  Citation: Malik, S.; Gupta, K.; Gupta, D.; Singh, A.; Ibrahim, M.; Ortega-Mansilla, A.; Goyal, N.; Hamam, H. Intelligent Load-Balancing Framework for Fog-Enabled Communication in Healthcare. Electronics 2022, 11, 566. https://doi.org/10.3390/ electronics11040566 Academic Editor: Juan M. Corchado Received: 12 January 2022 Accepted: 9 February 2022 Published: 13 February 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). electronics Review Intelligent Load-Balancing Framework for Fog-Enabled Communication in Healthcare Swati Malik 1 , Kamali Gupta 1 , Deepali Gupta 1 , Aman Singh 2 , Muhammad Ibrahim 3,4 , Arturo Ortega-Mansilla 2,5 , Nitin Goyal 1, * and Habib Hamam 6,7,8 1 Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab 140401, India; swati.malik@chitkara.edu.in (S.M.); kamali.singla@chitkara.edu.in (K.G.); deepali.gupta@chitkara.edu.in (D.G.) 2 Higher Polytechnic School, Universidad Europea del Atlántico, C/Isabel Torres 21, 39011 Santander, Spain; aman.singh@uneatlantico.es (A.S.); arturo.ortega@uneatlantico.es (A.O.-M.) 3 Department of Information Technology, University of Haripur, Haripur 22620, Pakistan; ibrahimmayar@uoh.edu.pk 4 Department of Computer Engineering and Research Center of Advance Technology, Jeju National University, Jeju-si 63243, Korea 5 Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico 6 Faculty of Engineering, Université de Moncton, Moncton, NB E1A3E9, Canada; habib.hamam@umoncton.ca 7 International Institute of Technology and Management, Commune d’Akanda, Libreville BP1989, Gabon 8 School of Electrical Engineering, Dept of Electrical and Electronic Engineering Science, University of Johannesburg, Johannesburg 2006, South Africa * Correspondence: nitin.goyal@chitkara.edu.in Abstract: The present technological era significantly makes use of Internet-of-Things (IoT) devices for offering and implementing healthcare services. Post COVID-19, the future of the healthcare system is highly reliant upon the inculcation of Artificial-Intelligence (AI) mechanisms in its day-to-day procedures, and this is realized in its implementation using sensor-enabled smart and intelligent IoT devices for providing extensive care to patients relative to the symmetric concept. The offerings of such AI-enabled services include handling the huge amount of data processed and sensed by smart medical sensors without compromising the performance parameters, such as the response time, latency, availability, cost and processing time. This has resulted in a need to balance the load of the smart operational devices to avoid any failure of responsiveness. Thus, in this paper, a fog-based framework is proposed that can balance the load among fog nodes for handling the challenging communication and processing requirements of intelligent real-time applications. Keywords: fog computing; load balancing; healthcare; cloud computing 1. Introduction Visualization of the future connected world is incomplete without including the Internet of Things (IoT). IoT devices are artificially intelligent and are available to be utilized by various applications that can provide efficient performance for end-users. The data of various applications are collected by these devices [1]. Various smart devices produce a large amount of data, which is utilized by various applications for better decision making and better services for end-users [2]. The interconnections between various devices and application helps in learning the existing system and improving it for efficient functionality. IoT is utilized in various fields for day-to-day activities, such as smart offices, buildings, healthcare, grid system, traffic management, healthcare, agriculture and many more fields. Medical services are an important concern in everyone’s life. The contribution to health services can reduce the cost and provide better services to people. Electronics 2022, 11, 566. https://doi.org/10.3390/electronics11040566 https://www.mdpi.com/journal/electronics