IoT or Internet of Things has been around for quite a long time now, it was in 1999 when Kevin Ashton coined the term Internet of Things.
As per Gartner the number of connected things is expected to touch 20 billion. If you have followed IoT you would notice that has always been a lot of focus on Smart Home and there definitely are various scenarios for the same. Three Square Market in August 2017, offered their employees to get a microchip embedded in their hands (One of the 1st to do so) using which employees could enter the office, logon to their PC.
In recent times there has been a growing trend of people wearing Smart watches to track basic information about themselves such as heart rate, no of steps taken. An App on our Smart Phone can also track the number of steps, but one might ask how is the Smart Watch different? If we look at this technically the App tracks the number of steps using GPS, while the Smart Watch will ideally have a sensor/actuator to gather this information. The Smart Watch can interface this data with a Smart Phone Via Bluetooth or Wi-Fi and from there the data can also be transmitted online to Patient Portals.
Every year around my birth month my office sends me for an annual health checkup, to setup an appointment I logon to my Office’s HRMS system and schedule a specific date. Other than my annual checkup if I am not feeling well and I want to go to the hospital, either I will call up and schedule an appointment or just walk-in to the clinic. Now, if a chronic care patient is unwell, he will also do the same i.e. schedule an appointment or walk-in. But, with an increase in Home Health, using IoT Doctors can monitor Patients Vitals and other parameters easily. One can also create a mechanism to automatically schedule an Appointment if specific Monitoring Parameters don’t seem correct. Would we want to do this for everyone? I don’t believe it would make sense, it will help to limit this volume to a specific set of patients (e.g. Chronic Care Patients). Once I reach the clinic for my annual check up the front desk employee asks for some documentation, I don’t have to fill in many details as the clinic has some of my basic information.
Many a times I think, how does a hospital get information of a person who is critical (Casualty), especially if no one is with the patient. One possible solution to this problem could be bio metric sensors, using which one could get Basic Information of the Patient, this in turn will save time and improve Patient Satisfaction. Obviously, this would be possible in places where Governments/Organizations have already bio-metric Id’s e.g. India using Aadhar.
Some Hospitals at the time of registration give the patient a RFID Tag (I did not get one), with the help of which the hospital can track the patient movement. A good example is that of Apollo Hospitals in Chennai, they use ICEGEN’s “Patient Mantra” Solution which helps them Locate and Track each Patient. Due to this, the Hospital was able to easily track patients who were going through 26 diagnostic procedures in one day. They were also able to identify which area is getting crowded and thus make some corrections.
Insurance Eligibility, is not only one of the most crucial steps in the Patient Journey but also many a times the most complex. Since mine was an annual checkup sponsored by my company, I was not asked these details. Though there isn’t a sensor which can check the insurance eligibility of a person, but there are solutions like pokitdok which provide a Cloud based API to validate Insurance. This can help improve the efficiency of the process.
In my annual check-up, the first step I had to do was give my blood sample, and obviously I had to wait for my turn. The Lab technician follows a standard procedure while drawing blood, one important aspect I notice while my blood is being drawn is keeping the environment clean. Before drawing blood, he used a hand sanitizer, wore a new set of Gloves and opened a new set of Syringe and needles. Once the process is done, the technician threw the syringe and needle in a bin labelled as bio-waste.
Cleanliness is very crucial for a Care Provider, as approximately 10% of Total Healthcare costs are related to Healthcare Associated Infection or Hospital Acquired Infection (HAI). Statistics show that more people die of HAI each year as compared to Breast Cancer and Prostate Cancer combined. Ohio Health uses RFID to track Hand-Hygiene Health Compliance to try and keep HAI in check. Prior to visiting a Patient, a Doctor needs to wash their hands, Ohio Health installed RFID sensors at washing stations to check if Doctors visited the washing station and based on statistics captured feedback is provided to physicians.
In case a Patient needs to be admitted, it is important to clean and ready the room for the patient. IoT in this space has done wonders for some hospitals. Bed Side Sensors at a New York Hospital help them to find out Bed Availability. Temperature Sensors monitor the Temperature of the Room before the patient enters the room. Hospitals in UK have combined the use of RFIDs/Sensors and Prediction Models to check the when a Bed could become available and thus improve efficiency.
After giving my blood sample, I was asked to wait in a room for my Stress test (running on a Treadmill). As a setup procedure I was made to wear a small device with leads connected to my chest. The small device was in turn connected was to a machine (on a trolley) with a small display which was showing my vitals. Before the procedure is started (i.e. I am told to run on the treadmill) the doctor took my Blood Pressure, and as the procedure starts the doctor keeps measuring my BP 2-3 times. Once the procedure is done the Doctor measures my BP one final time. All the time the doctor keeps entering this data in the system.
Like this device/machine the hospital has various other Point of Care Sensors/devices like Pulse Oxymeter, ECG, Electromyogram, Body Position other than the standard Blood Pressure Monitor, Glucometer. Various Hospitals have built interfaces with these devices/sensors to automatically capture this data in their HIS/EMR Systems. By doing so Hospitals are benefited with reduced errors due to Data Entry and real time monitoring of patients. A Hospital in Bengaluru (India) uses a wearable Fetal Monitoring device for expecting mothers which is integrated with a Mobile App and the Hospitals Information System. The App showcases information such as fetal heart rate and the doctor can monitor the same to take real time decisions. Apollo Hospitals in Chennai has connected all Medical Equipment to its Hospital Information System and doing so helps monitoring patients via a centralized system.
Another aspect to note here was documentation done by the Lab Technician, Nurse and Doctors. This documentation is crucial phase one to treat a patient and for billing purposes, as this data is used by Medical Coders to enter the ICD Codes. There are tools in the market which can help Physicians improve productivity, one example being of Nuance - Intelligent Virtual Assistant – Florence launched in 2015. Florence is a combination of IoT and Artificial Intelligence and has various voice driven workflows using which Doctors can capture vitals as well as place orders.
In the beginning we talked about how hospitals use RFID’s to track patients. Do you think hospitals could use RFID’s to track equipment’s? Yes, they do and one of the top reasons to do so is Theft !!! I heard of thieves breaking in a bank, but could not believe that could happen in a hospital? Thieves come dressed as employees and steal medical equipment. Hospitals use IoT (RFID) to help track various aspects of medical equipment like location, temperature, usage and electricity consumption in some cases. By doing so Hospitals can monitor thefts but this can also help reduce the cost of maintenance and improve patient satisfaction.
At the end of the check-up the data of all the Patient interactions would be sent to the billing team for billing and claim filing. IoT might not have a direct role in most of the Back-office processes, but there are some processes which could benefit by using IoT like Billing. We talked about Patients being given RFID Tags at the time of registration, which can also be used to track and locate a patient. The same RFID Tag can help track the duration a patient is at a specific department, this can be used for Emergency Patients. In some cases, since we track the usage of Medical Equipment we can use the information to enter the charges in the System.
Where do we go from here?
Overall, we see that IoT in a hospital environment is a growing reality, having said that there are still many challenges while implementing IoT. Security is one of the Top Concerns for IoT as one needs to maintain data privacy and integrity when transmitting data over a network. This becomes even more complex in a healthcare environment where we have HIPAA and other Data Privacy Norms. Another aspect is a lack of common Standards. As IoT is well hardware dependent, and there are so many diverse types of equipment’s/devices each having a different method of communication. This makes it complicated and time consuming to build interfaces with Hospital Systems (EMR) to capture the date electronically.
References:
• Gartner: IoT Statistics https://www.gartner.com/newsroom/id/3598917
• CNBC: https://www.cnbc.com/2017/08/11/three-square-market-ceo-explains-its-employee-microchip-implant.html
• Icegen: http://icegen.net/rfid-rtls-based-patient-tracking-solution-patient-mantra-at-apollo-hospitals-india/
• https://pokitdok.com/
• BBC: http://www.bbc.com/news/business-25059166
• Economic Times https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/hospitals-using-internet-of-things-to-improve-the-medical-facilities-manage-patient-information-better/articleshow/38825378.cms
• Healthitanalytics: https://healthitanalytics.com/news/ohiohealth-uses-big-data-analytics-to-increase-hand-hygiene
• Hospitalinformationsystem.com: http://www.hospitalinformationsystem.com/eye-hospital-asset-tracking/
• Nuance.com: https://whatsnext.nuance.com/healthcare/doctors-save-time-with-virtual-assistant-florence/
Short Bio: Harish Rijhwani has been associated with Healthcare Verticals at Syntel and Hinduja Global
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.