The “Internet of Things” is coming. If you had asked me a few years ago what that meant, I would have had no idea. It sounded to me like a futuristic sci-fi fantasy world, but the more I’ve learned about it, the more intrigued I’ve become about what it means for our future. It’s going to impact every industry that exists, and likely create new industries that we can’t even anticipate yet. In this blog, I explore what the “Internet of Things” actually is, and how health systems should be envisioning themselves as a part of this future.
When I was an undergraduate student at the University of Michigan, I got a part-time job assisting a couple of PhD students with their research on wireless sensor monitoring of structures, in particular, wind turbines. These brilliant guys would program small sensors that fit in the palm of your hand to capture movements generated by the wind forces pushing on the turbines. By placing the sensors throughout the height of the turbine, they could remotely capture the data needed to more easily predict when the movements might cause the structure to fail (in other words, catastrophically break apart) so that someone might put measures in place to prevent costly and dangerous damage.
Figure 1. Me, standing in front of the wind turbines where we tested wireless sensor monitoring in rural Northern Germany in 2008
Caught up in my own world of trying to finish my senior year, I didn’t realize that the work these guys had started was really a precursor to the connected world that would exist in the near future. The typical smartphone sitting in the average consumer’s pocket today has around a dozen or so sensors built in to provide data to the millions of apps at our disposal1. I’m amazed at the innovations that are already available to consumers, and I am intrigued to see where the continuous growth in technology takes us. With the rate of tech industry development, it’s impossible for any of us to ignore that what some are calling “the internet of things” is coming.
What is the internet of things?
A tech-savvy friend of mine once referred me to a technology blog that explores how severely the potential impact of these technologies is systematically underestimated, even now. It describes the internet of things as “a vision based on the prospect of processors becoming so cheap, miniaturized, and low-powered that they can be embedded, along with power sources, sensors and actuators, in just about anything, from cars and light bulbs to clothing and pills2.” Put simply, it can be thought of as a network of sensors that can collect data from everyday objects and make that data easily accessible for use in driving real-world decisions and operations. Intel provides a great visual framework of the internet of things, shown in Figure 23.
Figure 2. The Intel® Intelligent Systems Framework depicts a world connected through the internet of things
None of the components in this diagram is independent of any of the others; each piece of the system can contribute to the optimization of the others by making its data available for use. The intelligent hospital can take the obvious route to plug in to the data of intelligent medical devices for clinical use, but it can also adopt operational practices that rely on logistics optimization, energy management, or responsive systems to optimize non-clinical operations.
What are its applications in healthcare?
Today, tech companies are racing to develop applications across every industry that capture data and engage users to optimize the way we operate and live. Examples include connected vehicles that can monitor a driver’s activity and surroundings to prevent collisions, home monitoring systems that allow homeowners to remotely or automatically control their heating and cooling patterns, and wearable technologies that give us a better understanding of our sleep patterns and health or fitness activity.
Some of these areas are even starting to overlap, as evidenced by Ford Motor Company and Henry Ford Health System’s Connected Health App Challenge. The challenge is a competition that asks employees from both organizations “to submit concepts that utilize the automobile and wearable devices as components providing an effective health and wellbeing program for customers and patients of all ages and conditions4.” So now, not only are we wearing devices that can gather health related data and driving cars that can prevent collisions, but perhaps we are driving cars that can warn us to pull over before falling asleep at the wheel or an imminent seizure, or that send important health data to our doctors during our morning commute.
Getting data to our doctors is one big application that has people excited, particularly when it comes to helping patients with chronic conditions. Data collection through a wearable device for insulin readings, cardiac activity, or blood pressure monitoring can help fill in the gaps between doctor visits and can enable a provider to see a fuller picture of a patient’s health5. And although the popular iWatch®, Fitbits® and Garmin® watches of the world currently are aimed more at consumers concerned with weight loss or personal fitness goals, the idea of similar devices being used to monitor chronic conditions in the near future is more than plausible. Going a step further, some speculate that these devices will at some point actually be implantable6, which is something I can’t decide is either amazing or terrifying. Health systems are going to have to be prepared to integrate themselves with these technologies, but also through defining processes and policies for how to handle and interpret data that patients will be able to provide when using these devices.
Figure 3. A prototype “SMART Belt” that can monitor for seizure related activity in epileptic patients7
Wearable technologies are probably the most obvious health application that has gained popularity in the past couple of years, but there are applications beyond consumer devices that the internet of things can provide. The sheer volume of data made available allows for sophisticated analytics that can drive decision-making in an organization’s operations. One company capitalizing on this is called Virtual Radiologic Corp. (vRad), described as follows in an Accenture Technology report:
vRad has collected data from more than 22 million X-ray, MRI and tomography readings and patient studies. Now it has launched an analytics service that benchmarks radiology equipment utilization and results. Besides improving staff scheduling, providers can discover whether radiologists are over- or under-utilizing advanced imaging equipment. They can then shift the use of expensive MRI equipment to situations where it is likely to result in positive, and therefore revenue-producing, diagnoses. vRad is an example of the kind of information service that product manufacturers may want to offer on their own or through a partner.8
A health system providing radiologic services may be interested to know about the capabilities of companies like vRad, or perhaps even one day be able to replicate the analytics in-house to create its own optimized operational practices.
Even in non-clinical areas, hospitals are beginning to implement new technologies that provide data driven solutions for reducing waste and optimizing resources. In the last year alone, I’ve worked with health system leadership teams to develop processes that include smart inventory systems that can notify the supply chain department when linens, scrubs, or clinical supplies are low in a given area, and automated temperature monitoring systems that track storage conditions for sensitive materials, and real-time tracking systems that can tell you where and when a particular piece of equipment or staff person was last. These are just some of the examples available on the market today – implementing the technologies to capture these pieces of data is step one – developing the operational processes to do something intelligent with that data is what must follow to really take advantage of the connected world we are entering.
Not everyone might be on board yet
Whenever there is talk of changing the status quo, there are critics who speak out against the practicality of using these technologies and the data they provide. Wearable technologies, in particular, seem to be taking a lot of heat for not being reliable sources of clinical data. At this point in time, perhaps there is some truth to that – I know my own smartphone pedometer’s accuracy isn’t always spot on when I check it. However, as technology advances and devices are designed to be more clinical-grade, it will be important for providers to be willing to accept them as viable sources of real clinical data.
In a short article citing multiple healthcare leaders’ criticisms on wearable devices, one quote stood out to me in particular: “Physicians don’t need all the data… They just need the right data at the right time to take action9.” I understand that historically, providers have had to make clinical decisions based on their observations and what their patients are able to tell them about their symptoms. But if more data is made available, why not use it? Why not consider the full spectrum of information available about a patient’s health situation, when it could fill in the gaps outside of what a provider can directly observe? What’s more, patients who feel empowered by and embrace the use of these devices will grow to expect that their contribution of data be considered as part of their clinical care.
Indeed, historical observation of the relationship between clinicians and their patients has shown dramatic changes over the past decades as both medical technology and behavioral sciences advanced. One study states, “Although the modern clinical encounter has undergone a major paradigm shift from a paternalistic clinician-centered interaction to a more symmetrical patient-centric partnership, further enhancement of the clinician’s acceptance of the important role of the patient will be critical to facilitating patient empowerment10.” What better empowers a patient than giving them the ability to capture and view their own health information, and even see the immediate impact a treatment plan or behavior change may make on their outcomes? The attitude of “we’ve always done it this way” is not one that will transform healthcare. Providers and health systems are going to have to be open to exploring new sources of clinical data made available by emerging technologies in order to be at the forefront of clinical care in our connected world.
Why should health systems care?
Speculation on the growth and market potential for connected applications and services has been estimated at $10-20 trillion in global GDP over the next 20 years11. Forbes Magazine estimates that by 2020, the healthcare segment of this market will be around $117 billion12. If we are underestimating the potential of software driven innovations as some think, these numbers could be even larger. The point is, the trend is not going away – smart technology will be a given in our future, so the industry leaders of tomorrow will be the ones who position themselves to integrate with it today.
In healthcare, there already exist a plethora of technologies in various states of maturity – wearable devices that are perhaps not yet ready to be used as clinical-grade, beta-versions of monitoring devices, inventory tracking systems already being utilized in hospital operations, etc. The innovations we will see in the coming years will push these to new heights and give health system operations the opportunity to be leaders in adoption of the connected world empowered by the internet of things. Willingness to explore the opportunities presented by this world will be the differentiator between those who leverage the capabilities for optimization and those who stick to what’s been just good enough so far.
1T, Nick. “Did You Know How Many Different Kinds of Sensors Go inside a Smartphone?” Phone Arena. 6 July 2014. Web. 21 Jan. 2016. <http://www.phonearena.com/news/Did-you-know-how-many-different-kinds-of-sensors-go-inside-a-smartphone_id57885>.
2Rao, Venkatesh. “A New Soft Technology.” Breaking Smart. Ribbonfarm, Inc., 07 Feb. 2015. Web. 25 Jan. 2016. <http://breakingsmart.com/season-1/a-new-soft-technology/>.
3Ram, Satish. “Internet-of-Things (IoT) Advances Home Healthcare for Seniors.” Embedded Intel®. Extension Media, 2016. Web. 21 Jan. 2016. <http://www.embeddedintel.com/special_features.php?article=2721>.
4Shine, Kim North. “Ford Motor Co. & Henry Ford Health System Bringing Health Care to the Car.” News and Research. Henry Ford Health System, 18 Jan. 2016. Web. 20 Jan. 2016. <http://www.henryford.com/body.cfm?id=46335&action=detail&ref=2375>.
5Davies, Michael A.M. “Wearable Tech Can Extend Clinical Analytics.” Information Week Healthcare. 12 Aug. 2014. Web. 22 Jan. 2016. <http://www.informationweek.com/healthcare/mobile-and-wireless/wearable-tech-can-extend-clinical-analytics/a/d-id/1297924>.
6Martin, James A. “13 Wearable Tech Trends to Watch in 2016.” CIO. 23 Dec. 2015. Web. 22 Jan. 2016. <http://www.cio.com/article/3017995/wearable-technology/13-wearable-tech-trends-to-watch-in-2016.html?page=2>.
7Comstock, Jonah. “Mobile Epilepsy Sensors: Student-led, Stopped, or Stalled.” MobiHealthNews. 17 May 2013. Web. 22 Jan. 2016. <http://mobihealthnews.com/22450/mobile-epilepsy-sensors-student-led-stopped-or-stalled>.
8Daugherty, Paul, Prith Banerjee, Walid Negm, and Allen E. Alter. “Driving Unconventional Growth through the Industrial Internet of Things.” 2015. Web. 20 Jan. 2016. <https://www.accenture.com/us-en/_acnmedia/Accenture/next-gen/reassembling-industry/pdf/Accenture-Driving-Unconventional-Growth-through-IIoT.pdf>.
9Mottl, Judy. “Healthcare Leaders Bearish on Wearables for Patient Care.” FierceMobileHealthcare. FierceMarkets, 2 Nov. 2015. Web. 27 Jan. 2016. <http://www.fiercemobilehealthcare.com/story/healthcare-leaders-bearish-wearables-patient-care/2015-11-02>.
10Rozenblum, Ronen, Paula Miller, Disty Pearson, and Ariane Marelli. “Information Technology for Patient Empowerment in Healthcare.” Google Books. Walter de Gruyter Inc., 2015. Web. 27 Jan. 2016. <https://books.google.com/books?hl=en&lr=&id=0PJeCAAAQBAJ&oi=fnd&pg=PA3&dq=patient%2Bengagement%2Bin%2Bhealthcare&ots=m8F4WcrPzq&sig=l8wJKYY-E9NsOolQ9l2DlqRf9Wc#v=onepage&q&f=true>.
11Press, Gill. “Internet of Things By The Numbers: Market Estimates And Forecasts.” Forbes. Forbes Magazine, 22 Apr. 2014. Web. 20 Jan. 2016. <http://www.forbes.com/sites/gilpress/2014/08/22/internet-of-things-by-the-numbers-market-estimates-and-forecasts/#2715e4857a0b1658ba602dc9>.
12McCue, TJ. “$117 Billion Market For Internet of Things In Healthcare By 2020.” Forbes. Forbes Magazine, 22 Apr. 2015. Web. 20 Jan. 2016. <http://www.forbes.com/sites/tjmccue/2015/04/22/117-billion-market-for-internet-of-things-in-healthcare-by-2020/#2715e4857a0b72b86f482471>.
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