The Internet of Things

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The Internet of Things, that loose conglomeration of internet-enabled mobile and monitoring devices, has found its place in the healthcare industry almost by accident.  Providers and developers looking for population health management solutions and better strategies for chronic disease care started to turn to wearables, smartphones, tablets, and home monitoring devices on an ad hoc basis to solve specific problems facing their patients and their bottom lines.

But as EHR adoption flourishes and healthcare’s fascination with big data analytics starts to become big business, these experimental forays into leveraging the Internet of Things (IoT) for population health management and patient engagement are no longer a novelty.


The Internet of Things has become increasingly meaningful to healthcare organizations seeking more seamless, attractive, impactful ways to keep their patients happier and healthier on a larger scale.

What are some of the ways that healthcare organizations are using the Internet of Things to improve their population health management capabilities as the industry tries to balance consumer desires for innovative technology with smoother provider workflows and better outcomes?

Watching the rise of the wearable

Apple is pretty used to releasing disruptive mobile technologies by now, and despite its skeptics, the Apple Watch looks like it might be one of them.  The smart watch category has been staggering along as a consumer novelty for several years, but the wearable devices seem to have found a meaningful place in the healthcare industry thanks to HealthKit and ResearchKit, two projects that have already turned the wrist-top computers into Internet of Things superstars.

Academics have been enthusiastic over the big data analytics possibilities since the March announcement of ResearchKit, which promised a rich, cloud-based playground of anonymized patient information that could be used for everything from diagnosis Parkinson’s disease to managing asthma and diabetes.

A few pioneering healthcare organizations have already jumped on the chronic disease management possibilities of the wearable devices, including Ochsner Health System in Louisiana.  As part of its population health management efforts, Ochsner is using the Apple Watch and Apple HealthKit, along with wireless blood pressure monitors supported by its Epic EHR infrastructure, to help patients maintain better control of their hypertension.

“Typically, hypertension patients see their physician a few times a year. Now, we are offering a new way to deliver care in patients with chronic diseases in which we can communicate with the patient in a more intimate way, more frequently,” said Richard Milani, MD, Chief Clinical Transformation Officer at Ochsner Health System.

“We recognize that to be impactful with this method, we need to fundamentally change behavior,” he added. “We can do this by providing continuous feedback with reminders and words of encouragement to promote lifestyle modification. What better way than to utilize the capabilities of the Apple Watch to make this an easier transition.”

Improving home monitoring for chronic diseases

Bringing continuous monitoring into the home setting is one of the most immediate benefits the Internet of Things has to offer.  As patients of all ages and technical abilities become more familiar with the basics of internet-connected consumer devices they are now using for a wide variety of routine tasks, healthcare providers are now able to extend their presence into the daily lives of patients without an insurmountably steep learning curve.

A recent study of diabetic patients that included the use of wireless blood pressure and blood glucose measurement devices, coupled with an internet-connected pillbox that transmitted data directly to participating primary care providers, clearly showed the potential for home monitoring devices to help patients keep their chronic conditions under control.

Patients who participated in the study rated the equipment easy to use, unobtrusive, and helpful for their ongoing care and organizational skills.  Providers dedicated relatively little time to the care coordination project, and found the resulting reports beneficial for tracking their patients’ progress and requested that the data be integrated into their EHRs.

Using patient-generated health data to fill in EHR gaps

Collecting meaningful and pertinent patient-generated health data has been one of the biggest challenges of the Internet of Things in healthcare, and remains a problem for providers already overwhelmed with the sheer volume of clicks and checkboxes involved in basic EHR use.  A worryingly high proportion of providers have already taken a stand against an influx of new data that might complicate their workflows – how can they be convinced that data from wearables, mHealth apps, and other Internet of Things applications can have clinical value?

If patient advocates like Donna Cryer can’t convince providers that patient-generated health data is critical for better care coordination and improved patient engagement, value-based reimbursement certainly will.  As more and more revenue becomes dependent on patient satisfaction and patient outcomes, providers will need to heed the two-thirds of consumers who are adamant that mHealth data should be better integrated into their clinical care.

Smartphones and wearables are driving a major behavioral shift in consumer health and wellness,” said Gil Bashe, executive vice president of Makovsky Health. The company found that 79 percent of patients are interested in using some sort of wearable device to track their daily wellness metrics, especially if they had a specific chronic disease to worry about.  “Beyond a desire to speed access to information, consumers are using technology to engage proactively in managing their health. Savvy health marketers will apply these insights to engage and involve patients in more meaningful, customized ways.”

This patient-generated health data, collected passively by Internet of Things devices, has the potential to fill in the blanks inherent in EHRs, which have always been oriented to generate documentation of a specific episode of care.

“Using electronically collected patient-reported outcomes to capture the review of system outside of the clinic visit may not only improve the efficiency, completeness, and accuracy of data collection for the review of system, but also provide the opportunity to operationalize incorporating the patient’s voice into the electronic health record,” wrote University of North Carolina at Chapel Hill researchers Arlene E. Chung and Ethan M. Basch in a JAMIA article.

“Data rests at the heart of health IT’s capacity to help improve care quality and health outcomes: standards-based, interoperable electronic systems make it possible to access, share, use and re-use information that was once locked in paper charts kept by individual providers,” added representatives from the Office of the National Coordinator in January.

“As more and more consumers engage and adopt mobile health technologies to help them better track their daily health and wellbeing, it will be increasingly important to consider how those data can flow seamlessly from consumers to providers – and back – to help everyone achieve better health.”

Social media shows its worth for predictive analytics

Twitter may be better known as the forum of choice for celebrity feuds and pictures of restaurant dinners, but social media has proven to be a valuable tool for researchers looking to leverage big data from 140 characters or less.  Patients glued to their smartphones, the ultimate IoT devices, often mix in health-related complaints amidst their ordinary chit-chat, and data scientists are hard at work figuring out how those messages can be useful for healthcare organizations.

Thanks to the power of machine learning and sophisticated algorithms that can help extract meaning from seemingly mundane communications, Twitter is becoming a hotbed of big data analytics activity.  From identifying sleep disorders to interpreting the occurrence of adverse drug events, patients can provide a great deal of information into their health and wellness through social media and online search.

Providers may be able to directly benefit from these communications, as well.  Researchers at the University of Arizona are using a combination of keywords, time stamps, and location data from hundreds of thousands of tweets to chart potential emergency department usage among Twitter-savvy asthma patients.

The work has the potential to help model how and when asthma-related resources should be available in local emergency departments, says Dr. Sudha Ram, a UA professor of computer science and big data. “Interventions would be prioritized in time and place to reduce the risk for asthma ED visits,” she predicts. “For instance, public health resources could be used to reach out to patients from high-risk clusters or communities at any given time, and direct them towards less costly and more efficient care sites such as their primary care provider offices.

“Moreover, predicted risks could be spatially and temporally visualized, and made available to community stakeholders through various media sources,” she added, a resource that could be accessed through the same smartphones that generated the data in the first place.

Better device integration means better patient safety

The Internet of Things isn’t just a consumer-facing venture.  Providers are heavy users of mobile technology, too.  They rely on accurate, complete data from medical devices and secure messaging systems to keep them informed.  In the inpatient setting, the IoT includes laptops and computer workstations, bedside monitors, smartphones, tablets, and even implantable devices like pacemakers that beam data from inside the patients themselves.

Developers have struggled with the ability to ensure that the data from all these devices and tools can be synthesized and presented in a meaningful way, but healthcare organizations are increasingly making medical device integration a top priority for patient safety and care coordination.

“Our world is completely different today than what it used to be,” explained Amy Hester, PhD(c), BSN, RN, BC, Director of Clinical Informatics and Innovation at the University of Arkansas Medical Center, to  “Under the old way of doing things, it was possible for a patient’s vital signs to be 8 or 12 hours old by the time they were entered into the record.”

“It’s not like that anymore.  When we collect a set of vital signs or information from other devices like ventilators, that information is validated right there at the point of care.  It goes into the record straight away.  So everybody that needs to make care and treatment decisions about that patient has up-to-date, real-time information on that patient regardless of where they’re accessing that record from.”

“They don’t have to be on the unit.  They can be at home and access that information, or on their mobile device and access that information,” she continued.  “So our ability to have real-time access to data brings us into a whole new world now that we have our devices properly integrated.”

Whether intended for consumers or based in the ICU, medical devices are at the core of healthcare’s Internet of Things ambitions, and integration is the name of the game.  Data must be collected quickly and efficiently and presented in a meaningful, understandable way to its intended audience if it is to be useful for decision-making.

With population health management slated to become an increasingly pressing concern for providers shifting towards the financial risk involved in accountable care, the Internet of Things has already become a vital part of the industry’s efforts to meet the Triple Aim.  Wearables, smartphones, remote monitoring tools, and bedside devices that successfully combine into a seamless network of comprehensive patient data will provide newly actionable insights for healthcare providers seeking the best information available for clinical decision making and patient management.