Before you even fully wake in the morning, your bed has transmitted information about your sleep quality to your physician. Later in the day, your elderly mother's pill bottle alerts you and her physician's office that she hasn't taken her blood pressure med. Your refrigerator has already informed the grocery delivery service that you're running low on life's essentials of soy milk and wine.
Welcome to the Internet of Things (IoT). Anything that has the potential to have a sensor can communicate to anything else that has a sensor. Moreover, analytics that are "watching" the stream of sensor data can orchestrate activity; for example, sensors on cars that indicate a traffic gridlock can lead to analytics changing the traffic light sequence. If that sounds a little too Orwellian for you, imagine the tremendous benefits from a health and welfare perspective.
Connected devices are nothing new. But the connection to date largely has been proprietary — within the confines of a single institution. In addition, device connection usually assumed that a human being was available to read the device data and decide what to do next. The IoT raises the bar — enabling connection and communication from anywhere to anywhere — and allows analytics to replace the human decision-maker. The IoT can create new and customize existing processes, allowing us to control our home systems from the office through a smartphone or by sending a message to a technician that a piece of equipment has a part on the verge of failing and that a truck with the part has been dispatched.
The Internet of Things is an ever-expanding universe of devices and technologies with equally expanding potential uses. What qualifies a device to be part of the IoT? According to Verizon, a sensor-equipped "thing" must have three qualities. It must be aware; it must be able to sense and collect data about its surroundings, such as temperature and light or, in the case of health care, blood pressure and heart rate, for example. It must be autonomous. The data collected must be communicated to another device or central location automatically or when certain conditions are met. Lastly, it must be actionable. If an individual's blood pressure or blood sugar levels are at a dangerous level, it must automatically trigger an alert and initiate clinician action.
There are four categories of medical devices that meet the IoT criteria, according to a report by the Atlantic Council. The first is consumer-based; fitness tracking devices are an example. There are also wearable, external devices, such as insulin pumps, and there are internally embedded devices such as pacemakers and implantable cardioverter defibrillator devices and, more frequently, miniaturized (within the body) sensors. Lastly, there are stationary devices, such as home-monitoring devices, IV pumps and fetal monitors.
The IoT has been made possible by multiple technology advances. There has been remarkable innovation across a wide range of sensor technologies; think of the GPS in your mobile phone. Microprocessors are so potent and inexpensive that they can be attached to a stunning array of things ranging from shirts to human organs to rocket engines. The wired and wireless Internet provides a nearly ubiquitous, high-speed network. And, we are beginning to see the emergence of cloud-based, very sophisticated analytics that can read, interpret and act upon the collected data. Of all of these advances, the analytics are likely to provide the most power to the value proposition of the IoT.
Health Care Applications
For health care, the possibilities are tremendously exciting. Within the next two years, there will be 80 million wearable health devices. Right now, these are largely for personal use — think of the aforementioned fitness trackers such as FitBit and smart watches. The next generation of these devices — and that next generation is very near — will be able to do more than just track steps and calories.
For example, imagine the value to a patient whose irregular heart rate triggers an alert to the cardiologist, who, in turn, can call the patient to seek care immediately. Or, imagine a miniaturized, implanted device or skin patch that monitors a diabetic's blood sugar, movement, skin temperature and more, and informs an insulin pump to adjust the dosage. Such monitoring, particularly for individuals with chronic diseases, could not only improve health status, but also could lower costs, enabling earlier intervention before a condition becomes more serious. Already underway is a clinical trial that equips heart failure patients with sensors to measure key indicators like blood pressure and heart rhythm. By some estimates, there is a remarkable 64 percent drop in hospital readmissions for patients whose blood pressure and oxygen saturation levels were monitored remotely. Less patient-focused but invaluable to health care will be using the IoT to connect medical equipment, such as MRIs and CTs, to remotely monitor and maintain and to replenish supplies, reducing expensive downtime.
In several industries, we see the use of the IoT to choreograph complex processes: Cities managing traffic flow. Utilities redirecting power moving through a grid. Supplies being sent and rerouted to factories based on real-time needs identified through point-of-sale data. There is a high likelihood of health care equivalents.
Patients' movement through a hospital may be made more efficient through radio-frequency identification technology and sensors on patients, caregivers, rooms and equipment, using process analytics to identify and manage optimal flow. The IoT could inform caregivers that a procedure room is available or that a patient has spent too much time waiting in the emergency department or that a therapist is needed to staff a particular room.
The IoT also will provide data that can be leveraged by the emerging notion of "the digital phenotype." (See, for example, Sachin H. Jain, Brian W. Powers, Jared B. Hawkins and John S. Brownstein, "The Digital Phenotype," in Nature Biotechnology 33, 462–463  doi:10.1038/nbt.3223 [published online 12 May 2015].) As we know, a person's health is influenced by a wide range of environmental and behavioral factors, such as living in a polluted city and smoking. Data on these factors, such as activity on social media sites or shopping behaviors, complement the data gathered during the course of care. The Internet of Things will provide data that can be used to round out our understanding of the patient and his or her life settings. This broader set of data has the potential to improve the effectiveness of population health activities and strengthen predictive analytics.
We all know, however, that health care takes a cautious approach to adopting technologies and the IoT will be no different. According to Gartner's Hype Cycle of Emerging Technologies report, it will take between five and 10 years for full adoption of the IoT by health care. That cautious approach will serve health care well in this regard. The IoT is not without its hazards and limitations, and health care could be particularly susceptible.
Need for Oversight
Currently, there's little oversight of the IoT. In February, the Senate Committee on Commerce, Science and Transportation convened its first hearing on the IoT, trying to understand the implications while the technologies and uses are still developing. Lawmakers are also increasingly sensitive about regulation stifling innovation. Nevertheless, there are many potential implications of the IoT that will require some form of regulatory oversight. Among these are ensuring that the technology infrastructure is adequate to support the traffic volume of the Internet of Things. It is estimated that there may be 20 billion things connected to the IoT by the end of the decade.
Additionally, there are privacy concerns regarding the Internet of Things, and regulators will probably focus efforts there in the near term. Recently, Samsung was widely criticized for its smart TV's voice recognition capability. In the documentation, Samsung stated that if a consumer chooses to enable the feature, "Please be aware that if your spoken words include personal or other sensitive information, that information will be among the data captured and transmitted to a third party through your use of voice recognition."
Health care takes the privacy and protection of personal health information as a top priority. The Anthem breach hit home for many, as it exposed the vulnerability of such information. It wasn't an isolated case. In fact, the rate of information security breaches in health care rose 60 percent in just a one-year period. The IoT brings a new component and challenges into the protection of information.
Information collected from IoT devices will have great benefit for analytical purposes, helping us to better understand disease and treatment as well as manage the health of populations. But there are red flags. If information collected even from those seemingly benign fitness devices is sold to third parties, will consumers be inundated with ads for diet supplements? That's more nuisance than harm, but there are also security professionals who fear that the IoT could open up medical devices to more sinister aims, such as interfering with function. Hackers are probably not interested in harming individuals, but could do something on a larger scale, such as interfere with insulin pumps.
Currently, there aren't any standards or regulations to govern how information collected via the IoT is used. The National Institute of Standards and Technology is working on a guide to secure connected medical devices, using insulin pumps as the starting point and expanding to other devices in the future.
However, it will largely be up to the industry to adopt standards in data formats and systems as an initial step in addressing security of the devices and the information they generate — and to develop new methods of securing both devices and the information they generate. The methods we've used to date must be expanded to take into account an entire new generation of technologies, and that will require close coordination and cooperation across the industry to "secure" the Internet of Things for health care.
The Internet of Things will bring a stunning array of new capabilities to our personal and professional lives. These capabilities are embryonic in many cases, but there are enough examples across a range of settings and industries that we can begin to see a future that is quite exciting. The IoT brings several challenges that will require that individuals, the industry and government collaborate to ensure that the IoT's promise is fulfilled.
John Glaser, Ph.D., is a senior vice president of Cerner Corp., headquartered in Kansas City, Mo. He is also a regular contributor to H&HN Daily.