The Internet of Medical Things (IoMT)
Many of us are familiar with the term “the internet of things” (IoT), but only some know that the road to IoT began back in 1982, when grad students from the Computer Science Department at Carnegie Mellon University connected a modified Coke vending machine to the internet. This technology turned the machine into a basic smart device because it was able to provide networked status reports to the students about inventory and temperature control.
Today, our definition of IoT refers to the infrastructure of connecting physical objects to the internet, creating a smart device that enables communication between other smart devices or people. Reports indicate that globally, there were 8.4 billion IoT devices in 2017, and it is estimated that there will be 30 billion devices by 2020. By 2020, the global market value of IoT is projected to reach $7.1 trillion.
As global IoT grows, so too does the internet of medical things (IoMT). This technology is being used by individuals to track their health, for example via a Fitbit, and is revolutionizing the healthcare industry. Hospital and clinical staff are using IoMT technology to communicate with patients about appointments, medication management, lab results, care plans, and more.
IoMT at Home: Personal Health Monitoring
Wearable technology has been around since 1500 when Peter Henlein, a locksmith and clockmaker from Nuremberg, Germany, invented small, portable watches worn as necklaces or attached to clothing. The Apple Watch is a modern example of wearable technology. This electronic smartwatch is also a cellphone, MP3 player, personal assistant (Siri), and monitors the wearer’s health by using various apps.
Health apps that work with the sensors embedded in smart devices to collect data about a person’s heart rate, blood pressure, step count, etc. have become hugely popular. In September 2015, the IMS Institute for Healthcare Informatics, released a report that found there are more than 165,000 health-related apps available worldwide. In the United States alone, ABI Research expects digital wearable medical device sales to top $55 billion in 2022.
Clinical Applications of IoMT: Enhancing the Patient Experience
Originally intended for users to keep track of personal metrics and fitness goals, health apps and smart devices are becoming useful, sometimes life-saving tools for healthcare staff. Thanks to improved algorithms, the accuracy of the measurements taken, along with the resulting data, have progressed to a much higher standard. It is not uncommon for some nurses, doctors, and mental health professionals to develop care plans that include the use of apps and smart devices.
Massachusetts General Hospital (MGH) in Boston, consistently ranked as one of the top three hospitals in America by U.S. News & World Report, has tested various methods of internet-enabled technology with selected patients for years. A pilot study was conducted by Partners HealthCare Connected Health, at the outpatient clinic of the MGH Heart Center's Heart Failure and Cardiac Transplant Program (also managed by Partners HealthCare Connected Health), and published their findings in the April 2015 issue of the Journal of Medical Internet Research’s mHealth and uHealth journal (JMU).
The study used a monitoring program for patients who were experiencing heart failure. Patients were provided with a blood pressure cuff and weight scale to use at home, which were also connected to the internet. Patient’s vital data was streamed to their medical care team and patients could review the readings in real time, directly on their phones.
Authors of the study reported an improvement in patient satisfaction, citing that 95% of patient participants felt more connected to their care team and more confident carrying out their care plan.
How IoMT Is Reducing Readmissions
The Centers for Medicare and Medicaid Services (CMS) began to financially penalize hospitals for excessive readmissions related to heart failure. The Hospital Readmissions Reduction Program (HRRP) was added to the Social Security Act by the Affordable Care Act in 2012, and reduces payments made to hospitals. Up to 3% of regular reimbursements can be held back, which has become a significant expense. According to the CMS, approximately $564 million in payments will be withheld from 2,573 U.S. hospitals in 2018.
According to 2018 abstract from the Journal of the American Heart Association (AHA), heart failure is the primary reason for hospitalization in the United States, and more than 25% of patients hospitalized for heart failure will be readmitted within 30 days.
The AHA cites a three-month study from 2013 that compared telemonitoring care (TMC) and usual care (UC) for heart failure patients who were at high risk for readmission. A nurse-based telemonitoring program was used with 40 patients (who also received two home visits by a nurse) and 80 patients received usual care. The experiment found that the all-cause, 30-day readmission rate for the TMC group was 12.5% compared with 27.5% for the UC group. The heart failure, 30-day readmission rate for the TMC group was 2.5% versus 10% for the UC group. The decrease in heart failure readmissions also reduced the CMS penalty by roughly $118,400.
Even studies using mobile apps have reported similar results. In 2014, a Mayo Clinic study found that patients who participated in cardiac rehab, along with using smartphone apps to keep a record of their weight and blood pressure, lowered both cardiovascular risk factors and 90-day readmissions. Patients who used the apps and rehab treatment combination had a readmission rate of 20%, compared to 60% of patients who only completed rehab.
Improving Patient Care And Clinical Communications With Apps
Medical staff are using apps to access medical information quickly, enhance patient care, and communicate with each other. Mobile apps such as Nursing Central and Symptomia provide easily accessible, comprehensive resources about symptoms, diseases, health tests, and medications. MediBabble Translator is available in five languages and has thousands of translated questions and instructions so providers can conduct a patient’s step-by-step medical history.
Patients often have a whole team of medical professionals treating them. The Institute of Medicine found that each year the average elderly patient sees seven physicians (five specialists and two primary care physicians) across four different practices. Healthcare providers need to be able to communicate with each other about their patients’ needs. miSecureMessages is a HIPAA and HITECH-compliant secure messaging app that enables care teams to securely text with each other and share photo, video, and audio attachments.
The privacy and security of electronic protected health information (ePHI) is one of the primary concerns when it comes to IoMT. Cyber criminals are targeting ePHI because they can get a premium price for it on the dark web.
Our global healthcare industry will be worth an estimated $8.7 trillion by 2020. Hackers are profiting and selling stolen patient data to be used for insurance fraud, medication fraud, and other financial fraud schemes.
The effort to combat cybercrime and protect ePHI is ongoing and improving. According to Protenus, a healthcare IT company specializing in protecting patient health data, there were 477 reported healthcare breaches affecting approximately 5.6 million patient records in 2017. When comparing these numbers to their 2016 findings, there was a slight increase in the number of breaches (450 in 2016 vs. 477), however, the number of affected patient records experienced a remarkable decrease (27.3 million patient records in 2016 vs. 5.6 million).
Integrating new technology and ensuring its interoperability with existing systems and software can be an obstacle. Hospitals and healthcare organizations rely on a mix of different and disconnected systems to provide functionality for multiple areas in various departments. While sharing information between disparate systems has traditionally been a challenge, using an Integration Engine can bridge the communications gap.
Integration engines, such as MergeComm, use an information architecture concept known as a Single Source of Truth (SSOT). When separate departments use different data and systems, data silos are created. Retrieving information from, and updating these data silos, is time-consuming and leaves room for human error. Using a SSOT enables several databases to function as one. Information is communicated between databases and updated data is spread to the entire system – reducing the likelihood of duplicate information.
Future Of IoMT
Studies prove that IoMT is already improving care plans, outcomes, and readmission rates. The products currently on the market provide helpful information and measurements, but in the future, they could become sophisticated enough to detect diseases, bacteria, or even provide a credible warning that a person may have a disorder, such as sleep apnea, or provide information about how a disease is progressing.
Researchers at Rutgers University-New Brunswick have created a smart wristband that uses biosensor technology to count blood cells. Microscopic blood samples are collected through pinpricks and sent through a channel narrower than the diameter of a human hair. The sample is analyzed, then the results are digitized and sent wirelessly using a smartphone with an app.
Innovations such as insulin-delivery devices are already being used to improve medication adherence, and as smart device technology for real-time biometric tracking improves, so does the possibility for the delivery of precision medicine. The precise application of medicine has advantages over pills taken orally, metabolized, and distributed throughout a person’s body with possible side-effects.
The ultimate goal of IoMT is to make quality care accessible to everyone – no matter where they are located, improve people’s health, lower healthcare costs, and provide automation tools to minimize human error.