Linking patients and treatment systems over the Internet can save time, resources, and lives: how the Internet of Things is underpinning the Internet of Healthcare.
Advocates of machine-to-machine (M2M) enabling technologies are always ready to talk up the kinds of application it could benefit. Typically, M2M can be seen in a range of applications - security and surveillance, building automation, supply chains and logistics management - however, it is healthcare that is best placed to progress beyond proof-of-concept stage when it comes to the ‘device shall speak unto device’ model.In short, the M2M model uses wired or wireless connectivity to exchange information and communications between Web-connected devices without the need for human intervention.
The benefits are numerous for patients, carers and clinicians alike, and particularly if a migration from conventional to M2M is worked into planned technology upgrade cycles. Given that M2M can use a lot of mainstream ICT, its costs can be diffused and aligned with those IT lifecycles common to PC and Internet-connected medical devices, rather than very expensive specialist hardware and software. This benefits both physicians and healthcare finance offices.
Definitions of what M2M means for the healthcare sector vary between sources. Some benefits extend from established telemedicine systems; others are only practical using an M2M model and the assumption that patients have local access to broadband connection. M2M can, in theory, provide real-time statistics, faster responses and ongoing revenues throughout product lifetime.
The potential to automate healthcare procedures - freeing up staff and only involving doctors when they are actually required - is compelling for a healthcare sector looking to make best use of its available resources. Data regarding patients’ conditions can be more easily monitored, and can be fed into ‘big-picture’ data sets to be analysed for wide-scale trends. Applications can be more easily changed or upgraded. M2M also provides patients with more control over their treatment regime.
According to Vodafone’s mHealth programme, the need for technological intervention in the delivery of healthcare services is due to the kind of shifts in healthcare demand that are evident around the world: ageing demographics, a rise in chronic diseases (such as diabetes), allied to an increasingly technically-savvy patient population, are affecting the type and intensity of care required to the point where established healthcare models are becoming unsustainable.
Generically, the M2M model begins with a remote sensor gathering source data (blood pressure, heart rate, blood levels, say), and transferring it via a conventional Internet link through the public network, then routed to a controlling server; the data is then analysed and acted upon by host systems which can be hosted by a medical facility, or a cloud service provider, for example.
Telemedicine at work
M2M is associated with telemedicine, a technology that has been around in various forms for some years. Telemedicine is the use of telecommunications and IT in order to provide clinical health care remotely, overcoming distance barriers, and providing access to medical support that might otherwise not be so accessible. Telemedicine can also be part of the life-saving equipment used in critical care and emergency situations. The interface between healthcare and IT is always growing and already starting to infiltrate the social dependency between individuals, community group members, and social media, as well as what might be termed ‘personal ICT’. A recent report from Carers UK highlights how this trend should play a key role in bringing advance healthcare to an ageing population as unsustainable demands are made on health organisations’ resources.
Traditional telemedicine has mostly relied on special dedicated communication channels involving human supervision, whereas in the M2M context, much of the monitoring, data gathering and analysis occurs automatically between the connected devices. Different M2M telemedicine solutions developers are looking at different architectural models. A typical example of M2M communications is road traffic control.
The system connects to the sensor monitors and sends information on volume and speed characteristics; this is sent to specialised software that controls the traffic devices, including traffic lights and information signs. The incoming data is then manipulated to control the traffic flow.
State agencies are already on the case. The UK’s National Health Service (NHS) has begun investigating ways to deploy M2M healthcare. The government has challenged the NHS to find £20bn worth of efficiency savings by 2015; M2M is viewed as one way that this can be achieved. One of the first areas for M2M applications is patient monitoring. The aim is to use M2M technology to bring better compliance with prescribed treatments, faster reaction times to medical emergencies, and generally better outcomes for patients.
“There have been fundamental changes to how patients are being treated. The improvements in technology have shown patients using telecare devices in the home has reduced death rates by 45 per cent,” reports James Ferguson, national lead for the Scottish Centre for Telehealth and Telecare (SCTT), and an emergency medical consultant at Aberdeen Royal Infirmary.
According to the World Health Organization (WHO), almost a billion people globally suffer from chronic disease of some kind, and this figure will account for almost 75 per cent of worldwide deaths by 2020. The WHO predicts that the global telemedicine industry will be worth $18bn by 2015 due to new M2M functions in specialisms like cardiology, dermatology, dentistry, pathology, paediatrics, psychiatry, and radiology.
Financial telehealth savings
M2M’s potential has also been acknowledged at senior political levels. In December 2011, UK Prime Minister David Cameron launched the ‘3 Million Lives’ campaign (founded by the Department of Health, the NHS, and technology industry body Intellect) designed to enhance the lives of people with chronic conditions, such as heart disease and diabetes. The aim is to provide telecare and telehealth systems to three million people over the next five years.
The Department of Health has published findings from Whole Systems Demonstrator - a telehealth service provided to 6,000 people - that indicated that the adoption of telehealth techniques may have led to a 45 per cent reduction in mortality rates, 20 per cent reduction in emergency admissions, and 15 per cent reduction in A&E visits. Carers UK, meanwhile, is calling for the creation of a ‘Health and Care Technology Taskforce’ to bring together UK governments and key stakeholders to lead on actions to ‘unlock the potential of technology’ in healthcare.
The Internet is no longer forbidden by physical cable infrastructures. Integrating wireless M2M systems into the healthcare sector means patients can be monitored remotely using common communications links in (almost) real-time, which in many cases brings an immediate reduction in the amount of time patients need to spend in hospital. This also reduces any risks that patients might be exposed to while having to travel to and from appointments. The patient health data that can be transmitted includes vital heart rate and temperature statistics.
Telemedicine applications using intelligent devices worn or implanted by patients offer remote monitoring of biological data, such as illnesses involving high blood pressure, diabetes, obesity and cardiac disease. Such monitoring is ideal for those who are geographically dispersed or for the elderly who would otherwise have to be hospitalised and attached to bedside monitoring technology. Monitoring systems are calibrated to individual conditions, and raise alerts only if the evidence indicates that physicians need to intervene.
Healthy market value
“The market for M2M healthcare applications will be huge - $69bn in 2020,” forecasts Jim Morrish of market-watcher Machina Research. “We expect that $3.1bn of this revenue will go to the mobile network operators for provision of data carriage services, but the rest is up for grabs. Telecoms operators, equipment vendors and various service providers, will all want a slice of the pie, and who gets what all comes down to business models.”
One development might include the consumerisation of M2M healthcare, where patients select and pay for their own personal monitoring device, or use applications that run on their smartphone, tablet or PC. Products such as Sonamba’s Wellbeing Monitor can include carers as part of the monitoring team to ensure that medication schedules are followed, for instance.
Machina Research’s report ‘Machine-to-machine (M2M) Communication in Healthcare 2010-20’ predicts the installed base of connected M2M devices within the healthcare sector will exceed by 774 million by 2020. North America will be the largest region with a share of worldwide connected medical devices peaking at 54 per cent, and falling back to 42 per cent by the end of the forecast period as growth in Europe accelerates. Revenue growth should be matched against data growth expectations. Some M2M healthcare applications will have to handle big data sets.
Also forecasted is the total traffic generated by M2M applications within the sector and carried over wide area networks, which will approach 78 petabytes by 2020, a Compound Annual Growth Rate (CAGR) of 75 per cent from 2010’s 283 terabytes.
The total mobile network traffic generated by M2M solutions in the healthcare sector will exceed 33 petabytes by 2020, a CAGR of 66 per cent. The revenue from M2M connected healthcare applications is expected to reach $69bn in 2020. The majority of the revenue will be accounted for by the cost of equipment and materials, including storage to hold the data, much of which will have to be retained and managed over the term of a patients’ life. Healthcare telematics is an associated application that will also add value to the M2M healthcare sector.
Future of telecare
According to healthcare organisation Continua Health Alliance, 89 per cent of health agencies reported an increase in quality outcomes, 76 per cent cited a reduction in unplanned hospitalisations and 76 per cent reported patients improving self-care by proactive disease management.
“Telecare is better for the patient, medical professional, and the economy, but some doctors and patients still feel uncomfortable with these advancements,” says the SCTT’s Ferguson. “The common perception is patients should be treated in hospital, or at their GP surgery; but it is important to remember the majority of patients are aged over 80 with incurable chronic diseases. Telecare can help maintain their health.”
He adds: “Telecare isn’t for everyone, but as times change we need to embrace it. We are too fixated on face-to-face interaction. It’s time for healthcare to evolve like other sectors, such as banking and insurance, which have moved away from [the] face-to-face [model].”
Its assisted living, preventing diseases and chronic care management devices are engineered with GSM, GPRS, EDGE, UMTS and HSPA Cinterion products. These technologies provide users with unlimited mobility due to worldwide coverage and an interconnected roaming network. It is arguable that not being tied to geographical location for clinical visits, which would allow for recuperative vacations, could be an aid to both mental and physical recovery.
The opportunities provided by M2M telemedicine are attracting investment from mainstream technology providers, and the union between communications and remote applications is re-energising the pattern of partnerships between communications providers and vendors of endpoint devices. “Many of these technologies are designed to keep people healthy and in their home for longer before they need to go to the hospital,” says M2M healthcare manager for Sprint, Kelly Robinson.
“The trend to remote care is one of the largest trends that we are seeing. It’s being able to take care of people in their home or remotely by using wireless technology to really augment that physician and care providers role.” M2M care aims to bring benefits to the healthcare sector by maximising productivity, increased responsiveness through real-time alerts, enhanced safety, reduced expenditure, and an improvement in care management.
Innovative medical devices
Wireless technology vendor Sierra Wireless has partnered with PositiveID Corporation, a developor of medical devices and biological detection systems, primarily focusing on diabetes management. Sierra Wireless is embedding its AirPrime wireless communications into its PositiveID smart device Iglucose which acts as a diabetes management solution that collects, stores and transmits blood glucose readings from compatible glucometers in real time.
“For diabetics, it is helpful for their healthcare professional to understand blood glucose trends that occur on a daily basis,” says PositiveID vice president Mary Ellen Harrison. “For most patients, the way to do that is to keep manual logs of glucose levels, and then take those records to their doctor. But because the process is so time-consuming, few people actually do it. We need a wireless module that provides good battery life in a small footprint to keep form factor small.”
Last year (2011) GeaCom selected Sierra Wireless’ AirPrime wireless communications for its handheld multilingual medical communication system, Phrazer. The touchscreen device aims to help patients and caregivers address language barriers, culture differences or literacy problems to exchange critical medical information.
The wireless AirPrime enables the device to access and update patient information within an electronic health records system at an accident site or in transit to the hospital. “Caregivers struggle to provide quality healthcare to non-English speaking patients,” says GeaCom COO Chris Butler. Phrazer identifies what language a patient speaks, and collects personal information, medical history, symptoms and complaints by using interactive, prerecorded videos of a culturally familiar doctor speaking the patient’s preferred language. Launching in Q3/2012, Phrazer is targeting hospitals, clinics, care centres and ambulances. *