improving efficiency and outcomes in healthcare using internet of things
TRANSCRIPT
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CitiusTech Thought
Leadership
10 January, 2018 | Author: Mahesh Dedhia | Sr. Project Manager
Improving Efficiency and Outcomes in
Healthcare using Internet of Things
CitiusTech Thought
Leadership
2
Overview
As healthcare organizations strive to optimize their workflows and improve outcomes, they seek new avenues that can help them overcome the inefficiencies in their current systems and thereby extract more ROI. The key to achieve this depends on how well the providers and payers connect with the patients to provide timely treatment and preventive care. ‘Internet of Things’ has the potential to transform the way care is delivered, without having the patients to step outside the comfort of their homes
With the adoption of cloud and big data technologies, healthcare organizations are in a position to begin experimenting with IoT. Ranging from home care to smart facilities, there are many ways in which provider organizations can benefit by using IoT in their patient care workflows. E.g., a mobile app with patient geo-fencing capabilities can help optimize physician rounds by dynamically routing the physician to the nearest patient
Payers can leverage insights generated by IoT infrastructure to improve population health, increase patient awareness and reduce healthcare costs. Payers can also design more effective reward and retention programs using IoT generated data.
As IoT is evolving, adoption is slow but steady, and investments are being made by both startups and industry leaders. Healthcare is among the top 5 industries investing in IoT.
This document discusses how IoT can be leveraged to drive efficiencies in healthcare workflows and enhance clinical outcomes.
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Agenda
Introduction to Internet of Things
IoT: Recent Trends and Forecasts
IoT: Use Cases in Healthcare
IoT: Solutions in the Healthcare Provider and Payer Space
IoT: Adoption Challenges in Healthcare
Innovation Framework for Healthcare IoT Solutions
Technology Considerations while Designing IoT Solutions
IoT: Security and IoT Analytics
IoT: Standards and Regulations
Key Takeaways
References
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Introduction to Internet of Things
The Internet of Things (IoT) is the network of physical objects or things embedded with electronics, ubiquitous sensors, software and internet connectivity enabling it to achieve greater value and service by exchanging data. Each thing is uniquely identifiable through its embedded computing system and interoperable within the existing internet infrastructure.
IoT technology innovation plays a key role in connecting people around the world using healthcare applications and intelligent sensor network, collectively referred to as “Internet of Healthy Things”.
Coke started sending messages about the availability of a coke can using internet
1982
1999
2000
2003
2008
Current
Massachusetts Institute of Technology (MIT)’s Auto-ID Centre presented the concept of IoT
RFID deployed by US Department of Defence in their Savi program and by Walmart in the commercial world
Increasing investments in IoT across industries
MIT Auto ID Centre developed EPC, a global RFID-based item identification system intended to replace the UPC bar code
U.S. National Intelligence Council listed the IoT as one of the six ‘Disruptive Civil Technologies’
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Commercial IoT platforms such as Microsoft IoT Hub, IBM Bluemix, PTC ThingWorx, AWS IoT as well as open source IoT platforms like Kaa, GE Predix and DeviceHive continue to invest and innovate with IoT service offerings including secure messaging and device management
Hardware manufacturers like Cisco, Dell and Intel are investing in enhancing IoT gateways to support fog computing
Startups continue to invest and innovate in wearable and implant technologies to monitor stress levels, glucose levels for Type 1 diabetes patients and even predict seizures for epileptic patients
IoT security remains a top concern for IoT solution providers as well as consumers, given the prediction of billions of connected devices and their limited processing capabilities to counter security attacks
IoT: Recent Trends and Forecasts
Industry Forecast
$6 trillion to be spent on IoT solutions in the next 5 years
34 billion devices to be connected to internet by 2020
646 million devices to be used for healthcare by 2020
IoT healthcare market will grow at 17.7% CAGR globally during 2017-2022 with US leading at 78% market share
McKinsey Global Institute puts the value potential of IOT in healthcare market at $170B - 1.6T by 2025
Sources:BusinessInsider.comReport buyer
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Patients
IoT: Use Cases in Healthcare
Health Monitoring Geo-fencing
Fitness Tracking Improved drug administration
Clinical
Integrated Devices for Coordinated Care
Accountable care through predictive analytics
Operational
Improved Device Design
Predictive Maintenance
Remote Upgradation
Real-time access to patient data
Smart Facilities
Remote Patient Monitoring
Improved record-keeping of patient encounters
Dynamic scheduling of physician rounds
Population Health Management –Epidemic Detection
Predictive analytics on IoT device data
Reward & Retention Programs for health-conscious customers
Improved plan design by leveraging IoT data
Healthcare Workflow Automation
Improved inventory management
Collecting PHI through wearables and consumables
M2M integration in supply chain automation
Healthcare Providers Health Plans and Payers Medical Technology Life Sciences and Pharma
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IoT: Solutions in Healthcare Provider Space
Benefits of IoT-enabled Solutions Technology Enablers
Smart Facilities
Embedded sensors in infrastructure (lobbies, floors, etc.) can enable tracking of patient location and wireless monitoring of vitals in intensive care units
Sensor network inside hospital building enables staff / equipment scheduling, monitoring of prescription drug inventory
Network of location transmitters enable indoor navigation, tracking of location and activities where clinicians spend their time
IoT enabled sensors (RFID, NFC, BLE)
IoT gateways with encryption capabilities
Device management software
Cloud-based/on-premises data aggregation and analytics engine
Mobile app for tracking, alerts and secure messaging
Incorporating Patient-generated Data
Patient-generated health data collected passively by IoT devices has the potential to fill in the blanks in electronic health record systems (EHR) and used to generate documentation of a specific episode of care
Audio-video conferencing solution using smart phones enables incorporating the patient’s voice from telephonic consultation into the EHR
Custom-made wellness tracking devices and implants
Audio-Video conferencing and Recording solution
IoT Gateways supporting HL7 based integration with EHRs
Encryption and authentication support
Scalable storage with support for multimedia data
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IoT: Solutions in Healthcare Payer Space
Benefits of IoT-enabled Solution Technology Enablers
Population Health
Collecting population health data through payer-supplied or third-party consumer devices, such as activity monitors and vital signs measuring devices for predicting trends
Improving urban healthcare with the predictive analytics based on regional epidemic data generated through IoT infrastructure
Consumer health & fitness tracking devices
IoT gateways with deidentification and encryption capabilities
Device management software
Scalable NoSQL storage
Cloud-based/on-premises data aggregation and analytics engine
Mobile app for tracking, alerts and secure messaging
Identity server for authentication and access control
Incorporating Patient-generated Data
Analyzing patient lifestyle provides continuous feedback with notifications and reminders to promote lifestyle modification based on real-time health data analytics on real-time health
Consumer health monitoring devices that can transmit data over the internet, enable greater degree of preventive and remote care, especially for seniors and patients with chronic diseases
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IoT: Adoption Challenges in Healthcare
Key challenges for Healthcare CIOs Key concerns to IoT adoption
Consumer IoT
Integration of consumer wearables, with enterprise health data
Manage and secure user to device mapping
Analyze huge volume of data
Share healthcare data
Time to market, multiple device support
Variety of devices/sensors
Enterprise integration
Identity and access management
Security and privacy
Data portability
Standards Compliance
Enterprise IoT
Older equipment/devices with incompatible protocols and mode of communication (PSTN)
Lack of data portability from device to EDW –often unstructured or proprietary data formats
Security by obscurity
Speed of deployment and portability
Applicability of generic frameworks to healthcare
Enterprise integration
Identity and access management
Security and privacy
Data portability
Standards compliance
Infrastructure costs and maintenance
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Innovation Framework for Healthcare IoT Solutions
Structured and Unstructured Data
Heart rate, Respiration, etc.Clinical Data
Alerts, Notifications Recommendations
Data Mining Predictive Analysis Deep Dive
Device failure Patterns
Diagnosis Effectiveness
Environmental effects on Population Health
Device UtilizationPatterns
Remote Patient
Monitoring
Population Health
Management
Vulnerability study
Processed and Transformed Data
Non-clinical and Clinical Data
Integrated Device for
Coordinated Care
Non-clinical Data
Meaningful Data
CognitiveHIS /RIS
Improved Device Design
Remote Upgradation
Predictive Maintenance
Clinical Data Operational Data
Location data, Device specific Events & Failures
Communication & Aggregation
Sensor-based Devices
Intelligence
Innovation
Parsing, De-Identification, Aggregation & Processing
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Component Design Considerations
Nodes
(Edge Devices)
Devices with required sensors, cache, processing power and battery capacity
Supported connectivity protocols: TCP/IP, WiFi & BLE
IoT Gateways Secure data exchange between nodes & app server
Supported operating systems
Message filtering and aggregation capabilities
Programmability requirements, Local storage capacity and Device management
Protocols for Connectivity
Node – Gateway: RFID, NFC, BLE, Zigbee, Z-Wave, Gateway – App Server: Wifi, Ethernet, Cellular
IoT Platform Supported communication protocols
Device management
Secure messaging through HTTP, MQTT, CoAP, etc.
Support for popular IoT devices
Technology Considerations while Designing IoT Solutions (1/2)
Key Decision Making Criteria while Designing IoT Solutions
Interfacing requirements with third party hardware
Predicting the data traffic/volume
Setting performance benchmarks
Security mechanisms built into the software platform
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Component Design Considerations
Storage For Nodes: Flash drives, cards and solid state drives
For App Server/Cloud – Object storage solutions, public cloud storage, SQL/NoSQL databases
Device Management Software
Secure provisioning and decommissioning of devices
Automated and remote management
Ability to accommodate large variety of devices
Remote & bulk updates, failure detection, automated recovery
Note: Choice of connectivity model – device to device v/s device to app server v/s device to gateway – influences the components and their capability requirements while designing IoT architecture
Technology Considerations while Designing IoT Solutions (2/2)
Key Decision Making Criteria while Designing IoT Solutions
Maturity and industry adoption of the tools and platforms
Standards and regulatory compliances to adhere
Technical skillset at disposal
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IoT: Security (1/2)
Tools for Securing IoT Solutions
Device level security through secure booting, integrated crypto keys using Trusted Platform Modules (TPMs) and physical protection
Secure provisioning, identification and decommissioning of devices
De-identification of Personally Identifiable Information (PII)
End to end security using SSL certificates and TLS
Firewalls and intrusion prevention systems
Laying out an extensive and powerful infrastructure for Internet of Things comes with inevitable security issues that need careful analysis and risk evaluation
The Dyn DDoS attack caused by Mirai malware in Oct 2016, involving up to 100,000 endpoints reinforces the vulnerability and importance of security measures required for IoT solutions
Security design principles should be rigorously implemented to fortify the solution end to end, such as:
• Use Virtual Private Networks (VPNs) to access edge devices
• Initiate connection from edge device to the cloud, and not the other way round
• Allow file transfer only in one direction, if not required in both the directions
• Double-encrypt messages with sensitive data
• Restrict access to messages that can control the device remotely
• Implement thorough instrumentation to allow remote monitoring of the activity
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IoT: Security (2/2)
The EU’s General Data Protection Regulation (GDPR) will apply to IoT solutions, which mandates aspects such as:
Reporting of any personal data breach within 72 hours
User’s consent for processing their data
User’s rights for data portability and objecting to automated decision making
Prohibition for children under 13 to provide consent for processing of their data, on their own
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IoT: Analytics (1/2)
IoT business models will exploit the information collected by edge devices in many ways – for example, to understand customer behavior, to deliver services, to improve products, and to identify and intercept business moments.
With the unprecedented amount of data that will be generated by these edge devices, aspects such as storage, ownership and expiry of data becomes critical.
Choosing the right Cloud platform
Most of the cloud providers have storage and analytics offerings. Having IoT platform, storage and analytics engine on the same cloud greatly simplifies the solution design and maintenance. Keep in mind that since most of the IoT workflows are event driven, event processing and real-time analytics capabilities are key features for high-volume IoT solutions.
Key Considerations
Storage v/s Streaming
Managing the data generated by billions of devices will be a significant challenge to address during infrastructure and architecture planning. Even though cloud infrastructure will scale to accommodate large volumes of data, it may not be effective to store all the data traffic. IoT architectures need to evolve to perform real-time analytics on the streaming data and store only the results, as necessary.
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IoT: Analytics (2/2)
Distributed Analytics
As another design alternative, distributing the data analytics between the cloud, gateways and edge devices may result in optimizations at different levels, such as reduced storage needs and reduced network traffic. The aggregation and filtering that happens as part of the analytics reduces PII being transmitted over the network. As a by-product, it also reduces battery consumption of edge devices that would be used in wireless transmissions.
Ownership of Data
With increasingly vast network of sensors, IoT solutions will be able to gather tons of health, location and activity data. IoT solution providers will need to deal with this data with great care and consumers’ consent. Adoption of IoT will only add fuel to the discussion of ownership of data that started with the adoption of big data in healthcare.
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IoT: Standards and Regulations (1/2)
Implementation of an IoT solution involves a range of technologies. As multiple IoT solutions converge together, it will be instrumental for these solutions developed by different companies and service providers to be compatible with each other to enable reusability of infrastructure and insights gained through the collected data.
As with any industry, standardization will bring multitude of technological and commercial benefits:
Standardized hardware specifications will enable mass-production of edge devices that can operate in different geographies
Standardized communication protocols will enable smoother integrations and reduce the efforts spent in working around the compatibility issues
As technologies are standardized, business models benefit from and evolve around the APIs based on these standards
Governments and regulatory bodies define compliance rules around these standards, which in turn enables manufacturers and service providers to cater to larger consumer-base across geographies
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IoT: Standards and Regulations (2/2)
Areas of Standardization
Connectivity protocols for nodes and gateways – TCP/IP, Wifi, Ethernet and Cellular protocols are well established in this space. In addition, BLE and Zigbee have emerged as lightweight and low-power alternatives
Messaging standards – Even though HTTP is leading this front, for dealing with hardware with lower capacity and compute powers, lightweight protocols like MQTT, CoAP and AMQP are developed with IoT scenarios in perspective. These standards provide improved latency, assure different levels of Quality of Service to suit the needs and consume less power
Security standards – Security measures for hardware as well as data protection at various layers in the IoT solution are yet to mature
Regulatory requirements – Industry-specific regulations will evolve over time. Federal regulatory agencies like ONC and HHS in USA will play key role in protecting the consumers from any misuse of data
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Key Takeaways
Internet of Things has a lot of potential to improvise and automate existing processes and workflows across multiple industries and healthcare organizations are certain to be amongst the beneficiaries
A lot of work needs to happen in terms of establishing regulations and addressing security concerns. While these are difficult problems to solve, industries and governments together can bolster this space by leveraging knowledge and experiences in similar spaces
Increasing investments and maturity in technology areas such as Cloud, advancements in compact and smart devices, large-scale storage solutions and wireless communication, have given IoT solutions a real shot in the arm
On the other hand, advanced analytics and machine learning technologies are evolving at a rapid pace to be able to consume the voluminous data that IoTsolutions can generate
With the right ingredients in place, these are exciting times for innovators and businesses to be a part of the IoT wave
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References
Internet of Things – Wikipedia
Internet of Things for Provider Organizations
Population Health Use Cases for Internet of Things
Understanding IoT Security
Top 10 Internet of Things (IoT) Technologies for 2017 and 2018
IoT: Vision, Architectural Elements and Future Directions
IoT Developer Survey 2017
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Thank You
Authors:
Mahesh Dedhia
Sr. Project Manager
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