IoT Inspires Move to Therapeutic Systems that Support Integrated Care




Medical device manufacturers are used to innovating and optimizing the performance of individual products. But, with the increased availability of Internet of Things connectivity, it is making more and more sense to move up a level, and to perceive and design an entire suite of products devoted to a specific therapy, both inside and outside the hospital. 

This also fits with the drive for integrated care, particularly for chronic ailments. A connected suite of devices can more effectively measure and report results and can also be optimized over time, as rate and cost-reduction limiting steps are identified and redesigned.

Beyond the hospital bed

Treatment no longer begins or ends at the hospital. In the form of the patient’s phone, or even custom-built wearable devices, monitoring can follow them home. This minimizes inpatient costs, while still providing the data physicians need to track the effectiveness of treatment. 

It also gets the patient out of the hospital, a site of cross-infection, procedural errors, and emotional discomfort, and gets them home. 

Remote monitoring and its discontents

Wearables are everyone’s favorite manifestation of IoT technology. Once these devices move out of controlled laboratory settings and discover the dirty, noisy, high-impact real world, their accuracy falls off significantly.

In general, proponents sometimes underestimate how reliable and error-free a physiological measure needs to be before it can be used as the basis for medical decision making—and how hard that accuracy is to achieve.

Despite the challenges, the potential benefits are significant, and a number of companies are working on remote monitoring solutions to both chronic ailments, and post-operative recovery.

Atrial fibrillation

AF is the most common form of heart rhythm disorder, affecting between 3 and 6 million adults in the US, and contributing to 80,000 annual deaths, mostly through stroke and heart disease. While there are both surgical and drug treatments, there is currently no real cure, so monitoring of heart function through electrocardiograms is essential. But even portable ECG devices are expensive and cumbersome.

AliveCor sells a mobile device with embedded sensors and a corresponding app. If the patient feels fatigued, dizzy, or short of breath, they can grab the Kardia Mobile ECG, with both hands and put their forefingers on the sensors. The Kardia app can either provide an AF detection (with the guidance to see a doctor), and then allow the users to choose to send the data to a cardiologist. The opportunity to add other data by using voice memos as whether they were exercising or just had a Red Bull, can over time build a data record in which patterns can be discerned by the software’s machine-learning algorithms. 

Both AliveCor’s device and its algorithms are FDA cleared and CE mark approved. The device’s effectiveness stems from the fact that it is designed for one specific monitoring function, and provides information on one physiological condition. 

From this base, AliveCor is expanding, first into remote monitoring through a partnership with LifeWatch, and also to the heart as a whole.

“We’re taking advantage of the data and applying machine-learning technology to provide insights to both consumers and doctors through early detection of symptoms,” said AliveCor Chief Commercial Officer Doug Biehn. “This brings caregivers, patients, social pressure, and other factors together to drive behavior change and thus increase survival rate and peace of mind.”

Surgery and acute care

Modern surgery is an information-intensive business. An operating room (OR) is filled with video screens and data readouts. 

That vast amount of imagery, increasingly 3D, must be intelligently sorted, overlaid, and displayed to the surgical staff during surgery. All other data, from the patient’s electronic health record (EHR), from live cameras, from sensors measuring everything from catheter position to cardiac function can provide the surgeon with a comprehensive knowledge of the patient’s current state. 

There is also a potential huge gain from improvements in workflow. Hospitals are increasingly implementing real-time location systems (RTLS), mostly based simple radio-frequency identification (RFID) devices in order to track both patients and the state and location of all necessary equipment. Given the vast amount of equipment in hospital, which is frequently used in multiple locations, it has been surprisingly difficult to gain a comprehensive view of all available assets.

How medical device makers should approach this market

Despite the promise of integration, device makers have a long way to go. According to The Value of Medical Device Interoperability from the West Health Institute, using figures from HIMSS Analytics, while 90 percent of surveyed hospitals use six or more devices that could be integrated with EHRs, only a third of hospitals currently integrate any of these devices. 

The benefits of doing so, however, would be immense. The West Health Institute estimates an annual savings of $26 billion, coming from reduction in adverse events, reduced redundant testing, increased clinical productivity resulting from minimizing manual information entry, and shortened lengths of stay.

The IoT can help realize the benefits of interoperability.

Photo courtesy of AliveCor