Citizens’ dissatisfaction with the scope of the United States health care system has been a hot topic for many years. In a country where patient to nurse ratios remain 6:1, even universal health care coverage cannot guarantee adequate patient care. These issues were further highlighted by the COVID-19 pandemic, where inadequate hospital funding and lack of attention to patients led to challenging situations in hotspot areas. Although this pandemic will shape us for many years to come with far reaching impacts, social distancing norms have accelerated technologies that enable services to be delivered remotely, a capability even more necessary in our health care system. By providing care that can be delivered remotely, we can focus in-person care in our hospitals to only the ones who really need it. This allows us to scale our systems, protect lives, and safeguard economic activity. Since October 2019, I have been studying and surveying physician’s attitudes toward the usage of the Internet of medical things (IoMT) in the health care space. The goal of this work was to study areas where we can leverage technology to dramatically improve the patient care value chain without raising costs. Can technology, specifically IoMT, help us reduce hospital visits, enable remote patient monitoring, transfer medical supplies within minutes, and avoid irreversible damage due to lack of prompt care?
While IoMT and technology in health care is a vast area, this study focused on nine specific use cases and interviewed ten doctors across the United States and India. One of the goals of this work is to identify use cases that would likely be ready for implementation now versus those that carry more risks, or more time to develop. Use of drones for delivery, video monitoring of patients, connected in-patient monitoring, smart hospital waste management, and psychological state monitoring are use-cases that received the most positive responses.
Remote diagnostics and video monitoring
Remote diagnostics and video monitoring can be used to detect patient falls, harms, as well as monitor illness. It can reduce costs by enabling doctors to care for patients without the need for specialized/planned visits and also enhance efficiency. Remote video monitoring can be useful in a multitude of scenarios where patients are not physically present in the hospital, such as monitoring after discharge, identification of patients at risk for readmissions, and daily reminders to patients on medication. Using this technology, patient data can be monitored, recorded, and key parameters can be transmitted back to health care teams. Prompt transfer of data can allow for earlier patient diagnoses, leading to easier treatment and lower cost of care. Additionally, remote diagnostics technology can increase hospital availability while keeping patient health care costs low, as quicker treatment costs less for both hospitals and patients.
Doctors highlighted concerns from both a patient and physician perspective, which must and can be addressed with technology. Patients are primarily concerned with privacy and information security over the network and access by unauthorized people. Additionally, many doctors are hesitant to use telemedicine as a technique for diagnosis, due to concerns that it could not only be inaccurate but also unsafe. In the interview, doctors recommended the use of remote video technology monitoring for patients who do not require immediate medical care, improving the quality of treatment. Recent experience with the COVID-19 pandemic suggests the importance of not overloading the medical system with normal cases that can be handled without a doctor or hospital visit. It is clear that technology solutions, especially in security and privacy, along with collaboration techniques will greatly accelerate remote video monitoring.
Drones for medical supplies transportation
Could drones be used for transporting supplies such as medicines and other test specimens to obviate the need for hospital visits? This might include transporting blood and monitoring supplies, which would allow for faster care and faster treatment. For example, in smaller villages that are hard for ambulances to get to, a drone would be able to report the situation and transport helpful supplies such as monitors and bandages. Additionally, drones can be effective in efficiently transporting self-test kits to people in quarantine. In regards to the handling of this technology, only authorized individuals such as doctors and nurses would have access to the medical supply box being transported. This way, we can prevent unnecessary items from being sent and ensure maximum quality of patient care. Using drones also reduces costs for care, as prompt treatment leads to easier and less expensive treatment, while improving quality.
Based on the interviews, some considerations that must be addressed when handling the use of drones are temperature control and user compliance. This is especially important when handling the use of blood, since if drones overheat, then enzymes in the blood may deform, causing immense danger to the health of the patient. Doctors also pointed out how it would be difficult to monitor whether or not the materials would be handled properly upon arrival at the remote destination, and follow-up on the patients would be near impossible without a remote video monimonitoring set-up. Technology solutions that measure quality of supplies and correctness of procedures as they are applied would be needed to ensure everything is done properly at the remote site.
In-patient continuous monitoring
Due to the low nurse to patient ratio in some hospitals, vital signs are monitored every 4–6 hours, instead of continuous monitoring. This can lead to health complications and unexpected death. In-patient continuous monitoring of patients whose conditions require vital signs to be monitored more regularly can alert doctors of patient health deterioration, leading to quicker recovery and lower cost of treatment. For example, patients post-op require continuous monitoring; however, a small nurse to patient ratio in ICUs may lead to complications and/or death, as patients’ vitals may change tremendously over a short amount of time. Continuous monitoring would transmit data about patients to nurses continuously, allowing for earlier detection, recognition, and treatment of any abnormalities in a patient’s condition.
Doctors decided that more comfortable devices should be given to patients in the hospital so that patients continue to remain connected. The other area pointed out as a concern is around preventing false positives.
Psychological patient monitoring
Psychological parameter monitoring can be used to monitor those with psychological conditions (depression, paranoia) who aren’t admitted into the hospital in order to prevent sudden harm. This technology would track mood changes and immediately alert doctors of any issues. Implemented 24/7, continuous psychological parameter monitoring could prevent patient falls, accidents, and even death by alerting emergency services immediately of any suspicious behavior.
Besides the concerns regarding patient privacy and information security, doctors also agreed that online forums and social networking for psychologically impaired patients would be effective, as frequent social interactions are beneficial to the patient’s health.
Waste management monitoring
Current waste management processes in many hospitals entail unnecessary waste collection, as waste varies by time. Waste management monitoring in hospitals could alert hospitals when waste bins have been filled to a certain amount, which saves both time and money, as unnecessary collections are avoided. Currently, waste is taken out based on time; for example, some hospitals may take out the waste only once a week. This can lead to overfilling of the waste bins or even cost the hospital extra money if the waste bin is not full. Waste management monitoring should use sensors to alert the hospitals if waste levels are greater than 75%, allowing the hospital to be more efficient.
Interviewed doctors mentioned that these technologies are already being utilized at numerous hospitals and that the emphasis should be on utilizing reusable items, which would reduce not only waste but also costs.
IoMT use-cases progressing but hurdles remain
Favorable opinions received in interviews on the use-cases relating to drones, remote diagnostics, in-patient monitoring, and waste management are further strengthened by their increasing usage in our community. However, many doctors were less inclined to adopt the following technologies due to inefficiency and high risk. We must understand the reasons behind these unfavorable responses and present potential solutions for those issues.
In-ambulance patient monitoring
In-ambulance patient monitoring would be useful in situations where a patient’s condition requires immediate care while they are inside an ambulance. In these types of situations, an experienced doctor from the hospital would use biotelemetry technology, i.e., monitoring systems, to guide paramedics into properly caring for the patient. For example, when patients suffer from a heart attack, the first hour is the vital period of time in which the patient can be saved. In this scenario, in-ambulance patient monitoring from the hospital might be useful in guiding paramedics to provide successful care for patients. Video and remote patient monitoring technologies would enable the doctors to receive real time access to the patient’s vital signs.
Besides the concerns regarding patient privacy and information security, the interview highlighted physicians’ concerns about taking the patient to the right hospital. Doctors concluded that only some hospitals have the right facilities to treat certain complications, meaning that it may be more difficult to do so in an ambulance. For this reason, it is more important that patients get to the right hospital on time than for doctors to be guiding previously trained paramedics in an ambulance.
CO2 monitoring for SIDS
Carbon dioxide (CO2) level monitoring is useful in determining child health and preventing sudden infant death syndrome (SIDS), from which over 3500 babies die yearly. Often unaware of the child’s condition, parents are unlikely to know if their children are receiving enough oxygen. Monitoring CO2 levels could be a more effective way of alerting parents when children are not breathing. Numerous devices have been tested and implemented to try to prevent infant death from SIDS. However, current CO2 monitoring devices aren’t effective enough as they often malfunction. No evidence exists on the question of whether the current devices are life-saving. New approaches to CO2 monitoring may involve using wristbands and patches to determine whether the baby is breathing normally and measure heart rate, or devices that could be placed next to the baby to determine CO2 levels outside the baby. These would immediately alert parents of whether or not the baby is at risk for SIDS, thus allowing for life-saving intervention, preventing loss, and improving the quality of life.
However, doctors concluded that bulky sensors may increase the risk of suffocation of infants, as monitoring systems must be placed very close to the baby. Improving the quality of sensors still would not completely solve for SIDS but may be a useful step in alerting parents.
Prescription auto renewal with remote patient and dosage monitoring
Prescription renewal must be completed by a pharmacy manually with the doctor’s permission. Currently, patients face numerous unnecessary risks such as not receiving medications on time or even simply being unable to schedule an appointment, which may result in further complications. Auto-renewal would entail remote parameter monitoring of patients to send data back to doctors along with auto-renewal requests, where a doctor can prescribe appropriate medicine dosage based on the patient’s conditions. This would eliminate costs and losses that are currently incurred when caring for patients who are delinquent on taking medications.
Many interviewed doctors reported that patient overdose may become more common as access to prescription drugs becomes more widespread. Others also reported that clinical examination is a key part of determining which medicines a patient needs, rendering remote diagnostics inaccurate and possibly even unsafe.
Intraocular pressure monitoring for glaucoma
An increase in intraocular pressure can cause permanent damage of eyes (glaucoma), a condition that is irreversible. Remote monitoring of eye pressure using sensors as an add-on on glasses can prevent damage to the eyes by alerting doctors/patients when pressure has reached the limit advising them to seek immediate medical attention. This sort of technology could be useful in decreasing the risk of glaucoma, which requires treatment that is not only very difficult, but also very expensive for the patient. Pressure monitoring sensors can be used as aids for increasing quality of life while reducing health care costs of patients.
One consideration to take into account is inaccurate measurement. If the sensors detect an inaccurate amount of intraocular pressure, the patient may take unnecessary steps. Many physicians said that measuring intraocular pressure is not enough, as there are multiple other causes of glaucoma thatcannot be measured by the patient alone.
Supported by both the interviews and external research, we can conclude that IoMT can play a significant role in health care cost reduction while improving patient’s quality of life and scaling the health care system by reducing need for hospitalization. Doctors agreed that although some variables such as temperature and quality of supplies must be monitored, drones can be useful in transporting medical supplies to inaccessible areas. Additionally, patient information security risk must be addressed when using the various technologies. Contrary to popular thought, SIDS monitoring may prove dangerous for babies as it increases the risk of suffocation. Lastly, waste management monitoring may save both time and money for hospitals, as unnecessary collections are avoided. However, the creation of reusable materials may aid hospital efficiency even more. Furthermore, one cannot underestimate the importance of social interactions to address mental health issues and technology is not a complete cure for all issues.
Accelerated by the COVID-19 pandemic, the era of IoMT is already upon us. With sustained investment and innovation, IoMT has the potential to greatly expand the scope and scale of health care in the coming years.