What it will take to create ubiquity, security and insights in medical IoT

By Heather Mack
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With the ever-increasing amount of patient-generated data from connected medical devices, apps and sensors, it's important that digital health players build the right foundation to create a secure, reliable medical Internet of Things. While the elements are mostly out there, bringing all the components of digital health together is still the next frontier.

“When it comes to connected health, people always ask, ‘When are we going to be there?’ And my answer is, ‘When we can stop talking about it as eHealth or connected care – it’s just care. We don’t talk about eTravel or eTrade anymore, it’s just the way we do business,” Dr. James Mault, vice president and chief medical officer of Qualcomm Life, said during a panel at the Connected Health Conference in National Harbor, Maryland this week.

To make the leap from proliferation of devices, ideas and demand of connected health tools to a functioning medical IoT, Mault said the industry needs to identify both the barriers and accelerators that are needed to scale.

“There’s been a lot of hype and expectation literally over the past decade and so much has happened, but it’s still not ubiquity. You still aren’t seeing this type of care in terms of hundreds of thousands of millions of patients, and when I say patients, I’m talking about sick people,” Mault said. “The Fitbits of the world are doing a great job out in the Internet of Things in the wellness and fitness space, but now we are talking about some serious conditions."

First, there needs to be an effortless user experience, Mault said. Just adding Bluetooth to existing devices, for example, still results in a clunky experience. He sees wearable sensors and things like connected inhalers and insulin pens as poised to go a long way in terms of data capture, collection and transmission. Additionally, medical grade devices that provide information for life or death decisions must be trusted.

Karthik Ranjan, Director of Healthcare Technology at ARM (which licenses the intellectual property for chips that go in a variety of things ranging from medical devices to phones and servers), said his company sees ripe opportunity for partnerships that bring key metrics together, or build on top of each other. He pointed to the recent partnership between Fitbit and Medtronic as an example.

“It doesn’t stop there, with two devices working together,” he said. “Look at the smartphone. You turn it over and look at the back and it is blank. That area is ripe for putting more and more medical sensors. You already see that with Samsung putting heart rate sensors on the back. Imagine if we were to migrate to a world where you get sensors for “free” by buying a phone, and then you start getting insights.”

Ranjan said straightforward solutions that make it easy for the user could be the way to reach segments of the population who are hard to engage, such those who are young, healthy and indifferent and those that may have health issues, but are not motivated to make any lifestyle behavior change.

“I think if you can get patients through acquiring that data, give them some insights about what’s going on and get them engaged about their health, that also provides a great opportunity for the flip side of it, which is remote clinical decision making, he said. “Being able to get to the right specialist so they can get the care to that patient at the right time … I think we are at a very exciting place for that.”

As far as driving patient engagement, which is often the primary challenge for any healthcare professional, consumer-focused Fitbit believes the industry is finally making headway. As the wearable company dives deeper into healthcare, Fitbit’s vice president of digital health Adam Pellegrini said the goal is to get people as engaged with more serious aspects of their health than everyday activity.

“Marrying a good consumer experience that is engaging and inspirational, with community and challenges for consumer use, with meaningful insights from the things we do in healthcare every day is critical,” he said. “I think if you can find that nice balance, I think you can crack the code that we’ve all be searching for in patient engagement.”

Pellegrini said the Medtronic partnership is one of many that Fitbit hopes to have that will bring healthcare and wellness closer together.

But it’s not enough to identify opportunities for devices or figure out how to drive patient engagement to have a fully functional medical IoT, the panelists said. Having a network to keep that ecosystem functioning is also important.

Chinton Gohil, managing partner for Verizon’s Healthcare IoT program, said his company wants to be the backbone of this burgeoning industry. While much of the success of creating a seamless medical IoT system rests on the quality of data and level of patient engagement, a huge factor is the experience of the hospitals and providers delivering care.

“When you think about how hospitals and providers are going to deliver solutions to better patient care or better patient outcomes, who is going to do that?” he said. “We want to be the face of bringing that all together, so that is really what Verizon is focused on. Essentially, we need to stitch all these different technologies together and develop a business outcome roadmap.”

Mault spoke about Qualcomm’s experience as an enabler of digital health solutions, such as their partnership with UnitedHealthcare to offer a mobile-enabled wellness program, and said the industry needs to recognize that while the core competencies of wireless capability, power management and identity management are in place, they will have to evolve to support more innovation in healthcare.

“We need to turn that into a capability that suits and supports healthcare and the new needs of healthcare to become more connected,” he said. “We’ve taken an approach to create a continuum of connectivity from the hospital setting, in the intensive care unit, the operating room, and all the expensive life-supporting monitors out into the clinical setting and even into the home and wearables.”

In hospitals, Mault said, there is still a huge opportunity for better connectivity.

“As a cardiac surgeon myself, I can tell you firsthand that the way we have been taking care of patients in the operating room and in the intensive care unit has, sadly changed very, very little over the past 40 years. It's still very manual, it's still very haphazard, it's trial and error. And it’s not informed by a continuous stream of data,” he said.

To bring in more devices and generate more data, Mault said the next significant development will be a 5G network.
 
“This isn’t just about moving from 3G to 4G and getting faster data speed on your phone. That’s part of it. But what we are moving into is a scenario where we are going from about 14 billion connected devices today to over 50 billion connected things by 2020. Our current networks, as they are, aren’t really adequate to support this new world."

What Mault projects for the future is many pieces of data working together to inform clinicians without overloading them.

“Look at the ICU for example. Connecting to all these bedside monitors, the human body is generating about 20 million pieces of data per day. But very little of that is ever visualized and certainly never processed by even our best and brightest clinicians,” he said. “We’ve always been focused on one piece of data, but then bringing in two things, [like Fitbit-Medtronic], you can think, ‘Wow, what does that look like together?’ Now imagine having 20 different pieces of data coming together at one place and having it come in near-real time. It changes everything.”

Security will also need to evolve to support what Ranjan anticipated as more than 20,000 exobytes of data by 2020.

“If you tell the doctor, hey, you are on the hook to treat this patient but you aren’t seeing him face to face like you have been, that is a huge step for doctors I have talked to,” Ranjan said. “They get very nervous when you say that they have the same level of liability to treat a remote patient. It means you have to be able to trust the data in front of you.”Kobe 13 A.D. Shoes