How NHS and Assurance Maladie can optimize the emergence of IoT to provide a better service to their patients.

12 June 2017 | Share it on social networks

The historical approach of our healthcare bodies have been dedicated to the treatment of illnesses once symptoms have shown. However, as life expectancy improves with the aide of developing technology, we start to see a change in expectations and requirements from both patients and individuals. So how can the development of IoT affect healthcare, and what benefits and challenges can we hope to see?

From curing illness to preventing illness

Healthcare systems are historically dedicated to curing illness, currently in France prevention expenditure represents only 2,5% of curing expenditure1. As healthcare improvements make life expectancy reach high levels, we are living longer (more than 20 years of life expectancy gained between 1930 and 2010 in UK) but with more chronic diseases (heart disease, diabetes, cancer, ...). In the same time all generations are seeking for the preservation of their “health capital” even if they are healthy !

This epidemiological transition leads to a change of stakes… Healthcare systems must not only help with the treatment of patients with chronic diseases, but also on how to prevent further illness to affect the person. The system must differentiate between patient for treatment, and person for wellness - allowing mechanisms to promote health and autonomy.

Prevention must become the main effort of our countries to reinforce our capacity to stay as healthy as possible and to use health caring when absolutely needed. This goal is to help promotion of health management alongside our existing treatment/curing management.

Types of health care management available at present

  • Improving availability of healthcare information to the public i.e. to promote self-care. For example NHS choices or sante.fr are part of this new policy
  • Improving screening and vaccinations programmes led by government health agencies.
  • And the most interesting for us is the growing utilisation of IoT!

Let’s have a closer look at healthcare IoT opportunities

IoT technology and opportunities are extremely diverse and varied, from wearables, consumables and receptive detector tech. However, the current landscape of healthcare IoT generally follows these trends :

Powerful sensors

  • IoT use sensors that can be set anywhere without power supply, size or reliability concerns. Sensors registering heart rate, pills measuring blood markers etc.
  • This opens the path to precisely collecting physiological data. European standards like CE mark, allow confidence on these sensors.

Connectivity

  • Most devices are connected, directly to a network or via mobile apps, allowing instant sharing of the data collected.
  • This can lead to real-time recommendations based on medical algorithms analysing physiological data. It can also be used to prevent issues based on previously analysed data, like risky blood glucose levels.

Accessibility / User Experience

  • Access to information is simple and intuitive via apps available on various devices.
  • Patients and physicians can easily monitor results with comprehensive user interfaces. Both may receive warnings or advices adapted to the chronic disease monitored.

However, not all of IoT is made in heaven...

Many obstacles are still in the path

There are still concerns and limitations on healthcare IoT that must be addressed.

Reliability

  • Although one can find thousands of IoT systems available on the market claiming medical benefit, are they really based on a proven medical knowledge ?
  • In France several physicians created labels dedicated to assess medical value (medical relevance, useful for an algorithm computing insulin injection for example), security value (how it protects your data), legal value and ethical value. : mHealthQuality3 and MedAppCare4.
  • It helps users have confidence in IoT systems based on medical authority standards.

Privacy / Security

  • As the potential of IoT devices and mechanisms become more diverse, we also see an immediate and concerning correlation with unwanted reuse. The companies collecting these private health data could sell it or adjust fees to your behaviour.
  • We also see a steep rise in aggressive hacking whereby personal data is used as leverage against the user (and ransoms !).
  • In France, the e-health national agency has set up a mandatory security standard for companies storing health data5. Within the UK there is also the Data Protection Act which helps users have some rights with regards to their own personal data management.

Cost

  • In each country the social security system may choose to include the healthcare IoT in their caring options depending on the circumstances.
  • In the UK depending on the circumstances of the individual the NHS may choose to fund developing technology to treat the patient, but is not yet in the area of funding to prevent illnesses. Thus prevention is more dependent on the individual’s personal interest, and economic wealth as the IoT/wearable tech is not cheap!
  • In France some healthcare IoT options are under medical and economical study to reimburse the citizen if they have a chronic disease (for example diabetes6), if it improves the treatment … and reduces healthcare expenditures.

Healthcare IoT stakes are now more about ethics than technology

There are many advantages of using IoT for both personal and utilitarian purposes. Allowing personalised information to be gathered, and specialised solutions to be tailored to your behaviour is the most alluring aspect of healthcare IoT today.

However… is it really OK? Are we really comfortable with such methods?

People question the ethics of such tools that constantly collect data on the user. As the collected information is personal, the user may feel that the device is intrusive past its use. The second factor is that the user must be connected to benefit from the service, which may affect the user experience based on results. Will the data be used for the specific purpose or will it be passed on to third parties that may influence actions based on results?

We will all have to make this choice soon : do you think the risk of losing privacy and personal information is worth the endless types of opportunities that are available through IoT mechanisms?

Sources

1 : IRDES, 2014 : http://www.irdes.fr/enseignement/chiffres-et-graphiques/depenses-de-sante/comptes-de-la-sante-france.html

2 : Office for National Statistics : http://visual.ons.gov.uk/how-has-life-expectancy-changed-over-time/

3 : https://www.mhealth-quality.eu/

4 : https://www.medappcare.com/

5 : ASIP Santé “Agrément hébergeur de données de santé” http://esante.gouv.fr/services/referentiels/securite/hebergement-faq#3

6 : Diabeo is the first system that will be refund by the French Assurance Maladie : http://www.ticpharma.com/story.php?id=28

Sources:

https://www.forbes.com/sites/forbesleadershipforum/2011/07/14/promoting-wellness-vs-illness-its-all-about-we-vs-i/#c36dcc740b2a

http://www.francesante2017.fr/wp-content/uploads/2016/06/RN_LB_SANTE.pdf

http://uk.businessinsider.com/internet-of-things-in-healthcare-2016-8?r=US&IR=T

http://www.mc2i.fr/Les-modeles-economiques-des-laboratoires-pharmaceutiques-autour-de-la-m-sante

http://uk.businessinsider.com/internet-of-things-security-privacy-2016-8?r=US&IR=T

https://www.theguardian.com/commentisfree/2016/oct/02/brian-krebs-ddos-attack-google-protection-cybercrime

https://www.scmagazine.com/ethical-challenges-of-the-internet-of-things/article/538993/

http://www.legislation.gov.uk/ukpga/1998/29/contents

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