Healthcare is one of the industries that seeks to deliver medical services to patients on time. One of the issues it currently grapples with is real-time patient data exchange between various healthcare organizations. This challenge was solved by both centralized and decentralized cloud computing architecture solutions. In this paper, we review the current state of these two cloud computing architectures in the health sector with regard to the effect on the efficiency of Health Information Exchange (HIE) systems. Our study seeks to determine the relevance of these cloud computing approaches in assisting healthcare facilities in the decision-making process to adopt HIE systems. This paper considers the system performance, patient data privacy, and cost and identifies research directions in each of the architectures. This study shows that there are some benefits in both cloud architectures, but there are also some drawbacks. The prominent characteristic of centralized cloud computing is that all data and information are stored together at one location, known as a single data center. This offers many services, such as integration, effectiveness, simplicity, and rapid information access. However, it entails providing data privacy and confidentiality aspects because it will face the hazard of a single point of failure. On the other hand, decentralized cloud computing is built to safeguard data privacy and security whereby data are distributed to several nodes as a way of forming mini-data centers. This increases the system’s ability to cope with a node failure. Thus, continuity and less latency are achieved. Nevertheless, it poses integration issues because managing data from several sites could be a problem, and the costs of operating several data centers are higher and complex. This paper also pays attention to the differences in aspects like efficiency, capacity, and cost. This paper assists healthcare organizations in determining the most suitable cloud architecture strategy for deploying secure and effective HIE systems.

The Internet of Things (IoT) aims to wirelessly connect billions of physical things to the IT infrastructure. Although there are several radio access technologies available, few of them meet the needs of Internet of Things applications, such as long range, low cost, and low energy consumption. The low data rate of low-power wide-area network (LPWAN) technologies, particularly SigFox, makes them appropriate for Internet of Things applications since the longer the radio link’s useable distance, the lower the data rate. Network reliability is the primary goal of SigFox technology, which aims to deliver data messages successfully through redundancy. This raises concerns about SigFox’s scalability and leads to one of its flaws, namely the high collision rate. In this paper, the goal is to prevent collisions by switching to time division multiple access (TDMA) from SigFox’s Aloha-based medium access protocol, utilizing only orthogonal channels, and eliminating redundancy. Consequently, during a designated time slot, each node transmits a single copy of the data message over a particular orthogonal channel. To achieve this, a multi-agent, off-policy reinforcement learning (RL) Q-Learning technique will be used on top of SigFox. In other words, the objective is to increase SigFox’s scalability through the use of Reinforcement Learning based time slot allocation (RL-SCAP). The findings show that, especially in situations with high node densities or constrained communication slots, the proposed protocol performs better than the basic SCAP (Slot and Channel Allocation Protocol) by obtaining a higher Packet Delivery Ratio (PDR) in average of 60.58%, greater throughput in average of 60.90%, and a notable decrease in collisions up to 79.37%.