How IoT is becoming the pulse of healthcare

Healthcare CIOs’ budgeting for IoT devices is surging. Uses range from managing hospital facilities, medicines and medical equipment to monitoring patients’ locations, vitals and symptoms, with increased efficiency and data accuracy.

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The Internet of Things is made up of small computing devices with unique IDs connected together through a network and performing specific tasks. In healthcare that can mean monitoring building temperatures, air flow, medical devices or even the health of a patient in or out of a healthcare facility.

Because of their ability to independently communicate data, there’s potential for eliminating direct human interaction with systems equipped with IoT devices and central data respositories, automating processes and increasing efficiency and data accuracy.

A Gartner survey of 511 U.S.-based enterprise IT managers, released in January, revealed that IoT adoption is becoming mainstream. Eleven percent of those surveyed worked in healthcare enterprises, and 86% of those respondents reported having an IoT architecture in place for most lines of business.

The survey of organizations with annual revenues of more than $100 million also revealed that 79% of the healthcare providers are already using IoT in their production processes.

Healthcare CIOs’ budgeting for IoT is on par with that of other industries leading the IoT-adoption charge, including manufacturing, pharmaceuticals, energy, retail and transportation. In healthcare, according to Gartner, there has been 10% growth in budgeting for IoT in each of the past two years, with a 13% budget increase for the next fiscal year.

It’s not yet clear how the COVID-19 pandemic may shift the use of IoT in healthcare, but Juniper Research predicts a rise in remote monitoring to minimize public interactions. An early example: smart thermometer maker Kinsa aggregates users’ temperature and symptom data to identify possible outbreak areas across the U.S.

One of the fastest growing areas of IoT deployment in healthcare is healthcare facility infrastructure monitoring, according to IDC. Twenty-nine percent of healthcare facilities in Europe are piloting IoT devices for building monitoring and management, and 16% have production systems, according to IDC’s 2019 Global IoT Survey, which included 147 respondents.

IoT in healthcare survey results IDC

Devices that track temperature, staff hand hygiene and patients' adherence to medication at home are among the most commonly deployed IoT systems in Europe, according to IDC. (Click image to enlarge it.)

For example, Wi-Fi-enabled smart thermostats allow users to program and adjust temperature settings, but the devices can also be self-learning and adjust temperatures up or down based on trend data for when a building is typically occupied or unoccupied.

In hospitals, smart light bulbs, as well as hallway and room movement sensors, can communicate when staff or patients are present. The data can be used for adjusting environmental controls in large wings of a building.

IoT married with real-time location services (RTLS) enables hospitals to geospatially track patients. Admission wristbands, once simply made of paper with printed personally identifiable information, now often contain wafer-thin IoT chips that communicate a patient’s location in real time via Bluetooth Low Energy.

Sometimes patients check into a hospital and then decide to leave without treatment, a scenario that's not as rare as you might think. In other cases, patients may be on-site but not where they're expected to be. “They are there for a procedure and no one knows where they are,” said Gregg Pessin, a senior research director at Gartner. “Knowing where they are saves a lot of time and energy.”

Wrist and ankle bands today also track newborns in a maternity ward, helping to prevent infant theft. If an infant with a tracking device is removed from a specific ward, security teams can be alerted and elevators and doorways locked either automatically or manually.

Along with people, IoT tracking chips also keep track of medications and expensive hospital equipment, everything from crash carts and portable X-ray machines to wheelchairs.

Medical devices, including wearables, lead the way

Medical devices, however, are by far leading the IoT revolution. Vital-sign monitors, pacemakers, and continuous glucose monitors (CGMs) all produce telemetry data that can be automatically uploaded to a patient’s electronic medical record (EMR) and used by a physician for more accurate diagnosis and treatment.

Medical diagnostics make up a large portion of hospital bills, so whenever remote monitoring technology can move the routines of medical checks from a hospital to the patient’s home, the cost of care can be reduced.

Wearables such as the Apple Watch and Fitbit, combined with health apps, are expected to be one of the most lucrative markets for the industry. Morgan Stanley estimated that the healthcare market for Apple will top $15 billion in sales by 2021 and as much as $313 billion by 2027, based on the popularity of the Apple Watch and its health features, like monitoring heart rate and steps.

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The Apple Watch is among the most popular consumer health-monitoring devices.

Since becoming generally available in 2018, Apple's Health Records mobile patient health record aggregator has generally won praise from hospitals beta testing the app.

This year, one in four patients is expected to be participating in a "BYOD" — bring your own data — healthcare scenario, according to research by IDC.

"It's good to know all the relevant data on a patient — their meds, their allergies, their problem lists, lab results, radiology reports. On the flipside [for clinicians], it's just more data in my face..., it's just more data I need to sift through," Mike Restuccia, CIO at Penn Medicine, the medical school at the University of Pennsylvania, said in an earlier interview with Computerworld. (Penn Medicine is one of the 12 original beta testers of the Apple application.)

"I think that's going to be one of the next challenges for Apple," Restuccia said. "Now that this raw data is available, how do you translate it into something that's more user friendly, more intuitive for a clinician? It doesn't include physician notes at this point, which is probably a good thing."

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Apple's Health Records feature is part of the built-in Health app in iOS. (Click image to enlarge it.)

The Apple Health Records feature relies on the existing Health app (released in 2014 on iOS 8) to allow medical facilities to connect via an API to their EMR systems to share data with patients in a standard format.

EMR vendors such as Epic Systems, Cerner, Athenahealth, Meditech and Allscripts worked with Apple to enable integration with the mobile app. When a patient downloads the Apple Health app and chooses to allow their health data to be transferred from a healthcare provider to Apple's Health Record, it is encrypted and does not traverse Apple's network.

More than 400,000 patients who use the Johns Hopkins Medicine web portal powered by Epic's MyChart app now have access to their EMRs via Apple's Health Record, according to Dr. Peter Greene, Chief Medical Information Officer at Johns Hopkins Medicine.

“A Fitbit or an Apple Watch is an IoT device, but it’s not clinically rated, so a physician can’t use the data to base decisions on yet,” said Gartner's Pessin. “But the devices will get FDA certification eventually, and doctors will want to use the data from them.”

Bluetooth-enabled weight scales and blood pressure cuffs, together with applications for tracking disease or illness symptoms, automatically send updates to physicians and allow them to track a patient’s response to treatments without the need for multiple follow-up visits.

In-hospital IoT devices that can regularly measure a patient’s temperature, blood pressure, pulse and oxygen levels alleviate the need for a healthcare worker to perform the tasks. Perhaps more importantly, such automation reduces the possibility of human error for data entry into a patient’s EMR, which is common, according to Pessin.

“People making healthcare decisions have a more accurate view of what’s going on with the patient. It also means there’s an opportunity for healthcare to be delivered faster and better. More accurate information delivered quicker means physicians are able to respond faster and a patient is healed faster,” Pessin said. “That’s key and what we’re after there.”

In Europe, the top 10 production deployments for IoT in healthcare include temperature tracking, asset and inventory tracking and management, staff hand hygiene, remote monitoring of patients’ health conditions, smartwatches for health and wellness tracking, and smart pill boxes for medication adherence while a patient is at home, according to IDC.

According to Gartner, IoT devices used by hospitals and patients will grow exponentially over the next eight to 10 years for the following purposes:

  • To track the chronic condition status — global remote monitoring for chronic conditions will grow from one in 100 people with a device in 2018 to one in 17 with a device in 2028.
  • U.S. elder care and assisted living facilities will optimize scarce resources by increasing healthcare monitoring devices used around the premises from 1.5 devices per resident to 12 devices between 2018 and 2028.
  • Hospitals will locate assets and people, and consequently enhance asset utilization, by more than tripling the number of tracking tags they own worldwide between 2018 and 2028.
  • To keep nonurgent patients away from the ER and reduce unwanted, expensive hospital admissions, spend on chronic condition management (which accounts for more than 75% of healthcare spending) will grow from nearly $11 billion to $39 billion worldwide.
  • Providers will enable technology-assisted living at home (aging in place) or at the patient’s preferred location by increasing the number of assisted living devices from 8 billion to 96 billion worldwide at a compound annual growth rate of 28% between 2018 and 2028.
  • To improve patient outcomes as they move freely and to reduce the stock of equipment needed in healthcare providers, more than 40% of the healthcare IoT items shipped worldwide from 2018 through 2028 will be tracking tags.
gartner healthcare iot 2019 revenue forecast 2028 Gartner

According to Gartner, IoT spend by healthcare providers will grow from $16 billion in 2018 to nearly $52 billion in 2028 at a compound annual growth rate of 12%. Chronic condition management will have the largest revenue growth of $28 billion, but the highest growth rate will be in hospital hygiene monitoring (38% CAGR).

Healthcare IoT devices work in concert

Gartner, which calls IoT in healthcare “Internet of Healthcare Things” (IoHT), said devices can range from clinical, to facilities, to back-end office mechanisms that possess the intelligence and technology to connect, communicate and interoperate. They sense and monitor the state or performance of a patient, environment or other real-world objects.

IoT technologies are often integrated with one or more applications to provide a specific function, such as clinical patient monitoring for inpatients. Many other applications exist in the healthcare enterprise, including HVAC control, blood and tissue bank condition monitoring, and materials management or central supply inventory control, according to Pessin.

More important than what a single IoT sensor or meter can do is what a network of them can provide in terms of facilities’ historical trend data or remote monitoring that provides a vastly more accurate picture of a patient’s medical condition over time compared with a physician checkup.

Hospital facilities management is also benefiting from trend data sent to repositories that collect air conditioning, heating, or water flow throughout a building.

Smart thermostats, for example, constantly measure temperatures throughout a building, but the IoT devices also contain a clock for time stamps. Motion sensors detect when patients or staff are in rooms and hallways, so they have the potential to upload data into analytics systems to paint a bigger historical picture that can be used to adjust energy use or even improve patient care.

“That’s what I’m trying to communicate to clients,” Pessin said. “We have all these devices to deliver certain things, but we’re missing the fact that they offer embedded data and new insights about what's going on inside hospital. Situational awareness is important for the future of healthcare.”

Hospital ‘digital twin’ changes facilities management

Last fall, the University of California, San Francisco (UCSF) Health system opened a new 180,000-square-foot Precision Cancer Medicine Building (PCMB). Before the building was constructed, the facilities team, working with IBM Maximo, created a 3D digital twin of the PCMB with 63,000 “assets” or specific building objects and equipment imported from the architectural model. The assets represent everything from HVAC filters and plumbing valves to electrical outlets and fire walls, and many of them come with native IoT sensors that can be monitored and send alerts.

The 3D building rendering, built through Autodesk’s Revit building information modeling (BIM) software, is part of a computerized maintenance management system (CMMS) that allows facilities managers to see all their assets through a single pane of glass and respond to failing or failed systems in minutes instead of hours or days.

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The UCSF Precision Cancer Medicine Building as viewed using the Maximo 3D digital twin software. (Click image to enlarge it.)

For example, a facilities manager can click on an asset, such as a large air handler on the building’s roof, view the system’s filter and then drill down to see the manufacturer’s information, RFIs, AFIs or other metadata on that particular filter bank. A manager can then see all the other systems or areas of the building affected by the filter bank. Many of those systems come native with IoT sensors that can be connected through the CMMS software and used to report on system failures or potential problems.

There can be literally thousands of bits of information associated with a single building system, according to Bruce Mace, UCSF’s executive director of facilities. For example, a building manager can click on a specific hospital air filter and follow it upstream to the roof-top exhaust fan or follow it downstream to the rooms it serves.

“I can go all the way down to the control value from a vent being exhausted from a specific room. Any data such as heat, airflow, and temperature is becoming connected through this digital twin,” Mace said. “All those attributes that are trended over time are very valuable to somebody like myself.”

Prior to the 3D BIM software, facilities management used either paper diagrams or AutoCAD, which was two-dimensional.

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