Healthcare systems all over the world are struggling with two fundamental concerns – how to afford the rising cost of delivering care and how to integrate ever-changing new technologies?
These twin challenges are intrinsically connected, for emerging technologies offer the promise of making care more affordable as well as more effective. The rewards for successful implementation will be significant, for patients as well as for those responsible for the sustainability of healthcare systems.
In healthcare, the internet of things (IoT) is changing the way we think about looking after people. At the heart of this technological revolution is a focus on connectivity. Drug discovery and greater understanding of disease are critical. But these must go hand in hand with the way we exploit information and data, using internet-connected devices to process and inform the way we manage care.
The scale of investment underway in healthcare IoT is colossal. MarketResearch.com, the markets intelligence specialists, estimate that globally investment could reach $117 billion by 2020. North America will continue as the most significant market, with rapid growth on the back of the region’s advanced healthcare infrastructure and increased levels of research and development initiatives in IoT.
But, increasingly, the Asia-Pacific region looks to be an exciting market, supported by strong economic growth and rising disposable income, together with the emergence of IT-enabled healthcare services and the penetration of smartphones and wearable medical devices.
It is a huge number, but consider the extraordinary range of IoT applications in healthcare, encompassing systems and software, medical devices and services. The IoT in healthcare market includes implanted, wearable and stationary medical devices used in clinical research and by diagnostic laboratories, hospitals and medical centres.
In the healthcare industry, IoT has a wide range of applications, including clinical operations and workflow management, in-patient monitoring, telemedicine, connected imaging and medication management. Bluetooth low energy, ZigBee, satellite, wi-fi, near-field communication and cellular are some of the key connectivity technologies involved in IoT in healthcare.
One of the biggest challenges is how to connect this vast amount of health information, which is scattered and siloed, and make it accessible, using a common language that can understood and trusted by all.
At a very personal level, you may find the information you collect and hold via an app on your mobile phone about your lifestyle or the management of a health condition may be admired by your GP, but he probably has to conduct his own tests because the data is unlikely to be compatible with information systems, or considered to be a trusted source.
At a global level, healthcare providers, payers and manufacturers are often seeing a different version of the healthcare universe, which takes them in different, and sometimes conflicting, directions. Overcoming this incompatibility is critical. For example, a connected healthcare ecosystem that spans from research and development through to commercialisation and treatment adherence could be just the solution for life sciences companies and payers seeking to demonstrate value from new treatment outcomes.
The internet of things is changing the way we think about looking after people
An ecosystem in which patients can harness data from diverse connected devices will create a deluge of new data. Healthcare practitioners will be able to monitor a patient’s health, activity and reaction to treatments in real time. If a patient suffers a cardiac event or hypoglycaemic episode, for example, data can be used by the specialist to take immediate action.
This can include elements that are often out of the view of treating physicians, such as dietary information, which may impact outcomes. These indicators have a cumulative impact on the outcome derived from standard medical interventions. So, for the first time, healthcare systems will have a complete picture and be able to optimise treatments and environments for better outcomes.
The significant amount of data generated by a connected ecosystem can also influence the future trajectory of research and development. Real-world evidence provides significant insight into how a drug or drug class performs, or is used in real-world medical settings. The ability to transform real-world data sources quickly into evidence can improve health outcomes for patients by helping pharmaceutical groups be more efficient in drug development and smarter in commercialisation.
Is the NHS able to capitalise on IoT?
It is one of its biggest challenges as UK health authorities take steps to reconfigure the health service to make it affordable and sustainable. Last year’s Wachter Review of Information Technology in the NHS said creating a fully digitised health service was likely to be the most difficult reform. The NHS has a toxic legacy of IT failures, particularly in the hospitals sector where, tantalisingly, the potential for IoT transformation is greatest.
Robert Wachter, who led the review, advised that it was better to get digitisation right than to do it quickly. Return on investment should also be measured in terms of improvements in safety and quality, with cost-savings likely to take ten years or more to emerge.
One of the review’s recommendations was hospital trusts that were ready to digitise should be prompted to do so, with others encouraged and supported over a number of years. The result is NHS England’s Test Beds Initiative, launched in January 2016 with evaluation likely to take up to three years.
Two of the seven test beds are focused on IoT and form part of IoTUK, an integrated £40-million government programme that seeks to advance the UK’s global leadership in IoT. These comprise a diabetes digital coach, a project led by the West of England Academic Health Science Network in partnership with Diabetes UK and technology companies including Hewlett Packard and Technology Integrated Health Management, a collaboration between Surrey and Borders Partnership NHS Foundation Trust, and an array of health technology providers which will help people with dementia to live in their own homes for longer.
The devolved nature of the NHS in England means trusts are free to pursue their own IoT developments. The aspiration is that as systems become embedded, they will be adopted and implemented by other trusts. This approach will reduce the risk of repeating the major IT infrastructure failures of the past. What is certain is, sooner or later, the internet of things will be at the heart of the delivery of care across the NHS.
Case study: helping with dementia
The internet of things is being deployed to improve the lives of people with dementia. A project has been launched in Surrey and North-East Hampshire to test how technology can help them remain in their homes for longer.
The Technology Integrated Health Management project will provide people with dementia and their carers with sensors, wearable technology and other devices to monitor their health at home. These devices can, for example, detect if someone has left the house, had a fall, is not eating or drinking normally or has used the bathroom more than usual. If the technology identifies a problem, an alert is issued that is followed up by a clinician or carer.
The two-year project will involve around 700 patients and their carers, with a view to scaling IoT for dementia across the area’s 1.3 million population. Almost 250 people have come forward so far, with another 50 homes a month expected to be added through 2017.
Dr Helen Rostill, director of innovation and development at Surrey and Borders Partnership, who leads the study, says: “It is clear that people are desperate for a new approach to help support them to manage this condition and can already see how this study can benefit them.”
Ray Ledge, a carer from Farnham who looks after his wife Carol, adds: “The greatest thing about this study is it could develop into something very positive for the future and will give the medical community greater insight into the condition.”