Guest post by Susmit Pal, healthcare strategist, Healthcare & Life Sciences, Dell EMC
Aging populations and the rising incidence of chronic disease consume a disproportionate amount of healthcare resources. In the United States, about 75 percent of healthcare dollars go to chronic disease care and two out of every three Medicare recipients suffer from at least two chronic diseases. The pressure for relief will grow as the population ages with approximately 10,000 new patients estimated to enroll in Medicare every day for the next 15 years. The current demand for resources for chronic disease care combined with the imminent spike in Medicare enrollment beg for achievable solutions and strategies that address costs, care quality and outcomes in the short term.
Enter the Internet of Things (IoT), also referred to as the Internet of Medical Things (IoMT) within the healthcare industry. IoT is something that most are well-familiar with, but for the sake of clarity, we define it here as the purposeful connection of intelligent sensors, devices, and software to computer networking systems using Bluetooth, Wi-Fi, RFID or M2M wireless technology in order to promote an inter-functionality that serves a greater purpose. In healthcare, that greater purpose is the achievement of less costly and more information-driven and efficient patient care. Think wearable devices and wireless pill bottles, nanotechnology and ingestibles, and network-enabled medical devices like stethoscopes that can transmit cardiac data directly into a patient’s electronic health record (EHR).
The Impact on Chronic Disease Management IoT shows great promise in helping to improve the health of patients with chronic conditions. Combinations of remote monitoring, analytics and mobile platforms have repeatedly cut re-admissions of high risk patients with congestive heart failure (CHF) by more than half. Evermore affordable and easier-to-use devices, such as wireless scales and heart rate and blood pressure monitors are improving overall wellness for the chronically ill. In fact, some researchers estimate that the value of improved health in patients with chronic disease using remote monitoring could amount to $1.1 trillion per year by 2025.
At the consumer level, the rapid increase in the type and variety of personal mobile fitness trackers like Fitbit®, and online fitness applications for consumers demonstrates comfort with IoT to monitor physical health. Their very existence has created an avenue for patients to become more accustomed to tracking and managing their health online. In response, healthcare organizations are beginning to incorporate them into their consumer engagement strategies, while payers are starting to offer discounts and incentives tied to wellness management.
IoT is also helping to spur on some rather exciting new technological advancements in chronic disease management. Connected wheelchairs, for instance, are enabling people with disabilities to engage with care providers on a whole new level, communicating health alerts to care teams and repair notices to manufacturers. A group from the University of Missouri is spearheading a development project to utilize home monitoring sensors in an effort to prevent falls among the elderly by providing alerts to the patient when there is a fall risk, while Dell Healthcare is working with hospitals to leverage the use of tablets with integrated card readers to enable remote healthcare for home-based treatments.
There exists an even greater potential for IoT to impact chronic disease management at a population-level when combined with data analytics. For instance, Health Net Connect (HNC) has initiated a population diabetic management program with the intent to improve clinical outcomes and healthcare savings for diabetes, one of the deadliest and most costly of chronic diseases—and the results are impressive. They captured vitals and blood work from study participants over a 6-month period to measure the impact that routine teleconferencing and patient monitoring had on outcome. Patients in the program showed a significant decrease in key biomarkers, including 9.5 percent lower HB A1C and 35 percent decrease in LDL. To put that into perspective, for every 1 percent drop in HB A1C they estimate an $8,600 annual savings, and for every 1 percent decrease in LDL there is a 1 percent decrease in coronary heart disease, which costs on average a million dollars over a lifetime. HNC is continuing this program, noting that “this project has, and currently is demonstrating return on investment with cost savings, improved access for program members to their physician, improved clinical outcomes, and improved knowledge by program members on their disease condition.”
Guest post by Puneet Gupta, chief technology officer, Brillio.
For those in the healthcare industry, the future feels at once full of promise and always just out of reach. Transformational advances in technology are on the horizon and fast approaching—but anticipating and adopting new tech can seem like an impossible task.
Perhaps the most promising tech trend for healthcare is the Internet of Things (IoT): the increasingly interconnected network of intelligent devices and objects that share data and enable the physical world to be integrated into digital systems.
While nearly every industry can employ IoT systems to create greater efficiencies and support new business models, the healthcare industry is particularly poised for major gains. According to a recent report, IoT in healthcare alone will be a $117 billion market by 2020.
IoT technology and digital integration has enormous potential to create meaningful experiences and better outcomes for patients, doctors, and healthcare professionals. And yet, amid all this promise, the current state of healthcare IoT leaves a lot to be desired.
How Healthcare Companies Need to Re-Imagine Change
Why is IoT adoption still lagging in the healthcare industry, despite all this potential? Many companies are simply thinking about technological change the wrong way.
Naturally, most people try to think about such changes from a 30,000-foot perspective. IoT is such a huge strategic transformation, it’s easy to get overwhelmed and not know where to begin.
I prefer to look at things differently. Instead of surveying major paradigm shifts from a million miles away, let’s flip the model and focus in on micro-experiences—small, concrete touch points along a user’s journey where technology can make a meaningful intervention.
By building from the ground up in real-world contexts—instead of from the top down in the abstract air—you’ll be able to quickly implement a number of IoT solutions and see the impact. Overarching systems will organically develop up over time as you create valuable micro-experiences on the ground.
While contemplating a global shift only generates new questions, breaking IoT down into bite-sized, tangible moments grounded in reality opens the door for immediate achievements. That’s what we call the art of the possible.
4 Examples of IoT Micro-Experiences in the Healthcare Industry
In the spirit of focusing on context and individual instances, let’s look at four real examples of how we’ve deployed IoT micro-experiences in healthcare.
Guest post by Alexandra Roden, content editor, Connexica.
Just a few years ago, big data and the Internet of Things (IoT) were terms generally unheard of. This year they continue to revolutionize technology and the ways in which we acquire and process data, but what do they mean for the healthcare industry?
Xenon Health describe IoT as “a phenomenon through which the operational aspects of the physical world become increasingly integrated with digital platforms, enabling information to move seamlessly toward the computational resources that are able to make sense of it.” Essentially, IoT goes hand-in-hand with the mobile age and the diversity of data that is currently being retrieved from agile and mobile locations.
Big data is a related concept – it addresses the ever-increasing amounts of data that are created every second of every day and recognizes that these figures will only continue to grow. For example, in the “social media minute” every single minute there are 277,000 tweets are sent, Whatsapp users share 347,222 photos and Google receives more than 4,000,000 search queries. These figures are remarkable even for those of us caught up in the social media hype, and most shocking of all is the realization that the global Internet population now represents 2.4 billion people. That’s a lot of people creating a lot of data – the question now is how we can utilize this data in a meaningful way.
IoT has revolutionized many industries and will continue to do so in the foreseeable future, but what about healthcare? Organisations within this industry tend to adopt new technologies slowly, relying upon solid evidence and demonstrable impact and efficiency before committing to any such change. The shift towards IoT is, however, beginning to take place, and increasing amounts of available patient data are beginning to inform decision making processes within this sector.
Guest post by Eduard Goodman, chief privacy officer, IDT911.
Earlier this year, Centene Corporation lost six hard drives containing personal and health information of almost one million of its clients, including names, addresses, dates of birth, Social Security numbers, member identification numbers and health information. Unfortunately, Centene is only one of many healthcare organizations that recently had their sensitive patient information exposed. More than 113 million health records were breached in 2015 – which translates to one out of every three Americans being affected by a healthcare record breach last year. Medical identity theft is a disastrous trend that needs to be addressed. The good news is there are many steps healthcare organizations can take to reduce the risk of data breaches.
Electronic Health Records
As more and more healthcare organizations transition away from paper medical records and move to electronic health records, it is critical that security features are put in place to protect the vast amount of data being collected. Just as the digitally stored health information is more easily accessible for employees, it is also easier for cyber criminals to access. According to the Ponemon Institute’s The State of Cybersecurity in Healthcare Organizations in 2016 report, nearly half of those surveyed said their organizations have experienced an incident involving the loss or exposure of patient information during the last year. Strong encryption, routine vulnerability patches and multi-factor authentication are key to protect health data.
Mobile and BYOD
Greater connectivity means more convenience, but this also opens more doors for hackers to access healthcare networks. Healthcare organizations should set clear BYOD policies so employees understand what can and cannot be accessed from mobile devices, what operating systems are approved for use on the network, what security features and settings are required and what type of data can be stored on devices. While using mobile devices can significantly improve productivity, it is important to minimize security risks in order to protect sensitive data.
Internet of Things
The Internet of Things is a growing trend in the tech world that has also become popular in the healthcare industry. Now, medical devices can collect, track and share enormous amounts of data instantly through internet connectivity. As these medical devices were most likely added to pre-existing networks, they may not have the necessary security protections. Security vulnerabilities are not just limited to EHR and health networks anymore – medical devices must be thoroughly inspected as well. Just as computers and servers are patched for vulnerabilities, medical devices that connect to healthcare networks must also be regularly patched. If these IoT enabled devices do not have the necessary layers of security, they will become an easy target for hackers to access the healthcare network.
Gartner has estimated that some 6.4 billion connected things will be in use by the end of 2016, with some 5.5 million new things getting connected every day. There’s been a clear boom in health and fitness wearables, with healthcare consumers investing in tracking devices – sometimes with their employer’s encouragement – and the MedTech industry has jumped on this in a big way.
Fascinating IoT applications are being developed today, often through unlikely partnerships. For example, medical devices company Medtronic is developing an application that transmits wearables data to the IBM Watson cognitive computing and predictive analytics platform. And Swiss pharma company Novartis is joining hands with Qualcomm to develop an internet-connected inhaler that can send information to a cloud-based big data analytics platform for healthcare providers to use in treating patients. These are exciting examples of how technology and analytics can support personalized medicine.
However, there are a couple of big issues that the IoT movement has to contend with when it comes to the Medical Internet of Things (IoT). These issues concern us as consumers, and they also concern our employers and our healthcare providers equally.
Data security: The medtech industry is widely seen as unprepared for the security risk and vulnerability to hacking that their devices can cause for the rest of the healthcare system. This has immediate repercussions for consumers who may be unaware of the exposure of their personal medical information to cybercriminals. In addition, as healthcare providers start using medical information from these interconnected devices in a cloud-based environment, their enterprise IT, specifically electronic health record (EHR) systems, could be seriously compromised and vulnerable to hackers. And this brings us to the other, emerging issue that is beginning to get some attention in the exchange of IoT data.
Privacy and legal concerns: While there are undisputable benefits for healthcare consumers as physicians gain access to medical information from a range of connected devices, there is a real threat to privacy as well. We start with the question of who owns the data. State law in the U.S varies when it comes to this question, and device makers and other software providers may lay claim to the data which can be used against consumers. At the same time, collecting personal data through devices imposes a set of legal requirements on enterprises, starting with proper disclosures about the collection and use of the information.
Across nearly every industry, Lean process improvement and analytics have radically changed the way that businesses operate. Now, with the advent of big data and accompanying business insights, we’ve moved beyond troubleshooting problems to data-driven design and predictive analytics. The impact of these processes and technologies is felt at every level of the manufacturing supply chain. What happens when all of these innovations hit healthcare?
We’re already seeing many of them in action in hospitals across the world, which are now able to analyze the movement of patients, clinicians and equipment, thanks to RTLS and RFID – among the first Internet of Things (IoT) technologies. The central value proposition of IoT analytics and data visualizations in healthcare is that by providing clinicians and other users with actionable insight into their everyday processes, they will be empowered to understand and modify their behavior, and improve efficiency and the patient experience.
We know this technology works – revealing inefficient workflows, missing or insufficient levels of equipment, patients who have been waiting too long, and more. But acting on these insights to generate change requires more than technology. It needs visionary leadership to create cultural change, grounded in objective data and the real-time feedback it provides.
It’s no easy feat, and we’ve seen industrial engineers working to create change in healthcare for years. What’s different now is the data, which moves us beyond gut instinct or individual experience. Analytics in healthcare – based on objective and comprehensive IoT data – supports a constructive conversation about change, and can be used by staff at all levels to study the impact of an experimental process improvement. Hospitals can enable highly skilled workers to lead from within, rather than managing them top-down. They can leverage the experience and scientific mindset of clinical staff to identify new areas for growth, experiment to improve, measure success and continue to innovate with each new win.
That last point is perhaps the most important. For us to truly change healthcare, hospitals must develop a continuous cycle of improvement. This is what it means to be a Lean hospital in today’s data-empowered industry. Once the organization changes a practice or habit, it can study the impact of that change and then uncover other opportunities to improve further. The next set of practice changes may involve different measurements and metrics as the process of discovery continues.
Guest post by Mohan Balachandran, co-founder and president, Catalyze.
As we look back upon 2015, we can reflect, review and based on that and other factors, make some predictions about what next year will bring us. John Halamka had an interesting post that reflect on the bigger challenges, such as ICD-10, the Accountable Care Act and its implications on data analytics, the HIPAA omnibus rule and its impact on cybersecurity and audits and the emergence of the Cloud as a viable option in healthcare. We can expect to see some of these trends continue and grow in 2016. So based on these key learnings from 2015, here are a few predictions for 2016.
Cybersecurity will become even more important
In 2015, insurers and medical device manufacturers got a serious wake up call about the importance and cost of cybersecurity lapses. Healthcare data will increasingly be looked at as strategic data because we can always get a new credit card but since diagnoses cannot change, the possibilities of misuse are significant. Just as the financial industry has settled on PCI as the standard, expect the healthcare industry to get together to define and promote a standard and an associated certification. HITRUST appears to be the leader and recent announcements are likely to further cement it as the healthcare security standard. Given all that, one can safely expect spending on cybersecurity to increase.
IoT will get a dose of reality
The so-called Internet of Things has been undergoing a boom of late. However, the value from it, especially as applied to quantifiable improvement in patient outcomes or improved care has been lacking. Detractors point out that the quantified-self movement while valuable, self selects the healthiest population and doesn’t do much to address the needs of older populations suffering from multiple chronic diseases. Expect to see more targeted IoT solutions such as that offered by those like Propeller Health that focus on specific conditions, have clear value propositions, savings, and offer more than just a device. Expect some moves from Fitbit and others who have raised lots of recent cash in terms of new product announcements and possible acquisitions.
Guest post by Christina Richards, vice president, AOptix.
In recent years, the healthcare industry has experienced a Renaissance of sorts with the development and adoption of mobile and connected technologies. As a result, healthcare facilities the world over are increasingly making use of smart technologies to drive better patient outcomes, track equipment, and support overall operations. In addition, the developing practice of telemedicine is becoming increasingly commonplace for doctors in healthcare settings across the United States, which is raising new concerns about the infrastructure needed to support these real-time doctor-patient experiences.
Although the development of these digital technologies for healthcare applications is only in its infancy, we are already beginning to see their wide range of benefits, including the potential to help organizations achieve the Institute for Healthcare Improvement’s (IHI) Triple Aim of bettering the patient experience, improving population health standings and reducing the cost of healthcare. For instance, a 2014 study by Dale H. Yamamoto of Red Quill Consulting, Inc. found that that the average estimated cost of a telehealth patient consultation was $40 to $50 per visit, compared to the average estimated cost of $136 to $176 for in-person acute care.
With the widespread adoption of any new technology however, there is a learning curve to ensure that they can be effectively integrated into existing operations to capture the greatest benefit without compromising the level of care. But what does this entail?
As healthcare facilities become more connected through the Internet of Things, adoption will continue across a broad spectrum of devices and sensors—from wearable tech that monitors patient location and vital signs to analytics platforms that track staff movements and create more efficient workflows. While these devices span a variety of applications, they all share a universal purpose, which is the constant collection and analysis of data.
Likewise, video conferencing and other mobile approaches to telehealth are highly data-intensive, requiring the transmission and processing of large amounts of information. As a result, many healthcare administrators have encountered the need for far more robust mobile networks in their facilities to support the massive amounts of data traveling across their systems.
In considering other data requirements on the horizon, take the case of rapid genomic sequencing. While the new technology allows researchers to quickly determine the complete DNA sequence of an organism to predict disease susceptibility and drug response, the process requires the transfer of massive amounts of data. To make this information more widely accessible, one company, NantHealth, is looking into a method of compressing the data into a more manageable size so it can be shared with other facilities through high-capacity wireless connections, rather than strictly relying on fiber. With ever-growing levels of data becoming necessary in the healthcare system, new technologies and methods for managing it across various networks will become even more important.
Guest post by Geoff Zawolkow, CEO, Lab Sensor Solutions.
I woke up this morning, anxious about my doctor’s appointment. I quickly showered, dressed, walked and fed the dog, grabbed my phone, and hopped in the car for the 30-minute drive. As I took my seat in the waiting room I realized that I’d forgotten to set my home alarm.
Because of IoT the solution is now simple. I bring up the app on my phone and set the alarm to “Away”, and while I’m at it I decide to program my DVR to record the season finale of “Downton Abbey.” So, I bring up the DVR app on my phone and click-click-click, Downton Abbey will be recorded. Maybe I’ll watch last week’s episode right now, but with that, I’m called into the exam room for my appointment.
With IoT bringing convenience and luxury like this into the lives of everyone with a smart phone, it’s logical that this same technology has been extended for use by the healthcare community and the clinical laboratory in particular.
In 1999 when the article “To Err is Human—Building a Safer Health System” was published by the Institute Of Medicine, the number and complexity of medical errors shocked the whole medical community. Often, these errors could be attributed to human mistakes. Since that time the medical community has developed systems to help reduce those errors. Checklists during surgery, automated systems for testing blood in the laboratory, better procedures to prevent contamination. Even given these, eliminating errors has proven to be very difficult.
Security continues to be a major problem in health IT. The coming year will only bring more breaches and problems that must be addressed by those leading their organizations. In 2013 alone, millions of people were affected by breaches.
Breaches can be attributed to something as simple as a stolen device — flash drives and laptops, for example – to unauthorized access or disclosure of information by health system employees. For example, Healthcare IT News recently reported a four-year long breach by a single employee at the five-hospital Riverside Health System in southeast Virginia.
Health IT security issues are only going to get more pervasive, aggressive and encompassing in the years ahead. So, what can we expect as we look ahead? Here are some predictions about health IT security from the industry’s leading minds:
Remaining in compliance with these codes and regulations, like HIPAA, is key from a security point of view for healthcare organizations. Being compliant and ensuring that only the appropriate healthcare staff members and contract workers have access to the information they need to do their jobs ensures that the information remains secure and does not end up in the wrong hands.
Because of the sensitivity of the information accessed on a daily bases within a healthcare organizations and the number of people accessing the information – doctors, nurses, clinical and admin personnel, and contractors – IT security concerns will be slightly different than the highly publicized breaches we read about, like the recent Target breach that originated outside the organization.