Transforming healthcare with IoT

Speaking at Digital Government 2017, Eugene Farrell, Head of Information Services at the Office of the CIO within the HSE, provides an overview of IoT and healthcare.

Opening his address, Farrell emphasises the agility with which the digital revolution is ushering in change. “Two and a half thousand years ago, Heraclitus said that, ‘everything changes and nothing stands still’. That is no more evident than today where the world changes rapidly through the collaboration of people co-operating to put visions together.”

This, he notes, applies as equally to the world of health as anywhere else. It’s not so much a question of when change will happen (it already is), but how it will come about. “We need to imagine a world where IT can revolutionise healthcare. Technology is moving healthcare out of hospitals and community healthcare organisations and bringing it into to the everyday lives of patients using computers, mobile technology and networks.”

Connected health is aimed at maximising healthcare resources and it will increase flexibility of patient interaction with physicians and engagement with clinicians to ensure a better management of care. One HSE commissioned survey found that 60 per cent of physicians would monitor their patient’s health using a mobile app.

“We are using the technologies that already exist. We are using smart phones, remote sensors and the technology to allow this to happen. This changes how an individual will manage their healthcare and how we as clinicians work with people to create better opportunities for diagnosis, treatment and that sort of thing,” he observes.

Outlining that the future of healthcare is already revealing itself, Farrell provides three practical examples of how IoT is impacting on health in the world today.

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe a variety of medical terms. The National Respiratory Framework says that there is about 400,000-450,000 people who currently suffer from COPD in Ireland. 180,000 of those have moderate to severe disease. Applying new generation sensor technology, a wearable adhesive COPD patch can continuously gather diagnostic information such as heart rate, respiratory functions and physical activity or inactivity in real-time to allow us to make decisions for treatment and care.

Developed by Philips and the Dutch Radboud University Medical Centre Amsterdam, the sensor collects data, transfers it to the patient’s mobile device, through a Bluetooth mechanism, which is then uploaded to the cloud, allowing for the remote monitoring of patients and assessment of those episodes of care. “For us in healthcare, where we take IoT, we really need to create some business intelligence triggers that alert the doctor, possibly by pinging their smartphone, to say that ‘your patient here or at home needs intervention now’ and that their COPD isn’t working. Alternatively, the alert could tell the patient that they have been inactive and remind them that the prescription for their treatment is to get 30 minutes of exercise on a daily basis.”

Likewise, with diabetes, treatment requires blood analysis. Typically, individuals will prick their fingers and place them into a blood analyser which tells them what their glucose levels are and then self-inject insulin. However, a blood-glucose monitor, in the form of a small waterproof patch, can sit in a patient’s arm and record data pertaining to the blood glucose-level every 15 minutes for 14 days. This is then analysed by the reader and that information can then be uploaded to a mobile device containing a patient’s medical record.

“The continuous glucose patch, developed by Abbott Laboratories, is really the stock market of diabetes and glucose, providing data trends for 14 days, which are time and date stamped, enabling access to the history of their blood glucose. That is information which we currently depend on people to record in a written format and depending on where they are or what they’re doing in different circumstances, that record can be incomplete. IoT can benefit these people on a daily basis,” Farrell explains.

The future step for continuous glucose monitoring using IoT is subcutaneously inserting an insulin delivery device into a patient which is device connected to the monitor. This would reduce the need for self-monitoring, the pricking of fingers and daily injections of insulin by ensuring that the patient is monitored continuously.

“IoT isn’t just something that started in the last 20 years,
it has taken human collaboration over thousands of years to reach this point.”

The final example Farrell unpacks is related to hypertension or high blood pressure. Wearable devices, such as Fitbit and other fitness monitors, which record heart rates and blood pressures in real-time on a daily basis are being integrated into medical apps now to provide decision support for physicians across this case spectrum.

It’s estimated that 65 per cent of people over the age of 50 have high blood pressure and the majority do not realise. About 17 million people die every year from cardiovascular disease, predominantly from heart attacks or strokes. In Ireland, stroke has an estimated cost of €1 billion annually.

Farrell outlines: “The traditional way of diagnosing hypertension or high blood pressure is via a monitor fitted to the chest and collecting data for 24 hours. An individual would have had to go to the hospital to have that fitted and then to have it removed and the data sent away for analysis before providing a diagnose for high blood pressure. Finally, the individual would have to come to the hospital in order to receive treatment.”

However, the practical implication of IoT solutions mean that outpatient visits are reduced. “We have 400,000 people waiting in our outpatient services in the HSE, so if we can reduce the 65 per cent of over-50s needing to go to a cardiologist to have this done, it will provide huge benefits for the HSE.

“The IoT development that we would have relating to hypertension means that the patients who are at high risk of developing an adverse cardiovascular event could have a wrist monitor or watch feeding back to the wearer to ensure that intervention can take place. Conversely, it could be GPS tracked and an ambulance could be automatically dispatched.”

When we talk about IoT we need to consider where we are and what this means to us. IBM anticipates that there are going to be 4 million patients globally with health conditions who will use remote monitoring by 2020 and Gartner predicts that there will be 26 billion IoT devices by the same year. As a healthcare professional, Farrell indicates his preference for overlap with the sector.

“When we talk about IoT, there are significant challenges for its implementation within healthcare. We need to look at things like an individual health identifier. Once we gather all the information, we need to consider where we are going to put it and what we’re going to do with it. There’s no point in having charts and graphs from hypertension or glucose monitors if it doesn’t have any impact,” he emphasises.

Likewise, the HSE must consider patients, their personal data and the legislative requirements for data protection. “The biggest challenge for us, particularly within the HSE, over this last couple of weeks, has been cyber security and who will be able to access that information, the devices and the sensors.”

Concluding his address, Farrell reminds his audience: “IoT isn’t just something that started in the last 20 years, it has taken human collaboration over thousands of years to reach this point. We have entered upon a fantastic voyage.”

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