Monday, 19 June 2017

Blog Series: #IoT in Healthcare by Swetha Jegannathan @csweths



The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities (http://blog.hcitexpert.com/2016/05/infographic-iot-in-healthcare-opportunities.html) that present themselves to the Startups, Healthcare IT organisations are tremendous.
Presenting the insights shared by Swetha Jegannathan (@csweths) on #IoT in Healthcare #PhilipsChat.


Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
Swetha Jegannathan:
1. Geriatric Care - IoT is and will continue to be of great value in elderly care, allowing the doctors and care givers to monitor, track and alert when away from their loved ones - especially in cases of neurological disorders like Dementia and Alzheimer.
2. Maternal and Infant Monitoring - IoT, through monitoring devices worn by the individual, can provide timely intervention in the area of maternal and infant health - one of the primary goals of the UN sustainable development agenda.
3. Remote consulting - The low doctor patient ratio in India can be effectively overcome through remote consulting - making patients responsible for their well-being - leading to the doctors and hospitals prioritise focus on emergency and chronic patients.

Note: Since radio frequency is central to most of the IoT innovations, innovator must adhere to protection standards on effects of radio frequency (RF) fields as tabulated by the International Commission on Non-Ionizing Radiation Protection (ICNIRP, 1998) and the Institute of Electrical and Electronic Engineers (IEEE, 2005)

Further the paper “IEEE Standard for Safety Levels with Respect to Human Exposure to Radio Frequency Electromagnetic Fields, 3 kHz to 300 GHz” also gives few pointers on safe use of the IOT technology. http://emfguide.itu.int/pdfs/C95.1-2005.pdf

Q2: Is an IoT based system going to be a utility or a service?:
Swetha Jegannathan: The system will be successful if offered as a service. Hospitals would be the drivers providing this service to their patients with companies engaged in the manufacture and distribution of medical devices being the enablers of the technology.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
Swetha Jegannathan: RFID based devices connected through the anti-collision protocols and the Apple watch will be the future.

The RFID chips are inserted into the human beings for unique identification and capture of information relating to their general health and well being like blood pressure, weight, blood sugar levels.  The RFID tags can also be used for improving the efficiency of the medicine distribution networks as tracking of the medicines becomes easier.

Prevention of inappropriate usage of the collected information in terms of charging higher insurance premiums or classification of the individuals tracked by the device is one of the biggest challenges to its widespread implementation. However, if used judiciously, healthcare can certainly move from curative to preventive care.

RFID standards need to focus on the following:
- How the RFID systems work
- What frequencies do they operate on and how to use a common frequency across the globe
- Method of data transfer
- Communication between reader and the tags
- Complementary products development compatible to the RFID
 
Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
Swetha Jegannathan: In India, most of the patient data is available in physical form and this needs to be converted to electronic form.  Only if 100% of the required data is in electronic form, further analysis can be simplified.
For all the required data to be available electronically and their analysis, high end scanners, significant investment in hardware - to cater to large databases - and software (machine learning - image recognition; AI) to effectively manage data and make decisions. Further, a standard medical data code for data transmission and retrieval is a prerequisite.
Once the data is collected, stored and retrieved efficiently, analysis is accurate and easier leading to appropriate decision making.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
Swetha Jegannathan: Some usage of IOT in the indian and international hospitals are given below:
- GE used sensors in a New York hospital to track the usage of hospital beds resulting in  optimised occupancy levels and reduced the emergency room wait times by four hours.
- e-Alert, a HW/SW solution by Philips Healthcare, virtually monitors the health of its machines to prevent outages. Timely alerts on the wear and tear of the machines leads to savings on replacements and repair.
- In India, Manipal Hospitals has been using a wearable device for the expecting mothers to enable doctors to remotely monitor real time information of the growing foetus.
- Apollo hospitals has been an early adaptor of IoT in the country in healthcare for accessing patient records at one go with its Unique Hospital Identification initiative across the country.
In addition to the above, the hospitals can leverage IOT in the following areas:
- Clinical decision enablers
- Effective control on hospital borne infections
- Targeted and painless surgery using AI/ VR.
- Connected care pre and post discharge

Q6: What are the aspects of Connected Care for the Patient Care Continuum (https://twitter.com/HCITExpert/status/692309239570628608):
Swetha Jegannathan: Connected care for patient care continuum would include:
1. Preventive health - with regular check-ups, timely alerts and early interventions
2. In-Patient Care - Personalised treatment enabled by technology
3. Post operative care - Remote tracking, consulting and treatment follow-ups using telemedicine and diagnostic tools.

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
Swetha Jegannathan: The use case suggested is based on the premise that it is executed at state level involving the hospitals and care givers.
- The state monitors the citizen’s health using IoT technology - Wearable/ regular check-ups to name a few
- State collects data and, post analysis, alerts the hospitals if there is a deviation from normal
- Concerned citizen and the hospital are in touch and the identified individual is put on preventive treatment with periodic observation of the readings
- If the preventive treatment is successful, then sustenance is monitored through home care including life style changes
- If the preventive treatment is not working for the individual, further investigation is encouraged.  Post investigation, if the individual is diagnosed with the suspected condition, the relevant treatment procedure is given to the individual.
- Monitoring of the progress of the individual’s condition during the treatment is an important step
- On conclusion that the treatment is successful, the hospital, through IOT, will monitor the relevant data periodically.
- The hospital and the individual may decide to have remote follow up consultations till the individual is deemed to be healthy again and there are no signs of relapse.

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
Swetha Jegannathan:
The following are the healthcare based Smart City components:
- Digital e-health and m-health systems
- Remote patient monitoring leading to customised treatments and medication
- Devices and wearables linking patients with remotely present doctors and nurses
- Data anonymisation
- New innovations on sharing medical learnings that are digitally collected
- Common medical data standards for collection, distribution, analysis and retrieval

The implementation of the Smart City concept in healthcare can be achieved by having a model district containing the above components.  This model needs to be continuously monitored and course corrected (wherever relevant) for it to be successfully expanded to the state, other states and finally the country.

Healthcare based Smart City components, if implemented efficiently, will lead to optimisation of the healthcare costs incurred by the governments.

Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
Swetha Jegannathan: Thought, the initial investment and efforts required may be enormous, the patient convenience and hospital resource optimisation through the process streamlining will be worth the efforts and the investment. With the entire patient record being seamlessly available to all the relevant stakeholders, significant savings will be achieved in collecting, sharing and transcribing data - in terms of cost and time. This would also minimise medical errors and, in turn, enhance the reputation of the hospitals in the long run.

Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
Swetha Jegannathan: Human barcoding

Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
Swetha Jegannathan: In 5 years the patients should be able to experience hospitals as wellness clinics with patient centric design in both service and delivery being the priority. This would be achieved if the following plan in implemented in a systematic manner:
- The patient will be assigned to the nearest healthcare facility by the smart city based healthcare network algorithm
- When the patient walks into the hospital (without any physical file), the face recognition technology will retrieve his records and direct him to appropriate department for treatment and physician without any wait time
- Incase of further investigation, the medical record will be sent to the nearest laboratory that then collects the samples from the patient and send the results to the hospitals online for further deciding treatment protocol, including surgeries and therapies. Alternatively for some tests FDA approved diagnostic mobile applications can replace the laborious laboratory tests and share the results instantly with the hospital over the data cloud
- Painless surgeries with targeted robotic precision will be the norm
- During the treatment course (either as in-patient/ out-patient), medical prescription is shared electronically with the pharmacy that delivers the medicine to the patient
- Home care will be an extension of the hospital care with the wearables monitoring the patient’s health and alerting medicine/ therapy schedule
- Physicians will do remote consulting for acute cases, thus freeing them and hospital facilities to attend to only chronic patient in person
- After the recovery stage, the IoT based diagnostic kits will be used to monitor the health of the patient remotely and alert any relapse or detect a new condition

Thus, seamless integration of health system and data without human intervention (or edits) will greatly reduce medical errors and enhance the patient experience.

Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
Swetha Jegannathan: - Technologies looking at reducing or eliminating the radiation effects of radio frequency that is so central to IoT use cases.
- Smart human centric designs to make healthcare more patient centric without compromising on the human touch.


Stay tuned to the #IoT in Healthcare Blog series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

Author
Swetha Jegannathan
Swetha is a lifescience/ healthcare IT consultant with focus on business flow, pre and postsale lifecycle of a software. She has been fortunate to be part of different sub-sectors within the health and life science vertical, be it e-health and m-health at Eli-Lilly Co-Innovation lab for HCL, Singapore or Clinical Data Management & Computation and Laboratory Information Management Software (LIMS) suite at Phase Forward - Waban Software group (now acquired by Oracle) and Ocimum Bioslutions. She has catered to clients across major pharmaceutical majors in US, Europe and South East Asia.

She was instrumental is setting up the DNA sequencing wet lab for MWG Biotech (Now Eurofins), a German company, when they were establishing their base in India in 2004.

Swetha is also passionate about promoting green businesses and innovations that are socially relevant, economically viable and environmentally sustainable. An advocate and practitioner of natural living, she has also done social work assignments with focus on sustainable agriculture, food security and environment. (nominated for the UN Online Volunteering Award in 2010 and her volunteering work was published in UN Online Volunteering newsletter March 2011) and covered in The Strait Times, Singapore national daily.

Specialties: Digital health, Green business, Start-up facilitator, Business Analysis, Consulting, Entrepreneur, Marketing, Social Media, Project Management, Presentation Skills, Networking.

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