The 999-emergency service was first introduced in the 1930s. The last nine decades have seen the service expand from handling more than 1,000 calls in its first week of operation in London, to around 560,000 calls a week. This amounts to around 30mn calls a year, according to BT's archives.
Today, our devices go everywhere with us - whether on our wrists, in our hands or in our trouser pockets - it’s a wonder, in this connected era, that 999 or 101 emergency responders don’t know our names the instant our calls are connected. This very connectedness will have a huge impact in the medical world in a variety of ways –especially through telemedicine (and Remote Patient Monitoring in particular).
The remote delivery of healthcare services or consultations over a telecommunications infrastructure will serve as a window to cost savings, better treatment results and disease control. The FCC predicted that heath monitoring solutions could save the US alone $197bn over the next 25 years.
In a world where we record our exercise levels on our phones, track our 10,000 steps a day, and record our diets, pill intake, blood pressure, heartbeat and weight, the ability for medical IoT to connect this data to our online records hardly seems surprising. However, it’s how this data is then analysed that can drive real value, identifying trends unseen to the human eye, and ultimately enabling speedier diagnosis, treatment, and even trips to the hospital. Here I’ll look at a number of ways that telemedicine and analytics can change the dynamics of healthcare, releasing the pressure on already overburdened medical organisations and expediting trend detection and diagnosis.
The increasing demand on medical organisations
The demand on the medical world has never been so strong. In the UK, for example, the NHS is regarded as one of the best healthcare systems in the world, yet chronic underfunding and workforce shortages have placed extreme stress on its staff, the quality of care and patient safety. With a declining doctor-to-patient ratio striking healthcare organisations worldwide, doctors are now left playing ‘catch-up’ as population growth continues to soar without enough new blood coming through the system. General Practice (GPs) doctors are already pinned for being ‘stretched to the limit this winter’ according to BMA’s analysis of pressure on emergency care services.
Telemedicine and IoT offers the opportunity to create virtual hospitals and provide remote consultation, diagnostics and treatment. Remote Patient Monitoring (RPM), a crucial part of telemedicine, allows for the monitoring of patients outside of conventional medical scenarios e.g. in the patient’s home. Doctors are able to connect to their patients through different forms of communication including video conferencing and smartphones, allowing healthcare providers, such as the NHS to evaluate, diagnose and treat patients using technology without the need for an in-person visit, or taking up an extra hospital bed.
RPM enables the collation of patient data, not only from regular contact with the patients’ doctor but also through connected devices. Root Cause Analysis (RCA) can then combine and analyse the data collected from these IoT connected devices to provide a real-time full view of the patient and their circumstances. RCA generates a data loop that can help doctors analyse how our current activity could be impacting our health and potentially reach the root cause of our medical condition much faster, providing a timely diagnosis and evacuation of a person to the most suitable facility.
Meeting the demands of an aging population
Population sizes are growing, and life expectancy is on the rise. In 50 years’ time, the Office for National Statistics has projected that an additional 8.6mn people will be aged 65 or over in the UK – a population roughly the same size as London. As this aging population continues to expand, so does the number of people with chronic diseases – which will require constant monitoring of their medical conditions. Telemedicine could be the solution to help manage this growing and ever-looming reality.
A chronic medical condition such as cognitive heart failure, affects the pumping power of the heart muscles. By monitoring a patients’ heart rate, the combination of RPM and connected devices could enable the faster diagnosis of heart failure. To reach this speedier diagnosis, healthcare organisations can apply Root Cause Analysis (RCA) to collate the data and analyse any trends or potential high heart rate levels in the patient, which will help medical professionals to decipher what is impacting a patients’ heart rate.
Being ‘smart’ about remote patient monitoring
The number of young people being treated for type two diabetes is on the rise, according to an audit published by the Royal College of Paediatrics and Child Health. Diabetics need to ensure they consistently monitor their glucose and insulin levels. RPM enables continuous glucose monitoring, sending an alert from the sensors that their sugar level is low, advising the diabetic to have a ‘sugary snack’ or drink to increase their blood sugar levels. RCA can then analyse the frequency of these low levels and analyse any potential contributing factors i.e. diet or level of stress.
The rise of smart home speakers such as Google Home and Amazon Echo could also provide further insightful patient engagement, including reminders on taking medication, delivering alerts and asking questionnaires sent from the doctor.
Weathering the storm
When it comes to the world around us, the application and analysis of many sources of data, be it environmental, meteorological, as well as previous medical history, can be used to provide a truly comprehensive service.
The effects of global warming such as extended heat waves, severe air pollution and heavy flooding, introduces an extra burden to already overburdened healthcare systems in many countries. A particularly problematic consequence of climate change is the spread of vector-borne diseases into new areas. RPM enables immediate access to medical history, environmental data and sensor data. Data gathered from national agencies, medical files and sensors can also provide appropriate analytic and correlative methods - vital information which can be shared with smart city and medical operation Control Centres to help cope with outbreaks of diseases such as Dengue, West Nile Fever amongst others.
In extreme weather conditions, RCA can also analyse the data created from weather apps and end-user recorded weather conditions, to share instructions on how to arrive to designated ‘cool places’, or instructions on how to cope with severe pollution. For example, a dedicated smartphone app is being used in France – ‘EXTREMA Paris’ to help the inhabitants of Paris to cope with the increasing frequency of heat waves in summer. The data pulled from these applications can be included as part of a smart city control centre or the countries medical operations.
It’s not just global warming related - air pollution can also place a heavy toll on people’s health, contributing to conditions including cardiovascular disease, lung cancer and respiratory diseases. According to a study conducted in 2015, air pollution from traffic and industry is leading to the premature deaths of more than three million people a year – more than malaria and HIV/Aids globally combined.
In 2018, the UK government was criticised for failing to comply with air pollution directives and regulations. Governments and organisations can use medical operations centres (MOC) to measure, analyse and link the data being produced from air pollution monitoring such as the levels of particulate matter, ozone, pollen, NOx (nitrogen oxides), SOx (sulphur oxides) and VOC (volatile organic compounds). This will enable alerts to be issued to specific patients according to their medical conditions, as well as facilitate the closer monitoring of their conditions, depending on location and environment.
From the outside in, we are witnessing companies produce products for monitoring internal air quality (IAQ), like Foobot, Awair, Air Mentor and others, in an effort to improve air quality in homes, work and indoor public places. These tools can scan the air quality and alert in cases of high levels of pollutants, like dust and VOCs (volatile Organic Compounds) that can exacerbate asthma attacks, or CO2 that can cause headaches and dizziness. High levels of CO2 in office buildings and schools usually indicates a lack of proper ventilation, and these products can be used as a means to regulate and improve overall IAQ.
This local data can also be pulled and analysed in even more different ways: The roll out of smart cities will enable the assessment of the quickest route to take for emergency services by locating the best means of transportation, the most efficient route, the most relevant medical experts and assessing the hospitals which have the most appropriate equipment. Emergency services will no longer be left waiting for traffic to move aside, instead RCA analyse the traffic data and update the emergency services to the best route to the hospital with less traffic.
Envisioning the roll out and the tools making it a possibility
For telemedicine to be a success, the efficiency, availability and reliability of the network needs to be assured, as communication links across the network are responsible for ensuring the availability and accuracy of the data transported between patients, sensors and medical service providers (and other parties as required).
In order for healthcare organisations to reap the full benefits of telemedicine, they must have the correct tools to enable the 24/7 monitoring of the required communication links. This involves selecting service assurance solutions which includes sophisticated SLA analysis, RCA, analytics, and the management and operation of resolution processes via mechanisms such as notifications, escalations, automated commands and ticketing.
A part of telemedicine is the assurance of customisable analytics. Customisable analytics sourced from the generated sensor data, can enable the proactive identification of problems and implementation of resolution processes according to customisable policies and automation rules. Customisation in today’s personal era has never been so important, in fact customising the automated rules and processes enables the interaction and data sharing with other bodies (e.g. first responders, smart city operators, paramedics, specialists, etc.) as required.
Integrated platforms, that merge multiple data layers will then help qualify the analysis of the contextual situation to optimise the speed of problem detection and the efficiency of the resolution processes. Healthcare organisations should consider open APIs to combine with other information sources - to help better comprehend the problem, the situational context and the best way to approach the problem such as weather data, pollution data, data from emergency systems, traffic data and road closure data.
Any piece of data can be very valuable and can help save lives. Remote Patient Monitoring can drive the most value when it is coupled with analytics such as Root Cause Analysis, putting the patient and the data into context in a way that can make a tangible difference. The assessment of the situational context and the automation of proactive and reactive operational processes are also critical for enabling the application of focused actions attuned to the relevant situation. Telemedicine represents a large potential healthcare resource, and with the right support, service assurance solution and proactive awareness, it can lead to real benefits for healthcare organisations and patients.