With the NHS struggling under the dual pressures of a growing demand for its services and chronic underfunding, could the Internet of Things help make healthcare more efficient?
By equipping objects with sensors to monitor their environment and an internet connection to communicate, the Internet of Things will give organisations greater ability to gather data and report back in real time.
For the NHS, the IoT could present big benefits for patient care by enabling hospitals to track and monitor patients from the moment they arrived at hospital -- or even in the home before that -- with real-time data from sensors being automatically added to patient records without the need for nurses to take readings or update charts. At a more prosaic level, the IoT could allow the NHS to track expensive or vital (or both) equipment more effectively.
There are signs of an increasing appetite for IoT devices within the healthcare industry globally: worldwide spending on IoT in healthcare is expected to grow from $41.22bn in 2017 to reach $405.65bn by 2026.
The NHS, however, appears to be taking a more cautious approach. As part of an initiative to set up testbeds to pilot new technologies in the health service, NHS England and the Department of Health has awarded £10m in funding to two 'test bed' projects that it describes as "IoT-led".
One, Technology Integrated Health Management (TIHM), is aimed at helping people with dementia remain at home longer. Smart devices installed around a person's home can be used to monitor their health and wellbeing to check if they're still doing well, and alert health professionals to step in when needed. The second, the Diabetes Digital Coach, is an e-learning system to help diabetics get a better handle on their condition, but has only a minimal IoT component, with links to internet-enabled glucose monitors.
NHS Scotland has also begun IoT pilot projects. Caithness General Hospital, part of the NHS Highlands trust, has started using IoT-enabled hospital beds. The beds have been equipped with Bluetooth sensors, enabling them to relay information about their location and maintenance record. It's hoped the six-month trial will save NHS staff time on tracking down individual beds and calling up their maintenance data.
Currently, IoT within the NHS has one of two main aims: either to track expensive and sought-after resources -- expensive pieces of equipment or clinicians themselves -- or to move patients towards greater levels of self-care.
With an ageing population that has increasing numbers of long-term medical conditions, and constrained finances within the health service, those are likely to remain the key guiding principles of any NHS IoT rollouts in the future.
Rollouts are, for now, on the simple side: gathering or processing data, or monitoring location.
The simple nature of IoT deployments to date is partially a question of cost -- building anything more complex would require a more sizeable budget than cash-strapped NHS trusts may be willing to pay.
"If you're going to automate more complex medical activities using IoT, it requires a lot of effort -- you can't just buy something of the shelf. You need the medics to provide the medical knowledge, you need software engineers, you need hardware engineers to configure anything a bit more complicated, and you need systems integrators," Dr Vaughan Michell, consulting programme director at the Henley Business School, told ZDNet.
"Because it's quite involved, you need to think about the benefits you're going to get... and safety issues and unintended consequences if you want to do anything more unusual than just measure general parameters; that can be quite costly," he said.
Questions over security and standards will also need to be resolved before the NHS is likely to adopt IoT on a wider scale. While security has long been a concern around IoT adoption in general, it's a particular challenge for any healthcare provider: recalls of insulin pumps and pacemakers due to security flaws have shown that vulnerabilities in healthcare IoT hardware could potentially have life-and-death implications.
A lack of standards also means there's a risk that IoT will end up being rolled out in a piecemeal fashion, with a lack of interoperability between one trust and another, or even one hospital and another in the same trust.
There are also thorny philosophical questions around the use of IoT that need to be worked out before there's a more widespread use of IoT: for example, issues around data ownership. Should the data belong to patients, to the NHS, to the technology providers involved? And, as with AI, there are questions over who would be legally (and morally) responsible if an IoT system caused harm to a patient -- would it be the NHS, the hardware supplier, the systems integrators, or another party?
Integrating connected medical devices into established healthcare scenarios is difficult, warned consultants Deloitte in a recent report Medtech and the Internet of Medical Things: How connected devices are transforming health care.
"Health care providers, and in particular their EHRs [electronic health record], provide the central repository for data from multiple devices. For collaborations to be effective, health care providers need to grant medtech companies access to this data, under agreed and approved circumstances, including, where relevant, patient consent on how this data can be used," it said.
Nevertheless, despite the challenges, it's easy to see where more IoT could be deployed to cut costs or increase patient safety: monitoring levels of basic equipment on wards and reordering new stock when needed; recording and refining the performance of pacemakers, artificial pancreases, and the like; tracking blood and urine samples more reliably; guaranteeing the accuracy of prescriptions; directing on-call doctors to the right patient on the right ward in a busy hospital.
One example: packs of five gauze swabs are counted in at the start of any surgery and out at its close -- if the numbers don't match up, it can have serious consequences. With sensors attached to each swab, it would be easy to see if a mismatch in the numbers was due to a miscount or a stray swab being left in a patient, with obvious benefits for both patient and the NHS' legal budget.
The trend for medical devices to increasingly come with internet connectivity is also likely to force the NHS towards greater use of IoT. Medical devices, from blood pressure monitors to pacemakers to pill bottles and inhalers, are gaining connectivity, allowing doctors to monitor and refine treatment in real time.
In addition, the data gathered from sensors in diverse hospitals and from patients could prove hugely valuable in shaping public health interventions and central government's approach to NHS policy, especially when combined with other advances such as artificial intelligence. Another factor: increasingly, devices like the Apple Watch and wearables will be capturing more data about our long-term health, which can give doctors more data than they may currently be able to cope with.
Still, the march of IoT with the health services is pretty much unstoppable. What IoT offers -- the ability to increase efficiency and reduce the amount of time spent -- is exactly what the NHS needs.
"We have no choice -- in order to reduce costs and provide the support we need, we have to automate some of that basic data collection, and monitoring etc to free up skilled staff to focus on patient safety and patient service," Michell said.
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