John Gresham, VP & GM, DeviceWorks and Interoperability, Cerner
What Is IoT?
The Internet of Things (IoT) is a network of internet-connected physical objects or things embedded with electronics, software and sensors that are connected, enabling it to collect and exchange information. As a leader in EHR interoperability, Cerner is extending our position to IoT in health care through our CareAware device connectivity platform.
Technology research and analysis firm Gartner says that by 2020 there will be more than26 billion connected devices. So, what does this mean for health care?
The ability to connect to all network-enabled things, including mobile devices and smart sensors, will drive health care experiences of the future. Healthcare providers expect contextually-aware, mobile-enabled workflows to help them better perform their responsibilities and provide new levels of experience driven through more intelligent systems. These capabilities will profoundly shape tomorrow’s smart health care continuum and blur the distinctions between care delivery in traditional hospital settings and in the home.
"The market is looking to IoT-connected devices to enable more real-time insights and health status for the person"
The traditional fee-for-service reimbursement model is evolving to a value-based function, where providers and health systems are incentivized to deliver more value per service and keep people healthier. For this reason, the market is looking to IoT-connected devices to enable more real-time insights and health status for the person. Through the use of IoT devices, we aim to deliver true virtual care for improved chronic condition management, virtual video visits and other care coordination activities to streamline and bend the cost curve for health and care.
These virtual use cases outside the traditional hospital or clinic settings are most often considered when people discuss IoT in health care. That said, more innovative health systems have been using IoT in the enterprise to improve patient safety, streamline workflow for the patient and clinicians as well as drive hospital operational performance and throughput. The industry continues to evolve and expand in the enterprise; I have included some more frequent examples.
Mobile Vitals Capture
One of the leading causes of death in the acute hospital setting is sepsis. It is widely known that a specific range and pattern of patient vitals information is a key indicator of septic shock. Prior to connected devices, a caregiver would take a patient’s vitals, write them down on a piece of paper, put it in their pocket and take it back to the work station to enter into the laptop. As you can imagine, there are so many opportunities for delay or error during a scenario where time and analysis is of life-or-death importance. Unfortunately, this manual process is present across many health environments. Providers can collect vitals in a medical device that is synced with the EHR, enabling near real-time flow of information into the patient’s digital chart. The best part is that with the information contained in the EHR, we can now run sophisticated algorithms and analytics across the data to determine whether these vitals, in combination with other patient information, triggers dangerous conditions, such as sepsis. This is one of many ways that connected technology is assisting the delivery of care and making health care safer at scale today.
Hospitals contain many large medical devices that are costly to maintain. With a connected ecosystem, we can gather real-time performance and optimization information from these devices, such as a radiology machine, and proactively analyze utilization or determine if the device is nearing a failure situation. This is compared to the traditional process of estimating how many times that device has been used. This near real-time information enables proactive management and troubleshooting.
Automating Medication And Supply Management
Today, Clinicians are now automatically programming infusion pumps directly from the providers EHR system. Barcoding technology supports the five rights of medication administration: verifying the right patient, medication, dose, route, time for administering medications. With IoT connectivity, we can now scan the infusion pump to push the order from the EHR system, thereby automating the programming of the medical device. This can eliminate a major patient safety risk of incorrectly matched settings and provider order. The system is smart enough to detect an error and inform the clinician while recording the reason real-time if the clinician proceeds. Additionally, the pharmacy now has near real-time information on the supply in the medication bag hanging with the infusion pump. When the bag is near needing a refill, the pharmacy is notified ahead of time, enabling providers to refill and replace the bag before it ends. This helps the pharmacy work more proactively and optimize their supply, saves time for care giver and enhanced the experience for the patient. This is just one example of the vast opportunity for IoT to optimize supply management.
The Intersection of Mobility and IoT
Health care providers are increasingly focused on keeping their patients healthy before they become chronically ill and require costly treatment plans or admissions.
Wearable consumer devices, such as activity trackers, have become very relevant in managing personal health and wellbeing for engaged consumers. Remote patient monitoring devices prescribed by a health coach or provider are becoming more common use in the health care setting for chronic conditions–chronic obstructive pulmonary disease (COPD), diabetes and congestive heart failure (CHF)–that require more active monitoring of a person to ensure they are at an optimal health level. Being able to see the data from virtual connected systems and devices–scales, glucometer devices, blood pressure cuffs that send patient information to the care team–help providers monitor conditions and intervene when needed, hopefully preventing costly visits, readmissions or poor health outcomes.
With the advancement of location awareness systems, I expect the next 5–10 years of health delivery to be incredibly transformational in regards to how patients and providers experience and deliver care. I foresee that our industry will revolve more around consumer-directed care through connectivity with more guided intelligence made possible by a connected environment of systems and sensors.
Free flowing information between systems will allow us to change way care is delivered and help us deliver a care experience that is centered around the person.