Health-care IoT remains challenged by IT concerns, practitioner buy-in

Government regulations, safety and technical integration are all serious issues facing the use of IoT in medicine, but professionals in the field say that medical IoT is moving forward despite the obstacles. A vendor, a doctor, and an IT pro all spoke to Network World about the work involved.

Vendor: It’s tough to gain acceptance

Josh Stein is the CEO and co-founder of Adheretech, a medical-IoT startup whose main product is a connected pill bottle. The idea is to help keep seriously ill patients current with their medications, by monitoring whether they’ve taken correct dosages or not.

The bottle – which patients get for free (Adheretech’s clients are hospitals and clinics, as well as pharmacies and drug companies) – uses a cellular modem to call home to the company’s servers and report on how much medication is left in the bottle, according to sensors that detect how many pills are touching the bottle’s sides and measuring its weight. There, the data is analyzed to determine whether patients are sticking to their doctor’s prescription.

The challenges to reach this point have been stiff, according to Stein. The company was founded in 2011 and spent the first four years of its existence simply designing and building its product.

“We had to go through many years of R&D to create a device that’s replicatible a million times over,” he said. “If you’re a healthcare company, you have to deal with HIPAA, the FDA, and then there’s lots of other things like medication bottles have their whole own set of regulatory certifications.”

Beyond the simple fact of regulatory compliance, Stein said that there’s resistance to this sort of new technology in the medical community.

“Healthcare is typically one of the last industries to adopt new technology,” he said.

Doctor: Colleagues wonder if medical IoT plusses are worth the trouble

Dr. Rebecca Mishuris is the associate chief medical information officer at Boston Medical Center, a private non-profit hospital located in the city’s South End. One of the institution’s chief missions is to act as a safety net for the population of the area – 57 percent of BMC’s patients come from under-served populations, and roughly a third don’t speak English as a primary language. That, in itself, can be a problem for IoT because many devices are designed to be used by native English speakers.

BMC’s adoption of IoT tech has taken place mostly at the individual-practice level – things like Bluetooth-enabled scales and diagnostic equipment for specific offices that want to use them – but there’s no hospital-wide IoT initiative happening, according to Mishuris.

That’s partially due to the fact that many practitioners aren’t convinced that connected healthcare devices are worth the trouble to purchase, install and manage, she said. HIPAA compliance and BMC’s own privacy regulations are a particular concern, given that many of the devices deal with patient-generated data.

Moreover, amid all the hype over IoT, it’s easy to forget that the use of the technology in medicine is still relatively novel. Physicians are, of necessity, scientifically minded people, and the fact that there isn’t a large body of rigorous research demonstrating the overall value of medical IoT hasn’t helped to convince them.

“It’s not clear to me what the best use of these devices is in the clinical world,” she said. “It’s not to say that there isn’t utility, it’s that we haven’t conclusively shown that there is utility.”

Mishuris did praise some uses of IoT, including a connected glucometer that has helped some diabetes patients control their symptoms, thanks to the increasingly granular glucose measurements being provided directly to the physician.

“I think that for the things we have in place, particularly the glucometer, the clinicians really value the data they’re getting from them,” she said.

IT pro: Diverse medical IoT devices can drive IT ‘nuts’

Cambridge Health Alliance is a chain of hospitals and clinics that serves more than 140,000 patients in the north suburbs of Boston. CHA’s senior director of IT applications, Arthur Ream, said that the group’s facilities include a huge range of different IoT equipment, from smart-building systems and connected HVAC to diagnostic and treatment devices.

“It’s just such a diverse field, so much coming into organizations,” he said. “It’s driving CISOs and their technology staff nuts.”

Biomedical devices, in particular, pose challenges to the IT staff. Diagnostic devices have to be certified by the FDA, and if they’re modified – say, via a necessary software patch – they may have to go through the certification process again, depending on whether the inherent functionality of the device is changed by the update.

Moreover, many of those devices aren’t computationally sophisticated enough to handle some kinds of security software, said Ream.

“Protecting [them] is tough – you can’t necessarily put an agent on these things,” he said.

Nevertheless, there are some shortcuts to herding the various cats that Ream has to deal with at CHA. Heavy use of network segmentation is one technique, ensuring that diagnostic devices stay on their own network, separate from the operational Wi-Fi, guest Wi-Fi, and smart building systems, all of which have different segments.

Anything that helps with automated discovery and monitoring of devices on a given network can help as well, given the rapid advancement of healthcare IoT.

“Finding out what’s on your network – nobody’s come up with a real good product that has sensors, starts to pick up on things … at the lower levels of the network stack,” he said.

Despite all the headaches, however, Ream said that healthcare organizations should view the IoT as a business opportunity – the ability to offer new and different services, and to make healthcare more convenient for patients, can be an important competitive differentiator.

Connecting patient portals to electronic health records and mobile apps could result in a system that automatically checks patients in for appointments when they arrive at an office, said Ream, and even offer automatic handling of things like patient room assignments and co-pays.

“Health care is just an enormous business machine, and people completely forget about the monetary side of things,” he added.