11. Smart Medicine: We Have the Technology...

In other words, you don’t have to wait until your next visit to the doctor’s office to tell him that you’re feeling under the weather, have him draw blood and run the requisite tests, and then get back to you with a new prescription. Thanks to the IoT, all this information is available much sooner, in a combined form that makes sense of it all, and in a way that enables near-immediate analysis and response. This is how healthcare is revolutionized.

The IoT is changing all that. Physical records are being digitized, and new records are entered into centralized computer databases. Data is stored, not in a single office (or multiple offices) but in the cloud, so that all your various physicians, clinics, and hospitals can view and contribute to them as necessary. One doctor will be able to see what another has prescribed, eliminating cross-diagnoses and dangerous drug interactions, and resulting in more coordinated, effective, and efficient treatment.

This should also reduce medical costs, at least over the long run. If and when the right diagnosis is arrived at more rapidly, there will be less waste in the system. In addition, the IoT promises to make preventive medicine more common, and healthier people should require less longer-term medical attention.

In short, we’re looking at nothing less than a real revolution in healthcare. The results will be a lot more useful than that smart TV or talking refrigerators you’ve been eyeing.

• Decreased cost of care—Big benefit—the IoT promises to lower healthcare costs. We need that.

• Improved patient outcomes—Put another way, patients get better quicker, and with fewer mistakes along the way. If you’re sick, you’re more likely to get well.

• Real-time disease management—Instead of waiting for your quarterly appointment to check your blood sugar or thyroid levels, they get monitored every single day—and the results fed back to your doctor so changes in medication can be determined. In fact, the real-time, constant monitoring inherent in the IoT may reduce the number of doctor visits you need.

• Improved quality of life—With more effective treatments and more preventive treatments, people with both transitory and chronic illnesses will live more normal lives. In this instance, normal is good.

• Improved user experience—This means for both the patient and the healthcare providers. Yes, you want to improve the experience for the person receiving the healthcare, but there’s also benefit in making things easier and more user-friendly for the doctors, nurses, and assistants doing the day-to-day heavy lifting. If an IoT-based system can cut their workload or make it easier to make decisions or perform certain operations, all to the good.

These smart medical devices enable patients to receive the same level of monitoring at home that was previously only available in hospitals and other medical facilities. We’re talking remote monitoring wherever you may go, enabled by wireless communication over the Internet, that enables your physician or healthcare facility to track your health stats, physical activity, and drug consumption in real time—and alert the necessary personnel if a medical emergency occurs.

• Blood glucose monitors that track your blood sugar levels

• BP monitors that provide real-time BP readings

• Breathing monitors that track your pulmonary ventilation

• Electrocardiogram (ECG) monitors that track cardiac activity

• Electroencephalogram (EEG) headsets that keep tabs on your brain activity

• Hearing aids that tailor their performance to room conditions—and connect, via Bluetooth, to your smartphone so you can use them as headsets, as well

• Heart rate monitors that track the number of beats per minute, such as the Mio Link Heart Rate Wristband, shown in Figure 11.1

• Muscle fatigue monitors that use muscle contraction sensors to help in fitness training

• Pacemakers that send back information on the wearer’s heart rate and condition

• Pregnancy monitors to track the unborn baby’s heart rate and other key stats

• Pulse oximeters that monitor pulse and blood oxygen (O2) saturation via a fingertip sensor

• Sleep monitors to track and evaluate sleep patterns and sleep apnea

• Stress monitors (such as the Spire, shown in Figure 11.2) that track motion and respiratory patterns to determine when a person is becoming stressed or unfocused

Data from these individual devices can be integrated into larger systems (more on that in a moment) or tracked via PC/smartphone apps. For example, Manipal Health Services in India provides pregnant mothers with a wearable fetal monitoring system that ties into a corresponding smartphone app. This system provides mothers with real-time data about fetal heart rate patterns, uterine activities, and labor progress. This data is also transmitted to the physician’s smartphone or tablet; he or she can then make more informed decisions about what to do next. (The system is even active and useful during labor and delivery.)

And there’s more to come. How about micro cameras, in the form of edible pills, that enable doctors to remotely observe your internal conditions without the risk of surgery? Or an embedded motion detector that doctors can use to monitor the symptoms of Parkinson’s disease? Or a tattoo-like skin patch, like the one in Figure 11.3, that contains flexible, stretchable electronic sensors to monitor heart, brain, and muscle activity—or stimulate muscles, remotely—in a noninvasive manner?

With all these devices connected to a central monitoring system, doctors will be able to quickly and easily access patient information—both historical and current. This data can be combined with information gathered by other connected devices, such as smart scales, fitness bands, smartwatches, and the like, to provide a more complete picture of the patient’s health.

All this sounds futuristic, and it is. That’s because we’re marching inexorably into the future, where the IoT reigns. Behold the future—it is upon us!

Ideally, this type of ongoing monitoring and analysis can help keep you from needing emergency or extraordinary care. If you have BP issues, for example, these remote systems will see it and suggest the proper medication before it becomes a life-threatening problem.

The challenge is dealing with the vast amounts of data collected. It’s not nearly as simple as an individual checking his or her progress on a smartphone app. We’re talking data from multiple devices at multiple times—for each and every person in the medical registry. If and when everything gets connected and the data gets sent to the appropriate systems and services, making sense of these huge amounts of data is a mind-boggling enterprise.

It’s also a huge opportunity to those companies that can figure it out and offer solutions to hospitals and other healthcare providers. One company that’s working on it is Freescale Semiconductor. Freescale has developed a reference platform they call the Home Health Hub that enables application developers to create “telehealth” applications that collect and share patient data. As you can see in Figure 11.4, the Home Health Hub works with commercially available healthcare devices (BP monitors, thermometers, pulse oximeters, scales, blood glucose monitors, and the like), then distributes the collected data over the cloud to remote smart devices, such as PCs, smartphones, and tablets. This enables physicians, caregivers, and others a way to monitor the patient’s current health status, as well as provide alerts and medication reminders.

To make sure that most, if not all, medical devices work together to share their data in this fashion, the Continua Health Alliance, a coalition of healthcare and technology companies, has established guidelines for what they dub interoperable personal health solutions. These specs enable conforming devices to work together over Bluetooth, Wi-Fi, and ZigBee networks to share and distribute data. This specification is the backbone for the IoT in healthcare applications.

Some of this monitoring can be accomplished by the types of wearable devices we’ve been discussing. In addition, specialized sensors can be installed in the homes or apartments of older patients to monitor their health and physical activities.

This may sound futuristic, but much of this functionality is available today. For example, Healthsense offers the eNeighbor monitoring system for seniors. It uses sensors worn by the patient and installed throughout the home to detect any falls, note if an elderly patient has wandered off, and alert caregivers if the patient has missed taking any medication. The system also includes an emergency call pendant, which seniors can use to manually call for help if necessary.

Similarly, the BeClose system places smart sensors, like those shown in Figure 11.5, around the patient’s home to keep track of normal routines. When something is amiss—a prolonged absence, for example, or a missed meal—a caregiver or designated family member is notified by either text message, email, or phone call. If installed in a senior living facility, staff can monitor each patient’s activities via an interactive dashboard. (And still receive necessary alerts when things aren’t as expected, of course.)

Then there’s Independa, which offers Remote Care technology that can be used in either assisted living facilities or in seniors’ homes. All monitored data is displayed on the Caregiver Dashboard, shown in Figure 11.6, which can be viewed by caregivers over the Web on any personal computer, smartphone, tablet, or smart TV. The Dashboard also displays “smart reminders” for medications, events, and check-ins, as well as a Wellness Summary, suggested health measures, reports, and alerts.

There are many other companies getting into connected senior care, including a lot of custom proprietary solutions. The goal is the same for each—to improve the quality of life for seniors, while providing effective monitoring to keep them safe and healthy.

There are numerous approaches in development that will help ensure that people like you and me (and our elderly parents and grandparents) take only those drugs that have been prescribed and in the correct dosages. It’s a great application of developing technology.

The first and easiest solution is to use barcodes on all medicine containers. This type of barcode-based medication administration system is in use in many hospitals today, and they’ve cut the error rate substantially. This type of system is a bit unwieldy, however, and is typically tied to a workstation on wheels—not practical for in-home use.

An alternative approach is to make the whole process wireless. Medication containers have embedded radio-frequency identification (RFID) tags which are read (using near field communication [NFC] technology) by a tablet or smartphone. It’s more portable than the old barcode system and offers the potential for additional uses, such as tracking whether or not a given drug was beneficial to the patient. It’s all a matter of recording and storing the proper data, and then forwarding that data to the appropriate analytical application.

When used at home, an RFID-based medication tracking system can help to confirm that patients are actually taking their medications and remind them to do so. Data collected from the mobile app will be beamed back to the physician’s office, which can then generate summary reports or contact the patient with a gentle reminder or warning to do what they’re supposed to do.

For example, Vitality’s GlowCap, shown in Figure 11.7, is an electronic cap you can fit on just about any prescription drug bottle. It uses light and sound reminders to signal when it’s time to take that particular medication. When the pill bottle is opened, a chip inside the GlowCap wirelessly relays that information to your physician or caregiver. (GlowCap uses AT&T’s Mobile Broadband Network for data transmission, hence that rather large round wireless transmitter plugged into the wall in the background.) When all the pills are gone, push a button at the base of the lid to order a refill.

The next step moves beyond batch identification built into the meds’ container to identifying each unique pill in a bottle. If all pills are manufactured with built-in RFID transmitters, then they can be tracked individually via smartphone or tablet apps.

There’s a lot of data that could be gathered by smart pills. For example, the Digital Health Feedback System from Proteus features an ingestible sensor placed within a smart pill. The sensor is powered by contact with your stomach and transmits information not only about when the pill was swallowed, but also provides metrics regarding heart rate, body position, and activity. In this instance, the smart pill beams its data to a micro-electronic patch on the user’s stomach. The patch then transmits the data via Bluetooth to the patient’s smartphone, and from there to the doctor or other healthcare provider. The whole system is shown in Figure 11.8.

Human beings being human beings, we’re all going to screw up from time to time. But there are ways to reduce human error—and simultaneously improve the quality of hospital care.

Cue the Internet of Things and related smart technology. Connected devices and systems, along with intelligent data distribution and analysis, promise a revolution in the way hospitals work.

With all these monitors already in place, what can possibly go wrong? Lots, actually. That’s because in most instances, these devices are not connected to each other or to any central monitoring facility. They all operate independently.

And they’re location-dependent. If a patient moves from one room to another, or from the ICU or ER to a private room, he has to be disconnected from all the devices in the first room and reconnected to the devices in the next one. The devices in the first room don’t talk to the devices in the other room, so there’s no electronic history recorded or transmitted. All the data is unique to a particular device.

In addition, there’s no way to combine the data from these different devices to generate a holistic report of patient status. You end up getting a lot of nuisance alarms, fatigued staff dealing with all these different units, and a lack of understanding about what’s really happening with a patient’s health. And nobody is looking at this data in real time—only when something goes wrong.

My stepdaughter is a neonatal care nurse at a local hospital. She vouches for the inefficiency and ineffectiveness of today’s multiple-monitor hospital room. Yes, all these monitors are for the good, alerting staff when something goes off the norm. But there’s no way to look at all the monitor data in one place, either in the room or at the nurse’s station. And, believe it or not, long-term data is not stored or transmitted from any single device; if a nurse or doctor wants a record of a given statistic, she has to manually make a chart. That’s manually, as in by hand, using pencil and paper.

Wouldn’t it be better if all these devices not only talked to each other, but also to some sort of centralized dashboard? Where the settings from a machine in the ICU, OR, or ER could be automatically transmitted to the devices in the patient’s hospital room? Where a report or chart could be generated with a push of a button—even combining data collected from multiple devices?

Yes, it would. And that’s where the Internet of Things comes in.

What you want is for all settings to follow a patient, no matter where he or she is in the hospital. If a given infusion pump knows that the patient needs a certain amount of a given drug, then the infusion pump in the next room should be able to pick up those instructions without manual programming by the staff. (Each staff interaction introduces the possibility of human error, of course.) The historical data from the heart monitor in the first room should be combined with the more recent data collected from the similar monitor in the next room. And all this data should be displayed in real time, in summary and detailed fashion, on monitors in the patient’s room and at the nurse’s station.

Even better, you want all the connected devices to work together to produce smarter results. Consider the oximeter, which monitors the patient’s O2 levels. Today, low oximeter readings cause a lot of alarms, even though low O2 levels are typically only a concern when accompanied by a low respiratory rate. A better approach, then, would be a smart alarm that checks both O2 and carbon dioxide (CO2) levels. But that’s two different monitoring devices today, and they don’t talk to each other. Enable cross-device communication and some intelligent if-this-then-this algorithms, and you get a much more effective alarm—and fewer false alarms.

This doesn’t sound difficult, but it is a major challenge. In any given hospital, it’s a matter of dealing with, at any given time, thousands of patients and hundreds of thousands of different devices, with those patients moving from location to location on a regular basis. All those devices have to connect to one another and to a central system, with 100 percent uptime, complete data security, and real-time reporting.

Not that easy.

Figure 11.9 shows the functional elements of the ICE standard. It all starts (at the bottom of the diagram) with the patient and ends (at the top) with the clinician. In between are layers of medical devices, interfaces, network controllers, and an ICE supervisor. It’s all a way to get information about the patient—and that affects the patient—to the clinician.

The key elements in the ICE standard include:

• Network controller that generates alarms if a connected device malfunctions and also provides historical data logs.

• Network supervisor, the programming that provides the intelligence in the system and includes clinical decision support, smart alarms, and record-keeping functions.

• Network interface that connects medical devices with the network controller.

In the ICE environment, all devices—from BP cuffs to intravenous pumps—are interconnected using plug-and-play technology. The connections and communications between devices are standardized to ensure interoperability. The goal is to ensure the safe integration of medical devices from various manufacturers—which does not exist in today’s world—where each manufacturer employs its own proprietary technologies that don’t communicate well with those from other manufacturers.

The ICE standard is relatively new. Cross-disciplinary work on it began in 2006, and the initial standard was issued in 2009. The healthcare industry is large and ponderous, and doesn’t change easily or rapidly, so it will be some time before these standards see widespread adoption. Still, ICE represents a roadmap to healthcare’s connected future and the ultimate evolution into the Internet of Things for Medical Devices.

For example, the folks at 3M have developed the Littmann Electronic Stethoscope, shown in Figure 11.10. This nifty little gizmo lets your physician focus on listening to your heartbeat while it sends data wirelessly to a computer or mobile device. This one sounds so obvious that it’s surprising nobody’s thought of it before.

If you’re in the hospital for some reason, interfacing with all these increasingly smart medical devices, why not sleep on a smart bed? I’m not talking about one of those “sleep number” beds that lets you adjust the mattress firmness, but rather a holistic system with embedded sensors that monitor the patient’s vitals—and more—and feed them back to the nurse’s station.

For example, BAM Labs offers just such a system, called the Smart Bed Technology Solution. It employs a special sensor mat, shown in Figure 11.11, that is placed underneath the normal mattress. This mat monitors heart rate, respiration rate, motion (the patient’s changes in position), and presence (when they exit and enter the bed).

This biometric data is transmitted to the Smart Bed cloud platform (because all data must eventually reside in the cloud), then packaged into user-friendly applications that can be viewed on any Internet-connected device. This enables hospital staff and physicians to receive the data and any emergency alerts on their own computers or mobile devices.

If you really want to go high tech, consider the robot doctor, such as the RP-VITA Remote Presence Robot, shown in Figure 11.12, from iRobot and InTouch Health. This little fella enables doctors to conduct real-time clinical consultations when they can’t be there in person. The clinician controls the robot with an iPad app and talks to patients through the robot’s video-conferencing screen. It’s a great way to make more efficient use of a doctor’s time and to reach patients in remote or underserviced areas.

Today, if you visit a new doctor or clinic, they have to call your old doctor’s office and request that your paper records be faxed over for them to use. This is time-consuming and expensive, and can delay diagnosis and treatment—and can be life-threatening in medical emergencies when time is of the essence.

It gets worse when you consider all the data gathered by the new class of wearable medical devices. Why shouldn’t the data generated by your fitness band, smartwatch, or wearable BP monitor be consolidated with the rest of your medical records?

Of course, all your medical records should be centralized so that every healthcare provider you visit can see everything that’s happened to you—and that other clinicians have commented on—in the past. The fact that this hasn’t happened yet is because medical records have traditionally been paper records, and they’re not easily shared or consolidated.

The key to more effective and efficient medical recordkeeping is to go all electronic. This means keeping new records digitally, in computer databases that can be accessed from multiple providers. It also means digitizing your existing paper records, which is an enormous undertaking.

Once your medical records are all electronic, they have to be stored someplace. Since you need your records to be accessed by all your healthcare providers (and yourself, of course), that means cloud-based storage. When your records are hosted in the cloud, any medical professional (with your permission) can access your records to view the most current information in real time. That should reduce paperwork, speed up processing, and provide faster and more accurate diagnoses.

This type of centralized electronic health record is called a personal health record (PHR), and there are lots of companies working on them.

First, many individual clinics and hospitals are creating their own PHRs for their patients. While these services make it easier for people to view their own records at that facility, they typically don’t tie into records kept by other facilities and providers.

Beyond that, several big companies and organizations are trying to create PHR databases and applications that span multiple facilities and providers. Some of these are targeted at a given company’s employees or the customers of a particular health insurance company. Others are more universal in scope, vying to become an industry standard. In any case, there are a lot of big players trying to get a piece of the pie, as you’ll see.

HealthKit is initially being pitched to help physicians monitor patients with chronic conditions, such as diabetes and hypertension. As of early 2015, Apple has signed up 14 of the 23 top-ranked hospitals in the U.S. for the program.

The Dossia Health Manager, shown in Figure 11.13, is an app that provides health information personalized for your own family’s needs. You see a news feed with all your family’s activities and alerts, as well as recommendations to better manage your own personal health. The Health Manager taps into your personal health record, keeping track of medications, allergies, immunizations, doctor’s visits, test results, and the like.

As you can see in Figure 11.15, a completed MyMediConnect PHR includes all your pertinent medical data, including information about your medical conditions, allergies, procedures and surgeries, vaccinations, medications, doctors, insurance plans, Medicare claims, and family and social history. All this information is in one central location, presented in an easy-to-read and easy-to-understand format. You decide who else can see which information—including your doctors, family members, and such.

When an individual creates his or her HealthVault account, the account can be authorized to access records for multiple individuals. Each record contains medical information for a given individual. A single HealthVault account, then, might contain records for all members of a family, enabling parents to manage the records for their children, or older children to manage the records of their senior parents.

Individuals interact with their HealthVault records through the HealthVault website or PC/mobile app that interfaces with the HealthVault platform. (Figure 11.16 shows the Windows 8 version of the HealthVault app.) You can specify types of information to be shared with individuals (such as family members) and healthcare providers; not everyone you share with has to see everything.

You can also upload data collected by various medical devices, using the HealthVault Connection Center. This way your healthcare providers can see your personal fitness information or any other data you collect on your own.