What are the challenges of providing smart, connected healthcare and how can an IoT strategy overcome them?
Robin Duke-Woolley, the CEO of Beecham Research and Therese Cory, a senior analyst at the firm explore how to provide a continuum of connected care throughout the healthcare supply chain over the lifetime of a patient’s treatment.
3 challenges to overcome in connected healthcare
1. Datasets from devices must be integrable and interoperable to enable full analytics
Devices that connect healthcare equipment to computer systems for analysis are very specific as to what data they collect. The data sets emanating from separate devices are not necessarily inherently compatible or interoperable. The greatest challenge is to establish consistency of data between multiple data collection systems, to allow the data to be analysed in its entirety. Healthcare systems are also extremely complex in terms establishing secure communication between various data sources. For example, some solutions use multiple communication protocols. If a patient is being treated in multiplicity of ways, a single unified record should be accessible from anywhere by any person involved in the patient’s treatment.
2. Connectivity technology must be consistent and dependable
Hospitals and clinics routinely use Wi-Fi and Bluetooth for communication, technologies which have their advantages and disadvantages. However, many are struggling with Wi-Fi connectivity because it is not very stable when faced with high volumes of connected devices. Many older hospitals require investment to support better connectivity technologies in future. After collection, data is sent to the cloud and stored in the patient electronic medical record (EMR) where it can be analysed and monitored by medical teams through an IoT provider. Healthcare facilities need flexible, fast and reliable connectivity. In remote areas cellular connectivity has a clear advantage, and centralised cellular provides a
wider area of coverage. Cellular technologies, particularly LTE are anticipated to support better and more reliable connectivity. Intensive care units equipped with infusion pumps and vital signs monitoring equipment often utilise a hybrid connectivity solution, such as Wi-Fi and cellular.
3. Data must be securely held and privacy assured
In healthcare, data privacy, data security and data governance need to be established from the start. Notable pain points are around spectrum congestion and preventing cyber-attacks. As the use of wearable monitoring devices increases, particularly outside the hospital, these devices will be at increased risk from cyberattacks; there have been worrying reports of attacks on hospital websites.
A 3-step strategy to transform healthcare with IoT
TELUS Health is Canada’s largest healthcare IT provider. The company has invested more than C$3.2 billion in healthcare over the last decade. TELUS Health’s mission is to transform healthcare through connected health to help improve health experiences for all Canadians. Its social purpose focuses on improving access to quality healthcare and delivering better health outcomes through technology for all, including the most vulnerable citizens.
IoT is a growing business within TELUS. With its own IoT dedicated network to sustain the growth, TELUS is well poised to accelerate 5G adoption. TELUS IoT takes a vertical approach to market to solve customer challenges, so aligning with TELUS Health is a natural fit. The intersection of TELUS Health and TELUS IoT will drive meaningful change and accelerate digital transformation in a fragmented healthcare environment.
TELUS offers a range of smart healthcare options for clinical, pharmacy and consumer solutions. These comprise services to enable IoT to digitise and connect all parts of the healthcare ecosystem.
The company envisages three points of entry into the market:
Step 1: Build reach.
TELUS has strongly penetrated primary care
28,000 clinicians now use its EMR platform. 6,500 pharmacies also use its practice management and distribution solution. Electronic prescriptions connect physicians and dispensers.
Step 2: Calibrate patient experience
TELUS is looking to further penetrate the consumer market for virtual care. At present, 1.5 million Canadians use virtual care and the company expects this to accelerate in the future.
Step 3: Utilise data
Data is key to optimising healthcare outcomes. This means greater use of AI and business intelligence. At present there is wide disparity across the country regarding healthcare – five million Canadians do not have a doctor.
Who needs smart healthcare?
In parallel with the above, the company is targeting the following user categories:
• Government, primary healthcare providers including physicians, pharmacists and allied healthcare professionals; and hospitals and long-term care facilities: Providing support for these stakeholders.
• Employers: Through a global pandemic and an increase in mental health issues, there has never been more demand for employers to provide healthcare services to employees.
• Consumers and patients direct: Empowering Canadians to manage their healthcare, and providing value through innovative apps and connection services
3 key areas where connected healthcare is making an impact
1. Connecting hospitals and pharmacies
For hospitals, smart healthcare is using the power of IoT to digitally transform with people-centric healthcare solutions for better treatment outcomes. There is a high density of assets within the hospital environment that can usefully be connected – beds, wheelchairs and other assets.
TELUS sees the possibility to start connecting all these assets via application programme interfaces (APIs), introducing connectivity where there was none before. This then enables a richer, fuller set of information to flow to the right people at the right time, providing recommendations for treatments.
For these solutions, the company partners with ThoughtWire for a true IoT healthcare solution. ThoughtWire’s technology incorporates a digital twin approach for smart healthcare, through connecting data points, providing situational awareness to physicians and bringing realtime insight to healthcare workers. This approach can also monitor thestate of the patient and determine if they are deteriorating before they go into cardiac arrest, or monitor for prescriptions – whether these have been delivered, and whether treatment plans are being adhered to. It puts information directly in the hands of caregivers and management to create better patient outcomes, increase clinical collaboration and optimise workflows throughout the hospital.
Figure 1 shows how previously unconnected systems can improve situational awareness and reduce the cognitive load for clinicians and staff. Real time contextual data about the patient is sent to the IT system, which generates automated alerts if a risk threshold is passed.
The information can be used to recommend actions to the right people at the right time for critical path workflows, including patient code blue, transport and drug prescriptions. As a result, clinicians can respond rapidly to patient needs based on all available information, down to the latest patient vital signs.
PharmaConnect is a tool for connecting pharmacies with patients. Automated prescription reminders for refills or renewals help patients remain on their prescribed therapy, view their prescription profiles and order refills online. The tool sends automated messages from a library of templates to patients via email, text messages and other notifications to help them comply with their medications. The software also supports billing and claims reimbursement.
According to the company, one third of all prescriptions issued in Canada are not filled, and half of these patients do not adhere to their medication. Wearable intelligent devices should improve the data flow between patient and clinician and ensure adherence, leading to better patient outcomes.
2. Health for Good Mobile Clinics
TELUS Health sponsors a specially equipped outreach service, Health for Good Mobile Clinics in a number of Canadian cities. The country has different levels of maturity in respect of healthcare. The mobile clinics aim to bring healthcare to marginalised or homeless populations, as well as offer harm reduction services for people experiencing substance abuse.
These compact vehicles are equipped with TELUS Health solutions that enable the creation of an electronic medical record for each patient. The clinics build a comprehensive health history for the future care of the patients, while enabling improved access to shared information between healthcare professionals. As of 2019, there were nine such mobile clinics, and since its launch in 2014, the programme has generated 22,000 patient visits.
3. Healthcare services for consumers and patients at home
TELUS Health provides services for consumers and patients at home through their smartphones.
Babylon is a chat-style symptom checker powered by artificial intelligence, which provides patients with one-on-one virtual consultations with a licensed physician. Launched in 2019, Babylon has become Canada’s fastest-growing consumer virtual care service, with tens of thousands of users. This service is complemented by the company’s acquisition of Akira, a virtual care platform targeting insurers and employers which covers more than 500,000 lives.
TELUS also claims to be the largest Canadian-owned provider of personal emergency response services, supporting independent living for older citizens.
Espri is an app designed to support the mental health of front-line workers, particularly relevant in the pandemic crisis.
Home Health Monitoring enables patients with a variety of chronic diseases or conditions to monitor health factors from their homes through their computers and smartphones and share this information electronically with health professionals. By tracking the patients’ results regularly, the healthcare team can adjust treatments as required.
The future vision for smart healthcare
TELUS sees a number of improvements that can be made to overcome current challenges to a fully connected healthcare system and is working towards introducing these:
• System fragmentation
The Canadian healthcare ecosystem continues to operate in silos. Fully connected smart healthcare needs a fully digitised patient experience; however, in all healthcare, there can be resistance to major and sudden change.
Improvements are taking place across the country to ensure that there is an appropriate flow of information across the care continuum. New exchanges are being established, such as the TELUS Health Exchange, to support the secure exchange of information between healthcare applications. TELUS is working with a number of provinces to connect their systems for greater health system benefit. The pandemic has also highlighted the non-alignment of systems and the disadvantages it brings. Overcoming these will make for better collaboration between stakeholders and a more coordinated response for patient safety. With the pandemic, some issues that have not been addressed for a long time have suddenly been dealt with. For example, fee codes for physicians to bill for telemedicine and virtual consultations were implemented within two weeks. It was in response to this change that TELUS Health quickly developed a virtual
care solution that was seamlessly integrated into its electronic medical record solutions to enable 28,000 clinicians to conduct secure video consultations with their own roster of patients. TELUS also helped ease some of the burden on British Columbia hospitals by expanding use of their Home Health Monitoring solution to remotely track and support COVID-19 patients recovering at home.
• Future wireless networks
Today TELUS’ 4G LTE network covers 99% of Canadians. 4G can support 1,000 times the number of connected devices compared with Wi-Fi. Wi-Fi is a much-used form of connectivity in hospitals worldwide, but TELUS anticipates that it will have its limitations in terms of supporting the large numbers of connected devices in the future. The company sees private cellular networks as a way to address these limitations, particularly for continuous monitoring of patients.
Having started the build of a 5G network, the company anticipates that there will be many ways that 5G will provide tangible new value in healthcare. 5G is expected to support 10,000 times the coverage afforded by Wi-Fi. It will enable more pervasive and smart data collection, providing massive capacity and speed, with real time access to hospital support systems with many different types of devices connected. It will enable clinical support information being entered into the system in real time, allowing clinicians to suggest appropriate courses of treatment almost immediately. Latency is also much reduced with 5G, with lag time being an important differentiator for collecting data.
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