Of all the applications lumped under the general heading Internet of Things (IoT), connected healthcare is among the most exciting. However, it is a highly regulated sector and one that had to address the challenges of finding cost effective connectivity solutions and dealing with the privacy issues associated with the wider sharing of patient data.
Michael Barkway, consultant at TTP Group, a Cambridge-based independent technology and product development company, observes: ‘There is a world of regulated and unregulated devices and applications. The latter is storming ahead and is making a lot of innovative apps, but the medical world is more cautious.
‘A lot of progress is being made, but as with all medical devices it takes time; everyone is a little bit nervous and a bit cautious. You have to prove reliability, robustness and the ability to secure the data and demonstrate that what you put inside the body, for example, is clinically safe.’
The most advanced product areas to date involve outside-the body-applications, such as blood glucose monitoring for diabetics (although researchers are still seeking a solution that does not involve puncturing the skin).
Other areas include ECG readers for arrhythmia detection, sleep apnoea monitoring and various types of inhalers, which can record if the right amount of dosage is correctly taken at the right time. Barkway also points to more low-key applications designed to make sure people have taken their medicine at the right time and on the right day.
‘You can ascertain when the pill packet was opened and record that, so carers or family know that stage of the process has happened. This is being driven by drugs companies too – one of the important trends we are beginning to see is drug companies increasingly being rewarded for actual positive treatment outcomes, rather than just for delivering the drug.
‘In that space, we’re also working to enable the wired home, which lets families know the helper has been in and made sure the patient has taken the pill. This is in response to an increasing elderly population and attendance concerns – making sure the helper came in, the tablets are taken and that Mum is Okay,’ he says.
Turning to the connectivity element, Barkway says this has become much cheaper and is enabling the collection of data. ‘Both proprietary and open standards-based connectivity solutions are being used,’ he observes. ‘But you still need a sensor on the patient and it depends on what is being measured and monitored as to how bulky that device is.’
The Wi-Fi option
Matthew Edwards, marketing manager at Wi-Fi specialist Aerohive (pictured below), points out that while Wi-Fi may not be the best solution for low data rate, low power wearable devices, where a low-cost, wide area network may be required, but it is very appropriate for hospitals with demanding high bandwidth applications.
‘The challenge here is in designing and planning the Wi-Fi architecture,’ says Edwards. ‘In a hospital there are a lots of users, devices and bandwidth-heavy applications with different use cases that need seamless roaming and high levels of security. That means the network must be reliable with a high degree of availability and have the ability to scale up to meet future demand.
‘You are dealing with mission critical systems in most cases in healthcare. You have to consider the physical RF world and how that will work in that demanding environment. The perception is you can go to a retail store, buy an access point (AP) and replicate Wi-Fi like you have it at home – no, not at all,’ he warns.
Any hospital Wi-Fi system needs to be able to provide granular device and app management and a robust device authentication and monitoring process to make sure no one is abusing the network and to ensure privacy policies are enforced.
‘If you have other applications, such as smart building services management applications hooked up to your Wi-Fi, you could get hacked through a light bulb or an air conditioning system. We have seen this happen in retail. It’s fine to have a smart building management system, but that requires robust and constant network management and monitoring,’ says Edwards.
‘A fine balance has to be maintained between all these devices, services, efficiencies and increasingly wearables too,’ he continues. ‘There is real potential to boost healthcare provision here, but it must be based on a secure wireless platform. You must have the right platform, design and capability to on-board devices in a secure way or else it will be disaster.
‘So it is important to deploy enterprise grade Wi-Fi technology,’ asserts Edwards, ‘as then it is pretty easy to manage the bandwidth. You can establish your access and management policies and throttle the bandwidth for certain people or certain apps when necessary.’
Edwards also says the network must be able to respond in real time to ensure the quality of the end user experience is maintained as users move around the building. This requires a context-based network able to provide enough capacity should a large number of simultaneous users congregate in one place, for example.
Other connected healthcare applications may be better served by alternative low power, wide area wireless standards. One example is the solution developed by French company SigFox.
SigFox technology is already being used by Arqiva for its UK smart meter contract, but Cameron Rejali, CTO at Arqiva (pictured below), believes it can also be used as a real alternative to Wi-Fi and cellular solutions for healthcare.
‘Cell phones can be the home of a lot of things and Wi-Fi can do the connectivity, but for a significant percentage of the population that will not be the right solution, such as very young children, elderly and infirm people or people who simply have no access to broadband or cannot afford a device and airtime contract,’ points out Rejali.
‘SigFox sends little bits of data out on a regular basis, but in a far cheaper manner and without relying on Wi-Fi or a cellular smartphone connection,’ explains Rejali. ‘SigFox provides almost an order of magnitude cost difference; something like £2-3 a year compared with a cost for GPS via cellular of around £5 a month.’
The technology is based on transmitting an ultra narrowband signal, which is picked up by antennas, collected and sent to a doctor or monitoring station. It enables the sensors and IoT module to have a very long battery life – up to 10 years potentially.
Hence, SigFox is designed to enable the monitoring of IoT devices over a long period of time. ‘It enables location monitoring using a tracking device where the GPS co-ordinates are sent at programmed intervals. The advantage is that it doesn’t rely on a person to remember their phone, although they do need to remember to wear the bracelet with the tracker on it!’ says Rejali.
‘It’s designed for people without a mobile phone or who can’t handle new technology. It allows you to monitor them, check they’ve taken their medicine, but in a very cost effective, no battery required way; it is a new space,’ says Rejali. For home healthcare monitoring, a SigFox hub can be installed and more sophisticated medical applications run off it.
Connected healthcare, therefore, has a number of different connectivity options. The right one will be determined by the cost the user or provider wishes to incur, the sophistication of the application and what it requires to function effectively.
There is little doubt that connected health solutions are set to grow enormously, but it will take a little time yet to deal with the challenges.
TTP on cutting edge connected healthcare applications
TTP has developed more than 30 delivery devices and contributed to the development of many more including: pulmonary and parenteral devices; the delivery of liquids, powders and tablets; mechanical devices, electronic devices and novel mechanisms; eye and nasal delivery.
The company has helped develop a number of different inhaler solutions including the AstraZeneca Inhaler featuring a colour display to alert patients to the number of doses remaining in their inhaler.
It has enabled a device that is planted in a cow’s stomach with the data transmitted over a customised wireless protocol. ‘It sits in the cow’s rumen and continuously monitors acidity and temperature. That way you can alter the diet of the cow to ensure its health and optimize milk production,’ explains Barkway (pictured below).
TTP has also looked at negative pressure bandages. ‘Wounds respond well to negative pressure, as it draws blood to the wound and improves the healing time.
If you can insert a pump into the wound that allows you to be gentle and silent in extracting air from it, that is a way of improving the healing process. This could then be connected to monitor the pressure and transmit the data wirelessly,’ says Barkway.
Perhaps the real frontier in connected healthcare is connected in-body devices. TTP has developed battery-free, ultra-low power wireless sensor technology, which can be embedded in titanium orthopaedic implants for remote wireless monitoring and powered using new energy harvesting techniques.
The new sensors use ultra-low power electronics and energy harvesting techniques that make use of biological energy sources, radio waves, vibration and heat, and connect to smartphones or tablets using ultra-low power Bluetooth technology or near field communications.
TTP believes that these technologies will allow patients and doctors to monitor the performance of the implants and the progress of the healing process with fewer hospital visits, while ‘mal-union’ events could be detected earlier, allowing corrective intervention.
Barkway says: ‘In serious bone injuries, you often need a metal brace around it. As the patient is recovering it’s now possible to monitor the strain around it and measure how much support the metal brace is providing and how much the bone is taking on again. That information lets you know how far to push the therapy treatment. If the bone is still too soft you ease up on the therapy, or if it’s healing well then treatment can be accelerated.’
Another area TTP is examining is in-body ultrasound. If a patient has had a heart operation the doctors want to know how the surgery is going. By inserting an ultrasound sensor up a vein or a recess the doctors can get a live view of the surgery transmitted by video.