The IoT is the system by which semi-autonomous devices and applications interact with each other to address problems, tap opportunities, and generate efficiencies. We experience IoT in a growing number of tangible and intangible ways — think GPS maps that tell you which direction to turn — but perhaps no industry holds as much promise for the use of IoT as healthcare. In fact, some see IoT as the disruptive force that will revolutionize care and improve patient health in the 21st Century.
Compiled by Neal Learner, Contributing Writer
From notifying care givers of proper bed rail placement for patients with a high fall risk to directing patients to their medical appointments, the possibilities of the Internet of Things (IoT) in healthcare are truly endless.
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The IoT is the system by which semi-autonomous devices and applications interact with each other to address problems, tap opportunities, and generate efficiencies. We experience IoT in a growing number of tangible and intangible ways — think GPS maps that tell you which direction to turn — but perhaps no industry holds as much promise for the use of IoT as healthcare. In fact, some see IoT as the disruptive force that will revolutionize care and improve patient health in the 21st Century.
Aviv S. Gladman, MASc, MD, P.Eng, FRCPC, is CMIO and a critical care physician at Mackenzie Health, a Toronto-area regional healthcare provider and an IoT thought leader. Through the Mackenzie Innovation Institute, which operates a 34-bed smart Innovation Unit at the Mackenzie Richmond Hill Hospital, Gladman and his colleagues study how staff, physicians, and patients adopt and interact with new IoT technologies, as well as observe the necessary clinical practice changes and service delivery models needed to make it work.
Q: What are some existing applications of IoT in healthcare?
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A: We are now all mostly familiar with personal digital healthcare products such as the Fitbit and Apple Watch that monitor various health parameters and transmit the data to a central repository. As these devices become more advanced, we will see interesting cross-device applications of that data. For example, your physician may not be that interested in reviewing how many steps you take every day, but if you have just had knee surgery, that information may be quite relevant to your rehabilitation. What if your Fitbit could automatically transmit its data to the hospital, and it became part of the record of your hospital rehab? What if your Apple Watch displayed messages warning you about your high cholesterol level when you entered a doughnut shop?
Q: In what ways are you leveraging an IoT approach at Mackenzie Health?
A: We’re utilizing smart technology to build intelligent workflow automation into hospital processes to make them safer and more efficient. All of this is done in an effort to improve the patient experience. One of our first projects was to install smart hospital beds in our Innovation Unit. The beds remind nurses how to configure the bed rails to optimally protect patients at risk for falls. If the nurse forgets to reposition the bed after taking a patient to the bathroom, for example, the bed will notify the nurse. The beds can also detect patient position in the bed and notify staff immediately if a highrisk patient is exiting the bed without a staff member in the room. By knowing hospital staff location on the unit utilizing a real-time locating system, we are also building a realtime communication system that is more responsive to patient needs. For example, if your nurse is on break or assisting another patient in radiology, calls can be routed to the next most responsible nurse.
Q: What are some common challenges associated with IoT in healthcare?
A: The biggest challenges are getting patients to accept it in a very private part of their lives and getting clinical staff to accept changes in traditional workflows. In the Innovation Unit, we can take measurements that illustrate the impact of IoT technologies, making it far easier to convince staff and physicians of the benefits and helping identify and mitigate any concerns.
Privacy and security are also major considerations. We have heard recently about cars being hacked, IV pumps being hacked, and major data breaches all over the world. These are major considerations, but they shouldn’t be seen as major limitations. The technology to protect our IoT devices — or Internet of Healthcare Things (IOHT) as we call it — exists. Many hospitals just don’t utilize it effectively and appropriately on their own. This is why we work with companies like Blackberry, Cisco, and Thoughtwire.
Q: What benefits does IoT bring to healthcare facilities and their patients?
A: Providers spend hours every day not taking care of patients but waiting for the right person to answer a page, checking repeatedly to see if key bloodwork is available, or waiting for equipment to arrive. Patients spend hours every day waiting for things to happen for exactly the same reasons. It creates frustration on both sides, significantly escalates the costs of care, and increases the risk of medical errors. IoT technology is obviously not a complete solution, but the possibilities of these types of workflow automations will make healthcare more efficient and more cost-effective, improve outcomes, and create a better patient and provider experience.
We’ve also been studying how IoT impacts how nurses spend their time and the associated outcomes. We have been able to demonstrate that you can improve workflows, make it easier for people to do their jobs, and make a positive impact on the patient experience with IoT.
Q: Do you see IoT having a bigger effect on patient outcomes or day-to-day operations?
A: We are initially focusing on day-to-day operations in the belief that we will also see significant patient outcome benefits as a result. Like all quality improvement, often just measuring the problem is the first step towards solving it. In redesigning hospital processes to accommodate IOHT technology, we identify and fix a lot of workflow inefficiencies that we weren’t even aware of. It makes it harder to determine how much effect is IOHT and how much is patient care redesign. Personally, I think IoT will have impact on both outcomes and operations. When you think of IoT in terms of digital moments and IOHT in terms of digital health moments, it’s hard not to conceive of applications that will fundamentally affect patient outcomes.
Q: What changes will IoT bring to the way doctors deal with patients?
A: IoT will produce massive amounts of data, and data analytics will become a key tool in the armamentarium of physicians. The research and advisory company Gartner predicts the smart machine era will be the most disruptive in the history of information technology, will displace traditional IT people, and create entirely new fields. The same thing will happen to traditional medicine — adapt or perish. It already started with the internet age; IoT is just accelerating it.
Q: What changes will IoT bring to population health management?
A: Imagine that you were collecting data in real time from a global population of IOHT technology users. You could then mine that data to do studies of drug side effects, diseases, etc. in near real time. Beth Israel Deaconess in Boston is already doing some of this, not using IoT, but using data mined from their own health information systems.
Q: Are government mandates needed to ensure proper use of IoT?
A: There is a clear role for standards in IOHT. Whether the government should be the mandating body is questionable. In my experience with government healthcare IT agencies, there is a lack of coordination amongst local, provincial, and federal organizations which would make it extremely challenging for government-mandated use of IOHT.
The best example here is the cell phone industry. Twenty years ago, the big cell phone manufacturers got together and agreed on standards — Bluetooth, transferring contacts between phones, etc. You can send a Blackberry contact card to an iPhone, and it understands it because it’s in the same format. Everyone sells more phones because of that. We’re hopeful a similar movement will occur in healthcare. In the end, the organizations that thrive will be those that integrate well with others. Hospitals are not going to buy things unless they integrate with the processes they already have.
Q: How will IoT accelerate its entry into the healthcare industry?
A: Once the privacy/security aspects are addressed in healthcare, as they have been for decades in the banking industry, we will see much more willingness to adopt these technologies. Also, most hospitals — and particularly public hospitals — have an aging IT infrastructure. To utilize these technologies, hospitals will need to invest heavily in IT infrastructure and in interoperability between systems and devices.
We’re already seeing a lot more of this technology being applied in hospitals, and we’re seeing a lot more hospitals going digital. Once you get rid of paper, health data can be used to trigger automated events. We are almost certainly underestimating the impact of IoT in healthcare. Will intelligent machines eventually replace doctors? The same question is asked about every area of human endeavor.
The IoT is the system by which semi-autonomous devices and applications interact with each other to address problems, tap opportunities, and generate efficiencies. We experience IoT in a growing number of tangible and intangible ways — think GPS maps that tell you which direction to turn — but perhaps no industry holds as much promise for the use of IoT as healthcare. In fact, some see IoT as the disruptive force that will revolutionize care and improve patient health in the 21st Century.
A: We are now all mostly familiar with personal digital healthcare products such as the Fitbit and Apple Watch that monitor various health parameters and transmit the data to a central repository. As these devices become more advanced, we will see interesting cross-device applications of that data. For example, your physician may not be that interested in reviewing how many steps you take every day, but if you have just had knee surgery, that information may be quite relevant to your rehabilitation. What if your Fitbit could automatically transmit its data to the hospital, and it became part of the record of your hospital rehab? What if your Apple Watch displayed messages warning you about your high cholesterol level when you entered a doughnut shop?
