Remote Healthcare: Too Good To Be True?

A woman talks to her physician using a tablet from her couch from www.recruitingdaily.com.

It is no secret that things are changing rapidly in the healthcare industry, in large part due to the COVID-19 global pandemic (2). The increased use of Telehealth is drawing attention emerging technologies and how we can harness their power to improve healthcare for all people. Internet of Things (IoT) and Artificial Intelligence (AI) & Machine Learning, in particular, are shaping the direction of these changes and are enabling us to do things that we could never do before. It is an exciting time to be alive but how can we ensure that we are heading in the right direction?

What Are These Emerging Technologies Anyway?

Before we can understand the impact of these new technologies of the healthcare industry, we need to first understand what they are and how they work.

Image of a computerized brain receiving and producing waves from surveycto.com

What is IoT?

IoT is the communication network of software embedded in physical items in the absence of human interaction. Devices containing these softwares are able to communicate with each other to store information about the functions of the device itself and then communicate this information across other devices in the network, over the internet. IoT provides readily available access to information using the internet for the users convenience. Some major players in this emerging industry are:

  • Wipro Ltd.
  • TeleTracking Technologies. Inc
  • Microsoft Corporation
  • Cisco Systems
  • Amazon.com, Inc (AWS)

What is AI and machine learning?

AI & machine learning is the use of software technologies to make decisions in a way that imitates the way that humans think and process the world around them. Software technologies are trained to get better at recognizing patterns within the data they are provided so that they can arrive at accurate responses when faced with complex decision. This allows for the automation of some tasks, freeing human bandwidth to process even more complex decisions. Some companies involved in this field are (10):

  • Google Health/ Deep Mind
  • IBM Watson Health
  • Oncora Medical
  • CloudMedX Health
  • Behold.ai

IoT and AI & Machine Learning in Healthcare

Graph of the growing IoT in healthcare market size by component from2014 to 2025 from www.grandviewresearch.com

Wearable health trackers are becoming increasingly popular. Many people have are able to have instant access to basic health information like weight, heart rate, blood pressure and much more. More advanced devices can be implanted either as a solution to a life threatening heart condition or for longterm cardiac monitoring in patients with suspected cardiac conditions. The data collected from these devices is stored in an internet-based cloud network and can be accessed by your authorized healthcare providers to assist them in tracking your health. One such example is Medtronic’s Linq II device. Below is a video that provides an overview of how it was developed and how it works (8).

Such technologies provide opportunities for both the physicians and for their patients. Wipro, one of the companies leading IoT technology development released and article that outlines the positive contributions of IoT and AI & Machine Learning in an article called, “What can IoT do for Healthcare?” Some notable advantages are noted below (4):

  • Continuous access to real time data: These devices continuously track the events of the patient and are able to learn and develop a baseline that is unique to that patient. If the patient were to have an event, both the patient and the physician are able to keep track of the severity of the event, the frequency of these events and the context of the event ie. what was the patient doing at the time of the event. Access to this information in real time enables both the patient and their physician to have a better understanding of the patient’s condition and what treatment would be most helpful for them (5).
  • Less Expensive: The cost of remote patient monitoring and remote patient care visits is significantly reduced for both the patient and for the provider. The patient does not have to drive to the hospital, which might be far from their home. Patients with children do not have to pay for someone to watch the kids while they visit the physician and those with jobs do not have to take an extended amount of time off to visit the physician for a routine visit. Additionally, Physicians are able to see more patients than they would be able to when patients present in-person. Finally, it is less expensive for the hospital as less patients coming in reduces the wear-and-tear of the devices because of the high volumes of patients that visit the hospital.
  • Early Diagnosis: Continuous access to real time data allows the physicians to catch potentially problematic symptoms earlier and can reach out to the patient and make interventions if needed without having to wait until the next time the patient is available to go in.
  • Fewer Errors: Improvements are constantly being made as these technologies are exposed to more data about the patient. With time, these technologies are better able to filter out the noise and detect true events even when these seem small. This is something is almost impossible to do when the patient is only able to make it to the hospital once or twice a year.

These advancements have the potential to significantly improve healthcare both personally, through the personal data that is collected to create a personal profile of each person’s health, and globally. Remote healthcare provides a possible solution to the healthcare gap by giving access to people in remote places, access to great healthcare, from the convenience of their home. Remote healthcare is also able to alleviate some of the burden on the healthcare system as patient’s concerns can be triaged using tele-health and more resources devoted to managing urgent needs in the hospital.

Additionally, remote healthcare serves great benefit to patients with chronic illnesses. The goal for such patient is to keep them out of the hospital because their comorbidities put them at greater risk of death every day that they stay in the hospital. To be able to keep them out of the hospital with frequent monitoring provides the best outcome for their health.

Finally, it would be incomplete to discuss internet technologies without considering the potential impact of so much personal data being transferred and stored on the internet. As such, our ability to benefit from the power of IoT relies on the strength of the structures we put in place to protect this data.

What Would It Take To Normalize Remote Healthcare?

One would be tempted to ask: “With all the benefits we can get from remote healthcare, what have we been so slow to make it a standard?” The first barrier that needs to be tackled to normalize remote healthcare as a standard is privacy. While technology is making many advancements, policies and regulations have been one step behind. Personal Health Information (PHI) is very sensitive hence we cannot standardize remote healthcare without first finding a way to keep patients safe.

Additionally, people generally need to trust that technology works a lot better now. The COVID-19 pandemic provided a context in which remote healthcare could really have a chance. Due to the high risk of inpatient visits, the healthcare system had to quickly make remote healthcare widely available and restrict who could report for in-person visits. This gave patients little option but to give it a try. In a short report from CNBC on Telemedicine, they highlight that the number of medicare patients using telemedicine went up from ~11,000 people/week to 650 000 people/week (1). Increased awareness and exposure to telemedicine has allowed many people to quickly accept it as a viable alternative to in-person doctor visits.

Are We Jumping to Conclusions?

So far, we have mostly focused on the benefits of remote healthcare and the positive impacts it would have on our lives but before jumping to conclusions, we must consider key assumptions, uncertainties and any missing information.

  • We have discussed the reluctant adaptations to remote healthcare among patients and have made the assumption that since the pandemic, patients have been exposed to tele-health and are convinced that they would prefer to see more investment in tele-health over investing those resources in alternative ie hospital capacities and health insurance. Additionally, we have made the assumption that patients have been going to hospital almost exclusively in person because that is the only option that they had.
  • We made the assumption that patients would prefer having peace of mind about their health and that they would be willing to trade their privacy and ownership of that information to that end.
  • We cannot know how this will affect the training of healthcare workers in the future. Right now medical training relies on the ability to see the patients and do a physical assessment. Adopting remote healthcare would require a change in how medical professionals are trained. Additionally, we need to invest in incorporating Augmented Reality and Robotics to be able to provide more detailed information to a physician that is not in the same room as the patient.
  • We don’t know the cost. We made the assumption that investing in remote healthcare would save money but it is hard to determine who is bearing the cost? Would Doctors be paid less because the value of their training rests in being able to physically assess the patient but with telemedicine, this is limited. How would this affect insurance? Some of these questions are addressed in the CNBC report below (1).
  • Who has access to the data? How much of how it is being used do we know? These are questions we cannot fully answer at this point in time. However, these questions need to be addressed for Remote Healthcare to be able to protect the patient.

Should We Be Concerned?

While there is much to celebrate about remote medicine and the opportunities it will avail us, much thought must be put into making sure that the right structures are set up and the data collected does not fall into the wrong hands. Yuval Elovici gave a TedTalk about the dangers of IoT. He gives an example of what could happen if information and access got into the wrong hands (6).

In an article by the Opinion, writer Farhad Manjoo highlights how little we know about who has access to our data and how this affects us and those that are around us (9). As more data gets uploaded to the internet, we need regulations to protect the information on it and regulations on who gets access to what information. Once there has been a breach in one IoT device, hackers are able to access anything else that is on that wifi channel (7). Additionally Manjoo brings up concern about big brother, essentially arguing that with we are signing away our privacy without thinking and unknowingly allowing the government, and many others, unrestricted access to the most personal part of ourselves. Remote monitoring of healthcare devices require continuous tracking of the patient and thus, patients are essentially under constant surveillance.

There may also be many unintended consequences. Government regulations are a step behind and have been playing catch up with technology. Medtechdive wrote an article about how the government is trying to catch up with advances made in AI technology (3). Having continuous unregulated access to patient information puts us all at risk because we are all patients at some point in our lives. We need to figure this out before healthcare can fully be embraced. Furthermore, remote healthcare may unintentionally increase the disparities in healthcare by promoting confirmation biases about people of various descent. We would need to do further research to ensure that our remote diagnosis tools are trained to correctly identify symptoms of various diseases regardless of race.

To conclude, there is so much we stand to benefit from remote healthcare, however, there is a lot that we need to consider as technology advances. For starts, we need to empower the patients that are giving up a lot of their privacy for the benefit of good health. We need to set rules and regulations around the transfer of data from patient devices to the physicians. Additionally, we need to balance the privacy of patient data with transparency towards the patient as to what the data is used for, who has access to it and who is responsible for keeping it safe. Ultimately, it is the patient’s data and they should have the ultimate say about what happens to it.

References

  1. Is Telemedicine The Future Of Health Care?
  2. Accelerating the health economy of tomorrow: Transforming health systems and embracing innovation amid a pandemic.
  3. FDA AI-machine learning strategy remains work in progress
  4. IoT in Healthcare Industry | IoT Applications in Healthcare
  5. Aruba: The Rise of IoT in Healthcare
  6. How dangerous are IOT devices? | Yuval Elovici | TEDxBGU
  7. Internet of Things Security | Ken Munro | TEDxDornbirn
  8. Meet LINQ II™ Insertable Cardiac Monitoring System
  9. It’s time to panic about who’s watching us | The Opinion Pages
  10. Top Artificial Intelligence Companies in Healthcare to Keep an Eye On