The Medical Futurist | January 24, 2019

What do hospital beds tell about patients? How does an „indoor GPS”-system work? How could sensors and connected devices enhance both patient experience and medical resource efficiency? Here, we tell you everything about IoT within the walls of health facilities.

Emergency drones, Fitbits, and chatty hospital-beds

In April 2045, Paul was walking down the street with her 4-year-old daughter, Lily, in downtown Boston. They were heading to the ice cream & deli at the corner of the square two minutes from their home. Suddenly, the man experienced chest pain, started to breathe heavily and collapsed. Lily looked shocked, couldn’t move and didn’t know what to do. Some passers-by of the busy street noticed, some were too caught up in their daily rush. The control-driver of the 27A self-driving bus stopped, though, she saw the entire scene first hand as the vehicle stopped due to a red light next to the pavement. The woman called an ambulance, took the girl by the hand and checked the Fitbit on Paul’s arm.

At first, emergency drones arrived, scanned the entire scene and Paul for electronic information. They could also attach to the man’s Fitbit and harness data that might be relevant to the emergency team. By the time, the paramedics arrived at the scene on their self-driving ambulance, they could prepare for the case based on the data the drones sent back to the car. Not only there, but also the receiving hospital had access to the live patient data, and by the time Paul arrived at the institution, doctors and nurses could wait for him with the right equipment. In his case, it turned out that he had pulmonary embolism and had to stay in the hospital for anticoagulant therapy. Sensors in his bed made sure that he moved around sufficiently in order not to get pressure ulcers, not to speak about measuring his heart and respiratory rate. In case of any change, the bed sent a notification to the nurses’ station or the doctor’s tablet. Connected devices took care of Paul’s healing process all along the way until he could leave the hospital.

What is the Internet of (healthy) Things?

We live in the revolutionary era of electronic waves connecting our every gadget: in a smart home, the refrigerator could enumerate the items you have, for how long you have them (without judgment about last week’s half-eaten yogurts or pizza slices) and send off the shopping list to your smartphone. You can tell Alexa what song you want to listen to and you can turn the lights on and off from your cell phone. The Internet of Things (IoT) allows these to happen, through which connected devices communicate with each other. Gadgets collect, analyze and share data coming in via their sensors, and make certain if-then-style decisions. Artificial intelligence and digital assistants (both text-based chatbots and voice-based devices) are key components in the smooth operation of IoT networks.

The Internet of Medical Things (IoMT) is naturally about a connected infrastructure of medical devices, software applications, health systems, and services. However, it could extend way beyond the hospital. In the future, we can imagine that a smartwatch used at home will send back vital signs to a GP’s tablet about a patient, toilets with microchips similar to the MC10 biostamps will monitor urine – so you won’t need to bring your urine sample to the doctor anymore -; sensors will log movement patterns, bathroom sensors will follow patterns of water usage, or digital mirrors will measure basic vital signs. Or, we could imagine Dina Katabi’s connected device put into practice: it already allows monitoring patients’ sleep patterns, mobility, and gait. It can pick up on their breathing rates or detect if someone has a fall. It can monitor their heartbeats and even provide information about their emotional state. What if all that information could be sent back to the hospital for control in the future?

IoT and healthcare = love and marriage

Connected sensors measuring and sharing crucial data started to spread around in hospitals, in the GP’s office and throughout the entire medical and pharma supply chain. The Accenture 2017 Internet of Health Survey emphasized that almost three-quarter of healthcare executives say IoT in health will be disruptive within the next three years; first of all in three areas: remote patient monitoring, wellness/prevention – where the health sensors and wearables come into play – and healthcare operations, such as managing inventories of medical supplies. In sum, Accenture expects it to reach a $163 billion market in 2020!That’s a number you cannot ignore.

Health IoT could help optimize medication management processes, guarantee the accuracy of prescriptions, support remote monitoring of patients, doctors, nurses, etc, keep an eye on the levels of basic equipment on wards or reorder when new stock is needed. The multifaceted nature of connected networks comes in handy, and their possible areas of use seem to be endless. Here, we cherry-picked some of the latest examples of IoT solutions in healthcare.

Monitoring in-patients’ health

Sensors could track and monitor patients from the moment they arrive in a hospital – or even in the home before that – with real-time data automatically added to patient records without the need for nurses to take readings or update charts.

Hospital beds are the first choice for sensors placed in the closest proximity to the patient. For example, to avoid pressure ulcers from staying in bed for too long, SMI manufactures pressure sensors which can allow the mattress to intelligently redistribute force to minimize the occurrence of these types of ulcers. In December 2018, Hill-Rom announced that it equips its new hospital bedswith heart and respiratory rate sensors. Using EarlySense’ A.I. technology, they continuously monitor patients’ vital signs and alert nurses if a change is detected.

IoT networks could also help patients get back the feeling of control. For example, NYU Langone’s newly opened hospital offers MyWall, which lets patients manage daily needs like ordering meals and viewing entertainment via a tablet. Patients can also learn about their care team, plan and adjust room lighting or temperature.

Optimizing care processes

A busy hospital is a place where tracking patients, doctors, nurses, expensive medical equipment, the right medication, sought-after resources, and even hospital beds is an overwhelmingly complex and challenging task, and not doing it in time could even endanger patients’ lives. Some years ago, there was a case of a patient found dead in the stairwell of a California hospital.

That’s what the concept of the Autobed system goes against. It was developed by GE and introduced in the Mount Sinai hospital. AutoBed is an algorithm that uses the admitting nurse’s “triage” recommendation and real-time data on the availability of hospital beds (using real-time location awareness devices like radio-frequency identification tags, infrared, and computer vision) to figure out as fast as possible on which bed to put an incoming patient. The method proved to be highly effective: Mount Sinai decreased waiting times by 50 percent of their emergency room patients.

New York-based start-up, Inspiren, concentrates on mitigating patient neglect. Using computer vision, deep learning, and natural body-movement recognition, their IoT device, iN, detects staff presence and assesses environmental safety risks while simultaneously collecting and aggregating data from other medical devices such as EKG/vitals monitors and from environmental sensors detecting temperature, noise, brightness, etc. The byproduct is an intelligent system that gains insight into the care environment and mitigates the risk of human error. The data analytics engine then uses A.I. to create predictive algorithms to prevent injuries and medical errors. The Medical Futurist expects many more similar solutions to appear on the market to monitor medical staff and patient behavior to enhance the healing process.

Indoor GPS and medical devices

In the operational processes of large hospitals, enough attention should be paid on the inventory and maintenance of medical devices. IoT networks could mean an immense help in both areas. For example, RFID technology could be used for tracking medication and medical equipment via the unique identifier placed on the specific item.

Another method is the Real-Time Location System (RTLS) used to provide immediate or real-time tracking and management of medical equipment, staff, and patients within all types of patient care environments. While the technology differs from using location data captured by satellite trilateration, it can be thought of as a type of “indoor GPS” for hospitals. It works similarly to the RFID technology in the sense that the system includes location sensors that are attached to various assets be it a patient, a staff member or a piece of equipment.

However, it’s not enough to find a device or medical equipment, doctors need to have that in optimal working conditions. That’s what Philips aims to solve with its e-Alert system, which monitors medical hardware and alerts hospital staff in case of a problem. Moreover, it takes a proactive approach to analyze the actual state of equipment and notifying users in advance of emerging issues.

Hurdles of IoT: security concerns and lack of standards

While there’s no medical field where connected networks cannot have a positive impact on patient outcomes, most hospitals, and medical institutions which introduced IoT systems so far are still in the experimental phase – and thus, serious problems could arise. One of the most terrifying stories regarding the power of EHRs and computer-administered medication management was the story of teenager Pablo Garcia, who received 38.5 times the dosage he should have received due to a setting error in the EHR system.

Beyond errors arising from managing IoT networks or unfortunate system design flaws, two main hurdles hamper the adoption of connected medical devices in higher numbers – and both should be solved before going forward with the spread of the technologies.

The first concern is security. As the internet of healthy things is expanding, the points of vulnerabilities keep multiplying through a swarm of endpoints, networks, and channels. Some analysts say medical devices, in particular, have been identified as highly vulnerable and hacked medical devices may now be the single biggest threat to healthcare IT. Serious security threats are prevalent in the case of X-ray systems, blood refrigeration units, CT scanning equipment, implantable cardioverter defibrillators (ICD) or implantable neurological devices.

On the other hand, new medical devices, smartphone apps, sensor-based equipment are popping up almost every day: countless companies and start-ups introduce their own solutions with their own system, design, and logic for problem-solving. However, the pace of innovation is a lot faster than the regulatory framework, thus major guidelines for medical device development and industry standards are absent. This lack of standards means there’s a risk that IoT will end up being rolled out in a piecemeal fashion, with a lack of interoperability between medical institutions or larger units.

Thus, if we would like Paul to be taken care of by a swarm of invisible, yet reliable, secure and seamlessly working health sensors, we need to pay more attention to security concerns and industry standards. All-in-all, IoT has tremendous potential for making care processes and resource management in healthcare more efficient – and thus to enhance patient journeys towards health in a smoother and a lot more pleasant way.