Connected to the future

There are various different definitions of the internet of things (IoT) bouncing around high-tech labs and corporate boardrooms, but it can be largely summed up as, ‘a network of internetconnected objects able to collect and exchange data using embedded sensors’, according to Business Insider UK.

As everyone from city planners and white goods manufacturers to electronics retailers and carmakers has found out, IoT offers a range of opportunities that were previously unthinkable. It means that inert objects can be ‘brought to life’ to receive and send information.

In theory, machines should tell their operators they are about to break down. Traffic management systems, for instance, could route driverless vehicles onto quieter roads at busy times, while inefficient buildings manage themselves, according to mandated instructions. For those who are more forgetful, IoT could turn off their heating once they’ve left the house.

And this isn’t for the world of tomorrow: the growth of IoT has only just begun. According to Gartner, the projected number of ‘connected things’ in the global consumer segment is set to reach seven billion in 2018, rising to 12.9 billion by 2020.

IoT is already making waves in the healthcare space, where smart sensors are being used in a range of devices, such as inhalers and ingestible-smart pills that help to monitor adherence. Sensors can even be embedded in human skin to check blood glucose levels in people with diabetes, thus reducing the need for needle interventions.

Although sensor-driven devices aren’t anything new, the network infrastructure that allows healthcare providers to collate data, communicate, analyse and plan out treatment are now developing at an astonishing rate, with some of the world’s biggest hardware and software companies taking an increasingly proactive approach to building market share.

Tackling poor adherence

At Vodafone – which is one of the leaders in this space – Jon Lee-Davey, head of healthcare, IoT market development, works with medical device manufacturers to improve adherence rates among patients.

“Some of the stats from WHO [show] the adherence rates for certain chronic diseases are around 50%, so that’s a significant number,” he says. “If people aren’t taking their treatment or treatment isn’t being carried out as [it] should, the outcomes won’t be right, and that could lead to progression of the disease and further complications. So managing that is pretty significant, in terms of being able to control direct and indirect expenditure.”

The Annals of Internal Medicine calculated that a lack of medical adherence leads to 125,000 deaths a year, accounting for at least 10% of hospitalisations in the US. However, no silver bullet exists to tackle the problem. Poor adherence adds to the costs of care, with the same review finding that adherence issues cost $100–290 billion a year in the US.

A recent Vodafone white paper identified 700 reasons for poor adherence, including failure to collect prescriptions and patients stopping medication because they feel better. It also revealed that 16% of people polled had used an IoT-related healthcare device during the previous six months. This may seem like a low figure, but when compared with the market for wearables like Fitbit (18%), home security devices (13%) and smart-utility meters (11%), the appetite and adoption of connected healthcare devices is gaining traction.

“For us, it’s not just applied to healthcare,” Lee-Davey emphasises. “If you look across the whole piece, there’s a standard set of building blocks: devices that are connected via a network, transmitting data that’s then collated and hosted by a number of secure locations. And then there is a range of apps that can use and derive value from that data and present it in a way that’s valuable to users.”

Vodafone is one of several large telecoms companies aiming to work with medical device manufacturers (MDMs) to connect such devices, in order to gather data. This way, MDMs can develop bespoke apps that affect patient treatments or help medical professionals make decisions by analysing data that’s sent by the app, which they previously had to wait for.

Lee-Davey identifies a range of potential applications, including connected drug delivery devices like inhalers or injection systems, which will prove useful for “being able to make an informed decision, based on the data you can gather through connected devices over the timing of the dose”. He adds, “And you can check if the therapy is working [because the technology] helps [to] monitor and measure the treatment that’s being delivered to make better decisions.”

Connected devices give MDMs the chance to generate personalised data about how a treatment is working for patients. “The health professional can look at the data from the device and tweak it, and that makes the patient more engaged in the treatment since it’s responsive and they can see the benefit first-hand,” Lee-Davey states.

Reducing healthcare costs

There are numerous reasons behind the increased demand for connected devices, with cost topping the list. Current levels of healthcare spending are unsustainable, especially with the global ageing population and demographic changes in developing countries, where more people are becoming middle class.

“Accelerated urbanisation and access to middle-class comforts” promotes a sedentary lifestyle that leads to a “greater incidence of obesity, diabetes and other costly health conditions”, according to PwC. This, in turn, increases the pressure on policymakers, healthcare companies and insurers to find ways of reducing expenditure.

Connected devices can have a huge impact on this, says Lucas Josten, vice-president digital health at T-Systems. “Every modern healthcare system faces this particular problem, [where] the majority of people who arrive at an emergency department don’t really need to be there,”

He explains, “Healthcare professionals (HPCs) could double the time they spend with patients, and that’s why connected devices on narrowband is so exciting, as it’s a low-cost, low-power alternative [that] has advantages for the healthcare sector. There’s lots of potential.”

Josten also draws attention to asset tracking, which could add value to the hospital environment. “Medical staff waste a lot of time on inefficient processes, hunting for lost devices and so on. We’re focused on improving that workflow performance and helping the level of care,” he says.

The way forward

So, what’s next? Will connected devices evolve to power themselves or will most of the energy they use come from the infrastructure surrounding them?

“We see it evolving into the next generation of networks,” predicts Lee- Davey. “There’s a lot of talk about the introduction of low-powered widearea networks (WANs), [which use] lower-cost electronics, [with more] propagation of the signal that gives better reception and longer battery life. So, those allow us to consider a wider selection of devices that can be connected, and we can say it’s a much more universal and ubiquitous form of technology for MDMs.” This also hints at the next big thing in digital therapeutics, in which software apps will essentially become medical devices. “So, if I can manufacture physical electronic hardware then I can also make digital software alongside that, as I have the knowledge and know-how to assess a disease and help healthcare providers treat the patient,” Lee-Davey explains.

Josten agrees that using a model where manufacturers focus on a subscription service approach, which generates revenue across the lifetime of a device, is a game-changing move. “We are running design workshops [for] medtech companies to help them think about where they might create value and come up with new business areas. So, with hardware as a service, we’ve seen it in other industries and we do believe that it’s transferable to medtech too,” he points out.

Creating a viable value chain is one of the biggest challenges facing MDMs and their network partners. Lee-Davey believes that whoever solves the reimbursement dilemma will have made a huge stride forward.

“There are physical payment mechanisms for [a] physical product, but if you look at the service-based models, they’re great [because] they create value, but how is that reimbursed to the MDM? How is the HCP reimbursed for the time spent on reviewing data? What about the billable activity from the way legacy systems are set up? Some of those issues are being overcome, certainly, but that will take time,” he states.

As MDMs transition to a more value-based care model, and move away from shifting boxes to providing services that support the value of their product, telecoms and software providers are jostling to help guide them.

“MDMs have expertise in the treatment of a particular condition,” Lee-Davey highlights. “Whether it’s diabetes or a certain cancer therapy, they see this as an extension of their own capability up the value chain, but the product is only one aspect of that. There’s a huge amount of value in what they can do with the data that is generated.”

Naturally, given all this market potential, the number of tech firms eyeing up medical IoT shows no sign of dropping off any time soon.

Tackling the data challenge

T-Systems’ parent company, Deutsche Telekom, has a Cyber Defense Center in Bonn, Germany, that covers the whole of Europe. According to Josten, the centre was attacked 12 million times in one day recently.

“That means we have to protect our own system as well as our clients’ [data], and the servers have to be protected. So you need expertise in that area and, as more devices become connected and the need to transfer sensitive data around hospitals and the system at large, it means there is no future in this business without security. And that’s the core aspect of what we’re doing,” he says.

A recent survey conducted by the Economist Intelligence Unit (EIU) shows that growing customer concerns over privacy are being driven by the development of IoT. In regard to devices, 80% of consumers found security features very important, while 75% valued privacy over affordability (47%) and ease of use (48%).

Concerns over data security are keenly felt in the healthcare sector. According to the EIU report, 55% of those polled felt that security measures should be stronger.

“Cybersecurity is really important when it comes to patient data,” Josten states. He also points out that the General Data Protection Regulation (GDPR), which will come into force May 2018, should bring some clarity to this fragmented field.

Tellingly, Germany is the first EU member state to establish a new data protection act that falls in line with the GDPR, in the hopes that it will propel it to the forefront of Europe’s medical IoT market. “The telematics infrastructure that’s being rolled out in Germany is generally considered to be the most secure and advanced in the world,” Josten adds.