The “Things” That Our Internet Can Do For Our Healthcare

Through IoMT technology, the advancement of healthcare as we know it may still be in its early stages.

In everyday usage, the idea of the Internet and the World Wide Web have somewhat developed into interchangeable terms – as if the World Wide Web is the outdated jargon for what we now are more likely to call the Internet. But our level of connectivity to the actual Internet, which we, from a truly technical standpoint gain access to through “The Web,” has grown (and continues to grow) to a point where we are seeing that the scope of Internet utilization goes well beyond the access of the Web’s pages and its emailing capabilities. The Internet of Things (IoT), or the interconnection via the Internet of various computing devices that embedded in our increasing number of tools and objects, enables us to send and receive data through the use of these devices.  

The Internet of Medical Things (IoMT) then, defined by the Alliance of Advances BioMedical Engineering (AABME), is an amalgamation of medical devices and applications that can connect to healthcare information technology systems specifically while using these same networking technologies. Collectively maintained as a means of reducing unnecessary hospital visits and the burden on healthcare systems by connecting patients to their providers and allowing the transfer of medical data over a secure network, the IoMT has grown into a being that has contributed to our new reality, a reality in which the ultimate technological cliché, “The future is now,” may finally be the standard.
“We are in a place where, with the combination of 5G and mobile technology, these ‘things ‘are happening today, not tomorrow,” said Charles Alessi, Chief Clinical Officer, international, with the Healthcare Information and Management Systems Society (HIMSS), a global nonprofit organization that advises and provides thought leader support for the transformation of the health ecosystem through information and technology headquartered in Chicago, IL. 

With the expanding net of connectivity, benefits and consequences are sure to be realized. 

Examples of IoMT

According to an analysis by Frost & Sullivan, a California-based business consulting firm involved in market research and analysis, growth strategy consulting, and corporate training across multiple industries, the global IoMT market was worth $22.5 billion in 2016 and is expected to reach $72.02 billion by 2021. The IoMT market consists of such products as “smart” devices, including wearable technology (think Fitbit or Apple Watch) and medical monitors, that are used by industry and patients in the clinical setting, home, and community that are associated with telehealth and other services.
In the context of value-based care, and specifically transition from volume-based care, IoMT allows for providers and payers to better align around a shared-risk model, according to Dr. Javed Mostafa, PhD, professor of the Information Science & Biomedical Research Imaging Center at the University Of North Carolina at Chapel Hill School of Information and Library Science.1 Some of the myriad examples that exist today in the IoMT space include:

1. “Segmented Care”2:

• On-Body Segment – This can be broadly divided into consumer health wearable technology, such as those devices for personal wellness or fitness that typically are not regulated by health authorities but may be endorsed by industry experts for specific applications, as well as medical and clinical-grade wearables that are regulated and certified or approved for use by authorities including the U.S. Food & Drug Administration. These devices, such as those that detect falls or provide chronic pain relief by tapping into sensory nerves, may require a physician’s prescription. 
• In-Home Segment – includes personal emergency response systems connected to live call-in centers; remote patient monitoring for the management of chronic diseases, follow up on discharged patients, and medical management; and telehealth virtual visits through video consultations, evaluations, and testing.
• Community Segment – includes mobility services that allow passenger vehicles to track health parameters during transit, emergency response intelligence to assist first responders and other care providers, kiosks that dispense products or provide connectivity services to providers, point-of-care devices that are used by a provider outside of the home or traditional care setting, and logistic services that involve the transport and delivery of healthcare goods and services that are needed by providers. 
• In-Clinic Segment – includes IoMT devices that are used for administrative or clinical functions and that allow for providers to be located remotely while a device is being used by qualified trained personnel, such as cloud-based examination platforms for patient assessment at any point of care, digital stethoscopes, and telehealth examination devices for the heart, lungs, and other organs.

IoMT-enabled devices can also assist in managing and tracking product inventory, staff productivity, patient flow, and environmental monitoring (for example, facility temperature).

2. 5G Wireless (or 5th Generation of Cellular Network Technology): A faster connectivity to devices that speeds up the kind of data and volume of data that can be analyzed as well as the number of devices that the Internet can be connected to at one time. According to a study by Gartner, a Connecticut-based research and advisory company, 66 percent of businesses plan to deploy 5G by 2020.3
3. The Digital Twin: A digital replica of a living or non-living physical entity, for example, Google Maps is a “twin” of roads, or the Stanford University Living Heart Project.4 According to the AABME, these types of software concepts will serve as proxies for billions of individuals and monitoring devices by the end of the decade. For Alessi, they represent what might be the IoMT’s greatest benefit and key point of further advancement – preventative medicine. 
4. Organ Banking: According to the AABME, from the donor to the recipient, data tools will elevate the ability to monitor and control the history of the donated organ, including organ preparations and handling, short-term organ storage during shipping, cryogenic storage in biobank facilities, organ reconditioning, and the organ’s history after transplantation to help evaluate transplantation success.5
5. Surgical Robots: Autonomous surgical robots that perform procedures remotely and represent a rising segment of the industry, with investments from such companies as Stryker Corporation, Merck Co. & Inc., and Smith & Nephew.6,7

Appreciations & Tradeoffs

As with anything, the presence of IoMT brings with it some pros and cons. The advantages include increased access between providers and patients, as long as patients are willing to participate through a screen as needed, and the potential to predict disease processes through the utilization of artificial intelligence and machine learning. The inherent challenges include increasing risks or privacy and a need for healthcare providers to ensure that they acquire consent for each and every point of data collection of the patient along the healthcare continuum.
“With more connected systems helped by the arrival of 5G and by the fact that we are now more proficient in managing data, and large amounts of it, the potential impact of the IOMT to increase the number of data points is enormous,” Alessi said. “We have to be conscious and very careful about stewardship towards the data we collect because clearly there are some risks associated with such widely distributed systems. And that is associated with better cyber hygiene – cyber security becomes significantly more important, especially from the need to be careful about secondary use of data and how we use data as individuals.” 

With the continued increase of data collecting, the building of trust among patients remains paramount, even if it should be relatively easy to attain, Alessi added. “By definition, it is a free market and therefore one would assume that patients trust the providers they have chosen,” he said. “They can always go somewhere else if they don’t. But we have aging populations in most of the developed countries, which inherently means that we are going to find more things wrong with more populations and increasing multi-morbidity. Privacy is particularly important because the more data that we collect, the more susceptible we are to breaches and leakages of that data. We need to make sure that we are acquiring consent for any data gathering and using that data only for the purposes that the consumer has allowed us to use it.”
As a matter of trusting technology among patients, and therefore trusting providers to be in possession of technology that will impact one’s care planning, Alessi believes that patients are becoming more comfortable and that the perceived disconnect between patient and provider due to the use of technology is a bit of a misconception, according to Alessi. “I would suggest that there’s not a barrier,” he said. It is relatively easy to educate or inform people about the potential that exists to send data to a source where it can be analyzed appropriately and exacerbations of their conditions can be identified more quickly through the use of artificial intelligence and machine learning. But no matter where you are in the world, it becomes difficult when you are talking about wellness data. That’s why larger organizations throughout the world have used neutral, third-party organizations to manage data on the consumers’ behalf to ensure that data is being handled properly and being used appropriately.”

References

1. Internet of Medical Things Ushering in ‘New Framework for Value-Based Healthcare.’ TechWire. 2019. Accessed online: www.wraltechwire.com/2019/11/04/internet-of-medical-things-ushering-in-new-framework-for-value-based-healthcare
2.  Internet of Medical Things Revolutionizing Healthcare. AABME. 2017. Accessed online: https://aabme.asme.org/posts/internet-of-medical-things-revolutionizing-healthcare
3. Gartner Survey Reveals Two-Thirds of Organizations Intend to Deploy 5G by 2020. Gartner. 2018. Accessed online: www.gartner.com/en/newsroom/press-releases/2018-12-18-gartner-survey-reveals-two-thirds-of-organizations-in
4. The Stanford Living Heart Project Wins Prestigious HPC Awards During SC17. HPC Wire. 2017. Accessed online: www.hpcwire.com/off-the-wire/stanford-living-heart-project-wins-prestigious-hpc-awards-sc1
5. Rabin Y, Lewis J. The Future of Organ Banking. AABME. 2017. Accessed online: https://aabme.asme.org/posts/the-future-of-organ-banking
6. O’Heir J. The Education of a Surgical Robot. AABME. 2017. Accessed online: https://aabme.asme.org/posts/the-education-of-a-surgical-robot
7. Anand, A. Surgical Robots Market Transforming Technology, Industry Size Grows at a 18.94% CAGR, Top Competitive Share, Region Wise Analysis, Upcoming Trends and Forecast To 2024. MedGadget. 2019. Accessed online: www.medgadget.com/2019/11/surgical-robots-market-transforming-technology-industry-size-grows-at-a-18-94-cagr-top-competitive-share-region-wise-analysis-upcoming-trends-and-forecast-to-2024.html