Modeling the Barriers Affecting the Implementation of the Health Industry Based on the Fourth Industrial Revolution

Document Type : Original Article

Authors

1 Assistant Professor, Department of Information Technology Management, Payam Noor University, Tehran, Iran.

2 Assistant Professor, Department of Computer Engineering and Information Technology, Payam Noor University, Tehran, Iran.

10.48308/jimp.15.3.238

Abstract

Introduction and objectives: The emergence of the Fourth Industrial Revolution, also referred to as Industry 4.0, has brought about profound transformations across various industries, including the healthcare sector. This transformation is grounded in advanced technologies such as the Internet of Things (IoT), big data analytics, artificial intelligence (AI), machine learning (ML), and cyber-physical systems, all of which contribute to enhancing productivity, service quality, and patient experience. In this context, the concept of *Healthcare 4.0 has emerged as a novel paradigm focusing on process digitalization, optimization of healthcare systems, and leveraging advanced technologies. Despite its significant potential benefits, the implementation of Healthcare 4.0 in health systems faces substantial challenges, including concerns over data security and privacy, lack of standardization, managerial complexities, and resistance to change. The aim of this study is to identify and analyze the barriers to implementing Healthcare 4.0 within the framework of the Fourth Industrial
Methods: This applied research was conducted through a systematic literature review combined with expert evaluation. The study population comprised all relevant scholarly articles on Healthcare 4.0 and the adoption of Fourth Industrial Revolution technologies in healthcare, collected from reputable domestic and international databases. A purposive sampling method was employed to select the most relevant studies. The extracted data were reviewed and validated by 12 experts in digital health and healthcare technology. The DEMATEL method was used to identify the intensity and direction of relationships between barriers, while the ISM technique was applied to classify and level these barriers based on their degree of influence and dependence.
Findings: The analysis revealed that the absence of government incentives and support, lack of clarity regarding economic benefits, high investment costs, inadequate regulations, and the absence of a legal framework constitute the fundamental and most critical barriers to Healthcare 4.0 implementation. Furthermore, data security and privacy concerns, lack of common standards, and interoperability challenges were identified as the most influential factors affecting the adoption of Healthcare 4.0. In contrast, organizational resistance to change and managerial complexities were classified as dependent barriers, influenced by other factors. The ISM-based hierarchical structuring indicated that addressing root barriers could significantly facilitate the adoption process. These findings highlight the interdependence of barriers and the importance of strategic interventions targeting the most influential factors to achieve effective integration of Industry 4.0 technologies into healthcare systems.
Conclusions: The findings of this study provide valuable insights for policymakers and healthcare managers seeking to facilitate the successful adoption of Healthcare 4.0. By understanding the relationships among barriers and their hierarchical structure, decision-makers can prioritize strategic actions that address root causes. The study offers a foundation for future research aimed at integrating Fourth Industrial Revolution technologies into healthcare systems and designing optimal implementation models. Timely and targeted policy actions will enable healthcare systems to harness the full potential of these technologies, ultimately improving service quality, operational efficiency, and patient outcomes. Timely action by policymakers to address the identified barriers will enable healthcare managers and policymakers to develop strategies that ensure the successful implementation of Health 4.0 technologies in various countries, allowing them to fully harness the potential of this revolution in the healthcare sector.

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  1. Aceto, G., Persico, V., & Pescapé, A. (2020). Industry 4.0 and health: Internet of things, big data, and cloud computing for healthcare 4.0. Journal of Industrial Information Integration, 18, 100129.
  2. Ahsan, M. M., & Siddique, Z. (2022). Industry 4.0 in Healthcare: A systematic review. International Journal of Information Management Data Insights, 2(1), 100079.
  3. Ajmera, P., & Jain, V. (2019). Modelling the barriers of Health 4.0—the fourth healthcare industrial revolution in India by TISM.  Operations Management Research, 12(3-4), 129–145.
  4. Araújo, N. M. F. (2020). Impact of the fourth industrial revolution on the health sector: a qualitative study. Healthcare Informatics Research, 26(4), 328–334.
  5. Bharsakade, R., Acharya, P., & Ganapathy, L. (2020). Analysis of Driving & Dependence Power of Factors Influencing Industry 4.0 Adoption in Healthcare. 2020 International Conference on Industry 4.0 Technology (I4Tech). IEEE.
  6. Blobel, B. (2020). Application of industry 4.0 concept to health care. pHealth 2020: Proceedings of the 17th International Conference on Wearable Micro and Nano Technologies for Personalized Health. IOS Press.
  7. Bramer, W. M., Rethlefsen, M. L., Kleijnen, J., & Franco, O. H. (2017). Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Systematic Reviews, 6(1), 245.
  8. Cavallone, M., & Palumbo, R. (2020). Debunking the myth of industry 4.0 in health care: insights from a systematic literature review. The TQM Journal, 32(4), 849–868.
  9. Chen, J. K. (2021). Improved DEMATEL-ISM integration approach for complex systems. PLOS ONE, 16(7), e0254694.
  10. Chute, C., & French, T. (2019). Introducing care 4.0: an integrated care paradigm built on industry 4.0 capabilities. International Journal of Environmental Research and Public Health, 16(12), 2247.
  11. da Silveira, F., Neto, I. R., dos Santos, B. M., de Oliveira Gasparetto, R. M., Machado, F. M., Rodrigues, P. C. C., & Amaral, F. G. (2021). Industry 4.0 perspectives in the health sector in Brazil. Independent Journal of Management & Production, 12(1), 001–014.
  12. da Silveira, F., Neto, I. R., Machado, F. M., da Silva, M. P., & Amaral, F. G. (2019). Analysis of industry 4.0 technologies applied to the health sector: Systematic literature review. Occupational and Environmental Safety and Health, 701–709.
  13. DeFranco, J. F. (2024). Health Care 4.0 and Clinical Internet of Things. Computer, 57(10), 90–92.
  14. Golinelli, D., Boetto, E., Carullo, G., Nuzzolese, A. G., Landini, M. P., & Fantini, M. P. (2020). Adoption of digital technologies in health care during the COVID-19 pandemic: systematic review of early scientific literature. Journal of Medical Internet Research, 22(11), e22280.
  15. Goodarzi, G., Jafari, A. J., & Pour Koundelaji, A. Y. (2025). Implementation Strategies for Fourth Industrial Revolution Technologies in Iranian Industries Aimed at Industrial Development Based on Fuzzy DEMATEL. Industrial Management Perspective, 15(1) (In Persian).
  16. Goy, A., Nishtar, S., Dzau, V., Balatbat, C., & Diabo, R. (2019). Health and healthcare in the fourth industrial revolution: Global Future Council on the future of health and healthcare 2016-2018. World Economic Forum.
  17. Gusenbauer, M., & Haddaway, N. R. (2020). Which academic search systems are suitable for systematic reviews or meta‐analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources. Research Synthesis Methods, 11(2), 181–217.
  18. Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2022). Medical 4.0 technologies for healthcare: Features, capabilities, and applications.  Internet of Things and Cyber-Physical Systems, 2, 12–30.
  19. Haleem, A., Javaid, M., Singh, R. P., Suman, R., & Rab, S. (2021). Blockchain technology applications in healthcare: An overview. International Journal of Intelligent Networks2, 130-139.
  20. Ilangakoon, T., Weerabahu, S., & Wickramarachchi, R. (2018). Combining Industry 4.0 with lean healthcare to optimize operational performance of Sri Lankan healthcare industry. 2018 International Conference on Production and Operations Management Society (POMS). IEEE.
  21. Javan Jafari Bojnordi, A., Zahedian Nezhad, M., Bagheri, R., Bazrafshan, M., & Sohrabi, B. (2025). Identifying, ranking and analyzing obstacles to big data analytics implementation in the healthcare industry using an ISM approach. Discover Health Systems, 4(1), 32.
  22. Junaid, S. B., Imam, A. A., Balogun, A. O., De Silva, L. C., Surakat, Y. A., Kumar, G. & Mahamad, S. (2022). Recent Advancements in Emerging Technologies for Healthcare Management Systems: A Survey. Healthcare, 10(10), 1940.
  23. Kotzias, K., Bukhsh, F. A., Arachchige, J. J., Daneva, M., & Abhishta, A. (2022). Industry 4.0 and healthcare: Context, applications, benefits and challenges. IET Software.
  24. Kumar, K., Zindani, D., & Davim, J. P. (2019). Industry 4.0: Developments towards the fourth industrial revolution. Springer.
  25. Kumar, M. S., Raut, R. D., Narwane, V. S., & Narkhede, B. E. (2020). Applications of industry 4.0 to overcome the COVID-19 operational challenges. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(5), 1283–1289.
  26. Li, J., & Carayon, P. (2021). Health Care 4.0: A vision for smart and connected health care. IISE Transactions on Healthcare Systems Engineering, 11(3), 171–180.
  27. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.
  28. Manogaran, G., Thota, C., Lopez, D., & Sundarasekar, R. (2017). Big data security intelligence for healthcare industry 4.0. Cybersecurity for Industry 4.0: Analysis for Design and Manufacturing, 103–126.
  29. Marino, C. A., & Diaz Paz, C. (2025). Enhancing Interoperability for a Sustainable, Patient-Centric Health Care Value Chain: Systematic Review for Taxonomy Development. Journal of Medical Internet Research, 27, e69465.
  30. Mirzaei Eslamlou, A., Bagherzadeh Khajeh, M., Mahmoudzadeh, M., & Ramazani, M. (2024). Designing the Competency Model of the Workforce in Manufacturing Industries During the Fourth Industrial Revolution. Journal of Industrial Management Perspective, 14(4), 201–222 (In Persian).
  31. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), e1000097.
  32. Mongeon, P., & Paul-Hus, A. (2015). The Journal Coverage of Web of Science and Scopus: a Comparative Analysis. Scientometrics, 106.
  33. Mwanza, J., Telukdarie, A., & Igusa, T. (2023). Impact of industry 4.0 on healthcare systems of low-and middle-income countries: a systematic review. Health and Technology, 1–18.
  34. Nwobodo-Anyadiegwu, E., Tambwe, D. B., & Lumbwe, A. K. (2022). The Integration of Industry 4.0 in Healthcare Quality Improvement. 2022 IEEE 28th International Conference on Engineering, Technology and Innovation (ICE/ITMC) & 31st International Association for Management of Technology (IAMOT) Joint Conference. IEEE.
  35. Oduncu, F. (2022). Health 4.0 and Health 4.0 Technology Applications. Aurum Journal of Health Sciences, 4(3), 185–196.
  36. Paul, S., Riffat, M., Yasir, A., Mahim, M. N., Sharnali, B. Y., Naheen, I. T. & Kulkarni, A. (2021). Industry 4.0 applications for medical/healthcare services. Journal of Sensor and Actuator Networks, 10(3), 43.
  37. Popov, V. V., Kudryavtseva, E. V., Kumar Katiyar, N., Shishkin, A., Stepanov, S. I., & Goel, S.  (2022). Industry 4.0 and digitalisation in healthcare. Materials, 15(6), 2140.
  38. Rayan, R. A., Zafar, I., & Tsagkaris, C. (2023). Industry 4.0 technologies for healthcare: Applications, opportunities, and challenges. Blockchain Technology Solutions for the Security of IoT-Based Healthcare Systems, 23–44.
  39. Rokneddini, S. A., & Andalib Ardakani, D. (2024). Analysis of Organizational Factors Affecting the Adoption of Industry 4.0 Technologies in Small and Medium-Sized Companies. Journal of Industrial Management Perspective, 14(2), 85–112. (In Persian).
  40. Santiago de Mendonça, B., Rodrigues, L. F., & Araújo Ferreira, K. (2025). Healthcare 4.0: a systematic literature review. Journal of Health Organization and Management.
  41. Shafiee, S., Ghatari, A. R., Hasanzadeh, A., & Jahanyan, S. (2019). Developing a model for sustainable smart tourism destinations: A systematic review. Tourism Management Perspectives, 31, 287–300.
  42. Shafiee, S., Ghatari, A. R., Hasanzadeh, A., & Jahanyan, S. (2022). Developing a model for smart tourism destinations: an interpretive structural modelling approach. Information Technology & Tourism, 24(4), 511–546.
  43. Shafiee, S., Ghatari, A. R., Hasanzadeh, A., & Jahanyan, S. (2021). Smart tourism destinations: a systematic review. Tourism Review, 76(3), 505–528.
  44. Shakeri, H., & Khalilzadeh, M. (2020). Analysis of factors affecting project communications with a hybrid DEMATEL-ISM approach (A case study in Iran). Heliyon, 6(8).
  45. Sisodia, A., & Jindal, R. (2021). A meta-analysis of industry 4.0 design principles applied in the health sector. Engineering Applications of Artificial Intelligence, 104, 104377.
  46. Sood, S. K., Rawat, K. S., & Kumar, D. (2022). A visual review of artificial intelligence and Industry 4.0 in healthcare. Computers and Electrical Engineering, 101, 107948.
  47. Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital Transformation in Healthcare: Technology Acceptance and Its Applications. International Journal of Environmental Research and Public Health, 20(4), 3407.
  48. Thorne, S., Jensen, L., Kearney, M. H., Noblit, G., & Sandelowski, M.  (2004). Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qualitative Health Research, 14(10), 1342–1365.
  49. Valamede, L. S., & Santos Akkari, A. C. (2021). Health 4.0: a conceptual approach to evaluate the application of digital technologies in the healthcare field. Proceedings of the 6th Brazilian Technology Symposium (BTSym'20) Emerging Trends and Challenges in Technology. Springer.
  50. Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: the kappa statistic. Family Medicine, 37(5), 360–363.
  51. Wang, Q., Meng, N., Ma, Y., Wang, Y., Wang, K., Zhuge, R., ... & Wu, Q. (2025). Exploring the influencing factors affecting the operational effectiveness of public health emergency response mechanism: a DEMATEL-ISM-MICMAC mixed methods study. BMC Public Health, 25(1), 2078.
  52. Wolfswinkel, J. F., Furtmueller, E., & Wilderom, C. P. (2013). Using grounded theory as a method for rigorously reviewing literature. European Journal of Information Systems, 22(1), 45–55.