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Vol 25, No. 02, February 2021   |   Issue PDF view/purchase
COLUMNS
Revolutionising Healthcare in the Age of IoT
The convergence of the Internet of Things (IoT) and blockchain technology may just be the next frontiers of digital technology in the healthcare industry.
by Michelle Tan Min Shuen

The world is on the brink of a demographic shift – the global population is ageing, and at an unprecedented rate. Driven by declining fertility rates and remarkable increases in life expectancy, people aged 65 and over have outnumbered children under age five in 2018, for the first time in human history. In fact, the number of persons aged 80 years or over is projected to triple, from 143 million in 2019 to 426 million in 2050.

Population ageing is, without a doubt, a success story. Testament to human progress, it represents our triumph over diseases, injuries and early deaths that have long plagued human existence throughout history. However, this phenomenon also presents tremendous challenges. The sheer number of people entering their golden years will test the resilience of national infrastructures, particularly healthcare systems, which were initially designed to cater to a much younger population.

Accompanying the ageing population is a shift in the incidence and prevalence of disease. Described as part of an “epidemiologic transition”, this shift is characterized by the waning of infectious and acute diseases and the emerging importance of chronic degenerative diseases such as cancer, stroke, and diabetes. Increasing longevity with chronic diseases that are not immediately lethal has also contributed to the ubiquity of multiple comorbidities in the population. Unsurprisingly, there is an increasing demand for chronic disease prevention and control programs, which most hospitals fail to provide. The fact that only five percent of all health expenditures are spent on the prevention of illnesses is even more worrying given the fact that over 80 percent of all illnesses are preventable.

Transforming the way that healthcare institutions deliver care needs to be prioritized so as to continue to deliver effective care for a rapidly ageing population. There is an urgent need to shift global healthcare systems from one based on acute treatment of disease symptoms to one focused on prevention and long-term management of chronic illnesses.

The Internet of things (IoT)

The first step towards this paradigm shift is the penetration of the IoT into the healthcare sector. The IoT is defined as a system of interrelated, internet-connected objects that are able to collect and transfer data over a wireless network using Bluetooth, Wi-Fi, RFID or M2M wireless technology in order to promote an inter-functionality that serves a greater purpose. In healthcare, IoT is referred to as the Internet of Medical Things (IoMT) and it covers devices such as smart fitness trackers, wireless ingestibles, and the like.

A key feature of IoMT lies with its ability to gather patient data outside of traditional healthcare settings through remote patient monitoring. Through the use of IoMT-connected smart wearable devices that can accurately measure vital signs and disease indicators, healthcare practitioners can effectively scale services to not only obtain more accurate data from outpatients but also monitor more outpatients simultaneously, improving the quality and quantity of care delivered.

The problem of patient non-adherence is enormous and difficult to manage, proving to be a key issue in chronic disease management. When patients fail to follow treatment directories, be it drug, physical therapy, or lifestyle changes, this can lead to substantial worsening of disease, delayed treatment and increased healthcare costs. Rather than relying on information given to them by their patients which can be imprecise, remote and virtual care solutions enabled by IoMT can provide healthcare workers with continuous and precise measurements that inform better treatment beyond the acute care location.

Besides helping medical staff, the IoMT also encourages people to take more ownership of their own health. Incorporating relevant medical data into IoMT connected wearables can help turn non-adherent patients into people who are actively engaged in managing their health. By allowing patients to track their own progress and condition from the comfort of their homes, IoMT essentially helps healthcare to move “beyond the hospital to the community”, as noted by Dr Eugene Shum, Chief Corporate Development Officer of the Eastern Health Alliance. The rising popularity of mobile fitness trackers such as Fitbit and smart watches have also benefited the general public, creating an avenue for people to become more accustomed to tracking and managing their health online, as well as nurturing a new generation of increasingly health-conscious individuals.

In fact, connected wheelchairs which collect biometric information from the user and home monitoring sensors which alert elderly of fall risks on their mobile phones are just the tip of the iceberg when it comes to the many technological advancements that have been designed with IoMT in mind.

“It's about using technologies to bridge that space between the traditional physical setting of healthcare, and where people really want to live every day.” notes Marcus Grindstaff, COO of Care Innovations. Offering ever-greater levels of interconnectivity and operational advantages, the IoMT has demonstrated immense potential in revolutionising chronic disease management, and are quickly becoming a vital component of modern healthcare. Leveraging on IoMT not only helps to deliver better quality of care and patient outcomes, but also significantly reduces costly healthcare expenditures which prevent individuals from accessing healthcare, which translates into more opportunities for primary prevention and better prognosis of existing chronic diseases. Being prepared to harness this digital power would prove to be a key differentiator in our increasingly digitised world.

Blockchain Technology

As individuals increasingly become agents in their own care, digital technologies must protect privacy and security if use of digital applications in healthcare is to be sustained and even further developed. In the IoT, where devices capture and store huge troves of sensitive patient data via real-time health monitoring, blockchain has emerged as the most secure, decentralized platform for protecting the patient data from all types of threats and vulnerabilities concerning data security.

Blockchain is the backbone technology that is driving the digital revolution of healthcare. But how exactly does it work? Blockchain is a distributed ledger technology (DLT) that works by distributing data through nodes, allowing data to be stored globally on thousands of servers within the IoT rather than a single centralized data silo. In a blockchain, each node has a full record of the data that has been stored on the blockchain since its inception. Should the data in one node be tampered with, it can use the thousands of other nodes as a reference point to correct itself. This way, no one node within the network can alter information held within it, ensuring that the goldmine of patient health data is practically untouchable by hackers. This is extremely important since it would completely rule out tampering with medical records which is one of the biggest problems in today’s medical industry.

In the healthcare sector, the immutability of the data being entered makes blockchain an enticing method for storing data, with healthcare providers who have incorporated blockchain into electronic health records (EHRs) endorsing the technology to be highly effective when it comes to storing and retrieving med

Businesses today are still reeling from the disruptive impacts of IT heavyweights such as AI, IoT and blockchain, which threaten to revolutionise the whole healthcare industry. With human knowledge on these three innovations barely scratching the tip of the iceberg, few start-ups have dared to move into uncharted waters and design products or systems that breach the intersections between AI, IoT and blockchain. Yet it is the intersections which hold tremendous untapped potential for the technologies to be used together to bring forth completely new approaches to managing supply chains, data, transactions and more.

While IoT has been slated to be the next industrial revolution, major challenges regarding its security and scalability have increasingly been brought into question as the number of IoT connected devices increases. Almost all of today’s IoT ecosystems are based on centralized systems, and maintaining that network of functioning clouds and equipment becomes exponentially more expensive as the ecosystem continues to expand. Additionally, IoT devices are subject to various types of vulnerabilities which compromises the security of entire infrastructure.

This is exactly where a decentralized approach to IoT networking can come in handy. Adopting a secure, tamper-evident peer-to-peer communication model to process billions of transactions between IoT devices can also significantly reduce the costs associated with installing and maintaining various network and cloud systems and prevent the “single point of failure” vulnerabilities.

“The intersection of blockchain and IoT, as I see it, is that where IoT is currently weak is in security and reliability of connections at all times, blockchain is strong.” noted Dawn Barry, co-founder and president of Luna DNA. Blockchain presents itself as a viable solution and complement to IoT as its features precisely address the main security issues of the various types of IoT devices. IoT, in essence, is decentralized hardware looking for a decentralized security system, which is exactly what blockchain is.

The combination of blockchain and IoMT has broad potential for the creation of a plethora of services between devices and gives companies the opportunity to create value from collected data. An example of an innovative solution which incorporates IoMT and blockchain technology is a mobile edge computing framework used for in-home therapy management. With the aid of multiple non-invasive IoT sensors tracking the patient’s movement, the framework collects the therapeutic data and securely shares them with big-data repositories and its stakeholders. The blockchain for the therapy application uses a set of trustless Mobile edge computing (MEC) and cloud nodes for storing the committed blocks that contain therapy transactions. In fact, the growing number of emerging blockchain protocols, partnerships and IoT device providers possibly hints at the potential for the integration of blockchain in the IoT sector.

Capitalising on the synergy between blockchain architectures and the IoMT world would allow for much safer devices that are now in common use, paving the way for new possibilities in a variety of applications in healthcare. The convergence of these technologies is not a matter of if, but when, and as long as healthcare providers are willing to keep an open mind and create the required infrastructure and systems, there really is no saying how far digital technology can go in healthcare.

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