Guest Column | December 22, 2014

The Internet of Health: The Future Will Bring Life-Changing Advancements For Health And Wellness, But Data Challenges Will Remain

HITO Ahmad Kasmieh, Alere Analytics

By Ahmad Kasmieh, CTO, Alere Analytics

The Internet of Things (IoT), once applied to “smart devices” that have the ability to transfer data over a network without requiring human-to-human or human-to-computer interaction, has since evolved into the convergence of wireless technologies of all kinds, connecting and transferring data to and from the Internet. The IoT brings the promise of great opportunities, offering new commercial services and creating new business models.

However, the information is vast and technology hurdles from security, privacy, and processing will continue to impede progress. Alfonso Velosa, research director of IoT at Gartner, acknowledges that fundamental change is coming, but at a distant horizon of 10 or 20 years out. Velosa goes on to say that the interest in IoT is happening now because all the necessary ingredients, the semiconductors, sensors, software, and communications “have all come to align us on this path.”

True, technology has made great strides in processing big data from information collection and communication, but the IoT – which is almost limitless in information sources from your “smart refrigerator” to your Fitbit – ultimately does not make sense to be hosted all in the cloud without any, or at least some, organization, and structure.

With the advent of social media and user-generated data through devices, wearables, and mobile apps, one of the gradual evolutionary paths of the IoT is the Internet of Me. Personalization and ease of use are pivotal to adoption, and over the last few years, people have actively collected preferred content to suit their interests from shopping habits to their health tracking. However, this data currently has many masters, with one company owning your music library and another your online purchases, to multiple health networks housing your medical records.

The IoT is too large for any individual human or organization to effectively manage, interact or even be concerned with. Instead, the IoT should be classified into smaller context aware Internets of domains. Each Internet of Domain (IoD) pertains to an ecosystem of smart things that address as a whole or in part specific needs or functions within a specific domain or realm. Smaller instances of IoDs could be grouped to form larger IoD and ultimately grouped to form the IoT.

Instances of IoDs may materialize as circles that exist independently yet interact with each other when the opportunity arises due to proximity or event trigger. This classification could make the IoT more manageable and more tailored for individuals, groups and specific industries. Examples of an IoD could be:

  • Internet of Entertainment (IoE), which is dedicated to the distribution and content consumption of media such as TV, movies, music, concerts, travel, etc.
  • Internet of Health (IoH), an IoT domain dedicated to human health and wellness that spans care, monitoring, diagnostics, medication administration, fitness, etc.
  • Internet of Commerce (IoC), an IoT domain dedicated to conducting commerce spanning personal or corporate interaction with eCommerce and brick and mortar stores.

Each of these would have its own unique technology infrastructures that can manage data collection, information processing, aggregation, and actionable analytics, but can also overlap and coexist alongside each other at appropriate intersecting points. For example, the IoE and the IoH can overlap when a person accesses their music playlist that they use for their morning run, which they are also tracking and sharing on Facebook. Another example would be when the IoH and IoC overlap when a person is at a grocery store and is offered products that meet preset dietary preferences in the IoH. The IoE, IoH, and the IoC possibly existing as parts of an individual’s Internet of Me.

The Internet of Health (IoH): Opportunities and Challenges
Over the past several years there has been a fundamental shift in data collection, processing, and management blurring the lines between “owned” and “shared” data. With mobile applications at everyone’s fingertips, patients are now able to get more involved with their healthcare. They are able to access medical records, track their vitals with portable devices, get diagnostic lab tests conducted in the comfort of their homes, and monitor their health-related habits with Web-based applications on smartphones.

The FDA estimates that 500 million people worldwide will use a health app by 2015, and experts predict that by 2017 the global mobile health and wellness app market will be worth $26 billion. Wearables and smart apps are the first step, but on the horizon there could be a multitude of new health technologies such as implantable smart devices designed to improve the human function and to facilitate its interaction with other humans and systems to receive health services.

The goals are still the same: to ultimately extend human life, improve its quality, and increase happiness. The clinical workflows should then be ready to account for those technical additions to the human physiology and psychology to maintain an ever-growing holistic view of what human healthcare should cover, but until then the status quo reflects a fragmented system of disparate data silos, with little to no communication or interoperability between them.

Becoming an active participant in one’s own healthcare can be a very effective method to help improve and manage chronic care. Chronic disease accounts for the bulk of all healthcare costs in the U.S. Seven out of every 10 Americans who die each year (more than 1.7 million people) die of a chronic disease and 80 percent of chronic diseases are preventable.

Today, chronic diseases such as diabetes, cardiovascular disease, COPD, and hypertension are among the most prevalent, costly, and preventable of all health problems. Further, once data can be collected through electronic health records (EHRs), devices, and mobile apps, there are more advanced technologies that can help clinicians to monitor and better manage their patients’ health and wellness, such as clinical decision support (CDS) and analytics.

CDS can provide evidence-based recommendations in real-time and provide the necessary information for clinicians to implement more timely interventions for their high-risk and at-risk patient populations. Further, mobile apps integrated with CDS and analytics could deliver helpful reminders, behavior modification suggestions, and strategies for improving user health.

The new technology opportunities for managing chronic conditions and keeping healthy patients well are industry-changing and this healthcare transformation is already in progress. However, there is still much to consider. Building this new domain, the IoH, will require a great deal of technology investment. At the center of the issue is the data; who owns it, how it is collected, and how it can be protected and kept private while simultaneously allowing it to be shared.

An instance of an IoH could be personalized and dedicated to a single human, while other instances of the IoH could be setup by physician practices and payers as part of their businesses. It would be too much to expect from each smart device in a personal IoH to:

  • communicate with all other devices in a personal or external IoH and react if needed
  • defend itself against intrusions, data breaches and eavesdropping
  • analyze, secure and back up its collected data, and so on and so forth

We face similar challenges in our systems and networks today, and we may consider devising similar techniques to address those challenges. Such techniques would include wearable, future implantable, devices to provide the personal IoH the necessary network, firewall, and storage, as well as a Central Personal Processing Unit (CPPU) that can collect data from disparate IoH sources, analyze it, and manage their vast interactions and functions.

Communication and collaboration within and between patients, caregivers, and clinicians are key to the IoH success. Data communication needs to be bi-directional, not only pushed from a personal IoH to an authorized physician practice IoH, but in order for the data to be actionable, critical information needs to be sent back to the patient and clinician IoHs with real-time – and potentially life-saving – alerts and recommendations.

In addition to technology hurdles, there are human issues as well. Even if patients assign permission rights to their health data to their physicians, they are not always forthcoming. In a recent study that looked at real-world, patient-controlled access to electronic health records (EHRs), almost half of the patients who participated in the study withheld clinically sensitive information in their EHR from some or all of their healthcare providers.

This is where the tension really resides, the constant balancing act of having the convenience of data access and sharing of health information vs. security and privacy concerns. Some information is easy to share with a clinician, but other information, even if it is clinically relevant, is sometimes too difficult and embarrassing to divulge. Therefore in addition to technology infrastructure hurdles, there also needs to be a fundamental paradigm shift in human behavior in order for patients to evolve, adapt and ultimately embrace what the IoH could offer them, a secure Internet domain that can host all health information and push important health data back to the patient and their healthcare providers.

Today, healthcare stands at a crossroads. Technology advancements will enable tremendous progress in collecting, aggregating and sharing data, and there is an exciting future ahead. Mobile apps and wearables will soon be joined by smart implants and prosthetics, such as biomechatronics, and will require Big Data analytics to process and analyze these critical data points. Maybe, one day, this can all be found and accessed in the (future) Internet of Health.