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

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.