The Internet of Medical Things

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The Internet of Medical Things

by James G. Barr

Docid: 00021097

Publication Date: 2006

Report Type: TUTORIAL

Preview

A subset of the Internet of Things (IoT), the Internet of Medical
Things (IoMT) refers to a broad range of medical technology (medtech)
that enables the generation, collection, analysis, and transmission of
medical data for the purposes of diagnosing conditions and
treating patients. While forming a connected infrastructure of medical
devices, systems, and services that promote human health and safety, the
advancement of such technology also raises many privacy and security
issues.

Executive Summary

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A term coined by technologist Kevin Ashton in 1999,¹ the "Internet
of Things" refers to efforts designed to extend the dominion of the Internet
from cyber space to the physical world, creating a network of intelligent
devices and systems that form the mechanical equivalent of the body’s central nervous
system. The purpose is twofold:

To gather information about physical processes in order to improve them;
and
To exercise real-time control over physical processes in order to affect
greater efficiency, effectiveness, security, and safety.

Related Faulkner Reports

The Internet of Things Tutorial
The Internet of Things Market Trends Market
The Software of the Internet of Things Tutorial

Today, the Internet of Things is being divided – at least rhetorically
if not in actuality – into multiple subsets such as manufacturing,
transportation, and urban infrastructure. Apropos of the central
nervous system analogy, one of the more prominent divisions is called
the
"Internet of Medical Things."

The Internet of Medical Things (IoMT)
refers to a broad range of medical technology (medtech) that enables the
generation, collection, analysis, and transmission of medical data for the
purposes of diagnosing conditions and treating patients, forming a
connected infrastructure of medical devices, systems, and services that promote
human health and safety.

At the heart of the IoMT is its promise to preserve wellness, even
save lives. For example, with heart disease as a leading cause of death, IoMT-enabled
systems and devices like "KardiaMobile" (see Figure 1) can:

Capture a medical-grade EKG in 30 seconds anywhere, anytime
Detect atrial fibrillation, bradycardia, tachycardia, or normal sinus
rhythm
Store patient EKGs on their phone, and e-mail them to their personal
physician or cardiologist

Figure 1. KardiaMobile

Source: AliveCor, Inc.

IoMT Market

Expanding rapidly, according to Deloitte, the IoMT market will reach $158 billion by
2022, up from $41 billion in 2017.²

Equally optimistic, AlltheResearch predicts the IoMT market will be
valued at $254.2 billion in 2026, up from $44.5 billion in 2018.

The smart wearable device segment, which includes smartwatches and
sensor-laden smart shirts, will be a major contributor. As analyst Andrew Steger
asserts, "This area of IoMT is poised for even further growth as artificial
intelligence is integrated into connected devices and [proves capable of] real-time, remote measurement and analysis of patient data."³

Internet of Bodies

A crucial component of the IoMT is the so-called "Internet of Bodies" (IoB),
which, according to Northeastern University law professor Andrea Matwyshyn,
"refers to the legal and policy implications of using the human body as a
technology platform."⁴ More specifically, the term refers to
devices that operate within the human body or on its surface, such as:

Pacemakers
Drug-dispensing patches
Robotic limbs
Artificial organs
Fitness trackers
Digital pills

Cybersecurity is an issue, preventing hackers from interrupting
life-sustaining medical interventions, as well as privacy, stopping unauthorized third parties from gaining access to sensitive patient data in
violation of HIPAA and other similar statutes.

The Internet of Medical Things

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As suggested by Deloitte, the central organizing principle of the IoMT is
improving patient outcomes by leveraging information to:

Enhance diagnostic capabilities
Expand treatment options
Improve disease management, including the remote monitoring of chronic diseases
Decrease costs, which lowers insurance and patient out-of-pocket expenses
Provide a better "patient experience"⁵

This is accomplished by storing and sharing medical device data in the same
way that electronic medical records (EMRs) store and share patients’ medical
histories. But while EMRs are passive, used by physicians and other
medical personnel to inform diagnosis and treatment, many IoMT devices are
active and autonomous.

One exciting example is the digital, or electronic, pill, which along with
dispensing critical medication helps eliminate the eternal problem of people
forgetting (or refusing) to take their medication. As reported by Peter Holley, according to a 2013 study cited
by the National Center for Biotechnology Information, "Approximately 30 percent
to 50 percent of US adults are not adherent to long-term medications leading to
an estimated $100 billion in preventable costs annually." In response, Edward Greeno, medical director of the Masonic Cancer Clinic at
the University of Minnesota, is utilizing a relatively new IoMT device: the
digital pill. A digital pill contains a tiny, ingestible sensor, which
"transmits data from inside the patient’s body to a wearable patch placed on
their abdomen, which then connects to a mobile app that patients and doctors can
access."

"The sensor, which is about the size of a grain of sand and dissolves in the
gastrointestinal tract, also tells doctors when a patient has ingested their
medication. The information is compiled in a database that doctors can
access from their devices."⁶

IoMT Technology

The Internet of Medical Things is being realized through rapid technological
advances, principally:

The development of small, inexpensive, and durable biosensors
Major advancements in wireless technology
The ability to incorporate smartphones and tablets as medical management devices
Artificial intelligence

According to analyst Rick Martin, "AI will play an
increasingly-important role in IoMT. AI software is able to intelligently sort through a torrent of data from IoMT
devices, and provide medical practitioners only with data that needs their
attention. As the market grows, AI will be the silent partner doctors will come
to rely on to keep them informed, but not overwhelmed."⁷

In addition to hospital staff who benefit from a connected medical/IT
infrastructure, among the principal beneficiaries of IoMT technology are
patients suffering from chronic conditions like heart disease and diabetes. IoMT-enabled remote patient monitoring helps reduce doctor visits, as well as
giving physicians an early warning of any medical problems.

As an added bonus, Mr. Martin cites the ability of IoMT systems to heal thyself.
"MRIs, X-ray machines, CT scanners, and other equipment can be remotely
monitored for performance issues. Long before hospital staff notices a problem,
the manufacturer or service vendor can detect issues that need to be corrected.
GE, Siemens,
Philips, and other companies use IoMT for remote diagnostics, predictive
maintenance, and performance upgrades to their imaging products."⁸

IoMT Use Cases

To highlight the advantages of IoMT technology, analyst Nadejda Alkhaldi
cites four prominent use cases:

"Remote real-time
patient monitoring – Gathering data from medical devices
[permits the projection of] a holistic picture of a patient, and
[enables] constant monitoring that cannot be achieved through doctor
visits, even if those visits are frequent.
"Chronic disease
monitoring – There are medical devices that patients can use at
home to track blood pressure, sweat, and glucose level. According to
the Center for Disease Control and Prevention, 6 in 10 Americans
have a chronic disease, with 4 out of 10 having two diseases or
more.
"Verifying treatment
plan adherence – [Most often via] an IoMT pill.
"Timely and accurate
diagnosis – Connected medical devices allow capturing diverse
types of diagnostically relevant data that can be used by clinical
decision support systems. This includes psychological, [genetic],
and behavioral data. This diverse data projects a more realistic and
complete picture of a patient’s condition, [revealing] health
patterns that would not be visible to a doctor performing a one-time
diagnostic test."⁹

The Internet of Bodies

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While the use of "stationary medical devices," like X-ray machines and MRI
scanners, is normally non-controversial, IoMT devices
that penetrate (or become part of) the human body, like pacemakers and cochlear
implants, are causing concern among personal safety and autonomy advocates. That’s why a loose association of lawyers, journalists, medical ethicists,
and even some medical practitioners are advancing a new concept called the
"Internet of Bodies."

Part of the Internet of Medical Things, the Internet of Bodies refers to
medical or healthcare devices that are attached to, implanted within, or
ingested by patients. Examples include:

Fitness trackers (attached)
Cardioverter defibrillators (implanted)
Digital pills (ingested)

Since the IoB essentially connects a person’s body to the Internet, issues
surrounding personal privacy and cybersecurity have surfaced.

Privacy

As analyst Nicole Lindsay observes, while IoB devices are being employed as
"part of a broader effort to improve human health and not part of a strategy to
intrude on personal privacy," privacy still matters.

"What is particularly worrisome … is the
introduction of artificial intelligence (AI) into the equation. With AI, it is
possible to process massive amounts of data instantaneously, and to use powerful
machine learning algorithms to arrive at conclusions. AI could be used to create
a dystopian Orwellian state, in which all behaviors are tracked, all genetic
anomalies are edited or removed entirely, and all citizens are under constant
24-hour surveillance. Imagine being turned down for healthcare coverage because
an AI system detected certain warning signs in all of your biometric or
physiological data, or being required by the state to undergo behavioral
modification training for committing a ‘health crime.’"¹⁰

Emblematic of IoB privacy concerns is the human microchip implant. A
British firm, BioTeq, is presently producing and implanting human-grade
microchips, similar in concept to the chips that pet owners use to locate and
identity missing animals. Injected into a subject’s hand between the thumb
and index finger, the implant (see Figure 2), which boasts a miniature transponder, can allow
keyless access to buildings. More than a matter of convenience – and why
it qualifies as a medical device – the microchip, which can store medical data,
can facilitate entry for people with disabilities, including conditions such as rheumatoid
arthritis, multiple sclerosis, and motor neuron disease.

Figure 2. Human Microchip Implant

Source: BioTeq

Importantly, however, for employees of client firms deploying the microchips,
participation should be voluntary. Frances O’Grady, General Secretary of the British Trades Union Congress, says
that "The TUC is worried that staff could be coerced into being microchipped. We know workers are already concerned that some employers are using tech to
control and micromanage, whittling away their staff’s right to privacy."¹¹

While these risks may seem exaggerated, the law already recognizes a difference
between non-invasive data gathering, like fingerprinting, and invasive forms,
like blood or DNA sampling. Consequently, new legal and regulatory frameworks
must be established, in the same way that frameworks are needed to control other
emerging IoT technologies, like autonomous transportation.

Cybersecurity

While privacy is a long-term issue, an item of immediate import is cybersecurity
– the threat that hackers could assume control of a pacemaker or other IoB
device for purposes of extortion or even murder. Consider that in 2013, physicians attending former Vice President Dick Cheney
ordered the wireless capabilities of his heart implant disabled out of fear of
remote control assassination.¹²

Although not as dramatic but still as dangerous, IoB devices can contain hidden
vulnerabilities – exposures that cyber criminals might exploit. As
evidence, in 2017 the US Food and Drug Administration (FDA) recalled almost half
a million pacemakers over firmware-related security issues.¹³

The Big Questions

As regards the IoB elements of the IoMT, the big questions are:

Who controls the IoB devices in our bodies?
Who is responsible for ensuring the IoB
devices function as intended?
Who has jurisdiction over body-derived IoB
data?
How are disputes between patients and medical professional adjudicated?¹⁴

The Future of IoMT Technology

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The Challenges Ahead

The widespread
adoption of IoMT technology is likely years away. As reported by Meg
Bryant, according to Deloitte:

71 percent of respondents to a survey feel
hospitals and clinicians are not ready to use the data generated by
connected devices.
67 percent believe it will take another five years for FDA’s regulatory
framework for digital devices and medical software to catch up to what is
possible today.¹⁵

Other limiting influences according to Deloitte include:

"Interoperability – for interoperability to work
effectively, the direction of travel should be towards open platforms, based
on open data standards. This will enable payers, providers and technology
vendors to come together to make data more available to each another.
"Digital talent and building digital capability – there
is increasing concern among key stakeholders that a growing skills gap will
delay the deployment of IoMT solutions and constrain market growth.
"Scale– a key challenge for medtech is ensuring that
health care organizations, clinicians and patients understand the
added-value of connected medical devices and use them at scale to drive
better economics and patient outcomes.”¹⁶

The Nanobot Solution

In forecasting the frontiers of medical technology, analyst Filip Poutintsev
believes that nanorobots (or nanobots) hold the proverbial key. A nanobot is "a robot the size of a bacterium that can manipulate and control
materials at an atomic and molecular level. The first fruits of medical nanorobotics could begin to appear
in clinical treatment as early as the 2020s. Scientists envision two ways in which nanotechnology may be able to extend our
lives. One is by helping to eradicate life-threatening diseases such as cancer or heart
[disease], and the other is by repairing damage to our bodies at the
cellular level."¹⁷

The Dark Side

As with most technology, there is a potential dark side to future medtech. While trying to avoid visions of cyborgs, or
cybernetic organisms, the incorporation of medical devices within the human
body, which is now aimed at regenerative processes (such as disease reversal),
will inevitably – and probably quickly – refocus on human augmentation, creating
by design a new class of people.

Before this new reality manifests, it’s important for politicians,
bioethicists, and ordinary citizens to weigh in on a future where people already
separated by income inequality may be further divided by medical inequality.

The Pandemic Incubator

The current coronavirus pandemic will accelerate IoMT research and
development.

With the need for social distancing, physicians and other healthcare
professionals are interacting with patients over distance, often substituting
telemedicine techniques for in-person checkups.

Speculating on current and next
steps, analysts Ting Yang, Mattia
Gentile, Ching-Fen Shen, and Chao-Min Cheng believe that by leveraging
existing and emerging IoMT technology:

Healthcare providers could "create a medical platform to help
patients receive proper healthcare at home, and establish a
comprehensive disease management database for government and healthcare
organizations.
"Patients could upload their health status regularly to the IoMT
platform (clinical cloud storage) via the Internet, and their
information could be transferred to nearby hospitals, the Center for
Disease Control (CDC), and state and local health bureaus.
"Hospitals could subsequently offer
online health consultations based on each patient’s health condition,
and the government (the CDC, and local and state health bureaus) could
allocate equipment and designate quarantine stations (hotels or
centralized quarantine facilities) if necessary."

Importantly, patients "could dynamically monitor their disease status and
receive proper medical needs without spreading the virus to others."¹⁸

The impact of the coronavirus on the IoMT will last beyond the development of
a proven vaccine – or, in the absence of a vaccine, safe and effective
therapeutics. Even if Covid-19 is eventually conquered, which is not a
certainty, the healthcare establishment will need to plan for the next
pandemic. Much of their prospective work on prevention, containment, and mitigation will
rely on the Internet of Medical Things.

References

¹ "2013: The Year of the Internet of Things."
MIT Technology
Review. January 4, 2013.

² Meg Bryant. "Internet of Medical Things Market to Hit $158B by 2022,
Report
Predicts." Industry Dive. August 16, 2018.

³ Andrew Steger. "How the Internet of Medical Things Is
Impacting Healthcare." CDW LLC. January 16, 2020.

⁴ David Horrigan. "The Internet of Bodies: A Convenient – and,
Yes, Creepy – New Platform for Data Discovery. ALM Media Properties, LLC.
January 7, 2019.

⁵ "Medtech and the Internet of Medical Things."
Deloitte LLP. 2019.

⁶ Peter Holley. "Forget to Take Your Medication? A New Digital
Pill Will Alert
You – and Your Doctor." Washington Post. January 17, 2019.

⁷ Rick Martin. "Internet of Medical Things (IoMT) – The
Future of Healthcare." Ignite Ltd. November 30, 2018.

⁸ Ibid.

⁹ Nadejda Alkhaldi. "Internet of Medical Things: 4 Use Cases to
Enhance Your Healthcare Facility Operations." itransition.com blog. November 20, 2019.

¹⁰ Nicole Lindsey. "Internet of Bodies: The Privacy and Security Implications."
Data Privacy Asia. December 14, 2018.

¹¹ Peter Franklin. "Prepare to Be Microchipped." Unherd.com.
November 19, 2018.

¹² David Horrigan. "The Internet of Bodies: A Convenient – and,
Yes, Creepy – New Platform for Data Discovery. ALM Media Properties, LLC.
January 7, 2019.

¹³ Ibid.

¹⁴ "From IoT to the Internet of Bodies, Closer Than We May Imagine."
DistiINFO Publications. November 17, 2018.

¹⁵ Meg Bryant. "Internet of Medical Things Market to Hit $158B by 2022,
Report
Predicts." Industry Dive. August 16, 2018.

¹⁶ "Medtech and the Internet of Medical Things."
Deloitte LLP. 2019.

¹⁷ Filip Poutintsev. "Nanorobots Might Hold the Key
Towards Radically Extended Life Span." Medium.com. August 4, 2018.

¹⁸ Ting Yang,
Mattia Gentile, Ching-Fen Shen, and Chao-Min.
"Combining Point-of-Care Diagnostics and Internet of Medical Things (IoMT) to
Combat the COVID-19 Pandemic." ResearchGate GmbH. April 16, 2020.

Web Links

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Deloitte: http://www.deloitte.com/
US Department of Health and Human Services:
http://www.hhs.gov/
US National Institute of Standards and Technology:
http://www.nist.gov/

About the Author

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James G. Barr is a leading business continuity analyst and

business writer with more than 30 years’ IT experience. A member of

"Who’s Who in Finance and Industry," Mr. Barr has designed,

developed, and deployed business continuity plans for a number of Fortune

500 firms. He is the author of several books, including How to

Succeed in Business BY Really Trying, a member of Faulkner’s Advisory

Panel, and a senior editor for Faulkner’s Security Management

Practices. Mr. Barr can be reached via e-mail at
jgbarr@faulkner.com.

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