How technology is enabling in-home healthcare and monitoring
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Almost by definition, the Internet of Things doesn't differentiate, but it has reached a level of maturity that supports some partitioning.
The Internet of Industrial Things (IIoT) is one common example, but another is the Internet of Medical Things (IoMT). The term describes a shift that has been happening for some time, which is putting greater physical distance between healthcare providers and patients while at the same time and, perhaps ironically, allowing greater access to the professional care that people need.
The IoMT makes use of technologies that have been around for many years, such as teleconferencing and basic internet connectivity, and adds a level of intelligence that has become synonymous with the IoT in general. More recently, the IoMT has been one of the first vertical sectors to embrace artificial intelligence (AI) in a practical way, by using expert systems (a recognised form of AI) to augment the healthcare provider's own capabilities.
Together, these technologies allow patients to be monitored on a near-continuous basis, in the comfort of their own homes, and even be medicated remotely. As health services across the world feel the pressure of an increasing and aging population, we can expect this kind of more affordable and scalable healthcare to become a part of all our lives.
Bringing connectivity to healthcare
Healthcare relies on two things; access to relevant information, and the ability to synthesise that information. Professional providers and, increasingly, AI provide the synthesis, while in the IoMT it will be connected devices that provide the information; the raw data. This data will be collected using smart sensors, safely attached to the patient and securely connected to the healthcare professional.
Standards are now emerging that will help developers working in this area to create smart devices that are interoperable with a wider medical framework. For example, FHIR (pronounced FIRE), which stands for Fast Healthcare Interoperability Resources, is a standard API (Application Programming Interface) for exchanging healthcare records. It was created by the Health Level 7 International organisation, an ANSI (American National Standards Institute) accredited SDO (Standards Developing Organisation).
Microsoft has demonstrated how developers can use the FHIR standard to create IoMT devices for remote monitoring and share the data within its Azure cloud environment. To support this, Microsoft's engineers have created an open source FHIR-compliant server, as well as equipped Azure with the hooks needed to talk to remote medical devices.
Remote monitoring and national healthcare
As part of its Dynamic Purchasing System (DPS) framework, the UK's National Health Service (NHS) has already approved over 30 manufacturers as online consultation suppliers. This includes Medicspot, a company that uses internet-connected medical devices to provide remote diagnosis. The Medicspot Station is typically located within pharmacies, enabling patients to have private consultations with one of Medicspot's own doctors through a video link. The station's connected devices comprise a blood pressure monitor, thermometer, pulse oximeter, a close-up camera and a stethoscope.
Under the consulting doctor's supervision, the patient will carry out the examination by placing their finger in the oximeter, or holding the stethoscope to their chest, for example. Once a remote diagnosis has been made, the patient receives a prescription that can be filled at the pharmacy. The company claims its technology enables it to treat around 70% more conditions than those treated using other remote services, such as a video-only consultation with a GP.
The IoMT is also merging with the lifestyle sector, by bringing diagnostic capabilities to wearables already being used to monitor fitness, or record activity.
For example, smart watches can be used to connect to a smart sensor to relay data via the cloud to a doctor for remote diagnosis.
Continuous Glucose Monitors (CGMs) have been on the market for some time, but now they too are becoming 'smarter' through applications running on smart phones or smart watches. Once connected to the sensor, typically using Bluetooth, the app receives data from the CGM and displays the results to the wearer. The output may be something as simple as a good/bad indication, or more complex if the patient needs to know more. Essentially, the complex assessment of the raw data is handled by the computing power of the smart device, giving the wearer just the information needed to help manage their condition.
This is now being extended to include the automatic delivery of insulin. OpenAPS (Automatic Pancreas System) is an open source initiative created by a couple who hacked a CGM to use its data to control an insulin pump using a Raspberry Pi. Similarly, there are now examples of connected inhalers on the market aimed at asthma sufferers and people with COPD (Chronic Obstructive Pulmonary Disease). Propeller is a leading manufacturer of a connected sensor that fits to almost any manually operated inhaler to monitor the user's respiratory health. Like many smart IoMT sensors it connects to an app running on a smart phone/tablet to give the patient full access to the data and its meaning.
Adding value at every level
These applications are representative of the innovation happening in healthcare. At this forefront, where the internet meets the patient in their own home, there is a relatively high level of design freedom. Naturally, there will be requirements to meet, such as being in compliance with the Health Insurance Portability and Accountability Act (HIPAA). Generally speaking, however, almost any embedded technology can be used to enable innovative remote monitoring solutions.
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Blood pressure monitors can now easily be controlled using a smart phone |
In the examples outlined above, the key technologies are sensors and connectivity. In some cases, the type of sensor used may be based on proprietary technology, developed by or for the manufacturer to provide a competitive edge. In many cases, however, the sensors used will be general purpose sensors. In wearable devices, those sensors may be based on MEMS technology, which offers a high level of functionality in extremely small packages.
As we all become more comfortable with being actively involved with our healthcare and not 'just' a patient, we will be willing to use a greater variety of devices providing functions that were once the remit of the professional care provider. One piece of home healthcare equipment that bridges this boundary is the blood pressure monitor. Taking an accurate blood pressure reading requires a level of competence that most non-medical people simply don't have, but that competence can now be embedded within a portable device. MEMS-based pressure sensors are a vital part of the solution here and include a number of products developed by TE Connectivity's Silicon Microstructures. Its range includes sensors that provide a 16-bit digital output only, as well as devices that provide a digital output and amplified analog output. The sensors are available in gauge, differential and asymmetric differential configurations.
A key benefit of MEMS technology is its small size, which makes it possible to integrate a large number of functions into a small outline. An example here is the SmartSense wireless multi-sensor module from Invensense (TDK). As well as its sensing capabilities, the module also includes a rechargeable battery alongside Wi-Fi and Bluetooth connectivity. This fully integrated system, including software, can measure pressure, humidity, temperature, orientation, vibration and magnetic direction. As such, it could easily form the basis for personal fall monitors, motion sensors or environmental sensing solutions for vulnerable people in their homes or care establishment.
There are many challenges to providing wider access to healthcare to a growing and ageing population, but it is also true that there are many technologies now able to address those challenges. Not all medical equipment needs to be operated by a healthcare professional, and, as we become more familiar and comfortable with having advanced technologies in our homes, we will also grow to accept how those same devices could also help us monitor and maintain our wellbeing.
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