COVID-19 was first discovered in China less than a year ago. Since then, it has rapidly spread across the world, causing untold misery. Lives and livelihoods have been lost, the global economy has taken a severe blow, and the world is experiencing a type of crisis never witnessed in our living memory. While desperate attempts are being made to mitigate the suffering, for many, uncertainty hangs over their future.
The crisis has triggered a debate about the present health care delivery system. If ongoing developments are any indication, the Internet of Things (IoT) has the potential to become a game changer. It can help clinicians provide health care services from remote locations and, if the situation warrants, shift from patient-centered care to community-centered care.
The World Health Organization recently issued an interim guidance called “Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts” that says, “as hospitalization may not be possible because of the burden on the health care system, ” patients “with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels …or managed at home.” It goes on to state that “a communication link with health care provider or public health personnel, or both, should be established for the duration of the home care period.”
Remote patient monitoring (RPM) systems gather patients’ physiological parameters and transmit the data to health care providers. RPM can serve as this WHO-recommended communication link—and at the core of RPM is IoT. Remotely managed health care can lead to more efficient use of resources and the safety of patients and clinicians, limiting the spread of infections like COVID-19.
As yet, there are no specific medicines or vaccines for this highly contagious disease. The present approach of the health care system, focused on patients and hospitals, is under severe stress. There are not enough health care professionals. There are not enough hospital beds, mechanical ventilators, or oxygen cylinders—even in developed countries like Italy, Spain, the U.K., and the U.S. There is a shortage of intensive care units and high-dependency beds in hospitals required to treat the large number of COVID-19 patients who are queuing up for admission in large numbers.
This hinders the treatment of other patients requiring hospital care, jeopardizing their safety as well. In addition to these systemic issues, health care professionals themselves are under intense pressure. There are also worrisome reports about the transmission of the disease to health care professionals from COVID-19 patients under treatment, with some workers even succumbing to it themselves. The number of such cases is on the increase.
Based on their personal experience, Dr. Mirco Nacoti and his colleagues of Papa Giovanni XXIII Hospital in the province of Bergamo, the epicenter of the COVID-19 outbreak in Italy, recommended a home care approach for COVID-19 patients with mild symptoms in a recent article. The article argues that, under pandemic conditions, patient-centered and hospital-centered care “is inadequate and must be replaced by community-centered care. Solutions for COVID-19 are required for the entire population, not only for hospitals.”
The article goes on to elaborate that, lacking a sufficient staff and necessary equipment, overwhelmed by large number of patients to be attended, health care professionals are not able to give pandemic patients the necessary attention. Palliative care and hospitals are not able to maintain the expected standard of care. Doctors are often forced to choose between attending to pandemic patients and delivering regular services to other patients, such as child delivery.
Hospitals likely also facilitate virus transmission to other uninfected patients, contributing to the spread of the disease as ambulances and personnel rapidly become carriers of the virus. Front line medical staff can also become victims to COVID-19. According to the article, such disasters could be “averted only by massive deployment of outreach services.” This approach would limit hospitalization to a focused target based on disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing the use of protective equipment.
To provide sufficient health care support to COVID-19 patients and to slow down the spread of the virus, the medical community needs tools to obtain patients’ disease information. This data can help them decide on the course of treatment and to learn more about the disease itself.
Using clinical-grade sensors (often referred to as biosensors or biometric sensors) that are connected to RPM systems, it is possible to gather patients’ physiological parameters and analyze them. RPM is akin to PC-based data acquisition systems that are typically used in industrial applications. IoT is at the core of RPMs now being engineered and built, just as it plays an important role in industrial automation systems. The sensors used for measuring physiological parameters, such as the body temperature, heart rate, and blood pressure, are typically non-invasive, however—unlike the commonly used sensors in industrial automation applications.
Biosensors and biomedical sensors often come in the form of wearables or patches. They have built-in transducers that convert sensor outputs into electrical signals and transmit them from the patient’s location to the monitoring systems at the health care provider’s location for assessment and recommendations. Biosensors and biomedical sensors are the equivalent of multivariable transmitters used in industrial process plant applications.
With the help of analytical software, the patients’ historical physiological parametric data can be analyzed to detect or predict improvement or deterioration. At the individual level, such analysis helps health care professionals understand when to initiate appropriate remedial actions. At the collective level, analysis helps better understand the disease itself. RPM allows the data to be compiled, stored, and distributed in a structured and clinically relevant format, thus making better interpretation possible.
RPM systems built around IoT and wireless communication technologies such as Wi-Fi and Bluetooth—with their processing and connectivity capabilities—are emerging as potential solutions that will allow patients to stay in their homes while receiving the appropriate treatment. With the help of these RPMs, clinicians can direct treatment from remote locations. Even in the case of hospitalized patients, these systems will minimize the need for personal doctor visits to the patients’ beds and decrease the likelihood of spreading the infection.
Health care providers and authorities have found an ally in RPM typically built around IoT. Health care authorities, such as the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services, have recognized the situation. To respond effectively to the serious public health threats posed by the spread of the COVID–19, they have issued notifications that permit physicians and other health care practitioners to furnish services using remote communications technology to avoid exposure risks to themselves, their patients, and the community. The writing is on the wall—as the synonym of remote communications technology in the health care sector, IoT is headed for extensive use in the future. IoT offers a way out of some of the challenges of the health care industry, and may prove to be a game changer.
This article is a product of the International Society of Automation (ISA) Smart Manufacturing & IIoT Division. If you are an ISA member and are interested in joining this division, please email info@isa.org.