The Internet of Healthcare Things

All of a sudden, the Internet of Things is starting to connect my house and my car to the Internet. For example, I can monitor and control my thermostat remotely from my iPhone so my house warms up before I get home from a long trip. I also just discovered that my new washing machine can send diagnostic information directly to the manufacturer for service purposes. And I know that my next car will have built-in Wi-Fi that will allow my dealer to monitor its performance and even perform remote diagnostics and maintenance. I know my life will be better the day I can control my coffee maker from my new Apple Watch while I sit on the couch.

How about the “connected bathroom”? That sounds absurd but your bathroom may be leading the rest of your house in participating in the Internet of Things via connected devices that can continuously stream useful healthcare bits. The question is, who will be listening and what will they do with that data?

Let me paint the picture of Bob, a fictitious person, but reasonably representative of a typical older Canadian. Bob suffers from sleep apnea, is overweight, and has high cholesterol. He strives to take care of himself and has a CPAP machine that his sleep specialist recommended. This device collects all kinds of data about Bob as he sleeps and automatically transmits it over his home Wi-Fi network into the Cloud and ultimately to some software that can allow Bob and his sleep specialist to track his therapy progress and performance over time.

Bob’s wife also kitted out their bathroom with a spiffy new weight scale she bought from Amazon in a fit of New Year’s resolution guilt. What she didn’t realize is that the scale is also Wi-Fi enabled and capable of uploading stats to an app on their iPhones.

Bob’s youngest daughter bought him a Fitbit for his birthday. It’s not just an ordinary Fitbit, but the wireless edition that can transmit stats to Bob’s computer and his iPhone. Bob is still trying to figure that out. Not to be outdone, Bob’s oldest daughter gave him a new Bluetooth toothbrush that tracks and records his daily brushing habits and makes that data available to anyone who cares to monitor Bob. Unfortunately, that currently doesn’t include his dentist.

If you add it up, Bob has a total of five connected healthcare devices, the fifth being his iPhone which automatically measures things like the number of steps he takes during the day. Combined, these devices generate an amazing amount of health-related data about Bob that could be used by his care team to greatly improve his health outcomes. But are they? The answer is somewhat, but not nearly to the full potential for several reasons. First, each of the devices has its own unique and proprietary software or app to present the data in an un-integrated and unconsolidated way. Five devices, five apps. Twenty devices, twenty apps? I hope not. Second, very few of Bob’s health care professionals have the ability to receive his data. Yes, his sleep specialist likely has the software to see the data from his CPAP machine, but his general practitioner (GP) likely doesn’t. I’m sure his GP would benefit from having access to his weight history from that connected scale but doesn’t. And when Bob gets his new Apple Watch, do you think his GP, specialist, and even his pharmacist would like to have a peek into that data which would include blood pressure readings over time and amount of physical activity?

I would offer that your car dealer knows more about the health of your car on a daily basis than your doctor knows about the state of your physical health.

Where do pharmaceuticals fit in all of this? Well, no one has invented a connected pill … yet … but companies like Nicholas Negroponte’s Vitality have invented connected pill bottles that can generate data and alerts for adherence purposes when the cap is removed. Absent of that, the best alternative for connected data on your adherence is claims data from your pharmacy. From that data one can calculate prescription possession rates as a proxy for adherence. If you only filled your 30-day prescriptions 6 times during a year, then unless you have an underground supply of drugs, the best you can be is 50% adherent. What’s interesting about this parallel is, like the newfangled connected devices, the data exists but rarely make its way to your health care professionals beyond your pharmacist. If your physician had this data then he/she would engage you on the challenges you have with adherence rather than playing the guessing game as to whether you adhere or not.

The relevance of this “Internet of Connected Healthcare Things” to an investment community like the readers of this blog lies in the multiple opportunities that it presents. The gap in Canada between the data captured and available and how that data is actually used presents a huge opportunity for innovative healthcare IT companies. As amply demonstrated by eHealth Ontario, that gap will not likely be closed by the public sector, but rather by the private sector, as it has in the US. On the medical device front, a wise investor would research the company’s connected devices strategy. For the pharmaceutical industry, every pharmaceutical company needs to have an adherence strategy for their molecules, from clinical trial stage through to loss-of-exclusivity. I’ll provide more on the subject of adherence in my next blog.

Although I’ve mentioned and implied some specific products in this blog (e.g. Fitbit), I’m doing that by example as there are many good products in each category and I am in no way endorsing a specific product. The one caveat is the Apple Watch, which based on a single demo, looks to me to be really cool and potentially a game changer for personal health care and patient engagement. Again, more on that once I actually receive mine from backorder.

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