, wearable fitness trackers and sensors play a crucial role in detecting warning signs of chronic diseases at an early stage, promoting timely medical interventions. Smart city technology has also proved invaluable in public health management by continuously monitoring air and water quality. Policymakers have developed comprehensive policies for regular environmental data reporting, fostering healthier urban environments for the benefit of residents. With access to real-time data on disease outbreaks, healthcare providers can respond proactively, swiftly curbing the spread of illnesses. This proactive approach significantly contributes to improving public health outcomes and reducing the burden on healthcare facilities. Moreover, smart city technology optimizes healthcare services by efficiently managing resources and reducing patient waiting times. This leads to an overall improvement in the healthcare experience for individuals and facilitates better healthcare outcomes. The involvement of policymakers in the development and implementation of smart city technology is instrumental in reshaping healthcare delivery. Through their support, personalized, efficient, and accessible care can be delivered to a broader population while effectively managing costs. In this fast-evolving landscape, continuous innovation and collaboration between technology experts, healthcare professionals, and policymakers will be crucial in shaping the future of healthcare within smart cities. By harnessing the full potential of smart city technology, we can revolutionize healthcare and ensure a healthier and more connected world.
Implications of healthcare delivery innovation in developing countries
Implementing healthcare delivery innovation in developing countries requires a strategic and holistic approach that takes into account the unique challenges and opportunities these countries face. Here are some key steps to consider:
Implement Remote Monitoring and IoT Devices: Remote monitoring devices and Internet of Things (IoT) technology can help in real-time health monitoring, especially for chronic disease management. These technologies can be particularly beneficial in rural and underserved areas.
By taking a comprehensive and context-specific approach, healthcare delivery innovation can significantly improve healthcare access, quality, and outcomes in developing countries, ultimately contributing to better health and well-being for their populations.
Comparative analysis of developing nations with developed nations
Smart city initiatives in developed nations incorporate technologies like smart grids, intelligent transportation systems, and automated waste management, improving sustainability, efficiency, and quality of life. These nations also allocate significant resources to research and development (R&D), fostering innovation, technological advancements, and economic growth.
Developed nations prioritize environmental sustainability by investing in renewable energy, promoting green initiatives, and implementing strict environmental regulations. This focus on sustainability yields long-term economic and environmental benefits. Digital government services, such as online tax filing, e-voting, and digital identity systems, streamline administrative processes, enhance citizen engagement, and improve government efficiency.
Quality education systems in developed nations provide access to comprehensive and well-funded education. These systems leverage technology in classrooms, offer specialized programs, and emphasize continuous skill development. Developed nations also have efficient transportation systems, including high-speed railways, well-maintained roads, and advanced public transportation networks, enhancing connectivity, reducing congestion, and improving logistics.
Fintech innovations are prominent in developed nations, with digital payment systems, mobile banking, and blockchain technology. These advancements improve financial services, increase financial inclusion, and support economic growth. Additionally, developed nations leverage data analytics and artificial intelligence for informed policy decisions. They have robust data infrastructure, open data initiatives, and data-driven governance models.
Comparing these additional technologies and indicators with those mentioned earlier for developing nations highlights the disparities and areas for improvement. It also identifies potential opportunities for collaboration and knowledge sharing between developed and developing nations, enabling the transfer of expertise, resources, and best practices.
Practical implications and recommendations
The findings of this review have several practical implications for policymakers and stakeholders in developing countries. Firstly, the identified studies consistently demonstrate the potential of healthcare or smart health technologies to improve healthcare delivery and outcomes. This highlights the importance of considering the integration of these technologies into existing healthcare systems.
Secondly, the review findings suggest that healthcare or smart health technologies can address specific challenges faced by developing countries, such as limited access to healthcare services, resource constraints, and inadequate healthcare infrastructure. By leveraging these technologies, policymakers can potentially overcome these barriers and improve healthcare access and delivery in resource-limited settings.
Furthermore, the review highlights the need for policymakers to prioritize investment in digital health infrastructure and capacity building. Developing countries should invest in robust information technology systems, secure data management protocols, and training programs to ensure the successful implementation and sustainable use of healthcare technologies.
Recommendations
1.
Policy Support: Policymakers should develop and implement policies that support the integration of healthcare or smart health technologies into existing healthcare systems. This includes creating regulatory frameworks, guidelines, and standards to ensure the safety, privacy, and interoperability of these technologies.
2.
Infrastructure Development: Policymakers should prioritize the development of digital health infrastructure, including internet connectivity, telecommunication networks, and electronic health records systems. This will facilitate the seamless exchange of health information and enable the effective implementation of healthcare technologies.
3.
Capacity Building: Policymakers should invest in training programs to enhance the digital health literacy of healthcare providers, administrators, and other stakeholders. This will ensure that they have the necessary skills to effectively utilize healthcare technologies and maximize their potential benefits.
4.
Public-Private Partnerships: Policymakers should foster collaborations between the public and private sectors to leverage expertise, resources, and innovative solutions in the development and implementation of healthcare technologies. Public-private partnerships can help overcome financial constraints and accelerate the adoption of these technologies.
5.
Monitoring and Evaluation: Policymakers should establish mechanisms for monitoring and evaluating the impact and effectiveness of healthcare technologies. This will enable evidence-based decision-making and continuous improvement in the implementation and scaling up of these technologies.
By considering these recommendations, policymakers and stakeholders in developing countries can harness the potential of healthcare or smart health technologies to address healthcare challenges and improve health outcomes for their populations.
Limitations
It is important to acknowledge the limitations of our study, as they may impact the comprehensiveness of our findings. Firstly, the selected keywords and databases used in our study were constrained, potentially limiting the scope of the literature reviewed. Despite our efforts to include a comprehensive set of keywords and synonyms, it is possible that some relevant studies may have been missed due to variations in terminology or the use of different keywords that were not included in our search strategy. This could affect the comprehensiveness of the literature review and potentially result in the omission of relevant studies. Moreover, our access to certain databases was restricted, leading to potential gaps in the research we could access. Furthermore, we did not include the gray literature in our review, which represents an important gap in our study. Local field projects and initiatives, which could be valuable in understanding smart city healthcare developments, may not be published in scientific papers and thus were not considered in our analysis. Despite these limitations, our study offers valuable insights into the role of smart city technology in healthcare. However, it is essential to consider these limitations when interpreting the results, and future research could address these issues to provide a more comprehensive understanding of the subject matter.