The Convergence Of Health And The Internet of Things A Revolution In Healthcare

By Dr. David Liepert

No matter how healthy you are, you can always get better and you can always get worse. Meanwhile, our medical system remains focused on intervening only after a person’s health declines. Current professional care is reactive rather than proactive and preventive care remains relatively “hit and miss.” Our evaluations of intervention and response remain intermittent and what little health information is available is shared poorly between clients, clinicians, and healthcare facilities.

Consequently, chronic diseases such as heart disease, cancer, and stroke account for more than 50 percent of all deaths each year and are responsible for much suffering along the way. The effectiveness of either preventive or therapeutic care remains undetermined until after a patient is diagnosed, perpetuating the reactive care paradigm.

However, the medical device manufacturing industry is poised to fundamentally and profoundly shift that current paradigm through Internet of Things (IoT) enabled medical technology. This shift is inevitable according to BI Intelligence, Business Insider's premium research service, which forecasts that the installed base of healthcare IoT devices (not including wearable lifestyle devices such as fitness trackers) will grow from approximately 95 million in 2015 to 646 million in 2020.

When individuals begin to care more about their health and preventive pre-diagnoses care, the medical community becomes better equipped to deliver quality healthcare. This change can be driven by the intersection of medical technology and IoT which signifies a revolution in reactive and proactive healthcare. Through enhanced data integration and analysis, increased patient usability, and next-generation security measures, IoT enabled medical technology can empower healthcare providers and patients alike. These technologies can help prevent and predict the onset of disease or other health complications and enable clinicians and other care providers to respond more readily, rapidly, and responsively to any health concern.

Data, for instance, can help inform both clinician and patient about their therapeutic options and enhance their response. IoT will serve as the catalyst to deliver vast amounts of interconnected data that can be leveraged by all. As with all technologies, there are benefits and potential drawbacks. Healthcare providers and healthcare facilities remain concerned about data security and IoT device management. Clinicians, like myself, already handle patient information with confidentiality, but our responsibilities over the use and care of patient data will extend into the Cloud. There are a variety of technologies that are being developed as add-ons or being integrated within IoT to solve this security issue. It is important for clinicians to be cognizant of such issues and to utilize solutions that address these problems. Bottom-line: clinicians who manage to protect patient data and leverage IoT technologies will be the most successful.

Understanding Current IoT Enabled Medical Technologies
Copious amounts of data can be detrimental to a physician’s time. With the number of patients increasing, there is not enough time to analyze all aspects of a patient’s condition, let alone review all of their data. IoT enabled technologies can help alleviate these challenges by supplying physicians with pertinent information, thereby freeing them up to focus on critical and time sensitive issues. The top three clinician areas IoT can have an impact on are:

• Providing a summarized and holistic report of a patient’s condition with key areas for review identified.
• Better insight into patient adherence and rehabilitation through long term data collection.
• Facilitating data presentation, interpretation and “Knowledge Transfer” between care providers.

Today, IoT is already being leveraged in healthcare to help transform and expedite traditional procedures. The IBM Watson app, KnIT, developed with Baylor College of Medicine, is an example of an IoT enabled technology that transforms how data is captured, developed, shared, and used within the healthcare setting. IBM Watson analyzes data laterally as well as vertically to look for previously unseen connections. KnIT uses Watson’s innovative artificial intelligence (AI) platform to read and analyze millions of scientific papers, facilitating an efficient and economical system for data and knowledge sharing. In 2014, a Baylor team identified six new proteins to target for cancer research.

IBM and a team of specialists (among which I am included) are working to teach Watson to collect and interpret patient data in order to advise both clinicians and healthcare consumers on real-time health statuses in the context of an entire community of chronic disease sufferers. The goal is that Watson will be able to advise healthcare providers, researchers, and resources so that physicians and patients are supplied with the most current research and the most up-to-date assessment of a patient’s health and treatment plan going forward. In essence, Watson will free clinicians and caregivers from having to amass and analyze raw data, allowing them more patient-facing and patient-focused time.

Medical device companies, like Biotricity, are pioneering the development of remote patient monitoring technology. These companies are developing medical wearable devices that will have the capability to collect patient data in real-time and transmit it for analysis within the Cloud in a secure way. The technology is designed to seamlessly communicate data bi-directionally over a secure communications network to facilitate superior data analysis and integration into healthcare providers’ workflow. In turn, this will better serve the patient-consumer by providing their clinician with actionable data and feedback. Remote patient monitoring technologies such as Biotricity’s Bioflux can improve care, cut costs, reduce inefficiencies, and ultimately reduce suffering and save lives.

The Future Of IoT Enabled Medical Technology
In the future, the medical community fully expects that health systems will be able to leverage IoT enabled medical technology to gather real-time data and trace patterns to make predictions about community disease outbreaks. Hospitals may be able to leverage these technologies to gather real-time data and trace patterns to make predictions about treatments and outcomes at the individual level. The result is potential life, suffering, and cost-saving processes that would not be possible without the complex and comprehensive data analytics provided by IoT enabled technology.

Even now, the new Severity-based Stroke Triage Algorithm for emergency medical services (EMS) supplies ambulance crews with information and tools to better identify a stroke, assess a patient's overall condition, and determine the best hospital for the patient's specific treatment needs. Since stroke reaction time is so critical, this algorithm ultimately optimizes the delivery of patient care and demonstrates both the community and individual benefits of the IoT medical revolution occurring right now.

Today, traditional medical technology does not facilitate patient engagement, which in turn leads to nonadherence. For example, a traditional glucometer device will store and relay a few blood-glucose level readings but it will not provide useful information to diabetics regarding patterns in their blood sugar levels, nor will it perform a trend analysis so that individuals can see how their activities and health decisions are impacting their glucose levels on a daily, weekly, or monthly basis. These are capabilities that IoT enabled medical technology can offer. IoT devices have three concrete advantages to increase patient usability:

• Recording: Using IoT devices, patient data is recorded in real-time so that individuals can track their progress and the feedback loop is shortened. In fact, Abbott Laboratories Inc. has released data from a study showing patients who scan more frequently with the company’s IoT enabled real-time glucose monitoring system, Freestyle Libre, spend less time in hypoglycemia or hyperglycemia while having improved average glucose levels.
• Sharing: Patient data can be automatically transmitted, analyzed by software, and used to create a trend or pattern analysis.
• Reinforcing: IoT enabled medical technology can offer positive feedback and reinforcement, which incentivizes patients to continue to make healthy choices and to manage their chronic health conditions.

By providing patients with useful, real-time, and medical-grade health information, IoT enabled medical technology can foster greater engagement and adherence as patients begin to take their health into their own hands.

Security Concerns And The Future Of IoT Healthcare Technologies
The next generation of IoT enabled medical technologies will have built-in enhanced security measures. Data security will enable physicians and other caregivers to focus on healthcare without sacrificing patient safety or leaving their larger health networks susceptible to breach of privacy concerns or cyber-attacks. The vulnerability of virtual data storage has raised concerns and resistance to the implementation of early generation IoT enabled devices into the healthcare system. For example:

• MedJack enabled attackers to inject malware into medical devices and then across a network, making patient medical data available for tax fraud or identity theft.
• A 2015 ransomware attack on a German hospital disabled email and forced hospital employees to use paper and fax machines.

The grave implications of these sorts of attacks highlights the risks and responsibilities involved in handling delicate patient health data. This is forcing health systems, hospitals, and healthcare providers to reject IoT technologies. However, in boycotting these technologies the healthcare system is turning down cost and time savings as well as data and computational capabilities that could be critical in keeping patients alive.

Combined advancements in government policies and technology manufacturing guides, as well as advancements within the technologies themselves, are helping to mitigate data security risks by providing direction and improved security capabilities. This can be seen in the recently released FDA Postmarket Management of Cybersecurity of Medical Devices guidance. The recommendations advise medical device manufacturers and health care facilities to take precautions and ensure appropriate safeguards. They also suggest that hospitals and health care facilities should evaluate their network security and improve their virtual systems’ protections.

Similarly, the National Institute of Standards and Technology (NIST) released its Framework for Improving Critical Infrastructure Cybersecurity, which details how to develop secure and trustworthy digital systems. Device manufacturers, progressively more informed about the importance of such measures, are working to improve the reliable functioning of critical virtual infrastructure.

The IoT revolution has the potential to become medicine’s next leap forward, improving health today in the same fashion that antibiotics did in the previous century. We face great challenges as we seek to implement technological opportunities. The connectivity that IoT technology provides will ensure that all of us, whether as regulators, providers, or consumers, will face this century’s health challenges as a stronger, more connected population.

About The Author
Dr. David Liepert has been a practicing anesthesiologist specializing in the care of the critically ill for over 20 years. Currently he is the Quality Lead and Quality Improvement Champion as well as the Calgary Zone Patent Safety Director in the Calgary Department of Anesthesia, Pain and Perioperative Medicine, practicing out of Rockyview General Hospital in Calgary, Alberta. He received his Anesthesia and Critical Care training at both the University of British Columbia and Stanford University. A published medical researcher and innovator, he has contributed to anesthesiology, critical care and pharmacology textbooks, and is currently focused on optimizing and standardizing the management of medically challenging patients presenting for and recovering from surgery.