the many faces of iot (internet of things) in healthcare
DESCRIPTION
From The Guardian to Cisco, big business to small, it seems that everybody is talking about the Internet of Things — but what exactly is IoT and why does it matter? Taking a deep dive, we explore the many faces of IoT in Healthcare. Technology research and advisory company, Gartner, currently place the Internet of Things at the peak of inflated expectations and there are certainly challenges. But IoT also holds real promise for healthcare and it is already making an impact today. We demonstrate why the Internet of Things has a far reaching impact across all determinants of health and how it could lead to a broader model of healthcare. We look at some of the technologies that are available to buy or that are already in development today, whilst also exploring some of the very real challenges that integrating such technologies into healthcare presents. Finally, we offer some ideas about how you can get involved, whether you are a healthcare professional or not.TRANSCRIPT
Image credits included in presentation
THE MANY FACES
OF
IoTIN HEALTHCARE
INTERNET
OF
THINGS
IoT
Machine to Machine (M2M)
Web of Things
IPv6 may be adopted
Machine-Type Communication (MTC)
Intranet of Things
Claro Partners
Smart...SmartEnergy, SmartCity,
SmartGrid, etc.
Internet of Everything
Cisco
IoT evolving into WoT with integration into the Web
Application layer using standard web protocols
Industrial Internet
GE...
Replacement for SCADA & Telemetry
...also Industrial Internet Consortium
and others
Industrial Internet of Things
(IIoT)
Includes people, computers and data
Connected devices but within proprietary platforms
Internet of Things
...Vehicle (V2V), ...Infrastructure (V2I), ...Anything (V2x)
Vehicle to...
Ubiquitous computingThings that think
Hi, I’m...
but my friends call me...
A subset of IoT
but non-IP protocols are also
used
Embedded Internet
—including ‘living things’—Almost ‘anything’
connected to the internet regardless of location or other
physical restrictions.
Source: Gareth Baxendale, Head of Technology Services at the NIHR Clinical Research Network, WiFi enabled cows and the Internet of Things
Monitor
Analyse
Trigger Alert
Action
Process, analyse and communicate data
Collect and record data
Required action taken by device or human
The Internet of Things is process driven
26 billion
50 billion
75 billion
200 billion
Today, there are already more things connected to the internet than people
The human brain has 86 billion neurons
Flaming Lotus Girls Neuron by Ann Larie Valentine on Flickr https://flic.kr/p/75SmyS
Number of devices predicted to be connected to the internet by 2020
Cisco
Morgan Stanley
Intel
Gartner
What does this look like in
healthcare
?
Source: The Internet of Things Architecture, IoT-A
Hig
her
qual
ity
deliv
ery
Both little data...
Can affect whole communities and cities
Ability to act at scale
Ability to react with speed
...and big data
What can IoT do for healthcare?
Broader model of
healthcare
Prevention & Wellness
IoT has a far reaching impact across all determinants of health
Figure Source: Dahlgren, G. & Whitehead, M. (1991) The main determinants of health in Policies and strategies to promote social equity in health: Background document to WHO—Strategy paper for Europe
Being able to monitor and support a person free from ‘physical constraints’
will change the way doctors deal with patients.
Source: Gareth Baxendale, Head of Technology Services at the NIHR Clinical Research Network, WiFi enabled cows and the Internet of Things
Percentage of IoT devices found in healthcare
Percentage of IoT devices found elsewhere*
* Business/Manufacturing, Retail, Security, Transportation
Deployment of the Industrial Internet can help to drive down costs from clinical and operations inefficiencies by
roughly 25% or about $100 billion per year
30.3% 69.7%
Sources: Intel, A guide to the Internet of Things & General Electric Company (2012) Industrial Internet: Pushing the boundaries of minds and machines
The predicted global worth of IoT in healthcare
in 2025
$2.5 trillion
But is this just a utopian vision?
Image: © 2014 Debbie Stocker
“Have I taken my medication?”
Day 304: New Meds by kizzzbeth on Flickr https://flic.kr/p/bCBGFk Inyección de insulina by Sari Dennise on Flick https://flic.kr/p/7LNKnN; Lifeblood by Andrew Butitta on Flickr https://flic.kr/p/6g5zCD; Pills by David K on Flickr https://flic.kr/p/5Ya3x; By Alex on Flickr https://flic.kr/p/84G5UR; Pudge with his inhaler by Thomas Widmann on Flickr https://flic.kr/p/NiwcR
ELECTRONIC PILL DISPENSERS
Designed to remind individuals to take their medication at the right time and to ease the burden of complex medication regimens, electronic pill dispensers such as my uBox and MedMinder alert both the patient and their caregivers.
SMART WATCHES
Already designed to act as a health and fitness companion with all the capabilities of a fitness tracker, smart watches (such as Apple Watch) have the potential to integrate with multiple technologies, including those described here.
ELECTRONIC BOTTLES, CAPS AND POUCHES
Wireless smart pill bottles, such as Adheretech, measure the volume of tablets or liquid left in a bottle, while GlowCaps use light and sound to signal when it’s time to take your medication. Inhaler attachments, such as GeckoCap and Asthmapolis, monitor where and when an inhaler is used.
‘PHARMACY ON A CHIP’
Currently undergoing clinical trials, microchips drug delivery technologies administer controlled doses of a drug at precisely the right time via a microchip inserted on the waist. Still in its infancy, the technology holds promise for improved patient adherence managed remotely.
BIOMONITORING DRUGS
Ingestible sensors as small as a grain of sand exist today. Helius by Proteus Digital Health is a digital health feedback system. Embedded in a tablet, sensors communicate with a patch worn on the stomach. This then relays information to your phone, and further to your support network and care providers.
Available to buy or in development today...
“I want to track my own health and that of loved ones.”
Pregnancy by Titiana Vdb on Flickr : https://flic.kr/p/e4nLge Image by Darran Baldwin: https://flic.kr/p/fff9utRunner by Stuart Grout on Flickr : https://flic.kr/p/9HXRiX Bathroom scale by Magnus D on Flickr : https://flic.kr/p/8oDVuo
FITNESS
Designed to provide insights into our own health and motivate us to increasing levels of fitness, many of us are no doubt familiar with wearables that track our activity, such as the Jawbone UP, Fitbit, or more recently, Misfit Wearables’ Shine. LG and Intel also both produce smart ear buds that monitor your pulse.
HOME MONITORING
Home monitoring matters to both families and care providers alike as it enables independence. Systems such as Sensormind, Sonamba, Numera Libris and Libris+ use sensors to detect activity, analyse behaviour and automatically detect problems.
WELLBEING
Psychological wellbeing is vitally important and IoT can help. From wearables focused on breath patterns and fitness, such as Spire and Lumafit, to stress mapping bicycle helmets, such as MindRider. Or what about Olive, an intelligent bracelet that monitors heart rate, skin conductance, ambient light, motion and skin temperature?
FAMILY
IoT knows few bounds when it comes to supporting our loved ones. From the virtually invisible electronics of MC10 (above) to Pixie Briefs smart nappies, which analyse urine, check hydration levels and identify signs of UTIs. Kolibree is a connected and gamified electric toothbrush, while other wearables help keep track of your pregnancy.
CLINICAL SUPPORT
AliveCor is a heart monitor that attaches to your smart phone and is capable of recording ECGs. Physicians can use the technology to detect arrhythmic cardiac disease, irregular heartbeat or abnormal heart rhythm. AliveCor ECGs can also be automaticallly uploaded into select Electronic Health Records (EHR).
Available to buy or in development today...
“Can we get to the scene of an emergency faster?”
DSC08469 by perthhdproductions on Flickr https://flic.kr/p/daiBwA; Ambulance in Motion by Benjamin Ellis on Flickr https://flic.kr/p/6qa5ym; Paramedic at Vauxhall Helicopter Crash by R4vi on Flickr https://flic.kr/p/dM8x4M; London Air Ambulance by Smudge 9000 on Flickr https://flic.kr/p/4UQzUK
eCall (an interoperable, harmonised in-vehicle emergency call system) will be mandatory in all new car and van models produced within
the European Union by October 2015
Sources: HeERO Harmonised eCall European Pilot & Daily Mail (2014) EU to bug every car in UK with tracker chips
“We want to prevent and control infections.”
MCs Visit to the Hospital by kris krüg on Flickr https://flic.kr/p/cyVcQ; Washing hands (before shot)_0033 by James Emery on Flickr https://flic.kr/p/4xFfxG; Clean Hands by Arlington County on Flickr https://flic.kr/p/7zg6GJ; Poke by Thirteen of Clubs on Flickr https://flic.kr/p/9jfqsg
Sources: Postscapes, Intelligent M: Reducing infection through RFID; Postscapes, Hand hygiene monitoring system: HyGreen; BIOVIGIL; eWeek (2014) IBM, OhioHealth use big data to prevent infections in hospitals
To reduce healthcare associated infections (HAIs), companies such as Intelligent M, HyGreen, IBM in collaboration with OhioHealth, and
BIOVIGIL are creating sensor technologies and networks to monitor hand washing practices in real-time.
Inside the air ambulance on 17th from Rourkela to Bhubaneswar by Sadasiv Swain on Flickr : https://flic.kr/p/ovrc7s; EEG with sleeping boy by Jemaleddin Cole on Flickr https://flic.kr/p/d8szf; A mother’s hands by Cheryl on Flickr https://flic.kr/p/5QRFfo; Canberra Hospital Walk-in centre staff at work by DIBP images on Flickr https://flic.kr/p/9tTxUR
“Is it possible to develop a predictive lifesaving approach?”
The LIFEPAK 15 portable heart monitor and defibrillator allows medics in the field to capture patient data and send this information directly to the hospital. Such M2M technology enables faster response times. It also ensures that patients are routed to the correct hospital for treatment, appropriate caregivers are notified and swift diagnosistic decisions are made.
IBM are working on a host of predictive solutions designed to improve healthcare in real-time, enable faster interventions and save lives.
Project Artemis, developed in collaboration with the University of Ontario Institute of Technology and the Toronto Sick Kids Hospital, allows subtle changes to be detected in nosocomial infected infants 12 to 24 hours before any outward signs appear.
Other projects aim to detect complications in brain injured patients, stroke victims and critical patients in ICU before they occur.
Sources: PTC (2014) Saving lives: ambulances get connected to the IoT; M2MNow (2011) Multi-tech cellular development platform and Physio-Control combine to save lives; IBM Big data in healthcare: real-time health monitoring and intervention; IBM (2013) UCLA relies on breakthrough ‘big data’ technology from IBM to help patients with traumatic brain injuries; IBM (2010) IBM Analytics helps medical
researchers detect complication in stroke patients; IBM (2013) Emory University Hospital explores ‘Intensive Care Unit of the Future’
“We want to increase medical device utilisation.”
CT Scanner, Crash Cart by Civilian Scrabble on Flickr https://flic.kr/p/vUki6; treat2 by MilitaryHealth on Flickr https://flic.kr/p/cRK86s; Big MRI by liz west on Flickr https://flic.kr/p/kJ4Pa
Using IoT, Varian Medical Systems have seen a:50% reduction in mean time required to repair connected devices$2,000 reduction in service costs for each problem resolved remotely20% fewer technician dispatches worldwide
105,000 CT scanners and MRI machines
There are
globally
Sources: Forbes (2014) 3 ways the Internet of Things is revolutionizing health care & General Electric Company (2013) The Industrial Internet @ Work
By connecting medical devices and machines to the internet it becomes possible to monitor in real-time, run remote diagnostics, provide virtual hands-on support, automate replenishment and analyse utilisation.
“As a nation, effective public health policy is important.”
Crowds by H. Michael Miley on Flickr https://flic.kr/p/f9Jjxv; Driving Cars in a Traffic Jam by epSos.de on Flickr https://flic.kr/p/9w8eWL; Map of London sewers Westminster by Matt Brown on Flickr https://flic.kr/p/83ZKDt; GWU School of Public Health Building 42840 by Ted Eytan on Flickr https://flic.kr/p/nUc1et
Underworlds: smart sewage system
Source: Wired UK (2014) ‘Smart toilets and sewer sensors are coming’
Examining aggregated wastewater across several cities, the Underworlds project is designed to establish the techniques and technologies required to deploy a near-real-time network of biosensors, automata and purpose-built labs.
Decorated sewer cover by Chris Schrier on Flickr https://flic.kr/p/9jVFCd
Once realised, this will enable real-time public health strategies, inform policy, and provide greater insight into urban health.
Sparks to ignite a flame
Tea candle in the dark by Markus Grossalber on Flickr https://flic.kr/p/du6AgS
Reputedly one of the slowest adopters—second only to shipping
The bow of Majestic Maersk by teralaser on Flickr https://flic.kr/p/gbi4Kg
Healthcare is a late and slow adopter of technology
Sources: The Healthcare Industries Task Force (2004) & Tim Jones, Board Member West Midlands AHSN (2013)
An unofficial online survey of WiFi availabilityfor frontline NHS staff found
only 23% had access to free WiFi
Others were denied access even where WiFi was available or had to pay for it
Source: Professor Jonathan Kay, Clinical Informatics Director, NHS England (2013)Survey run by NHS Hack Day community with support from HANDI Health, Tactix4 and openGPSoC; 650 respondents Free WiFi by Sébastien Bertrand on Flickr https://flic.kr/p/juq2v
Information governance challenges are significant
Interoperability | Data integrity Access control | Data quality | Security
and Compliance
Back to Work by Death to the Stock Photo
Source: Almost Human, ‘Arrhythmia’, Season 1, Episode 6
Source: Wired (2014) It’s insanely easy to hack hospital equipment
2 year studyAll medical equipment: radiology, MRI, ultrasound, mammography systems, cardiology, oncology, lab systems, surgical robots, fetal monitors, ventilators, anesthesia
It was possible to deliver random shocks to a patient’s heart, remotely manipulate drug dosages, change radiation exposure limits in
CT scanners and alter digital medical records
The stakeholder landscape is challenging—more often than not, the economic buyers and end users are not the same but both need to be convinced!WBS International Healthcare Case Competition 2014
Reimbursement for digital health interventions is still a work in progress. Steve Blank
Sources: Rock Health (2014) Reinventing Life Science Startups Part II: The rise of digital health & WBS International Healthcare Case Competition Participant Briefing: Part 1
Business Model Canvas: Business Model Generation
How will change happen?
How will change happen?
Adoption of industrial
internet by healthcare
How will change happen?
Adoption of industrial
internet by healthcare
Consumer adoption and
demand
Change is inevitable
Adoption of industrial
internet by healthcare
Consumer adoption and
demand
Make your own healthcare role IoT enabled
Educate yourself on what’s available. There’s usually a tech solution out there somewhere!
Lobby for change and access to IoT in your healthcare environment
Use IoT for your own benefit
Make a note of patient recommendations and share these with your colleagues
Find an executive sponsor or innovation champion to support you
Recommend IoT solutions to patients
I’m a healthcare professional.
What can I do?
1
2
3
4
5
6
7
Lobby for change with your doctor and consultant
Use Google to learn about Healthcare IoT solutions
Use IoT for your own benefit
Become politically active
Join a patient group
Buy IoT presents for people
Recommend IoT solutions to friendsI don’t work in
healthcare. What can I do?
1
2
3
4
5
6
7
8
Start an IoT business
If you would like support to develop your Internet of Things strategy or would like to
understand the disruptive nature of these new technologies and business models, contact the
Stocker Partnership and get started today!
+44 (0)24 76 100 193
STOCKERPARTNERSHIP
The Stocker Partnership
is a strategic innovation
consultancy
We help organisations to
create and exploit new
opportunities
024 76 100 193
Matt Stocker
Debbie Stocker
www.stockerpartnership.com
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BUT WE ARE
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Illustrations by Stina Jones (stinajones.co.uk), and Matt Stocker