A few years ago I needed hand surgery. Shortly after checking in to the outpatient surgery department, the helpful nurse attached EKG leads onto my arms and chest, and a pulse oximeter to my finger. The monitor next to my bed flickered and came to life. Then, colorful telemetric and oximetric tracings in a nursing station computer reflected an exact copy. A record in the hospital intranet recorded my wellbeing overtime. Wireless connectivity allowed an extra pair of eyes to watched me and to ensure wsaberrant flickers do not go unnoticed.
In a way, healthcare has spearheaded the forefront of the universal connectivity—some warning signs simply can't wait for someone to come and check every 6 hours. Telemetry monitors, pulse oximetry, bed alarms are just some examples of how interconnected "things" make for a timely alert system detecting the smallest deviation from normal.
One purpose of this near-time update is obvious—early detection leads to early intervention and improved outcome.
Today, advancements in technology promises to bring the same level of attention to daily life. The Internet of Things (IoT) describes the increasing prevalence of internet connectivity for everyday objects. First computers, then cell phones, watches, and eventually your insulin pump, your implantable cardioverter/defibrillator, your contact lenses. Universal internet connectivity of medical devices through 4G LTE or satellite allows constant monitoring and triggers emergency alerts should it detect critical values in blood glucose level or heart rhythm.
Up and Coming
Based on work published in AJMC, Big Data shows promise predicting outcome in metabolic syndrome and is on the brink of revolutionizing healthcare. is the natural extension of Big Data that comprises both its input and output: connected objects will provide a large influx of data, and connected objects will carry out actionable knowledge arising from this data. Forbes estimates IoT in healthcare alone to become a $117 billion industry by 2020. The big question is whether adaptation of this technology can provide sufficient boosts in efficiency, safety and early warning system in healthcare to offset its own cost.
Despite the clear use case of early alarm, the IoT goes much further. Here I outline several other areas in which are impacting health.
Efficiency and Quality
Many hospitals stockpile inventory because it is difficult to keep timely count of every bar of soap, every pair of socks, every bag of normal saline. Existing efforts using RFID or barcode have made it possible to reduce medication error and improve accounting. takes this technology one step further. In a world with universally connected inventory utilizing small low-cost chips, a dashboard can keep real-time accounting of supplies and automatically place orders for restock when items run low.
IoT can also improve the uptime of expensive hospital equipment. A hospital's typical CT and MRI machines are high-cost equipment. When such an equipment breaks down, not only are patients unable to get their important diagnostic exam, it also creates a backlog and the hospital loses revenue. Rather than routine maintenance, some hospitals have moved to using internet-enabled diagnostic tools that are permanently installed in the scanners to diagnose small problems before they become big problems.
Finally, rather than relying on provider-reported flaws on medical devices, a Silicon Valley startup company has developed smart cardiac catheters which automatically detect flaws and send quality improvement data directly from the catheter to the manufacturer. In the world of IoT, medical devices leverage the power of Big Data to improve their quality.
Doctors have known for a long time that a patient who needs to take pills 4 times a day is less likely to be fully compliant than patients who only need to take pills once a day. Traditionally, doctors have asked patients to bring their pill bottles to appointments. By looking at the number of pills left over, a doctor determines whether the patient has been taking them as prescribed. However, this method is slow—by the time a noncompliant patient sees the physician it will have been weeks or months later.
The advent of smart sensors allows pillboxes to recognize when it has been opened and closed. Doctors can recognize when patients are taking their medications at the right time.
In the book Nudge, renowned behavioral economist Richard Thaler makes the case for subtly changing people's behavior to improve human conditions. Additionally, quality improvement literature shows that complex interventions like comprehensive education, data, or even signs do not work nearly as well as a timely reminder when the right action counts.
For the health provider who must manage hundreds of data pieces on a daily basis, it is easy to forget simple little things. Integration with smart sensors on a frequently used object like the modern hospital pager or stethoscope can help ensure that these important little actions are not forgotten.
One user case scenario is hand hygiene. As early as the 19th century, the benefits of handwashing were established as a clear source of reducing hospital-associated infections. More recently, the Joint Commission published a monograph that showed a hospital with high compliance is overall safer than a hospital with low compliance for hand washing. Although healthcare has made great strides in promoting hand hygiene, maintaining high compliance is a challenging task for every health system. In the world of IoT, a timely and gentle vibration to the wrist as a health provider exits a patient's room harnesses the power of behavioral economics for improved compliance.
IoT is the next natural step of Big Data in healthcare. The wealth of data arising from ubiquitous connectivity will help us better understand not just disease processes but also improve the way existing services are delivered.