As NDRC and e-Health Ireland prepare for a Future Health pre-accelerator this summer, venture investment leader Fergus O’Dea outlines the structural issues blocking internet of things innovation in healthcare.
We stand at the brink of an internet of things revolution, with the expectation of up to 30bn devices connected to the internet by 2020.
Yet healthcare systems, which are perhaps in greatest need of reform, stand apart as seemingly impervious to this revolution. There are huge opportunities for IoT technologies to change the way we provide care, however, there are a number of structural issues that have historically led to reluctance to adopt new technologies in the healthcare space which must be overcome in order to address this growing opportunity.
1. Context dependency
At the forefront of IoT are industrial sensing applications in energy and telecoms, where operations of diverse assets can be optimised by simple smart sensors that provide dumb data which, when aggregated, yield insight, but do not need any contextual information for sense-making.
Patient data, on the other hand, is highly context dependent. Vital signs and behavioural patterns are highly dependent on the specific circumstances at the moment of data capture and, therefore, require either sensors that are capable of capturing multi-dimensional data or require input from the user to make sense of univariate data.
One significant form of context is the individual patient’s health circumstances. For example, 62pc of Americans over 65 have multiple chronic conditions, the interaction of which must be holistically assessed for that individual.
2. Institution infrastructure
To date, the major successes of connected medical devices have been incremental improvements in how data is transferred from devices rather than truly reshaping how care is delivered – see connected continuous positive airway pressure ventilators (CPAPs) or cardiac monitoring devices.
One of the reasons is that the necessary support infrastructure was already in place in these instances. Healthcare systems are significantly underdeveloped when it comes to outpatient care, which generally involves a day visit to the hospital, a GP visit or a home visit from an underpaid and overworked nurse.
‘Deploying connected data to transmit data from outpatients is analogous to putting wings on a submarine’
Deploying connected data to transmit data from outpatients is analogous to putting wings on a submarine – the hardware may work but without the institutional incentives, know-how, training, legal frameworks etc, there is no hope of it working at a system level.
These problems are exacerbated by a regulatory landscape which is struggling to keep up with technological advances, and the constant threat of litigation faced by many healthcare practitioners, which means that more data may simply mean more opportunities for lawsuits.
3. Payment pathways
Ingrained payment pathways pay for existing methods, but are slow to react to new approaches. Thankfully, more outcome-focused payment methodologies have started to gain traction in the US – check out some approaches at the US Centers for Medicare and Medicaid Services – and one can expect to see more new technologies that can allow payers to manage large populations more cost-effectively in the future.
Widespread adoption of the electronic health record will be a key enabling technology in this regard.
‘Data is only valuable if it is actionable, and the above factors make it difficult for healthcare professionals to gather, interpret and respond to the data’
4. Closing the loop
As in all IoT applications, the data is only valuable if it is actionable, and the above factors make it difficult for healthcare professionals to gather, interpret and respond to the data. But at the heart of many chronic diseases is patient lifestyle and behaviour, which are not easily changed. It is relatively straightforward to programme a piece of hardware to respond to local environmental data, it’s altogether a different challenge to re-programme patient behaviours.
Despite these obstacles, with the right patient-centred approach, IoT offers a future where patient empowerment, coupled with targeted support and early intervention where required, allows us to deliver better quality of care more cost-effectively, and allows patients to remain healthy and at home for as long as possible.
By Fergus O’Dea
Fergus O’Dea is a venture investment leader at NDRC who, prior to this role, held various positions in industry including commercial manager at ResMed and senior scientist at Pfizer Biotech. O’Dea holds a master’s in biopharmaceutical engineering and an MBA from UCD.
NDRC and e-Health Ireland will host a Future Health pre-accelerator in summer 2016 and are eager to help entrepreneurs tackle the challenges outlined above. If you would like to get involved in the pre-accelerator, register your interest at ndrc.ie/futurehealth.