Connected Health and IoT in healthcare delivery: Are we ready?

Connected health and IoT can be powerful forces for change in healthcare delivery. Conflicting reimbursement models and low adoption rates for mHealth applications are among the issues we need to address.

connected devices
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The HIMSS 2016 juggernaut gets underway this week in Las Vegas. The event is a barometer, among other things, of trends and issues defining technology in healthcare delivery. This year, one of the exhibition themes is Connected Health.

So why the focus on connected health this year, and why is it important?

To understand this, we need to look at the convergence of multiple socio-economic forces as well as industry trends in healthcare.

Let’s start by looking at the definition of Connected Health. While the term means different things to different people, it is used commonly to describe the enablement of healthcare delivery through improved communication between stakeholders, mainly patients and providers, through connected devices. Importantly, the term is more than just mHealth or telehealth, two other terms that are commonly used in relation to connected health.

A couple of high-level trends driving Connected Health (or cHealth, as some have started calling it) are:

1. The shift from episodic, in-person encounters between patients and providers to an "anytime, anywhere" mode of care delivery. In particular, Millennials are defining this experience with their lifestyle and preferences.

2. The proliferation of whole new classes of devices (Internet of Things or IoT) that can connect to one another in the context of a connected health program.

Gartner has estimated that some 6.4 Billion connected things will be in use by the end of 2016, with some 5.5 million new things getting connected every day. We are aware of the boom in health and fitness wearables with healthcare consumers investing in tracking devices – sometimes with their employer’s encouragement. While other sectors such as manufacturing have been using wearables in a wide range of applications such as safety, productivity, and workplace collaboration, the IoT movement is nascent in healthcare.

However, fascinating IoT applications are being developed today, many of these through unlikely partnerships. Medical devices company Medtronic is developing an application that transmits wearables data to the IBM Watson cognitive computing and predictive analytics platform. Swiss pharma company Novartis is joining hands with Qualcomm to develop an internet-connected inhaler that can send information to a cloud-based big data analytics platform for healthcare providers to use in treating patients.

Despite the promises of connected health for improved outcomes, the growth rate for connected health programs has been slow.

Firstly, connected health and IoT do not exist in a vacuum. No one is interested in connecting things because they can be connected, even less for making clinical decisions based on data from these connected things. At the same time, the ability to take advantage of connected devices for improved healthcare is constrained by the market and regulatory forces.

-- There aren’t that many “clinical grade” mobile applications that can connect devices for clinical use. A recent study by the IMS Institute of Health Informatics ( IIHI) reports that while there are over 165,000 mobile health apps available on iOS and Android, only 2% of these apps can connect to a patient to a provider system. The bottleneck in mHealth applications has implications for patient engagement levels, quality and safety, according to a report by the Commonwealth Fund. However, the IIHI report states that one in ten apps can connect to a device or a sensor, which significantly improves the ease and accuracy of data collection in a clinical setting.

-- The regulatory and reimbursement environment for connected health programs have to improve to accelerate adoption rates. Consulting firm Deloitte has published the results of a survey of physicians and healthcare consumers that suggest that there is potential for increased cost-effectiveness of healthcare programs for high-cost populations from cHealth program. The report mentions remote monitoring and telehealth in value-based care (VBC) programs such as Accountable Care Organizations (ACO). However, disconnects between fee-based reimbursement at physician level and the push for increased VBC models at the enterprise level create conflicting incentives between stakeholder groups.

-- The benefits of connected health programs will come about when the data can be analyzed to develop holistic views of patients and patient populations that can drive outcomes. This is probably the least mature aspect of connected health programs today – partly as a result of the varied data sources and formats, and partly due to interoperability challenges. The latter has been the focus of prior HIMSS conferences and continued to be one for this year as well.

-- Information security and privacy concerns play into this equation as healthcare providers start using medical information from these interconnected devices, especially in cloud-based environments. Enterprise IT, concerned about vulnerability to hackers, are leery of exchanging data with IoT devices. While there are indisputable benefits to healthcare consumers from their physicians gaining access to medical information from a range of connect devices, there is a real threat to privacy as well. As employers start using wearables data to gather information an enterprise level for managing healthcare benefits, collecting personal data from devices imposes a set of legal requirements on enterprises, starting with proper disclosures about the collection and use of the information.

Eventually, all these challenges will be overcome, simply because the potential benefits of using IoT data for connected health far exceed the downsides and risks. However, in the near term, technology is evolving at an explosive pace, and the regulatory and legal infrastructure are unprepared for the sudden increase in complexity that all this causes. We are going to see fascinating times ahead as healthcare gets swept up in the great technology advances we see today.

I hope to learn a lot more about this at HIMSS 16. I hope to see you there.

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