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Swipe right for better health: How the Internet of Things can transform patient care

The Internet of Things (IoT) is a blend of the digital and physical worlds. It’s a system of internet-connected computing devices — mechanical machines (home appliances, vehicles) and digital objects (wearables) — that transfer data and ‘communicate’ over a network, without human interaction.

It’s estimated that billions of devices now belong to the IoT — all filled with thousands of sensors transmitting data in real-time:

  • lightbulbs that can be turned on with an app
  • kettles that can be set to boil with a finger swipe on your phone
  • internet-connected clothing (Google and Levi jackets)
  • driverless cars

Devices that wouldn’t traditionally be expected to connect to the internet now form part of the IoT’s growing inventory.

 

“IoT initiatives can create real impact in health care, from tele-monitoring to improve chronic disease care management to innovative health care payments,”  believes Dr Sneh Khemka,  Aetna International’s Vice President of Population Health Solutions and vHealth.  In this article, Dr Sneh explores how these connected devices are improving patients’ access to care, re-shaping treatments and delivering a better patient and caregiver experience.

“With the accelerating digital transformation in health care taking place now, several use cases of connected health care already exist” shares Dr Sneh Khemka. “From smart homecare and surgical robotics to the new FDA approved smart pill, Abilify MyCite — the health sector is embracing the IoT, and ready to grow with it.”

In 1999, British technologist Kevin Ashton created the term ‘Internet of Things’ to define a network that not only connects people, but also the objects around them. By 2016, worldwide spending on IoT technology was already $157bn and projected to be $457bn by the year 2020. So where are all these devices you might ask? While worldwide spend on retail IoT devices — the wearable Fitbit being a popular example — accounted for $2bn in 2017, the health care industry spend on IoT accounted for $5bn.

“The revolution is mounting with the boundaries of retail, health and fitness blending into a single goal — improving access to health care,” Dr Sneh explains. Fitbit alone boasted device sales of 60 million by March 2017 with 25 million engaged users as of January 2018. The device claims to help users stay active, fit and healthy through real-time tracking and biometric analysis of activity levels, sleep, food and weight.

“Through use cases we have witnessed how the IoT is improving access to health care and supporting patients in managing their chronic conditions, at a growing rate. Analysts believe a tectonic shift is imminent, with a growing role for the Internet of Medical Things (IoMT) and Internet of Healthcare Things (IoHT),” continues Dr Sneh.

The IoTis already helping patients manage their medications and monitor their long-term conditions.  Adding sensors to medicines or delivery mechanisms (for example, inhalers) allows doctors to keep track of whether patients are sticking to their treatment plan. One collaboration saw the creation of the automatic pancreas; a piece of software that uses Continuous Glucose Monitor (CGM) data, a predictive algorithm and a tiny DIY computer to control the actions of an insulin pump.

With well-known corporates and clinicians in strong partnerships to collaborate, innovate and create new technologies, patients are set to benefit from better quality, more integrated care experiences.

The first hurdle: Age, adoption and culture

“Mobile technology and wearable devices have been widely accepted by Millennials – those growing up as the technology emerged,” says Dr Sneh. “Even Gen X has given the world early adopters who are proud wearable owners — proactively choosing to measure their activity.”

“Other generations are less keen and use devices less frequently, if they do have them,” he continues. “Some are gathering data, but they’re not actively interpreting it. One of the barriers is perception and trust: where is my data going? Who has access to it?”

For the adopters, organisations such as Apple, Nike and Fitbit are actively using that data to help influence individual and collective behaviours. “The gamification of physical activity and competitiveness on a social level is very powerful for younger people – and it’s all designed to improve outcomes”.

“Despite some initial wariness and caution hindering adoption, we have seen attitudes soften towards the IoT in health care in the last four years — trust and acceptance continue to grow,” reveals Dr Sneh.

How can the IoT further transform healthcare?

Primary care and family doctors

Consumer tech may have been first to market, but the delivery of care is beginning to come to the fore. Services such as virtual health (mobile health) as well as connected ‘smart medicines’ have become more prevalent — improving access, diagnosis, treatment and long-term condition management.

“The IoT is going to grow exponentially in primary care in the next five years,” states Dr Sneh. “Access to general practitioners, day-to-day monitoring of long-term conditions, adherence to prescriptive medicines and routine monitoring of vital statistics will all be affected by IoT technology.”

Dr Sneh Khemka explains how the traditional primary care visit to the doctor’s office (family doctor or general practitioner (GP)) could soon morph into a virtual visit on a mobile device or PC supported by data collected by the IoT.

Treatment

The IoT is also beginning to play a huge role in secondary care (specialists and hospitals, for example) and tertiary care (social and community care) — where clinicians are able to utilise data to make real-time decisions for patients.  

“Connectivity within hospitals allows carers to provide more timely, accurate and appropriate decisions. 10 years ago, a doctor would need to hunt down a paper medical file. This would often result in delays — particularly with regards to lab tests. Now, lab microscopy results can be accessed instantly which allows for treatment decisions more quickly,” explains Dr Anushka Patchava, Manager, Global Commercial Strategy, Population Health, Aetna International.

Dr Anushka continues, “This new layer of connectivity helps hospitals to function more effectively,” he continues. “For example, live data accessed on iPads and medical devices enables doctors to obtain patient information at their fingertips; driving better evidence-based decisions at the point of care. And what does this mean for the patient?  Better outcomes.”

In another example, innovators have been experimenting with the use of activity trackers to gather lifestyle data on patients being treated for multiple myeloma. The electronic trackers and the patient will log activity level, fatigue and appetite with  all data saved to an app on their phone. Data will be gathered before, during and after treatment to monitor its effects, and inform further treatment decisions.

Prevention and planning

The IoT can also be used to monitor the incidence, prevalence and location of diseases (e.g. flu strains) as they occur, and potentially trigger early intervention to stop them spreading.

“With hospitals operating at near full capacity, and the media publishing ‘Winter Crisis’ stories - the IoT would be welcomed to help demand and capacity planning. Through identifying pressures in the system, and sharing this with managers in real-time, we can begin to shift the model from ‘crisis’ to ‘early intervention’” explains Dr Sneh Khemka, referencing the UK Secretary of State for Health and Social Care, Jeremy Hunt’s, recent decision on routine operations for January (2018) regarding the influx of ‘flu patients. “Forward planning has eased pressure [on the NHS] and it was all enabled by the IoT.”

However, despite innate optimism, barriers remain, preventing universal adoption amongst patients and clinicians alike, and the investment cost associated with technology isn’t surmountable in an already financially-stricken National Health Service. Plus, there’s the release of the new General Data Protection Regulation (GDPR), raising the issue of security and privacy.

Privacy

The issue of privacy is essential to address: who owns your data? And how is it protected? While there are immense benefits to clinicians being able to access and share data to improve treatment of particular conditions, there is also a real threat whereby this data could be stolen, used — or sold —for unethical, perverse purposes. Data protection remains a critical challenge for innovators as well as a hot-button issue preventing consumer adoption.

IoT and health care providers

The IoT is empowering health insurers and health care providers to personalise patient care. The adoption of technology sanctions doctors to collaboratively create a more tailored, multi-disciplinary care pathway for their patients.

Dr Anushka concludes, “Life choices, motivations and approaches to fitness and health are very person-centric and the IoT needs to be able to respond to that. Do I want or need a mindfulness and stress management app or a running app? Or both? Or neither?”

“Some health insurers are incentivising behaviours by offering discounted or free wearables to promote physical activity amongst members. This encourages individuals to engage, drives positive outcomes and can even lead to lower premiums. This also permits the health care ecosystem to gather anonymised data, gain insights, predict trends and drive early intervention to stop disease progression.”

What does the future look like?

The future promises some exciting innovations for health care and the IoT.

One of the most exciting is smart pills, which can transmit data from the human gut and are already heading to market (e.g. Abilify MyCite). Also on the horizon are electrical simulators that could accelerate bone growth and smart contact lenses which have been advertised to provide ‘super human vision’.

There is also the emergence of advanced machine learning, where computers collate data, and use pattern recognition algorithms to interpret this and, in some instances, produce second-by-second recommendations. This has been tipped to be a game-changer in Radiology, where futurists believe with AI technology and deep learning, radiologists may even be, one day, entirely replaced.

And finally, new blockchain technology — could this be the saviour of our workforce issues? A challenge embraced by Google’s DeepMind and others, working closely within the UK National Health System.

The ultimate aim of the IoT in health and health care can be described by this hypothetical story:

While at a party, a woman receives an alert message: a text, a call or the voice from a home assistant — as per her communications preference. The alert comes to her based on the combination of algorithmic analysis and processing of data from various sources converted into a single piece of information that recommends an action to avoid a health care episode: ‘eat something’.

On another occasion, the algorithm makes an acute assessment and an ambulance is sent directly to the women or her connected car may drive her to the closest ER based on an imminent, anticipated acute episode.

Who is responsible for your health?

Whatever futuristic technology arrives on our doorstep next, our day-to-day health remains our responsibility. Whilst impressive, the IoT can’t eat the vegetables, go to bed earlier, perform resonant breathing or do 10,000 steps for us.

Further reading:

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