Big things are expected of the Internet of Things (IoT) in a plethora of industries, and healthcare is no exception. The market is poised to reach $117 billion by 2020 according to business intelligence company MarketResearch.com.
IoT covers a broad spectrum of interconnected devices communicating across the net that together can have benefits for the treatment of patients, the workloads of practitioners, and the wealth of the nation.
They extend across the entire healthcare pathway, from monitoring patients in the home, to interaction with professionals and treatment in hospital smart beds.
The technology has transformative potential for healthcare, but must overcome a number of barriers before it can fulfil its promise. Gartner research vice president and former medical doctor Anurag Gupta told Computerworld UK about some of the hurdles.
The current financial strains on the health service are only going to deepen as demand rises while budgets fall. Technology can support cost savings, but the NHS has a chequered history of innovation marked by spectacular failures such as The National Programme for IT.
The current funding system is predominantly hospital-centric, with the biggest financial share allocated to NHS hospital trusts that tend to act reactively rather than tackle problems at the root. Successes have been limited as the deep structural issues remain.
"We just throw technology at the problem without making underlying changes in the way things work," says Gupta.
"In the new digital world, which is more consumer-focused, what we are doing is we are trying to create a consumer-grade digital convenience on top, without making changes in the underlying process."
Any future IoT initiatives will need to be implemented in line with a strategy for transforming the fundamental culture and policy.
Healthcare sector silos
IoT helps devices talk to each other, but healthcare itself is too dispersed to communicate effectively.
"In the healthcare market we still live in the siloed world, which basically means that data sits in operational silos or in clinical silos and nothing talks to each other, which is another major problem," says Gupta
"We need to focus a lot more on understanding the data that's coming up, because only then can we optimise the whole system much better.
"To really make sense of the system we need to connect the dots. That's really important."
The silos must be torn down for IoT to flourish, with support attracted from every level of the organisation.
"Unfortunately what happens is that we either have a top-down approach or we have a bottom-up approach," explains Gupta. "We don't do an all-in approach."
Cultural barriers to IoT in healthcare
Many members of society are uncomfortable using emerging technologies, particularly the elderly who are so often the intended beneficiaries.
Robots, telemedicine and chatbots are services expected to become increasingly common methods of helping an ageing population live independently at home.
Japanese company SoftBank already sells a "humanoid robot" called Pepper to care for the country’s elderly that they claim has the ability to perceive emotions, but the adoption rates of such technology will vary depending on the cultural acceptance of using it.
Cultural hurdles apply to professionals as well. Practitioners often make assumptions about the preferences of the patient, rather than giving them a choice of the available treatments.
"The whole patient pool is like a customer segment," says Gupta. "Hospitals should segment the customers too...to understand who the right candidate for what kind of thing is."
Options should be offered when the service user is discharged, while data mining utilised to cluster service users by their type of care, condition or age. Older people may be resistant to IoT innovations such as chatbots, but millennials may prefer them as they're more convenient than an in-person visit.
Misconceptions about IoT in healthcare
Practitioners also need more impetus to promote emerging technologies, such as incentives to see people remotely.
"The hospital reimbursement system at this point in time has got different reimbursement rates for online or in-person, and that's something which we have to change," says Gupta.
"If you're a GP here practising in the NHS, you should have an incentive to allow people to see you remotely so that it frees up your time, which is not the case right now."
The cost savings will only be prioritised when each part of the organisation shares in the benefits, but the support of the medical community and policy-makers can be neglected by developers. Their buy-in is essential to ensure the solutions are effective, and their concerns would be reduced by more active engagement.
A common worry is that technology could replace them, despite it being primarily used to support their decision-making and reduce the menial tasks of their working day through monitoring and analytics.
IoT remains limited in its potential applications. More unequivocal areas of treatment such as vital signs monitoring, radiology images analysis and interactive chatbots for common queries are ripe for exploitation, but more complex and ambiguous medical diagnoses remain out of reach.
"We are a couple of years away in terms of making clear cut medical diagnoses where there's a lot of grey area," says Gupta.
The public are also often misinformed about how their data will be used. Concerns over privacy have killed off promising proposals such as the care.data electronic records initiative, despite the data being anonymised and service users given an opt-out option on its use.
Greater involvement in the planning process would assuage their concerns and fully inform them of the benefits their data will have on treatment.
"It's committing to a common good, which we are not telling people in the right fashion," says Gupta. "The way the whole concept has been put up is not proper."
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