Background Utilization of the widely used wearable sensor and smartphone technology for remote monitoring represents a healthcare breakthrough. This study aims to design a remote real-time monitoring system for multiple physiological parameters (electrocardiogram, heart rate, respiratory rate, blood oxygen saturation, and temperature) based on smartphones, considering high performance, autoalarm generation, warning transmission, and security through more than one method. Methods Data on monitoring parameters were acquired by the integrated circuits of wearable sensors and collected by an Arduino Mega 250 R3. The collected data were transmitted via a Wi-Fi interface to a smartphone. A patient application was developed to analyze, process, and display the data in numerical and graphical forms. The abnormality threshold values of parameters were identified and analyzed to generate an autoalarm in the system and transmitted with data to a doctor application via a third-generation (3G) mobile network and Wi-Fi. The performance of the proposed system was verified and evaluated. The proposed system was designed to meet main (sensing, processing, displaying, real-time transmission, autoalarm generation, and threshold value identification) and auxiliary requirements (compatibility, comfort, low power consumption and cost, small size, and suitability for ambulatory applications). Results System performance is reliable, with a sufficient average accuracy measurement (99.26%). The system demonstrates an average time delay of 14 s in transmitting data to a doctor application via Wi-Fi compared with an average time of 68 s via a 3G mobile network. The proposed system achieves low power consumption against time (4 h 21 m 30 s) and the main and auxiliary requirements for remotely monitoring multiple parameters simultaneously with secure data. Conclusions The proposed system can offer economic benefits for remotely monitoring patients living alone or in rural areas, thereby improving medical services, if manufactured in large quantities.