Making the right connections in modern healthcare

Connected healthcare has the potential to transform medical care, but to be successful it requires a holistic approach to people, cultures, processes and technology, as well as overcoming regulatory, patient privacy and data security issues, reports Kate O’Flaherty

Making the right connections in modern healthcare

It is slowly making headway, but a number of challenges are delaying the move to a truly connected healthcare system. Across the globe, regulation is holding back the sector, and the security of patient data remains a tenaciously thorny issue.

In the UK, the NHS has embraced healthcare technology to some extent, but there is still much more to be done. It is held back by cultural issues that go much further than just technology, with projects having to go through numerous trials before they can be implemented.

However, the ageing population, combined with a rise in lifestyle-related health conditions, is creating a more urgent need for medical care to extend outside of hospitals.

This is resulting in multiple offerings from healthcare firms, such as blood pressure cuffs, weight scales and heart-rate monitors that can detect problems before they become critical.
According to Gus Talavera, connected health lead at Accenture’s global internet of things (IoT) practice: ‘These early-warning signals enable timely intervention before there is an emergency, reducing costly hospital stays.’

Technology is helping doctors and healthcare providers to gain the information they need without having to see every patient in person. It is even seeing some GPs using video to discuss and assess symptoms, in combination with wearable monitoring technology that can manage everyday health.

Saverio Romeo, principal analyst at Beecham Research, says: ‘You can reduce the visits to the GP – and this is one of the most expensive parts of healthcare.’

New solutions
Previously, the connected healthcare market was dominated by solutions aimed at managing heart disease, diabetes and chronic obstructive pulmonary disease (COPD). This is now changing, with applications spanning a much wider range of chronic diseases, says Christoph Westerteicher, business director, Philips Hospital to Home International at Philips Healthcare Global.

One of Philips’ solutions, about to be trialled in Leeds, helps patients monitor their white blood cell count outside of the hospital. Minicare H 2000 Home Monitoring Service uses remote data exchange and a finger prick test to check white blood cell levels in patients receiving chemotherapy.

Philips is also active in medication dispensing. The firm’s automated dispenser can be loaded with up to 28 days of personalised pre-packaged medication, assisting older people and chronically ill patients who have difficulty adhering to complex treatment regimes.

Accenture has worked with Philips on a smart headset to help surgeons operate without having to look away from the patient. Another project centres around an Emotiv headset, which uses brainwaves to control devices such as lights, televisions and medical devices to help people with neurodegenerative diseases gain better control of their lives.

Vital signs
Another company, Oxehealth, has developed vital signs monitoring software that allows video cameras to be turned into health monitors. The Oxecam operates on the same principles as Star Trek’s ‘Tricorder’, delivering contactless vital signs monitoring from several metres away. It can be used in a variety of conditions, even in darkness or when subjects are lying under bedding.

The firm has completed a number of successful trials at neonatal, intensive care and kidney units at Oxford University Hospitals. ‘The first market we are launching in is secure rooms – monitoring mental health patients and prisoners, building on a clinical study at Broadmoor Psychiatric Hospital,’ Jonathan Chevallier, CEO at Oxehealth, explains.

A trial with a major UK police service is also currently under way, with the aim of preventing deaths in custodial suites.

A new device aimed at the wellness market where consumers manage their own day-to-day health, sits under the umbrella of Project Genesis, developed by VSP Global’s innovation lab The Shop and manufactured by another VSP company, Marchon.

The glasses feature health-tracking technology embedded in the temple of an optical frame. The sensors track steps, calories burned, distance travelled and overall activity time, synching via Bluetooth to a custom application.

The data challenge
At the heart of all the devices is data, which poses the single biggest challenge and opportunity for connected healthcare today.

‘There is an increasing level of public concern across many European markets about what happens with personal data once it has been shared. Where does the data go; who is looking at it; and how carefully is it being looked after?’ Westerteicher asks.

He adds: ‘Both patients and care providers want to know that their data is safe and secure at all times. Those developing connected healthcare solutions have a responsibility to make sure this is done. In Europe, it means complying with the strict legislation that governs privacy, and ensuring any data collected from patients is managed in accordance with both EU and national law.’

However, the level of contrasting regulation and validation in different jurisdictions across the world forms a barrier to connected healthcare’s adoption. Primrose Mbanefo, Accenture Connected Devices and Embedded Software practice, and the Accenture champion on the Cambridge Wireless Healthcare Special Interest Group, explains: ‘If, for example, a company wants to implement a wearable device for healthcare, without global standards, the same validation needs to be done several times – even if requirements are roughly the same.’

There is also the danger that medical devices can be hacked. It is therefore the responsibility of the public, industry and lawmakers to ensure proper privacy guidelines are in place for connected devices, says Mbanefo.

Change averse
Another challenge in the UK centres around the NHS, which can be averse to change. It is much easier to work with hospitals that are already early adopters of technology in other areas, says Alison Burdett, chief technology officer, at Sensium Healthcare – a company that offers a device for monitoring vital signs in hospitals. ‘In some hospitals there is an inherently conservative culture around technology, which can be difficult to overcome,’ she explains.

Additionally, connectivity can be an issue: as this must be appropriate to the application. Whereas Wi-Fi is not considered to always be secure or reliable enough for mission-critical healthcare applications, GSM can be expensive.

GSM works well for more complex content such as video, or devices that rely on interactivity. However, it will often require a connection to a gateway such as a mobile phone or modem, and must be set up manually in the field either by a healthcare worker, patient or patient’s family, Ian Stewart, director of channel and proposition at Arqiva points out. ‘Such devices have higher set-up costs and are more complex. Plus, they are tricky to maintain and support remotely.’

With this in mind, Arqiva is deploying Sigfox’s low power, wide area network (LPWAN) radio technology. Sigfox-enabled sensors do not need to connect to a gateway as they connect automatically and directly to the radio network themselves, Stewart says.

Although it is slow – and therefore unsuitable for high bandwidth applications – LPWAN technology could revolutionise drug dispensation and hospital operations, according to Mbanefo.

She explains: ‘One could foresee drugs being dispensed in LPWAN-enabled smart pill boxes or LPWAN-connected operating rooms, for example, which can directly report their frequency of use.’

Personal area networks
Another useful connectivity solution in healthcare is wireless personal area networks (WPAN), such as Bluetooth Low Energy (BLE) and Zigbee, says Mbanefo. This type of network can help to bring insight into data, she says, which can then be shared with healthcare professionals.

But reliability is also important. Neal Humphrey, account manager at Alcatel Lucent enterprise UK, emphasises the importance of prioritisation to keep networks up and running. ‘The clinician accessing vital data on their tablet is naturally of far greater importance than the patient attempting to stream videos on a similar device.

‘As the mobility trend continues to gather momentum, health trusts must have the future-proof infrastructure in place to meet consumer demand and effectively manage devices containing both personal and corporate data,’ says Humphrey.

Connected health is evolving – albeit slowly – but several issues must be resolved before the market really takes off.

The current challenge centres more on effective integration of the services into routine care, according to Philips’ Westerteicher. ‘Although successful, many of the local connected care pilots fail to scale, and their potential impact is not leveraged. Connected care is about focusing on all elements – people, processes, technology – and taking a holistic approach.’

Connected health of the future
It is predicted that implantable and digestible technology will soon become readily available, allowing advanced insight into personal wellness and health over the coming years.

Mbanefo cites the example of the ability for patients to swallow microscopic cameras and transmitters in small capsules, which transmit data regularly during their time inside the body. She predicts: ‘This sort of technology will lead to a step change in health and wellness related awareness for digestive issues, blood disorders and calorific intake.’

In acute and chronic care, Mbanefo suggests that insulin, blood sugar, calorie and nutrition trackers could be ingested as nanobots which continuously monitor the individual and are connected to pharmacies and health care professionals in the community. In the event of a chronic flare up, ingested trackers would be able to notify emergency services of the patient’s location and identity.

Wellness solutions will also become more sophisticated. In the future, a user’s car might not start because it has been notified of a weight loss goal and the food tracker has fed back information relating to high calorie intake. Or a user’s walking route could be changed because sensors are picking up a cold virus contagion in the area.

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