About a year ago I was in a meeting when someone casually threw out the acronym IOT. I was too unhip to know what it meant at the time (probably still) and I asked for clarification, which brought me exceptional scorn while I was told it stood for “Internet of Things.” Well I had heard of that, but hadn’t yet added the new acronym to my hipster vocabulary (or my health IT bingo card). Apparently, IOT is now a thing. But I guess that’s redundant.
And a pretty big thing, as it happens, if you look at all of the development going on around, well, things, that will network with each other over the Internet. To be honest, I’m not sure what is on the Internet if not for “things;” perhaps “stuff”? I guess Internet of Stuff doesn’t sound as cool and iOS, as an acronym, is already in use by our friends at Apple. Internet of Cats? Might get confused with the International Olympic Committee (IOC). Internet of Bull Shit? Sounds like an uncomfortable gastrointestinal ailment (IBS).
So IOT it is and I can now say it casually like all the other nerd princes and princesses out there in my field, as if we invented it. Truth is, nobody does it better than the folks outside of our healthcare world when it comes to connecting things through the Internet. I don’t mean the NSA, although they are probably the 10th degree black belt representatives of this skill set. I was thinking more about retail companies and those who want to separate us from our money.
I read an article the other day in Forbes called Amazon and IBM Just Kicked the Internet of Things into High Gear and it was both compelling and alarming, which sounds exactly like everything new in healthcare.
Amazon’s new entry into the IOT is the Amazon’s Dash Button. The product is a little stick on button that you can put anywhere in your house (or wherever there is wifi) and when you push the button, you can re-order whatever it is you programmed the companion app to buy. The example Amazon uses is laundry detergent or diapers or whatever—just put the little Dash Button on the washing machine or the changing table (or baby’s forehead if you want to be sure you always know where to find it), tell your app that’s what you want to buy when you push the button, then push it when you need a refill. Voila! The thing will show up care of Amazon prime in Just in Time (JIT) form. A whole bunch of product manufacturers are trying to save you a step by integrating the Amazon Dash Button right into their products (e.g., Brita, Whirlpool, Brother printers) under Amazon’s Replenishment Service.
When the healthcare world thinks about IOT, we tend to focus our energy around wearables and stickables and all those data-collecting devices that send data to the ever-darkening cloud for sharing and analyzing, not so much for consumer purchasing. But perhaps that’s the next logical step? Walgreens app is basically this without the button on your medicine cabinet, allowing you to reorder your pharmaceuticals when you are running out. Wouldn’t college students love a button that delivers drugs on a JIT basis? Now that I’m older, I’m more interested in a button that automatically refills my bourbon glass, but hey, to each her own.
Connecting billions of medical devices to the Internet, both in and out of the hospital and home settings, poses an interesting set of questions and issues. Yes, it’s great that we can easily share data and that it can be used for patient monitoring, personal health improvement and/or the greater good, such as in the Apple Research Kit scenario.
On the other hand, someone has to do something with all of that data or it is just a bunch of garbage made up of 1s and 0s cluttering the information superhighway when I am trying to watch cat videos on YouTube (my personal favorite found here…makes me laugh every time!)
And the IOT in the form of a bunch of monitorable medical devices is also a prescription for a massive increase in already problematic alarm fatigue. A patient’s hospital room is already wired up with so many things that generate so many alarm-creating moments ignored by nurses that alarm fatigue is now considered the number 1 patient safety concern by ECRI Institute in their 2015 report. Now imagine if even less trained, more distracted home caregivers have their phone buzzing constantly as the IOT sends warnings and indicators to them about their loved one, who may not even be close by. Will that be a help or a harm in the end? If a patient’s bedside is covered with so many buttons it looks like a concertina, will the ultimate noise be a symphony or a cacophony? Time will tell, but if you need to order a concertina, press the button below.
Where would a button like Amazon’s Dash be helpful for patients and caregivers? I can imagine scenarios where this is really helpful for ordering medical supplies and prescriptions/ groceries for those who can’t travel outside the home easily. Certainly it would be useful for critical care devices, such as defibrillators and fall monitors, to send alerts through the cloud to emergency responders when triggered by simple buttons or sensors that detect usage.
But at what point does the commercial/retail angle of this IOT concept get all too grotesque when applied to healthcare? Where is the line between a defibrillator being pulled off a wall triggering an alert to send an ambulance and the same signal triggering Amazon to ask if you want to buy funeral services for a loved one? I’m sure some of you just got totally horrified, but if you look at the way the Internet works today, the push marketing triggered by certain key words (and presumably sensor use) can get pretty, well, targeted. In America we are material girls living in a material world, but at some point, even Madonna would call time out on the use of data to trigger retail entreaties of a highly personal nature. How will the IOT revolution in healthcare find that line so it doesn’t end up as the Internet of Things That Piss You Off Because Enough Already.
And by the way, if you don’t know my new acronym—IOTTPYOBEA—I will scornfully explain it to you in our next meeting.
ps–Posting this while on my way to HIMSS15, the world’s largest healthcare IT meeting. It’s kind of like entering the Globe of Death but where everybody is sporting wearables rather than riding motorcycles. IOT, here I come.
pps-In case you are not a hip hop fan, the title of this post is a play on the lyrics of the song OPP by Naughty by Nature. I’m guessing this isn’t the song playing on most HIMSS’ attendees’ iPods.