A new paradigm, known as the Internet of Things (IoT), has an extensive applicability in numerous areas, including healthcare. The advancements of electronics has enabled miniaturized sensors, processors and communications functionalities to be integrated into everyday objects, making them ‘‘smart’’, such as smart watches, fitness monitoring products, food items, home appliances, plant control systems, equipment monitoring and maintenance sensors and industrial robots.
By means of wireless and wired connections, they are able to interact and cooperate with each other to create new applications/services in order to reach common goals. IoT in healthcare has unparalleled benefits which could improve the quality and efficiency of treatments and accordingly improve the health of the patients. IoT has now formed its subset called Internet of Medical Things (IoMT), that is used for remote monitoring of the patient’s or the client’s health through wearables (including ECG and EKG monitors), smart sensors, and mobile apps.
Health care systems are often highly dispersed, encompassing multiple locations such as clinics, inpatient wards, outpatient services, emergency departments, operating theaters, intensive care units, and labs Mobile devices satisfy this need to communicate and collaborate by offering multiple means of communication, including: voice and video calling; text, e-mail, and multimedia messaging; and video conferencing.
The use of mobile devices to remotely monitor the health or location of patients with chronic diseases or conditions has already become a viable option. Real-time monitoring via connected devices can save lives in event of a medical emergency like heart failure, diabetes, asthma attacks, etc.
Today’s advancements in wireless connectivity, sensors, computing power and IoT platforms make it easier and cheaper to build a robust smart connected infrastructure of medical devices, software applications, data, analytics and healthcare systems and services. AI is also used to enhance Internet of Medical Things (IoMT). Developing Internet of Medical Things (IoMT) strategies that match sophisticated sensors with AI-backed analytics will be key for developing the smart hospitals – and smart homes – of the future.
Smartphone are also one of the critical element in the Internet of Things (IoT), that has an extensive applicability in healthcare. The applications could be running on a smartphone, which receive the data and present it to the end user, that is, the patient, hospital administration, or physician in the case of healthcare.
These data stored in the cloud and can be shared with an authorized person, who could be a physician, your insurance company, a participating health firm or an external consultant, to allow them to look at the collected data regardless of their place, time, or device.
Cloud-based storage and file-sharing services that can be accessed using a mobile device are also useful for information management, since they allow users to store, update, and share documents or photographs with others without exchanging a flash drive or CD. Cloud-based information storage provides the additional advantage of permitting information to be accessed instantaneously from multiple devices, which allows people who are collaborating together to share materials quickly
Medical device manufacturers and software engineers continue to take advantage of smartphones’ capabilities, adapting them to serve as diagnostic tools that patients and caregivers can use in the home. Clinicians also are beginning to use them in their practices. Smartphones now offer voice and text, web searching, global positioning systems (GPS), high-quality cameras, and sound recorders. With these features, as well as powerful processers and operating systems, large memories, and high-resolution screens, mobile devices have essentially become handheld computers.
The smartphone can be considered as the user’s ultimate device for IoT and IoE interactions and control. Smartphones can interact seamlessly with various devices using different types of connections such as Bluetooth, near-field communications (NFC), Wi-Fi, etc. The IoT device or sensors integrated on smartphones collect health and other context data such as temperature, blood pressure, oxygen and blood sugar levels, weight, ECGs and geolocation. These data could be stored in special databases or in the cloud and retrieved by the user later upon need, using the smartphone dedicated application.
The rapid integration of mobile devices into clinical practice has, in part, been driven by the rising availability and quality of medical software applications, or “apps.” Apps are software programs that have been developed to run on a computer or mobile device to accomplish a specific purpose. Mobile apps can also be used directly to conduct simple examinations for visual acuity or color blindness, as well as blood pressure or glucose level. Mobile device apps can provide public health surveillance, aid in community data collection, or assist disabled persons with independent living
Smartphones also have the capability to monitor the performance of medical devices being used to aid patients. For example, Medtronic is marketing a mobile app for patients with pacemakers that communicates with patients’ smartphones and tablet devices. The MyCareLink Heart app securely sends device data to the Medtronic CareLink network, which can eliminate the need for remote monitoring hardware, according to the vendor, which manufactures biomedical engineering devices and technology.
Devices and Wearables
In the past decade, smaller, more compact and mobile systems have arrived. Remote patient monitoring (RPM) devices are wearable or wireless solutions that enhance patient mobility, enable the collection of vital signs and other data, and convey real-time information to healthcare providers and analytic software via the IoMT. These can be used either inside a hospital or clinic, by a visiting nurse, or remotely, operated by the patient for optimum personal mobility.
Consumer-grade wearables – Smart devices that include Fitbit and other fitness monitors, activity trackers, and Apple watches, among others. One of the newly-introduced devices of this kind is Apple Watch Series 4 which can monitor heart rate, calm breath, detect falls, count calories and so on depending on the apps installed. Some of the devices, like fitness trackers, correspond to smartphones apps which collect and display necessary statistics.
The Fitbit smartwatch is a wearable wristband that tracks and transmits wellness habits and data, including exercise, heart rate, sleep, nutrition, weight, menstrual cycles, and more. The Fitbit Sense recently received FDA 510(k) medical device regulatory clearance in the U.S. and CE mark medical regulatory approval in Europe for its ECG capabilities, which can detect and monitor atrial fibrillation and measure blood oxygen saturation levels, a functionality that has new prominence in consumer-oriented devices in the age of COVID-19.
Medical-grade wearables – Regulated, clinical-level products that are used under the guidance of a clinician, including devices designed to manage pain, improve physical performance and resolve other health issues. Remote Holter monitors are wearable EKG technologies that interface with patient or healthcare providers via a smartphone or tablet and the IoMT. Unlike traditional Holter and cardiac event recorders, these inexpensive, often disposable devices are simply applied on the patient’s chest.
Smart pills – An emerging category of devices that can be swallowed by a patient, wirelessly transmitting data about a patient’s internals to medical providers. Systems that collect cardiac data, for example, can use AI to create electrocardiogram (EKG) interpretations to assist the cardiologist with patient diagnosis and treatment plans.
In-hospital devices – A large segment of devices, including MRI machines, used to track hospital assets, monitor patient flow, track inventory (such as pharmaceuticals), and manage other hospital resources.
Rapid advancements in the area of sensors, antennas, and high-speed interconnects will enable medical devices to take full advantage of 5G technology, and simple, less regulated medical devices will evolve into more complex, highly regulated devices that can provide mobility, convenience, and enhanced medical communication for users and healthcare providers.
Sensors are essential components of Iot nad MIOT and include sensors like mobile phone sensors, chemical / biosensors, EO/infrared sensors, environment sensors, Chemical and Biological sensors, medical sensors, Radar, Sonar, and RFID. Applications may also include navigational sensors like GPS, accelerometers, gyroscopes, and IMUs.
The sensors and actuators should be small size, low in cost, and generally have limited memory and computing capability. The advances in MEMS, Nanotechnology and Biotechnology need to be leveraged to develop nanoscale and energy efficient sensors and actuators. There is requirement for software such as operating systems that are deployable in low-power IoT devices and support device connectivity.
The development of wireless wearables for the IoMT market requires advanced sensor technologies to capture vital signs data and other critical diagnostic information. Numerous sensor types are used in these devices, such as piezo film sensors that measure physical activity and sudden movement, pressure sensors that measure blood pressure and inhalation, temperature sensors that measure body temperature, humidity/moisture sensors that measure relative humidity (perspiration) levels, photo-optic sensors that measure pulse oximetry (SpO2), infrared (IR) sensors, ultrasonic sensors, piezoelectric accelerometers, and capacitive, inductive, magnetic, and haptic sensors. Increasingly, connector suppliers are developing these products for the IoMT market.
TE Connectivity’s digital temperature sensors are embedded into home healthcare and personal temperature tracking devices that can transmit data via the IoMT. These sensors provide accurate measurements of temperature with a digital output signal and small circuit board package for medical devices to monitor the temperature of air in respiratory devices. TE Connectivity’s digital temperature sensors provide 0.1°C accuracy, are available in miniature packages designed specifically for tight spaces, and respond quickly to changes in temperature.
TE Connectivity Thermopile Infrared (IR) Sensors are designed for non-contact temperature measurement from a distance by detecting an object’s IR energy. The higher the temperature, the more IR energy is emitted. The thermopile sensing element, composed of small thermocouples on a silicon chip, absorbs the energy and produces an output signal. IR temperature sensors enable accurate non-contact temperature measurements from the ear, forehead, or skin. TE’s discrete, negative temperature coefficient (NTC) thermistors are miniature in size, highly accurate, precise, and offer excellent long-term stability.
Amphenol Advanced Sensors designs and manufactures an extensive line of Thermometrics brand NTC thermistors and non-contact IR temperature sensors for vital signs monitoring. Amphenol manufactures interchangeable thermistors and IR sensors for oral, rectal, tympanic, and auxiliary temperature measurements for predictive, clinical, or home use. Amphenol also produces tiny thermistors for fluid temperature during dialysis, which is increasingly being performed in patient’s homes.
The stethoscope enables amplification of breath and heart sounds that provides insights into lung and heart function. . Smartphones now enhance the power of the stethoscope—patients and many doctors use smartphone-based amplifying devices to replace the earpieces from the traditional stethoscope, enabling patient engagement and a more informed patient-physician dialogue.
A new application can interpret breath sounds and coughs in combination with other symptoms that the patient enters, returning results that can indicate the likelihood that a person has various respiratory conditions. The application, ResApp, uses the smartphone’s microphone, and is particularly effective at diagnosing asthma and pneumonia.
Most ECG machines are consoles about the size of a laptop computer, attached to as many as 12 wires that are then attached to a patient’s body. Today, crude ECG recordings can be taken by smart watches; there’s a variety of opinion about the accuracy and clinical effectiveness of these recordings. Even better ECG recordings can be taken with smartphone apps connected to as few as four leads that most anyone can be taught to attach. Other new systems include devices the size of a business card that the users can touch with their fingers to get an ECG reading that connects wirelessly to a smartphone.
Electroencephalogram devices measure the electrical activity of the brain. They are used for a variety of purposes, including diagnosing and monitoring patients with epilepsy. Traditionally, epilepsy patients have had to travel to EEG centers, where they are fitted with several leads that are glued to their scalp. But with smartphone technology, it’s possible for patients to monitor themselves at home and transmit the data to their neurologist. A proof-of-concept study in Nature.com determined that this innovation could soon make EEG technology available to millions of epilepsy sufferers who have limited access to EEG centers.
Every pediatrician has an otoscope for looking in children’s ears, generally to diagnose ear infections. he cameras on smartphones now provide such high resolution under limited light conditions that a simple attachment provides high-resolution magnified views, giving doctors—and now parents—the ability to capture images of the ear drum, which can be sent to a doctor.
The cameras on smartphones now provide such high resolution under limited light conditions that a simple attachment provides high-resolution magnified views, giving doctors—and now parents—the ability to capture images of the ear drum, which can be sent to a doctor.
Specialized attachments and associated applications have turned smartphones into devices that produce images almost as good as those available in eye doctors’ offices. The technology may not become available to the general public, however, because these examinations often require the use of pupil-dilating eye drops, which are used only in office settings. Simpler devices, however, are able to perform visual acuity exams, alerting patients when their eyeglass prescriptions become outdated.
Vendors are beginning to look for ways that smartphones could enable clinicians to quickly and inexpensively gain insight into patients through imaging. For example, Butterfly Network, a rising medical imaging company, is making a pocket-sized ultrasound device that plugs into an iPhone. The medical imaging firm began selling its first product, called the iQ. Priced at $2,000—significantly less than conventional ultrasound imaging machines—it could make the scans vastly more accessible.
In another example, a novel way to locate “regions of interest” in dermoscopy images can improve the detection of skin lesions, through the use of an app on a consumer mobile device, enabling real time identification and diagnosis of cancer and other skin conditions, according to new research reported in arXiv.org, part of the Cornell University Library. The approach uses an attachment to a smartphone that improves its ability to image skin lesions.
Engineers at the University of Wisconsin-Madison have developed a spectrometer that is so small and simple that it could integrate with the camera of a typical cell phone without sacrificing accuracy. The device contains photodetector arrays overlaid with photonic-crystal slabs placed on top of the detector pixels, giving each pixel region a different spectral response. The individual spectral responses are complicated and finely patterned (“random” spectral filters) and an algorithm is used to extract the spectral profile of the incoming light. This compact and low-cost spectrometer could help turn ordinary cell phones into advanced analytical tools.
Using smartphone screen Army engineer develops large biocular
The U.S. Army’s night vision laboratory was awarded U.S. Patent 10,520,720 on Tuesday for a device known as “Large Format Biocular Lens.” The new invention leverages the performance of the now-standard 5.5″ smartphone screen (2,160 x 3,840 pixels) to create an imaging device that’s lightweight, using a plastic design for all but the outermost lens, relatively short, and easy on the eyes. Biocular lenses are widely used in head-up and head-down displays for both modern military and commercial aircraft, flight simulators, microscopes for semiconductor device inspection, and medical applications.
“The total length of the invention is about 223 mm (8.8 inches), which is very compact considering the focal length is about 165 mm,” the patent states. Using the larger mobile phone style display requires less total optical magnification to achieve the same field of view as other bioculars, and it allows a larger aperture space within which the operator’s eyes are comfortable, which dramatically improves the appeal of the invention.
The role played by mobile devices and apps in health care education is expected to grow. Medical school HCPs and students predict that mobile devices and apps will become even more integrated into patient care and will eventually completely replace textbooks.
5G is Expected to be a Transformative IoMT Technology Accelerator for MedTech Connectivity
5G technology will ultimately be able to offer speeds up to 100 times faster than typical hospital wireless networks, enabling more multi-user platform capacity, faster downloads, and near real-time communication on mobile devices. This will bring multiple benefits to medical environments, including remote patient monitoring, diagnostics, complete and accessible documentation, and even remote assistance with therapeutic procedures.
The lower latency of 5G is expected to make remote and robot-assisted surgery more accessible as well. Intuitive Surgical, the largest pioneer of surgical robotics, along with Medtronic, Johnson & Johnson, Siemens, and others, have doubled down on their investments in robotic-assisted surgical technologies. Intuitive Surgical contracted InTouch to create an IoMT network connection platform for its global users. InTouch, which is now part of Teladoc Health, offers its Solo Telemedicine platforms, including a COVID-19 infectious disease emergency solution. This technology brings remote, robot-assisted surgical procedures to remote locations around the world.
TransEnterix has obtained FDA 510k clearance for the Senhance Surgical Robotic System, which performs laparoscopic hernia repair, gallbladder removal, colorectal, and gynecology procedures. 5G speeds, coupled with haptic force feedback sensors, create a combination of force, vibration, resistance, and motion sensations to heighten the surgeon’s sense of touch response. The primary haptic sensors include eccentric rotating mass vibration (ERMV) motors, linear resonant actuators (LRAs), and piezo haptics sensors (PHS). Other connectivity products employed in these transformative IoMT technologies include card-edge and RF connectors and cable assemblies.
British companies have already developed numerous space-enabled medical applications that could help to inspire the hospital’s technologies. These include several projects designed to support a coronavirus-hit NHS, such as a fleet of drones that will ferry much-needed medical supplies – including Covid-19 test kits and PPE – between hospitals, freeing up NHS staff, and reducing unnecessary physical contact.
Potential applications could include new diagnostic tools to speed up diagnosis and treatment, logistics solutions for keeping track of medical supplies, and telemedicine devices that enable medics to care for patients remotely. The facility could even incorporate technologies pioneered on missions to the International Space Station. “As demonstrated by the many satellite-enabled solutions developed to support the coronavirus response, space has a crucial role in addressing healthcare challenges that face society,” said Elodie Viau, director of Telecommunications and Integrated Applications at ESA.
Issues and Challenges
Several issues challenge the future integration of mobile devices and apps into health care practice. Among the concerns raised regarding mobile devices are: their reliability for making clinical decisions; protection of patient data with respect to privacy; impact on the doctor–patient relationship; and proper integration into the workplace. In addition, HCPs have expressed concerns about lack of oversight with respect to standards or content accuracy, especially for apps involved in patient management.
Some physicians have voiced concerns about diagnostic devices being used in patients’ homes. Expertise and judgment are required when interpreting any medical test. Nevertheless, no one expects smartphone-based devices to completely replace the physician. Only trained cardiologists can read ECGs, and only trained neurologists can read EEGs. For other devices, physicians can and should actively participate in guiding the patient through the diagnostic and therapeutic process. Skilled nurses can help patients use these devices in ways that can greatly increase their accuracy. Still, there’s a risk that patients might take too much medical care into their own hands, increasing the need to offer close provider-patient interaction in their use.
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