The Internet of (Health) Things

As we approach Digital Health Week and the role vendors can play in advancing the cause of digital health, I would like to reflect on the latest IT trend sweeping the globe: The Internet of Things.

The Internet of Things (IoT) is the network of common devices and sensors that are connected to the Internet and capable of sending and receiving data without human intervention. The most obvious examples are the chip-enabled devices and appliances finding their way into our own homes such as smart stoves, refrigerators, thermostats, water and electricity meters, televisions and alarm systems. These devices can accumulate a mountain of data about our daily living habits and can communicate the data to some Big Data warehouse in the sky.

IoT leverages other advances in technology such as ubiquitous wireless connectivity, Big Data and the cloud. It is fast becoming the central nervous system of our “smart communities” and promises to redefine how we think about our environment.

Concurrent with IoT is the emerging Internet of Health Things (IoHT). There is a rapid convergence of information and communications technologies and medical devices that is blurring the lines between specialized health software and hardware and consumer electronics.

As far as I can tell, nobody is “building” the IoHT. You don’t see it in the strategic plans or health infostructure blueprints of Canada Health Infoway or our provincial and territorial governments. It is growing organically as the public, health care providers, and a growing cadre of developers find new uses for consumer electronic devices and build apps to address specific health needs.

So what are these “things” in the Internet of Health Things?

  • IoHT includes implantable devices surgically implanted by physicians, such as pacemakers, which are configured and managed externally using Bluetooth or other wireless technology. It can also include external devices that are plugged into our bodies to administer medications such as insulin pumps.
  • IoHT includes wearable devices that can clip to our belts, be sported on an armband or embedded into our watches or eyeglasses to measure our activity or heart rates.
  • IoHT includes remote monitoring devices that can be installed in a patient’s home to track blood pressure, weight, blood glucose levels and other important health data. This would also include consumer electronic devices such as smartphones and tablets that run specialty health apps or are integrated into health solutions.
  • IoHT includes the back-end systems built to power these mobile and remote monitoring health solutions, including cloud and Big Data infrastructures and our legacy infrastructure of classical health IT systems.

All of these devices contain software and firmware that provides the “smarts” for the smart devices. As part of a system, they can all collect and disseminate information that enhances the clinician’s ability to deliver quality health care, and the public’s ability to better manage their own health. However, this means that the various components must work together, or interoperate, which means we need standards for data, connectivity and communication.

Our current view of interoperability is focused on how a doctor’s electronic medical record can communicate with a hospital information system and other classical components of our health infostructure, and similar connections. We need to start thinking about how my cardiologist’s smartphone is going to interoperate with my pacemaker and the backend EHRs and EMRs that my cardiologist and GP are using to monitor and manage my condition. We need to start thinking about how we can integrate data about my exercise levels, eating habits, blood pressure, heart rate, glucose level and other data from my Internet-enabled devices.
True to form, the Internet of Health Things continues technology’s penchant for outpacing global society’s capability to address the issues raised by its very existence. The issues of safety, privacy, and security are not new, but the Internet of Health Things increases the risk by several orders of magnitude.

Consider that its been demonstrated that wireless-enabled pacemakers and insulin pumps are vulnerable to hacking where the hacker could deliver a fatal jolt or dose. Consider that in 2013 there were almost 100,000 health apps available in the major app stores. Consider that an infinitesimal number of those apps were subject to any certification or licensing.

Addressing safety, privacy and security concerns is critical to unleashing the power of IoHT. Regulators and healthcare jurisdictions around the world have been reluctant to tackle IoHT. While some efforts are underway internationally to address the safety of Software as a Medical Device (SaMD) solutions, the scope of the challenge is formidable. This is going to take some serious rethinking about how we confirm that any “thing” connected to our networks does no harm.

I’m going to argue that it the primary responsibility of the vendor community to ensure that the products and services that they contribute to the IoHT are safe, secure, private and interoperate effectively with other parts of the system. But the vendor community can’t do it alone. Making products safe, secure and private comes at a cost. The healthcare community must be prepared to pay a premium for quality products and services, and must ensure that their procurement requirements exclude vendors who do not conform to reasonable national and international standards.

Some of the foundations for a safe, secure, private and interoperable IoHT are in place. For example, Privacy by Design, a concept developed by Dr. Ann Cavoukian, Executive Director of the Institute for Privacy and Big Data at Ryerson University, that establishes a set of principles where privacy can be baked into products and services at the design stage. COACH has recently published a set of eSafety Guidelines that provides guidance on to build safety into the design and operation of digital health solutions. There are ample standards in place for security and Canada Health Infoway has been advancing the cause of clinical interoperability in Canada.

The Internet of Health Things promises to revolutionize health care in the same way the Internet has transformed societies. It will be the central nervous system of the ubiquitous digital health world that we are striving to create. As we approach Digital Health Week, lets celebrate our achievements but look forward to a world we can barely imagine: the Internet of Health Things.

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