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Infographic: IoT in Healthcare: Types of Opportunities
To develop an IoT based solution like TRIVENI, it is important to understand the market opportunity. In this infographic we leverage information from various reports that define the market opportunity that allow for the development and investment in such a solution
We present the total economic impact of IoT in the Healthcare Industry as also the types of opportunities that can be explored by Healthcare Technology vendors
Your partner in Digital Health Transformation using innovative and insightful ideas
TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information:
Data | Medical Devices | Connectivity
Just the other day we heard the SpaceX rocket zoom off to the space to deliver a satellite to the geospatial orbit, Rosberg won the 2016 russian grand prix & Mars rover continuously transmitted the images and vital parameters from millions of miles away in the space
The above three scenarios present the ability to stream data in realtime to a base station providing the ability to remotely monitor the performance of a space-craft, a formula 1 car and a remote autonomous vehicle.
Similarly consider the following use cases in relation to a patient in a Healthcare setting:
patient information in a Hospital
patient in an ambulance or
patient under homecare
presents use cases that require remote monitoring of patient information.
The existing technological paradigms such as IoT, data streaming analytics, connectivity & interoperability allow for a framework to allow for remote patient monitoring in each of the three Healthcare use cases
I would like to propose TRIVENI, a remote patient monitoring solution that is a confluence of three aspects of patient information
Triveni proposes to implement a plug-n-play framework that will allow for easy connectivity between healthcare information sources. The etymology of the word TRIVENI in Sanskrit means “where three rivers meet”. Similarly, the three aspects of Patient Information need to be integrated to meet the requirements of a remote patient monitoring solution
Focus areas of TRIVENI
Initially to showcase the Proof-Of-Concept for the solution, the above three focus areas will be considered to present as the use cases. Each of the three focus areas present the ability to test the confluence of three aspects of Patient Information defined above
Need for TRIVENI
The Tower of Babel (Pieter Bruegel the Elder, c. 1563), a metaphor for the challenges existing in medical device semantic interoperability today
Piecemeal integration creating information silos; leading to difficulty in sharing patient information
Silos unable to deliver real-time patient data reliably; leading to lack of data synchronization to ensure latest time-aligned data
Vendor Dependent solutions; leading to internal battlegrounds
Lack of semantic interoperability between systems; leading to a tower of babel situation in medical device semantic interoperability
Captive investments by healthcare facilities in existing medical devices leading to a long time before the medical devices can be replaced with newer systems with easier connectivity features
The Remote Patient Monitoring Process Flow
Typical Remote Patient Monitoring process (adapted from Center for Technology and Aging)
The Center for Technology and Aging indicates a 5 – Step process for Remote Patient Monitoring. The 5 steps are essential to deliver a continuous flow of patient related information to the remote base station monitoring a patient(s) in any of the use cases or the focus areas presented earlier
The Remote Patient Monitoring Process Flow Mapped with TRIVENI Framework Components
It becomes imperative for the solution to incorporate these founding principles of a remote monitoring process into any framework/ product of such a nature. The process steps get implemented in the TRIVENI framework, allowing for the continuous monitoring of patient information from the various connected systems.
The processes allow for a modular approach to the Product Definition of the TRIVENI framework, with the ability for each component of the platform to evolve as dictated by its internal technology and thus enables each component to incorporate newer technology paradigms as and when they present themselves
The TRIVENI Components are
TRIVENI Connect ®
A programmable Connector that allows the transmission of data from the connected medical device
Supports BLE, Wireless technologies
TRIVENI Hub ®
A Medical Device Data Aggregator that has the ability to receive data from the TRIVENI Connect and transmit the patient vital data streams to the TRIVENI Exchange
Supports 2G, 3G, Wifi, 4G networks
TRIVENI Exchange ®
TRIVENI Exchange is a secure, reliable patient vital data store that can seamlessly transmit data received from TRIVENI Hub to TRIVENI Apps
SSL Security, supports interoperability, Data Delivery to TRIVENI Apps or Connected EHR Systems (via HL7)
TRIVENI Apps ®
TRIVENI Apps have the ability to securely receive identified patient’s Medical Data from the TRIVENI Exchange
TRIVENI Apps are delivered on Android, iOS, Web-based platforms
The TRIVENI Connect is a device that acts as a converter that allows any medical device to connect to the TRIVENI system. The Connect device for instance will be connected to a Patient Monitor via the RJ45, RS232-to-USB converter. Once connected, the TRIVENI Connect will automatically download the relevant driver from the TRIVENI HUB, that allows for the Patient Data Stream from the Monitor to be streamed. Additional features of the TRIVENI Connect are:
Has the ability to Fetch Data from the connected Device
No. of Manufacturers
No. of Devices
One TRIVENI Connect per Device
Convert Data from Device by encoding Device Data with Following information
Device ID, Manufacturer ID
Ambulance ID/ Hospital ID
The TRIVENI Device Should be configurable with the above data. Additional capabilities of the TRIVENI Connect are:
Allow for Access Point Configuration
Via PC/ Via mobile device
Configure the TRIVENI Exchange IP
Send Data to TRIVENI Exchange
Over the Air
Linux Based, WiFi USB Dongle with a RS232 – USB Converter
The TRIVENI HUB is a device that acts as a data aggregator device at the remote location. All the Patient Data streams from various connect devices are routed to the HUB. The HUB can be configured via a mobile app. Using the mobile app the users will be able to configure various aspects of the TRIVENI HUB like the internet connectivity, TRIVENI Connect linked to the HUB, Username and password configuration of the HUB & Connect devices, Store and forward configuration to name a few.
The HUB device has the following features:
Is a WiFi Router + Cellular Modem
Has the functionality to work as a patient data stream aggregator with a store and forward feature
Has multiple SIM slots or Multiple USB ports for Broadband Connectivity
Will Work as a WiFi Router Access Point for the TRIVENI Connect
Will work as a Cellular Modem for Transmitting the data to the TRIVENI Exchange
Will work as a WiFi Router Access Point for the TRIVENI Connect
Will connect with the Hospital LAN to connect to the Internet
Has the ability to store and forward patient data
Data streams will be prioritized based on the QoS of network connection
Ability to send data packets over multiple networks to reduce packet loss
Data aggregation from multiple types of sources other than TRIVENI Connects
Maintains the security of the data-on-move over wire and when data-stationary when within the TRIVENI Hub by enabling security protocols (SSL) and encryption of data
The TRIVENI EXCHANGE is a Medical Data+Media Server that can be configured as a Virtual / Physical Server. The EXCHANGE has RTP/ RTSP/ RTCP Capabilities for Live Streaming of the Patient Data Streams from each of the HUBs connected to the EXCHANGE.
The features of the TRIVENI Exchange are
Site Configuration: Allows the Creation of an Identity for a Client (Ambulance Services/ Hospital Provider)
Identification/ Allocation of IP Address (Destination IP for Medical Data Streams) for the TRIVENI Exchange
Allows the configuration of the TRIVENI Connect’s to stream data to the Identified IP Address
Has the ability to update the TRIVENI Connect / TRIVENI Exchange Firmware OTA
Has the ability to receive Voice and Data Streams
Has the ability to enable Live Streaming of Data, Video and Voice to TRIVENI Apps
Can be Configured for each client in a multi-tenant server configuration.
Has a Medical Data Controller module to identify the source and destination of the medical data streams
Ability to allow store and forward data on demand
Allows data push or pull configurations for the TRIVENI Components
Maintains the “device” drivers for various types of patient sources
The TRIVENI APP is an android or iOS based app. There are two APPs that come with the TRIVENI framework. One APP is for configuring the remote configuration for the connect and the hub devices at the location for the client
Another APP is for configuring the Exchange and for viewing the data being streamed from the various devices connected to the patients in the remote locations
Enables Care Anywhere
Web-based, Android or iOS based apps
Allows for a two way communication between devices
Free to download app on the App Store
Allows the user to authenticate her credentials
Allows two way communication between the Apps between two users
Ensures the reliability of the data
Security enabled to ensure patient data authenticity
TRIVENI Apps will be developed as web-based and subsequently as native apps
TRIVENI apps will incorporate the usability guidelines for the healthcare based apps
TRIVENI apps can be configured for data push or pull options
TRIVENI apps enabled with security and data encryption profiles
There are two types of TRIVENI Apps: TRIVENI HUB & TRIVENI EXCHANGE apps to configure remote and base components
Interoperability Considerations for Medical Peripherals
If one was to trace the progression of delivery of printer drivers, it presents an interesting case study regarding how hardware-software interoperability has progressed over the years in the IT industry. And studying these aspects help us to, hopefully in the future define the way Interoperability in the Healthcare Industry should be handled.
Printers have been essential hardware devices that are connected to the software platform (OS) via various types of connectivity platforms, and service the productivity needs of the organisation.
Lets consider the various Printer installation processes we have seen in the past
CD with OS compatible drivers: Printers started out as peripherals that required a specific driver to be installed on the system (PC/ Laptop/ Server) that was going to be connected to the printer, via a printer cable
OS with Pre-installed Printer Drivers: Then we progressed to the OS itself having a list of compatible drivers that enabled the OS to auto-detect the type of printer or peripheral that was connected to the system. This also allowed for network printers to be installed in the network and allowed for the print server to have all the relevant drivers installed just on that server. PCs in the network wanting to use the printer resource, just needed to send the document to the print server.
Cloud Printers: Now a days, it is possible to connect the printer to the cloud via HP-ePrint or google printer services and access the printer from anywhere in the world.
Device & Software Interoperability
Taking learning from the way peripherals interoperability has been handled in the IT industry, Healthcare Interoperability should be a de-facto feature that should be present in most systems
Interoperability needs to be made as a plug-n-play feature in the Healthcare Services and Solutions. What are the various “Peripherals” that need to be connected in the Healthcare Industry?
Healthcare Information Management Systems
Additional Thoughts on Interoperability
Now the idea for defining the progression of a hardware connectivity w.r.t. The Printer device, is to try and define how medical device connectivity & interoperability should be enabled in the future
Currently, Interoperability is a “Service” that is offered as part of the implementation process by the system integrator or the vendor of the healthcare software. The point is, why should the customer bear the cost of “connecting” the hardware and software OR two software’s within an organisation
In Healthcare we are working towards providing such seamless and plug-n-play connectivity between EMRs, medical devices and now a days, additionally the mobile health applications.
Was in a tweetchat sometime ago on the Need for Time Management for Practitioners (physicians, nurses, allied health professionals) in Healthcare, by the HealthXPh communities Weekly Tweetchat, Every Saturday.
During the conversation it was really interesting to hear from the practicing doctors regarding how they have to manage their time and work towards scheduling themselves around their HealthIT systems and their patient care activities.
It was really interesting because, aren’t the Healthcare IT solutions supposed to ease the workload of the users? Arent the solutions supposed to be developed around providing the Time Management activities of the healthcare practitioner?
Which again brings me back to my earlier question, arent the Healthcare IT solutions help the Healthcare Practitioner Manage their time? After all we have taken the paper records and replaced them with the feature rich and innovative healthcare IT solutions.
But then why do we hear the doctors say that they are losing direct face time with the patients?
Why are the nurses unable to find time to keep up with the IT and non-IT related work they are supposed to be doing daily?
In the multiple product development lifecycles that I have been through (and the experience of the reader might be the same or vary) I have found during the requirements phase there are two types of users, the first category are the ones who have perhaps not used a system earlier but would like to implement a healthcare solution. The second category are the ones who have had prior experience working on a solution and would provide their requirements that incorporates the enhancements or the lacunae that the earlier solution had.
I think the EHR systems are in this conundrum right now, wherein they need to fit into these two categories of users and fast. Building products is a capital intensive enterprise and the ‘project management’ practices are always focussed on gathering requirements and completing the project.
But during this ‘Delivery’ process are the requirements of the two categories of users been analysed in a way to deliver solutions that will take into account the needs of the users and come up with a solution paradigm that helps each of these users to ‘Manage’ their time.
Should the solution make a Healthcare Professional work their way around the solution, or should it be the other way.
I think it is this need for the solution to now work around every Healthcare Professional to help them manage their time better that will bring about the version 3.0 of the EHR solutioning.
In the version 3.0 of EHR solutioning multi-disciplinary teams will come together to develop the solutions that work around each users life-at-work and helps them to Manage their tasks in their workplaces.
As indicated in the recently concluded ArabHealth a message went out indicating that “One size does not fit all”
Extending the analogy to an EHR solution: If there is a uniqueness in treating each patient, it is obvious that the activities that a Doctor or a healthcare professional would do would be unique. At this point I do agree, that the process would perhaps stay same for the 80% of the time, but the datapoints to be presented or captured would perhaps be different from patient to patient.
I therefore think that the next generation of EHRs should be able to incorporate these variations as part of workflows that allows the solutions to be adoptive to the end-user requirements across specialities.
Some feature considerations for the next gen EHRs.
Incorporate Task and Workflow oriented frameworks. The workflow in the hospital is not stationary, it evolves as often as a patient’s condition
Incorporate the Healthcare Practitioner’s daily activities in the workflow, help them manage their time a, and not they working around what the system has to offer.
OK, so we converted all the paper forms into electronic formats and now have the ability to analyse them. Its now time to bring in cognitive platforms that present to a doctor generated pages that are relevant to a patient. 80% of the forms are not filled in 80% of the patient visits. Then why should all this data be ‘presented’ to be filled for each patient?
At the design time consider the time and motion analysis for each category of user, develop solutions to incorporate their activities.
EHRs should adopt a multi-form factor delivery approach. Now its clear, the desktops and PCs are here to stay. Go back to the drawing board and develop ‘for-each’ form-factor. A one size fits all or a responsive approach perhaps will not work in the case of the healthcare multi-form factor solutions approach. After all you cannot expect a 5 page form to be answered on a mobile device, just because we can make it responsive.
Make EHRs with the analytics first approach. Since the first systems, its always been the need to capture the infomation on systems so that we can analyse the data later. Today there should be the need to revise the data structures to meet the demands of analytic and cognitive computing.
Am sure there are more that can be collated, but will keep that for the Zen Clinicals series that I have been working on to define what a next generation EHR should have as core feature set and that is different from what it is today.
Founder HCITExpert.com, Digital Health Entrepreneur.