10 Mar

Connected Health and the Internet of Things

For the past three years, Chesapeake Physician has attended the HIMSS mHealth Conference in Washington, DC, to report on the latest trends in healthcare mobile technology. This year, the conference was renamed Connected Health to reflect its broader scope and its integration with a CyberSecurity and Population Health Summit, with the goal of creating more transformative mobile healthcare approaches.

The latest buzzword – the Internet of Things (IoT) – was on lots of lips at the conference.

An app that stood out from the conference crowd was SmokeBeat, a data-analytics software platform that works with standard smartwatches and wristbands to identify, in real time, when users are smoking and take them through an effective smoking cessation process. An app developed by a Chesapeake-region physician for diagnosing and treating concussions is also highlighted here.

The Internet of Things (IoT) is yet another healthcare acronym, albeit one shared with other industries. While definitions vary, it refers, essentially, to connected smart sensors. A 2015 MarketResearch.com report projects that the healthcare IoT market will be worth $117 billion by 2020, and healthcare is expected to be among those industries that benefit most.

The applications of IoT are numerous, spanning from the increasingly ubiquitous smartwatches to home monitoring equipment to sensors that can promote hand washing in a hospital. Hospitals are also using IoT to track patients, equipment and staff. For example, radio frequency identification tags (RFID) are being used in combination with mobile scanners and the ‘cloud’ to track medical inventories and reduce the need for costly overstocking.

Real-time location systems (RTLS) use geolocation technology embedded in a smartphone or navigation system to track shared equipment such as infusion pumps, wheelchairs and defibrillators. And clinical staff in the PACU can determine where patients are in the ER or OR to predict their arrival in the ICU, or medical surgical staff can predict when patients might arrive from the PACU.

The IoT also has the potential to improve drug management by adding RFID tags to medication containers, and around the corner is the ability to embed the technology into the medication to create smart pills that monitor medication usage.

Innovative Smoking Cessation App

An intriguing new app unveiled at this year’s conference uses real-time identification of hand-to-mouth gestures such as those used in smoking to improve healthy behaviors. Given that smoking kills nearly half a million Americans each year, and that smoking cessation is one of the hardest ‘prescriptions’ for patients to follow, a meaningful mHealth approach to cutting back is intriguing.

According to the CDC, as of 2010, about 42 million adults in the U.S. smoked, and the number was growing about 2% per year. While roughly 70% of smokers want to quit, only half of them actually try to quit, and only about 6% succeed. Mobile technology has proven helpful for promoting the adoption of healthier lifestyles, including helping them monitor their activity or quit smoking, but a new app called SmokeBeat takes that help to another level of sophistication.

The app was launched by an Israeli company called Somatix in November 2015, after it analyzed the motions involved in smoking a cigarette. According to Eran Ofir, CEO of Somatix, SmokeBeat is the first app to use the power of hand-to-mouth gesture recognition by using an accelerometer and a gyroscope to identify when a user is smoking.

The company has been thoughtful in its approach to designing this app, using behavioral psychology based on sound academic research. After analyzing the movement patterns and speeds involved in smoking a cigarette, it uses a complex algorithm to determine when the hand-to-mouth gesture involves smoking a cigarette versus eating, drinking or another activity. While not perfect, it’s helpful for the average person, whom Ofir claims underestimates how much they’re smoking by 30%.

The goal is not necessarily to have the person quit smoking completely, but to have them understand how much they’re smoking, when, where and why, and to decrease how much they smoke through personalized incentives.

Ofir says, “Most people think they smoke less than they actually do. SmokeBeat helps them track their smoking habits, including the number of cigarettes they smoke, where they smoke most, when and why.”

He adds, “Our goal is harm reduction. Every cigarette decreases a person’s lifespan by 11 minutes. Because social support is the biggest factor in successful smoking cessation, we also can help them join a group, or create their own supporting group of friends and family.”

Ofir and his colleagues combine the data with tailor-made incentives to quit. “We provide four types of incentives: rational, social, financial, and emotional. We can measure the responsiveness of each person to these different incentives and find what is most motivating for them.”

While SmokeBeat is hardware agnostic and runs on most smartwatches and wristbands available, it initially is available only to users of Android phones, but will soon be available to those with iOS.

Joining Forces With Employers and Insurers

Using the data provided by Somatix, companies can determine which programs are most effective, get insights on their employees’ or members’ habits, and customize reports to meet their needs. Because smoking is linked to so many diseases, a growing number of employers and insurers are willing to pay people to cut back.

“Companies are willing to pay up to $1,500 per employee to address smoking in their employees,” Ofir states. Some large companies, such as IBM and others, spent tens of millions in internal campaigns and cessation programs for their staff. “We can provide incentives for people to smoke less and set goals by the number of cigarettes they smoke or the dollars they spend. We can do predictive analytics so that we know when a person is likely to smoke, based on his location, timing habits or people he is with, and suggest healthier alternatives to a cigarette.”

Currently, a few heath insurance companies, clinics and employers are using SmokeBeat in pilots outside the U.S. The company is taking its first steps in the U.S., presenting its platform to employers, clinics and other related organizations in the healthcare system.

Insurers, employers and clinics can analyze the data collected via the app, get a dashboard report and offer personalized health plans, combined with incentives that work and positively influence the cost of healthcare for their members, employees or patients.

Potential Interventions in Eating Disorders, Substance Abuse

Perhaps the most exciting aspect of the technology offered by Somatix is its potential to ameliorate health problems such as eating disorders, manage medication and alcohol consumption, or help people care for older relatives. For example, analyzing movements involved in consuming food, drinking or even vomiting using the gyroscope and accelerometer could theoretically allow medical professionals to track how much an anorexic is eating or when someone with bulimia is purging. For frail older adults, the device has the potential to monitor how much they eat and drink, helping caregivers intervene earlier to prevent serious health problems.

Youth Concussion Assessment Apps

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Gerard Gioia, PhD, pediatric neuropsychologist and director of the SCORE Concussion program at Children’s National Health System, collaborated with colleagues at University of North Carolina at Chapel Hill and PAR, Inc., to develop smartphone and tablet apps for youth coaches, parents, athletic trainers, and other healthcare professionals to help them recognize and respond to concussions.

The free app for youth coaches and parents, Concussion Recognition & Response (CRR), is based on information that Dr. Gioia developed with the Centers for Disease Control and Prevention’s Heads Up initiative (cdc.gov/headsup). Parents and coaches answer basic questions about the athlete’s signs and symptoms to determine if he or she has suffered a suspected concussion, and receive recommendations for the appropriate next steps.

Dr. Gioia explains, “The app creates a good assessment and communication tool for parents and coaches. The information logged into the app can be emailed to the pediatrician or ER provider, or can be printed out. As a clinician, this kind of information is hugely helpful.”

The app has been downloaded by tens of thousands of people. “Families love it because they don’t have to remember what to ask or what to look for. The app guides them through the process. It’s like the ‘911’ of concussions,” Dr. Gioia comments.

A separate but related app for health professionals, called the Concussion Assessment and Response™: Sport Version (CARE-Sport Version), helps athletic trainers, team physicians and other qualified professionals assess the likelihood of a concussion, rule out cervical spine injury, evaluate cranial nerve function and respond appropriately.

Eran Ofir, CEO of Somatix

Gerard Gioia, PhD, pediatric neuropsychologist and director of the SCORE Concussion program at Children’s National Health System, Washington, DC

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