Internet of Things (IoT) in the Healthcare Setting

POWERED BY satellites and landlines, Internet of Things (IoT) dates back to 1962 with the advent of the Internet as part of the Defense Advanced Research Projects Agency. One of the first examples of IoT involved a Coca-Cola machine located at Carnegie Melon University that programmers connected to the Internet to check if drinks were available and if they were cold before making the trip to get them. But, IoT wasn’t officially named until 1999, and by 2013, it had evolved into a system that used multiple technologies ranging from the Internet to wireless communication, microelectromechanical systems and embedded systems, among others.¹

While IoT is difficult to precisely define, Kevin Ashton, an expert on digital innovation, is credited with the first version’s definition in 1999 in the RFID Journal: “If we had computers that knew everything there was to know about things — using data they gathered without any help from us — we would be able to track and count everything, and greatly reduce waste, loss and cost. We would know when things needed replacing, repairing or recalling, and whether they were fresh or past their best.” Essentially, IoT is anything that can be connected digitally to communicate in an intelligent fashion.²

IoT in Healthcare

IoT has changed the world, influencing the way people live and work. Officially, IoT in the U.S. healthcare system mainly started with the Health Information Technology for Economic and Clinical Health Act in 2009 that stimulated the adoption of electronic health records and supporting technology, allowing patients to be more engaged in their treatment. Today, IoT in healthcare is projected to transform the industry. Grand View Research released a report showing global IoT devices in the healthcare market were valued at $58.4 billion in 2014, and in 2020, they will reach nearly $410 billion.³ And, in 2017, research from Aruba Networks found that by 2019, 87 percent of healthcare organizations would have adopted IoT technology, with 73 percent of applications used for remote patient monitoring and maintenance, 50 percent for remote operation and control, and 47 percent for location-based services.^4,5

What’s driving this growth? First, major companies such as Medtronic Inc., Philips, Cisco Systems, IBM Corp., GE Health and Microsoft are developing products specifically for medical applications. Second is the growing prevalence of chronic diseases and an aging population prone to chronic diseases that are spurring governments to develop digital health solutions to improve access to healthcare services and decrease costs.3 In addition, there is increasing demand from consumers for remote and home health devices.⁴

IoT in Action

The range of IoT applications in healthcare is vast, especially when including personal healthcare, the pharmaceutical industry, healthcare insurance, remote telehealth services, facilities, robotics, biosensors, smart beds, smart pills, etc. Yet, today, the majority of IoT devices in use can be divided into three major groups: wearable external devices, implanted medical devices and stationary medical devices. Wearables are typically biosensors that monitor physiological data with remote/wireless communication. With wearable devices, medical professionals can get a more detailed understanding of their patients’ conditions. Some examples:

• The Proteus Digital Health Feedback System is a wearable sensor or patch that gathers information from a digestible sensor that is consumed alongside oral medication. The digestible sensor is made of magnesium and copper and is activated when it gets wet in the stomach. The wearable sensor is secured on the patient’s torso and collects information from the activated digestible sensor in the stomach, including when the medication was ingested and activity level and rest patterns of the patient. The wearable sensor then relays the captured information to the patient’s mobile device, which can then be shared with healthcare providers via a web-based portal.⁶
• Zephyr Anywhere’s BioPatch is a device attached to a patient’s chest that helps track a patient’s condition minute-by-minute instead of the usual four- to eight-hour interval while at the hospital. If there is a dip in their health or condition, nurses and doctors are notified immediately from the patch to a smartphone.⁷

The adoption of implanted devices is still in its infancy, but in essence, they replace, support or enhance biological structures such as implantable infusion pumps, cardiac pacemakers, etc. Some examples:

• The Eversense Continuous Glucose Monitoring System is an implantable, fluorescence-based sensor, a smart transmitter worn over the sensor to facilitate data communication and a mobile app. The sensor, inserted subcutaneously in the upper arm by a physician via a brief in-office procedure, displays glucose values, trends and alerts. The data is then transmitted to an external transmitter that can be monitored by a healthcare professional.⁸
• Researchers at the Georgia Institute of Technology have created a new medical sensor to treat brain aneurysms. The device, which is battery-less, is a capacitive sensor with an inductor that is implanted in the blood vessels of the human brain to help doctors assess any abnormalities that can cause patient death.⁹

Stationary devices can be used for clinical operations such as telehealth, connected imaging, lab tests, imaging, etc. Some examples:

• AirFinder is a real-time location system that uses open-source iBeacon, Bluetooth Low Energy technology and Symphony Link integration to track supplies in an operating room or throughout an entire hospital or facility.³
• Microsoft’s Power BI collects and analyzes electronic health records (EHRs) and then pairs the information with open data sources to allow users to visualize data and explore service area patterns. Power BI brings data together on one platform so a network of doctors can share EHR data or metrics to better predict, for example, when flu season will hit and how severe strains might be.¹⁰

IoT’s Increased Need for Security

With 30 percent of healthcare organizations using IoT for sensitive information, there is a need to balance utility and security.⁴ Even with secure methods to communicate information to the cloud, the information is vulnerable to hackers. To counter risks, the U.S. Food and Drug Administration (FDA) has published numerous guidelines to establish end-to-end security for connected medical devices, and these devices will likely continue to be regulated.

In 2018, FDA issued the Medical Device Cybersecurity Regional Incident Preparedness and Response Playbook that outlines a framework for health delivery organizations and other stakeholders to plan for and respond to cybersecurity incidents around medical devices, ensure effectiveness of devices and protect patient safety. It is intended to supplement existing health delivery organization emergency management and/or incident response capabilities with regional preparedness and response recommendations for medical device cybersecurity incidents. Specifically, it identifies how hospitals and other organizations can develop a cybersecurity preparedness and response framework, which starts with conducting device inventory and developing a baseline of medical device cybersecurity information.¹¹ The playbook can be downloaded at www.mitre.org/publications/technicalpapers/medical-device-cybersecurity-regionalincident-preparedness-and.

Unlimited Benefits of IoT

Possibly more than any other industry sector, healthcare has the most potential for IoT use. Its benefits include reduced costs, increased efficiency, upgraded management of drugs and medication adherence, reduced errors and waste, improved treatment outcomes, enhanced data access, more personalized care and fewer hospital and doctor visits. Yet, inherent to these benefits come security risks that could expose healthcare organizations and patients to cyber mischief and attack. To counter these vulnerabilities, FDA and organizations responsible for creating IoT devices are forward-thinking to make safety and security a priority.