| Summary: | Background: the increasing adoption of smart and wearable sensors in the healthcare domain empowers the development of cutting-edge medical applications. Smart hospitals can employ sensors and applications for critical decision-making based on real-time monitoring of patients and equipment. In this context, quality of service (QoS) is essential to ensure the reliability of application data. Methods: we developed a QoS-aware sensor middleware for healthcare 4.0 that orchestrates data from several sensors in a hybrid operating room. We deployed depth imaging sensors and real-time location tags to monitor surgeries in real-time, providing data to medical applications. Results: an experimental evaluation in an actual hybrid operating room demonstrates that the solution can reduce the jitter of sensor samples up to 90.3%. Conclusions: the main contribution of this article relies on the QoS Service Elasticity strategy that aims to provide QoS for applications. The development and installation were demonstrated to be complex, but possible to achieve.
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