The Internet of Healthy Things (IoHT) for Healthcare Organizations Webinar

© 2016 InterSystems Corporation. All rights reserved.
Todd Winey, Senior Advisor, InterSystems
Planning for the Internet of Healthcare Things (IoHT)

1 | © 2017 InterSystems Corporation. All Rights Reserved.
Agenda
• State of IoT in Healthcare
• IoHT Value Paths
• Keys to Managing IoT data in Healthcare
• A Real World Example of IoHT Thinking – Partners Healthcare

Laying the Groundwork for the IoHT
• Smartphone Penetration Surpasses 80% of the US in 2016
• NYU Langone Medical Center study (June 2015)
• 58% of smartphone users have downloaded a health-related app
• 41 % downloaded more than five apps.
• Proliferation Consumer health tech
• 38 million fitness wearables sold in 2016
• Up from 25 million in 2015

IoHT Market Reality
• Gartner's Hype Cycle for The Real-Time Health Systems
• 5 to 10 years for mainstream adoption of the IoT in health care
• Market is growing rapidly, however….
• Few early success stories - utility unproven
• Wearables - Wonderful or Worthless?
• 1/3 of all fitness trackers abandoned after the first 6 months of use (Ledger, 2014)
• Only 50% of Fitbit’s 20M users actively used tracker in 2015 (Associated Press, 2015)
• Build it and they won’t necessarily come….
How to approach this Brave New World strategically?

Gartner Hype Cycle – Real Time Enterprise
These
technologies
feed the IoT
IoT Platforms
5-10 year
timeframe

The Value of IoT in Healthcare (IoHT)
• Two levels of value
• Operational Efficiencies – Addressing Specific Pain Points
• Optimization of single data transaction
• Focus on cost reduction, asset efficiencies
• Just get specific data into the EMR
• Data Supply Chain – Key to Precision Medicine
• Optimization of All data transactions
• Data moves to all players at the Right Time – information Life Cycle of IoHT
• Creation of the Digital Phenotype from IoHT data

Operational Efficiencies
• Decreased Costs, Reduced Errors
Accurate collection of data, automated workflows combined with data driven
decisions cut down on waste, reduce system costs and minimize errors.
❑ Wireless asset management
❑ Medical device connectivity
❑ Temperature & humidity monitoring
❑ Interactive patient care systems
❑ Location Condition & Sensing Technology
❑ Patient Throughput and Capacity Management
Likely happening RIGHT NOW in your organization, with focused programs on targeted problems.

Data Supply Chain
• Improved Outcomes of Treatment
• Caregivers access real time information that enables them to make informed decisions ensures
health care provision is timely and treatment outcomes are improved.
• Improved Disease Management
• Patients are monitored on a continuous basis and health care providers are able to access real
time data, diseases are treated before they get out of hand.
• Enhanced Patient Experience
• The connectivity of the health care system through the internet of things, places emphasis on the
needs of the patient. That is, proactive treatments, improved accuracy when it comes to
diagnosis, timely intervention by physicians and enhanced treatment outcomes result in
accountable care that is highly trusted among patients.
Thinking strategically about IoHT.

IoHT Vision – The Digital Phenotype
• Maximum value and disruptive innovation will come from new, not yet
created data sets
• Future usefulness of IoHT is to turn information into “Digital Biomarkers”
• Digital biomarkers are consumer-generated physiological and behavioral
measures collected through connected digital tools.
• Collecting, producing, processing raw data to create valuable analytics and
insights - The Digital Phenotype in Healthcare
• Precision Medicine – all data used precisely, including the digital biomarkers
People are increasingly leaving a footprint of their health status through technology, including social media,
forums, online communities, wearable technologies and mobile devices,” Dr. Sachin Jain

Data aggregation, integration, transformation, storage
and management
VNA
Imaging + Clinical
Genomic Medicine
Genomic + Clinical
Population Health
Financial + Clinical
IoHT
Mobile + Clinical
Innovation and
Insights at the
Intersection of Data
Sets

True Precision Medicine Requires
Complete Information
Clinical information, genomics, claims, images, and sensor data coupled with socio-economic information yields the true
unified view of the patient.
Imaging
Financial
Clinical
Genomic
MobileDemographic
IoHT
IoHT data is a
critical input of
the Digital
Phenotype
Complete Information
= Clinical, Financial,
Genomic, Mobile,
Demographic and
Image data =
Precision Medicine

Guidance on Managing IoHT Data

Leveraging IoHT data in Real World
• Serve two masters – clinicians and patients
• Clinicians are busy, need focus
• Deliver data that is meaningful, relevant and contextual
• Patients expect control and awareness
For clinicians there's a need to devise more intelligent ways to aggregate
data across all patient devices, assimilate it and make the data available
to everyone within the workflow of the care of that patient.

Managing the Data for Clinicians
• Many “solutions” want to dump a bunch of data on the clinicians
• “Let them sort it out” – recipe for dissatisfaction or disuse
• IoHT/continuous data does not mesh well with episodic interactions
• “Just get it into the EHR?”
• View IoHT as a Big Data challenge
• IoHT data spans EHR systems
• Need to share with expanded care teams
Have a data management plan to handle multiple devices across multiple
EMR and clinical systems

IoHT Means “Devices”
• Mobile
• acute monitoring, wearables, health apps, BP monitors, oximeters,
glucometers,
• HIM
• MFPs, scanners, faxes, printers, tablets, smartphones
• Imaging
• X-Ray, scopes, ultrasound, wound care
• Lab
• hematology, biochemistry, immunoassay, PoCT
…broad definition, but all are becoming “smarter” and smaller

Healthcare “Devices” Connectivity Reality
• Focus on the plan, NOT the “things”
• IoHT is an exercise in endpoint management, not endpoints
• For any HCO, IoHT is a mix of endpoint management approaches
• Device Concentrators from large vendors – GE, Philips, Siemens
• Proprietary Connections to legacy devices
• Direct API connects – need to manage a significant number of direct APIs
• API Management Platforms – i.e. Validic
• Evolving Devices on FHIR (DoF) standards
Find ways to efficiently support all approaches, interchangeably

Physicians have limited time and limited data
Solving for Limited Data - Bring them the data
• Not a document repository
• Supports rendering in native systems
• Respect workflow
• Unstructured data into structured data and available for analytics
Solving for Limited Time - Automation
• Offload select functions to intelligent software
• Support clinicians without trying to replace them
• Flexible data source - Same data visible in the LCV is available to any solution that needs it
• Deliver data to any solution that needs it
• Gap analysis and alerting - Unburden the provider’s brain

Patient Expectations Requires More Planning
• Disconnect between other IoT efforts and healthcare
• A palette or box of razor blades has no expectation of privacy
• IoHT is really the Internet of Patients (IoP)
• All device data associated with a patient
• With that comes consent and privacy requirements
• Thoughtful downstream data use to leverage the Digital Phenotype
• Understand your Data Supply Chain
• Be able to see it and manage it
Granular consent and privacy controls at the discrete data level

Think About Your IoHT Platform
• IoHT is on a whole different scale
• Because it is healthcare data, its not just a “normal” Big Data issue
• Governance and Consent issue are greatly magnified
• Industrial IoT platforms lack this knowledge
• Think about reuse scenarios for data and plan for it
• IoHT has a lot of useful “data exhaust”
• Potential legal, marketing, and public-relations risks around
leveraging that data.

Consent for IoHT
• Healthcare Consumerism will demand patients to take ownership of
their personal data
• IoHT systems need to be transparent.
• Patients must be able to review when their personal data is collected
and how it is used.
• Patients will give or withdraw consent.
• Consent should not only be "in or out" but granular.
• Patients must be able to choose subsets of data they are willing to share with
IoHT systems and with whom they will share it.

Thinking IoHT
Practical Advice

Strategic Thinking
• Create an IoHT Team
• Analyze existing projects
• See how they fit into larger IoT Thinking as Endpoints
• Establish measurable and explore financial viability
• Start Small
Endpoint = any “smart” source contributing data. IoT thinking is about managing
LOTS of endpoints but viewing connectivity as the starting point, not the end.

What to Look for in IoT Technology*
• Devices and their application software management
• Data aggregation, integration, transformation, storage and management
• Event processing: rule engines/orchestration/business process management
• Programmability, Analysis and data visualization
• Security
• Multiple message protocol communications
• Adapters for endpoints and OT and IT applications
• A user experience policy and technology enabling self-service
• Ensure that policies address the privacy, security and compliance challenges associated with
patient generated data by IoT projects
*Gartner: Hype Cycle for Real-Time Health System Technologies, July 2016

Managing Endpoint Risk
• Across sectors, the devices that comprise the IoT are as diverse as
the industries that use them.
• These devices, however, share two important attributes:
• they can collect, store, and transmit personally-identifiable information (PII) and
• they can be compromised.
• IoHT carries two more attributes:
• Enhanced privacy risks
• Enhanced security risks

What to Plan For
• Risk Mitigation
• Data Governance
• Focus governance efforts on Data Security.
• IoHT efforts must institute reasonable security.
• Generally reasonable data security

Risk Mitigation Plan
• Inventory and Classify your “IoHT” devices organization wide
• Beyond inventory – data map where it resides, originates, moves and
transmission capabilities
• Apply risk models to device groups
• Focus on High to Medium risk first
• Establish monitoring and security plans
• Focus on weakest devices first
• Basic security hygiene
• Repeatable plan for each implementation
Probability
High
Severity
HighLow

Generally reasonable data security
• “Security by Design.” -
• Ask your IoHT partners if they “build security into their devices at the outset, rather than as an
afterthought.”
• This includes performing a HIPAA-like security risk assessment, considering how to minimize the
data devices collect, store, and transmit, and testing security measures before launch.
• Personnel Policies that Promote Good Security.
• Organizations should address product security “at the appropriate level of responsibility.”
• Data Minimization.
• In the health IoHT world, more is not always better.
• Notice and Choice.
• Providing consumers with the ability to make informed choices about how their data will be used
and disclosed is especially important for sensitive health information.

Questions?

Thank You
Todd Winey
Senior Advisor, Strategic Markets
InterSystems
Todd.Winey@InterSystems.com

TODD WINEY
Senior Advisor, Strategic Markets
InterSystems
Todd Winey is Senior Advisor, Strategic Markets, for InterSystems HealthShare. With over 25 years of healthcare IT experience
spanning payer and provider information technology, he brings a strategic perspective to healthcare IT that is eclectic. Mr.
Winey’s career in healthcare IT has evolved along with the industry itself, from early coding and reimbursement software, claims
adjudication, document management systems, acute clinical systems, to interoperability, medical device connectivity and health
information exchange. An early contributor to the utilization of resource-based payments schedules across commercial,
worker’s compensation and auto liability insurance lines, Mr. Winey was also a frequent consultant on state fee schedule
creation. His current focus is on the intersections of healthcare data and interoperability across the markets of clinical
laboratories, imaging, genomics and IoT. His career includes Senior Product and Business Development positions at ADP, First
Health/Coventry Health, Picis, Optum and InterSystems.

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