In the healthcare market, the Internet of Things (IoT) offers real benefits, both from devices attached to the outside of the body and those implanted under the skin. For these devices to be successful, they must be sufficiently small, not interfere with the body’s everyday operation, run almost indefinitely off-grid and, most importantly, be extremely reliable. Many of these goals have already been met, but some challenges remain, especially for the more difficult use cases.
The IoT offers many advantages to healthcare, not least maximising the efficiency of expensive resources and staff time. Information garnered from IoT devices can reduce the time needed for processes such as monitoring. The IoT may also be used for other things, such as pharmaceutical distribution.
The need to get better value for money and increase efficiency has driven healthcare providers to be early IoT adopters - with initial projects now undergoing large-scale trials. It is predicted that IoT in relation to the healthcare market will grow to almost $410 billion by 2022, with the potential for savings being enormous.
Today, almost everyone has their own connected health monitor - their smartphone. Though there are many associated healthcare apps, such equipment is not the best tool via which to carry out medical sensing and measurement. It is, however, an ideal link between specialist sensors and the Internet. Furthermore, it provides a familiar, highly intuitive user interface.
The market is awash with sensors that collect and monitor health data. Devices, such as those from Fitbit and Apple, can measure pulse rate, sleep periods and physical activity. That data can then be combined with other data for more in-depth calculations.
For specific medical applications, some companies are launching specialist products. Radboud University Medical Centre, for example, is testing medical-grade devices based on Philips technology. These are intended to support patients with chronic obstructive pulmonary disease (COPD), a lung condition that causes severe breathing difficulties (and is responsible for more than two million deaths per year). The devices are worn on the patient’s chest and measure breathing and heart rate. Data is uploaded to the Internet for healthcare professionals to access. Doctors get alerts in emergencies and better insight into long-term changes in the condition. Patients can also see the results, enabling them to understand their condition and the impact of any lifestyle change.
There are so many advantages to using the IoT in healthcare applications, that widespread adoption looks highly likely. Could we even be heading to a future where a doctor prescribes IoT monitoring in the same way drugs are prescribed today? We may be, but there are some obstacles to overcome first. Even though there are extensive trials in progress - and many of these will become normal procedures in hospitals - there needs to be another leap before some of the technology can be used outside controlled environments.
There are many challenges within an engineering context. Any wearable device must meet certain criteria - primarily to be able to operate in a variety of environmental conditions and not harm the wearer, provoke allergic reactions or overheat. The kit must also be resistant to sweat and be safe in the case of spillages. Even more care is needed when the device is implanted under the skin. Electronics are generally not intended to operate in such a hostile environment. More importantly, the devices must also be sterile and stable, to avoid injury.
The challenges healthcare IoT faces are not, however, all technological based. Ethical and legal questions are some of the most daunting, with legal issues potentially forcing designs to be implemented in a way that’s counter-intuitive from an engineering perspective. Consider defribillators: engineers designed the first defibrillators to be recharged inductively. But, after legal advice, they had to redesign these devices to use a non-rechargeable battery, because there was risk of legal challenges in the cases where the user failed to recharge the battery in time. The lawyers stated it would potentially cost less to replace the device every so often than for the company to be at risk of legal proceedings.
Other challenges include security and software. How complex should the devices be? Each layer of complexity adds points of failure. Communicating over the Internet is a necessity and also a weakness - how do we stop this link being exploited maliciously?
Designers of IoT healthcare devices could learn from other industries, including aerospace. Here, critical systems often have redundancy to provide high levels of uptime. Devices are developed in such a way as to ensure decision-making is as accurate as possible by having multiple pathways in the hardware and software. And a fail-safe monitor is often used to oversee the system. These features ensure a device is robust, but they put pressure on available resources. Having redundant systems running eats into the power budget and makes the system bigger and costlier. These problems are generally accepted in the medical community and products, such as pacemakers, already contain many of the features mentioned. The IEC 62304 standard for medical device software already dictates the use of independent control measures.
The IoT is destined to have a major impact on healthcare during the coming years, but this sector is very different from any other in which IoT operates. Technology must evolve accordingly in order to meet with the stringent demands that are now being set.