The Internet of Things is one of the newest and most promising trends in the healthcare industry. This rapidly proliferating collection of Internet-connected devices, including wearables, implants, skin sensors, home monitoring tools, and mHealth applications has the potential to connect patients and their providers in ways never before imagined, harnessing the power of big data analytics with innovative and exciting techniques.
As patients snap up millions of consumer-grade devices and health IT developers eye new ways to collect, analyze, and report on patient-generated health data, it would seem that the healthcare Internet of Things (IoT) is destined for immediate success.
However, no new health IT option is without its drawbacks, and the Internet of Things is producing just as many headaches as success stories as it works through its growing pains.
Many providers feel as if they do not have the bandwidth to integrate IoT devices and data into their already-crowded workflow, and it’s difficult to tell which of the dozens of new industry offerings will bring value to their patients in a time of constant and contentious change.
With so many competing initiatives vying for provider attention, will the Internet of Things become a valuable addition to the clinical decision support and patient engagement toolkit, or will wearables and smart scales turn into nothing more than a nuisance?
In this primer, HealthITAnalytics.com explores how the Internet of Things could change the healthcare delivery system for the better and how provider organizations can prepare themselves to overcome some of the obstacles involved in translating patient-generated data streams into actionable insights.
What is the Internet of Things?
Seven years ago, long before the advent of the smart watch or the endless parade of fitness trackers, the number of internet-connected devices in the world surpassed the number of people who own them.
The FTC estimates that there will be 50 billion devices connected to the internet by 2020, from refrigerators and toasters to cars, home thermostats, cameras, pet monitors, and infusion pumps.
A recent Tractica report states that the wearable device industry is likely to ship 97.6 million gadgets a year by 2021, creating a $17.6 billion industry juggernaut, and a Statista estimate predicts global shipments of smart wearables will be close to 1.4 billion by 2019.
Most of these devices connect to a user interface through an app accessible by smartphone, tablet, or desktop computer. These control points allow users to view their data, perform basic analytics, send updates to social media platforms, or share information with a circle of friends.
These devices, along with the apps and cloud storage facilities that store the data, comprise the Internet of Things. The value of cultivating such a network of devices comes from the ability to personalize services, use analytics to detect patterns, send information to remote locations, and motivate users into achieving specific goals.
While many of these consumer devices are little more than novelties intended to provide peace-of-mind, comfort, or entertainment to their users, the healthcare industry has quickly leapt on the idea of using connected devices to monitor chronic disease patients, bring independence to the elderly, and warn clinicians of imminent adverse events.
Since it is widely recognized that only a fraction of a patient’s health is directly related to the clinical care they receive, it is important for providers to understand what happens to a patient when he or she is not in the clinic.
The Internet of Things could allow clinicians an unrivaled degree of access into the daily routines and choices of their patients.
If a primary care provider knows that a patient with heart failure isn’t taking as many steps each day as she normally does, it’s possible that a check-up may be required. If the blood glucose monitor of a pediatric diabetic is constantly sending alerts that the patient is approaching dangerously high levels, it might be time to schedule an educational session about dietary choices with the parents.
IoT data could be the key to intelligently targeting preventative care and forestalling crisis events by extending the reach of providers and giving patients the background support they need to make better decisions.
However, the concepts are so new and the infrastructure so immature that there is a significant gulf between the patients who are generating the data and the providers who don’t necessarily want to deal with it.
Why don’t providers want to bother with IoT data?
What makes the IoT so frustrating to use? Too much data without enough insight leaves clinicians feeling frustrated, overwhelmed, and unable to get to the crux of what will help them treat their patients more effectively.
IoT developers boast about their ability to generate real-time streaming data, but rarely get the interfaces right for their users.
On the consumer side, device owners are generally disillusioned by the quality of the apps that let them control their gadgets, says a report by Argus Insights. Lackluster analytics capabilities, constant crashes, data syncing woes, and haywire notifications make it difficult to sustain engagement.
Source: Argus Insights
On the provider side, the situation is even more convoluted and confusing. Electronic health records rarely have the ability to accept, analyze, and report on patient-generated health data from IoT devices in a way that lets providers work to the top of their skillset.
While most providers are familiar with the fact that mHealth and IoT apps and devices are very popular among their patients, only a scant 15 percent had discussed the use of these tools with their patients as of June 2015. In another survey, half of providers said that additional data, such as medication adherence information, would probably not be very useful for their decision-making processes even if it could be presented in a user-friendly way.
There’s simply too much hype without a simple, intuitive way to consume important results, argues Ben Jonash, Principal at Doblin, the design and innovation arm of Deloitte LLP.
“[Patient-generated health data] is this messy, undefined stack of data that doesn’t sit within the EHR system,” he said.
“Can providers trust it? Do they? Is it good data? The number one reason why clinicians don’t like PGHD is the hassle factor. It’s too much work to determine whether they’re being sent a signal or just too much noise.”
“A primary care physician isn’t going to sit and stare at a live feed of your blood glucose monitor,” he pointed out. “They want to see digital therapeutics incorporated into a better way to deliver medical care.”
"The number one reason why clinicians don’t like PGHD is the hassle factor."
Patients would like to see the same thing, added Gerard Nussbaum, Director of Technology Services at management consulting firm Kurt Salmon.
“[Clinicians] have to give feedback from these activities “The patient wants to be able to look at the nice little graphs and charts that of her sleep data and draw her own conclusions about her habits or her problems. She can point to the information when she sees her doctor and ask informed questions about it. It involves the patient. It’s bidirectional. That is very important when it comes to engagement.”
And a high level of patient engagement is becoming increasingly important for provider reimbursement. As value-based reimbursement continues its march towards becoming the primary means of payment, healthcare organizations will need to overcome their reluctance to leverage the Internet of Things and work with their health IT vendors to create new strategies for integrating, analyzing, and presenting patient-generated health data.
How will the IoT environment change healthcare delivery?
Whether they like it or not, it appears that healthcare organizations are going to have to embrace the IoT trend eventually. Wearable fitness trackers and sleep diary apps are just the tip of the iceberg when it comes to health-related devices. Disposable skin patches, contact lenses, implantable devices, and even tiny cameras and nanobots that can be swallowed as pills are all on the horizon.
How can providers get ready for this new influx of data sources? They can start by assessing their current EHR processes and health IT infrastructure to identify opportunities for improvements. That may mean taking another look at where PGHD fits into the workflow, says Brian Carter, Executive Strategist at Cerner Corporation.
“There are studies that show if information is even one click removed from the main EHR interface, they’re not going to use it,” he said. “I think the degradation rate is something like 90 percent after having to go one click deep.”
“It needs to be a first-class data citizen, but only if we handle it intelligently. Because I can’t justify putting data on the first page if it’s not interesting.”
As health IT developers start to meet industry demand for better ways to interact with data, providers may soon have more options for technologies that will help them use the IoT for smarter patient care.
The growing consumer thirst for provider to take their FitBits seriously may also have a positive ripple effect on another sore spot in the workflow: the lack of data interoperability.
“[PGHD] needs to be a first-class data citizen, but only if we handle it intelligently."
“There’s really amazing value in the prospect of providing an integrated view of data to these users, because right now, they are logging into ten different systems and trying to mentally assemble conflicting data, which doesn’t help anyone,” said Bob Rogers, Chief Data Scientist at Intel Corporation.
“Pulling all that data into a unified view that enables us to optimize healthcare as a system at the same time as optimizing healthcare for an individual’s needs is one of the biggest challenges we’ll face.”
The IoT could provide the impetus for the industry to move more quickly towards adopting the data standards that would bring harmony to disparate data sources, especially as it proves its value for chronic disease management, remote monitoring, and even predictive analytics.
In turn, this will make it easier for care managers to engage with patients, and easier for patients to stay connected and motivated with their individual treatment plans. Sustained engagement will create lasting behavioral change that may mitigate or reduce the impact of common chronic diseases, such as heart failure and diabetes.
“The challenge [of the IoT] is about creating the right habits and reinforcing the message and linking these strategies back to what matter,” Jonash said. “It’s about making sure you’re not completely dependent on the patient to self-manage the situation, because most people just can’t do that.”
Ultimately, the Internet of Things could be the spark that ignites reduced costs, better patient engagement, and better outcomes across the board – all three facets of healthcare’s Triple Aim. But the IoT will not succeed unless providers can steer their organizations towards a broader acceptance of patient-generated health data and health IT developers figure out how to manage, filter, and present this information in a meaningful way.
As the market for healthcare Internet of Things devices continues to grow, and consumer excitement over the potential of this new ecosystem reaches a fever pitch, healthcare organizations must quickly develop the strategies and competencies required to make patient data, patient engagement, and patient-driven decision-making a top priority.