A Systematic Literature Review of Innovations, Challenges, and Future Directions in Telemonitoring and Wearable Health Technologies

Telemonitoring and wearable devices are transforming healthcare by enabling continuous patient monitoring and personalized interventions. However, their integration remains fragmented due to technical, ethical, and regulatory barriers. This systematic review, following PRISMA 2020 guidelines, synthesizes insights from 165 studies (2020-2024) to assess key advancements and persistent challenges. AI-driven diagnostics show potential but require clinical validation, while energy-efficient communication protocols lack standardization. Data security improvements, such as hybrid encryption, enhance protection but introduce computational overhead. Regulatory misalignment and clinician skepticism hinder interoperability and large-scale adoption. Despite usability advancements, disparities in patient accessibility and clinician engagement highlight the need for human-centered design. To convert promises into practice, we outline a blueprint that pairs harmonized regulatory pathways with explainable, edge-deployed AI, leverages low-latency data exchange, and promotes cross-sector interoperability convergence. Realizing this agenda through longitudinal, multicenter trials and inclusive, community-anchored implementation will unlock equitable and scalable telemonitoring ecosystems.