An integrated health ecosystem can be greater than the sum of its digital devices

The Internet of Things (IoT) has five components:

1. Inputs devices and sensors: Devices and sensors begin the IoT cycle by gathering and sharing modality-specific data.
2. IoT platform: To communicate with each other, the devices are integrated on an IoT platform that provides the infrastructure and standards/protocols for seamless connectivity.
3. Artificial intelligence: Sophisticated machine-learning loops that interpret the data, derive insights, and determine responses have long replaced linear if-this-then-that logic.
4. Actionable feedback loops: The AI engine activates automatic responses (e.g., through an effector arm) and/or synthesizes insights for human interpretation or future machine learning.
5. User interfaces: Finally, users interact with the devices and consume the information and insights generated by the IoT ecosystem.
   

In-home automation is an example of how these five components are brought to life. Smart home devices (e.g., smart light bulbs, thermostats, locks, refrigerators, garage doors) are connected to a home automation platform. This allows an AI engine to combine data from multiple devices and drive actionable feedback loops. For example, when the AI engine recognizes that the garage door has been left open, it might use motion-sensor data and geofencing (smart phone GPS location) to determine that (a) the home is vacant and (b) that nobody is likely to return in the immediate future based on prior patterns. The system determines the best course of action is to shut the garage door for security and send an update memo to the home owner.

IoT could generate profound insights in health care

Similarly, the digital health ecosystem abounds with opportunities to advance care and improve the health experience. Real-world data generated by the health IoT is becoming increasingly abundant and accessible. A recent Deloitte survey found that consumers are becoming more interested in technology such as wearables and mobile apps, for health purposes. Specifically, 60 percent of respondents said they are willing to share data gathered from wearable devices with their doctors.¹ Health-related IoT ecosystems have the potential to generate profound insights and enhance patient care—even within the home.

Consider patients who are living with diabetes. A health IoT ecosystem might enable more precise glucose control, which could help improve short- and long-term health outcomes. The input and output devices for this particular ecosystem (a digital glucose monitor, an automatic insulin pump, a smart watch, and a smart pill box) connect through an AI-enabled diabetes management platform. On its own, the continuous glucose monitor could make insulin dosage recommendations. But the digital ecosystem becomes even more powerful when data—including patient activity levels and smart pill uses—is added (e.g., heightened stress, changes in physical activity or forgetting to take medication). By tapping into historic activity patterns, the system could further refine the recommendations. For example, by prompting the user to decrease his insulin dosage on Saturday mornings when he plays basketball with neighbors. With the patient’s verbal confirmation, the adjusted insulin dose would be administered. An ecosystem like this—in which real-time data feeds are processed and combined with predictive models—enables truly personalized health interventions when properly integrated, optimized, and monitored.

How can health care organizations win the IoT race?

Health care organizations that want to take advantage of IoT and virtual health will likely need to work through some key steps to realize this digital health ecosystem vision:

• Inputs and platforms: Integrating multiple inputs onto a single platform, or compatibility across multiple platforms, can be challenging. Many companies have a proprietary strategy for delivering IoT, which means users are restricted to a list of devices that are compatible with the platform they choose. Health care organizations that want to build an IoT platform should first consider the standards through which the devices can be accessed and how the devices will communicate and interact with other components of the ecosystem. More specifically, these organizations will likely need to determine whether the platform is capable of supporting data from multiple existing and future inputs. Organizations should consider the extent to which the platform is customized in-house vs. relies on standard configurations by the platform vendor. In health care, there are few clear IoT standards and protocols.² Although some partnerships are being formed to develop standards, work still needs to be done to foster true interoperability and increase industry adoption.³
• AI and data management: Data is the backbone of the IoT ecosystem. Without data, AI cannot perform analytics and generate actionable feedback loops. Data security is paramount when handling PII/PHI (personally identifiable information and personal health information). Data that circulates between distributed devices and end-users is especially vulnerable to security breaches and unauthorized access. Developers should take proper measures around encryption, access control, and traceability, and overall compliance with HIPAA requirements (for example not all consumer electronics are HIPAA compliant!). Organizations should ensure that data security and integrity is ensured throughout acquisition, processing, storage, transfer, and use.⁴ Similarly, special attention should be placed on any AI engine’s ability to meet pertinent standards and requirements (which can vary with geography and the regulatory regime under which the solution falls).
• User interfaces: Particularly in health care, simplicity and user-friendliness are paramount to promote adoption and prevent possibly severe health implications. Challenges include limited IT literacy among users, which can lead to difficulties related to installing, configuring, or integrating the devices.⁵ Organizations that want to build IoT devices should consider developing a friendly, easy-to-comprehend user interface and user experience (UI/UX) that will help address this common adoption barrier. When building the user interface, health care organizations should pay close attention to accessibility (e.g., for elderly or disabled patients), expandability (the ability to add other devices and functionalities), and engagement (capabilities like gamification and nudging that use behavioral economics to improve well-being). Deloitte and the Perelman School of Medicine at the University of Pennsylvania recently published the results of their STEP UP study, which highlights that gamification combined with wearable fitness trackers can lead to sustained results (more steps).

Seven questions organizations should answer on their health IoT launch path

Health care organizations should build IoT into their broader virtual health strategy, specifically geared toward patient engagement and care management objectives. To achieve IoT’s potential, health care organizations should consider the following seven questions:

1. Where is IoT likely to have the biggest impact on the quadruple aim (i.e., enhance the patient experience, improve the health of populations, reduce costs, and enhance the caregiver experience)?
2. In which ways can IoT solutions radically re-imagine patient engagement and care management? How can organizations manage implementation to maintain patient safety and improve the patient experience during the transition?What additional inputs might need to be combined with the existing digital/virtual health infrastructure to integrate IoT into care management plans, thereby creating an ecosystem powered by multiple devices
3. What additional inputs might need to be combined with the existing digital/virtual health infrastructure to integrate IoT into care management plans, thereby creating an ecosystem powered by multiple devices?
4. How should the organization source its IoT platform? What existing platforms and solutions can accelerate the journey to implementation?
5. How can the organization address physician resistance to technology adoption in the clinical setting and generate insights that physicians will trust?
6. To further enable IoT adoption, how can the organization align its consumer and physician-engagement strategy with user-friendly interfaces?
7. How can an IoT platform reduce total cost of care, become self-funding, and free up resources for investment in other critical capabilities?

Most health care organizations are in the early stages of developing a health IoT ecosystem. As they embark on the journey toward the future of health, they should acknowledge that the true strength of IoT resides in creating an ecosystem that brings together multiple devices to create insights and outputs that improve health.

^{Endnotes
1. Inside the patient journey, Deloitte Insights, September 25, 2018
2. Inside the Internet of Things, Deloitte University Press
3. Six IoT implementation challenges and solutions, Control Engineering, October 15, 2018
4. Eight barriers to consumer IoT adoption, InfoLink, July 18, 2018
5. Eight barriers to consumer IoT adoption, InfoLink, July 18, 2018}

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