The Internet of Things (IoT) has been defined in different ways. Some consider it to be purely machine-to-machine communication, others view it as the interaction of smart devices (an electronic device than can communicate with other devices) with the internet. Whatever the definition, the IoT vision is clear – an enhanced communication system that enables continuous real-time flow of information.
What is the internet of medical things? - view the infographic here
The continuing development of smart devices coupled with advanced telecommunication systems are enabling this vision and driving us towards the generation and exchange of ever increasing volumes of data. IoT could help underpin a ‘connected health system’ – one in which information can be accessed and transferred more easily and efficiently between different parts of the health system and in doing so improve and enhance how health is managed. Although progress is being made towards this vision, there are challenges to overcome before IOT become a commonplace in healthcare.
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What is the IoT?
The internet of things brings together a technologies such as wearables, data storage, analysis and telecommunication to allow greater networking between devices and information exchange. IoT applications are based on different combinations of these technologies resulting in different levels of applications. Simple applications for example can track an individual’s activity (e.g. Fitbit) but do not analyse the information or transmit it to other devices independently. Complex applications are those that monitor, analyse and prompt a response (e.g. a smart inhaler that records and transmits usage data to a digital platform allowing the user and clinicians to examine usage and adherence).
How could IoT be used for healthcare?
IoT devices and systems are being developed by a large number of companies, with healthcare applications being targeted for both health systems, as well as individual citizens. This is sometimes referred to as the internet of medical things (IoMT)
Two areas where IoMT are currently having an impact are assisted living and chronic disease monitoring. Devices that monitor activity around the home and transmit this to either a carer or health professional are enabling supervision of home environment and provision of care at home in vulnerable groups.
IoT-enabled devices such as wearables and ingestibles are available that allow greater physician-patients engagement to ensure compliance with treatment and medication and enable remote health monitoring. The main area being targeted is diabetes although devices are being developed for conditions such as asthma, and cystic fibrosis.
The value of IoT for healthcare has been recognised by the NHS and is being trialled in two NHS test bed projects. Technology integrated health management (TIHM) is aiming to identify technologies that can be placed in people’s homes to improve care for people with dementia and the Diabetes Digital Coach is examining the use of remote monitoring and coaching technology for better self-management of the condition.
Where are we now with IoMT?
Current IoMT uses tend towards the simpler rather applications i.e. we have a number of Smart devices but they are not connected to a wider ecosystem. Technical, ethical and legal challenges need to be addressed before the more sophisticated and potentially transformative applications of IoMT can emerge:
Technical and scientific barriers
- Understanding what it means - At a very basic level, while the marriage between big data and efficient communications systems can lead to improved healthcare, there is still the challenge of knowing which bits of data are most relevant, how to analyse them, interpret them, and how best to act on the information generated.
- Interopability - One of the barriers to more complex applications of IoT is the need for improved ways of transmitting data to and from wearables and keeping that information safe.
- Related to this, there a many vendors and manufacturers of IoT products for healthcare but currently, there is a lack of compatibility across devices, making the ultimate goal of connectivity across devices a challenge.
- Digital infrastructure in healthcare - There is the need for a digital infrastructure that seamlessly brings together data from different sources. Current IoMT based devices used within healthcare and applications being developed have limited scope in terms of connectivity and applications due to underlying issues with digital infrastructure. Specific digital systems that can incorporate and take into account IoMT need to be developed and current limitation in networking and existing data silos need to be overcome.
The ethical, legal and regulatory challenges
- Data ownership - It is unclear who will own the data generated by IoMT systems. This may be easier to define with current applications, as data is shared between a limited number of parties and/devices (e.g. user/healthcare provider or user/device), but may not be as straightforward as the types and amount of data generated grow and networks increase in size.
- Safety, privacy and security - An on-going concern in relation to developing IoMT in health is safety, privacy and security of data. This is influenced by the type of data that is collected (e.g. anonymised aggregated data vs identifiable data), the security of the data collection instrument (e.g. ensuring devices are safe from hacking) and the degree to which data is shared between smart device, system, system operators, participants and third parties (e.g. controlling access to data).
A paradigm shift in the way we think about health?
IoMT can create a paradigm shift in the interaction between different parts of the health system by allowing more remote monitoring, easier access to and quicker flow of larger volumes of information and greater citizen/patient involvement in health care. This may put greater responsibility on individual patients for monitoring their conditions and managing their care. It will also require secure and robust systems to manage and secure data, as this will be critical to safeguard data and build the patients and public’s trust to sharing their data. In addition systems will need to be created that enable assessment of this information, be it by an algorithm or health professional.
Although current technologies are limited in their connectivity both with external systems and in the range of current measurable characteristics, this is hardly likely to be the case for much longer. Investment in IoT is large and societies are becoming increasingly reliant on algorithms to provide them with efficient and effective solutions. Further developments in this field are going to be influenced by the degree to which individuals are willing to be monitored and share this information.