Apps, IoMT, and The Future of Connected Healthcare

The technological revolution has heralded improvements in the safety of vulnerable people at all levels. Some of the simplest developments have triggered massive changes to the structure of healthcare; consider the development of the patient-controlled ‘buzzer’ in hospitals[i] – without this kind of nurse-call system, hospitals might never have moved away from the Nightingale wards towards the privacy and dignity afforded by individual rooms[ii]. Although the benefits of such a move are undoubted, it meant that healthcare workers were not able to physically oversee their patients as a cohort, triggering further technological developments like falls sensors and movement monitors; technology begets change begets technology, ad infinitum. Rapid Responses and Tracking Trends Falls sensors have been in use in some form for many years, but the advent of the smartphone app has revolutionised the technology, with remote alerts and trackable activity meaning safety and peace of mind. Similar technology is quickly becoming commonplace in healthcare. For example, a sensor that can be worn or attached to a bed or chair can be used to monitor seizures. Connected devices can alert a designated carer or family member, to concerns, and an app gives the user the ability to record the time and duration of seizure activity. Physical sensor linked to remote devices can do more than call for help, they can enable people to identify trends and manage their conditions.[iii] Adding connectivity to technology means the ability to monitor, alert, record, collate, audit and track trends; any functionality that can be programmed into an app connected to a physical sensor. Remote monitoring at home means that relatives can be alerted to safety issues wherever they are. Whether they’re in the immediate area, or further afield and able to notify an appropriate responder, knowing that they will be informed of any safety issues as they arise can give much-needed peace of mind for loved ones, and an unprecedented level of safety for vulnerable people in their own homes. Safety in Independent Living Remaining independent and able to live in their own homes is of the utmost importance to many people who develop extra care needs, whether in the older population or in younger people with supported living needs[iv]. This is just one of the driving forces behind a health and social care system that is increasingly focused on supporting people at home, even those with complex care needs. Undoubtedly a formal care setting is an appropriate option for many people, but for those who wish to live at home, there are more ways than ever before to support people with safe, independent living for as long as possible[v]. For people living at home alone, wearable ‘panic buttons’ to call for care services in the event of illness or injury have been around for a long time – this is now more of a last resort, as movement and falls sensors can be incorporated into a person’s home. This means that an emergency service or designated care provider can be alerted to concerns without having to rely on a person being alert and well enough to call for help. Monitoring practical activities of living like the opening of windows and doors or the regular – and safe – use of electrical devices in the home can give clues as to daily habits. An adaptive machine learning algorithm can identify behavioural trends. With enough data, this level of automation can then spot anomalies and create alerts which can then be acted on by carers or care teams.[vi] IoT in Medical Devices Programmable implanted or wearable devices like cardiac rhythm recorders and insulin pumps are now commonplace, first line in treatments and investigations. The idea of devices that can link with other interoperable systems means that closer monitoring, tracking and trends informs care and condition management by healthcare professionals and patients alike.[vii] Devices that can be accessed by patients who can alert their care teams about issues, which can also use their own integrated connectivity to relay readings, especially those of concern to on-call care teams means that care can be incredibly fluid. Devices that can automatically collate information over time and be accessed by a care team have inherent benefits for accessibility of care. Previously, diabetes care might be directed based on a patient’s self-reported blood glucose monitoring – relying on someone bringing a booklet of numbers for a nurse to flick through has clear drawbacks. Healthcare that is reliant on someone being able to accurately monitor and report on their condition, and to advocate for themselves among professionals, is not accessible healthcare. There must be room in a healthcare system’s philosophy for people who cannot or will not fully engage with independent health management. Medical technology should not be reliant on patients’ abilities to use it or to have access to the internet or smartphones. Incorporating IoT into our Understanding of Everyday Healthcare In an increasingly interconnected world, the very terminology that we use to describe the incorporation of connected medical technology is fast-becoming redundant. In fact, medical devices with some form of ability to be monitored or interrogated externally or remotely predate the spread of the language we use to describe it. IoT has emerged in the public understanding, as even our household appliances join this new technological revolution. The way we describe the interconnected world has retroactively influenced the language of existing medical connectivity to fit general public understanding. To retrospectively name medical technology to fit with emerging trends in general tech seems like an outmoded response to a public perception – connectivity and cutting edge technology are not novel in healthcare. They are, in fact, so integral that it almost counterproductive to describe them in a way that seems to put them alongside and adjunct to modern medicine, rather than a natural part of it. We can celebrate the integration of interconnection without it seeming like an alternative pathway to the same goal; connectivity is medicine, and medicine is connectivity. About the Author Elaine Francis is a registered nurse with 18 years' experience in healthcare. She turned to medical writing to follow her passion for realistic and accessible medical communication, and is also currently working towards a master’s degree in the History of Medicine. When Elaine isn’t writing or nursing, she spends her time telling her children to tidy up. www.elainefrancis.com [i] Drue RH. (1976) System links nurse call/locator, patient intercom, emergency call. Hospitals 50(17):78-80. [ii] Hurst, K. (2008). UK ward design: patient dependency, nursing workload, staffing and quality—an observational study. International journal of nursing studies, 45(3), 370-381. [iii] Beniczky, S., Karoly, P., Nurse, E., Ryvlin, P., & Cook, M. (2021). Machine learning and wearable devices of the future. Epilepsia, 62, S116-S124. [iv] Dale, B., Söderhamn, U., & Söderhamn, O. (2012). Life situation and identity among single older home-living people: A phenomenological–hermeneutic study. International Journal of Qualitative Studies on Health and Well-being, 7(1), 18456. https://doi.org/10.3402/qhw.v7i0.18456 [v] Riikonen, M., Mäkelä, K., & Perälä, S. (2010). Safety and monitoring technologies for the homes of people with dementia. Gerontechnology, 9(1), 32-45. [vi] Yacchirema, D., de Puga, J. S., Palau, C., & Esteve, M. (2019). Fall detection system for elderly people using IoT and ensemble machine learning algorithm. Personal and Ubiquitous Computing, 23(5), 801-817. [vii] Ray, P. P., Dash, D., & Kumar, N. (2020). Sensors for internet of medical things: state-of-the-art, security and privacy issues, challenges and future directions. Computer Communications.

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