Real-Time Medical IoT Device Data Ingestion Architecture

Create a high-performance database architecture capable of ingesting continuous streaming data from multiple medical IoT devices (wearables, remote monitoring sensors) with sub-50ms latency and guaranteed data integrity. The system must handle concurrent writes from thousands of devices, implement automatic schema evolution, and provide built-in anomaly detection for potential medical emergencies. Include strategies for horizontal scaling, write optimization, and predictive indexing.