• Christy Cheung

Our Interconnected World

In conversations around technology, I often heard the word “Internet of Things (IoT)” floating around. I never quite understood what it meant. Artificial intelligence, machine learning, blockchain are all equally buzzword-like, but IoT was some nebulous term that I could not make sense of. When researching into this topic, I realized that these fields and their technological capabilities have significant overlap, and all, in some form or another, contribute to the speed, efficiency, and interconnected-ness with which we operate in society today.

IoT refers to the way in which the physical environment we live in communicates with the virtual space. Information captured on a sensor is communicated to other devices and as a result, the ambient temperature inside our homes is automatically adjusted before we step through the door and the steak is properly sous-vide just in time for dinner. The electronic devices that fall under IoT are those that accompany our daily lives: appliances, lights, thermostats, coffee makers, smartphones, smartwatches, smart-anything. The basis of IoT is built upon real-time information that is tracked, stored, and analyzed, which allows for “a giant network of things,” one that connects people with people, people with things, and things with things.

It seems like with IoT — a seamless integration of sensors and devices knowing our schedules and our exact whereabouts, and making adjustments as needed, — our day-to-day becomes incredibly streamlined. If we apply this more broadly, we go beyond the individual and we start to transform the way cities are run; for example, we see improvements in traffic conditions, energy efficiency, and waste management. By 2030, it is estimated that 500 billion devices will be connected. To provide some context, that would be equivalent to 58 smart devices per person in the entire world.

Now, using quality data to improve decision making, as IoT does, is, unsurprisingly, going to benefit patient care, disease management, and health outcomes. Looking inward at the healthcare sector, we have seen a rise in smart devices targeting chronic conditions such as diabetes, asthma, and COPD.

Let’s elaborate on these use cases.

In 2019, the prevalence of Type I and II Diabetes was 9% of the Canadian population, or 3.65 million individuals, but if we included those who are pre-diabetic or are undiagnosed, that number jumps to 29%. The American statistics are similarly appalling. Diabetes is a chronic condition that requires sound monitoring of blood sugars, proper administration of medications (of which there are many), and a comprehensive understanding of the numerous factors, which can affect blood sugars, such as stress, exercise, and concomitant medications. Patient education is key; however, even the most health literate of patients can get inundated with information and feel frustrated when their blood sugars are out of control. Using IoT technologies is not meant to be a replacement for any of the healthcare interactions that currently take place, but it can provide better guidance for patients affected by this condition.

For Type I diabetics or Type II diabetics who require insulin, a continuous glucose monitor (CGM) device helps to continuously monitor blood glucose (sugar) levels. The latest of the smart CGM technologies includes devices like the Freestyle Libre, which connects to an app on the iPhone, Android, or Apple Watch, and allows the individual to check their readings and to detect trends in real time. Not only that, but given the permission, caregivers can also have access to the data captured on the smart CGM, allowing them to intervene when necessary. Smart insulin pens such as Gocap and Esysta, work similarly and have the added benefit of automatically recording the time, amount, and type of insulin injected in a dose.

Patients with asthma and/or COPD, with the exception of a trigger-induced form of asthma, require regular use of inhalers. Propeller Health is a company that has developed a sensor that attaches to an inhaler or bluetooth spirometer. As you can probably guess, the sensor connects to an app, which tracks how well your symptoms are controlled and provides personalized insights such as individual triggers. The app itself also offers important environmental information — air quality, humidity, and temperature — based on your location. There are currently over 100,000 patients using this technology-enabled inhaler and the market continues to grow.

Switching our brains to the more technical side of IoT, let's tackle what goes on behind the scenes. For any sort of communication that happens within a short range, such as feeding data from an inhaler sensor to an individual’s smartphone, Bluetooth would be sufficient. For longer range communication involving, for example, data reaching a patient’s care team, LTE would be required


The following graphic from the peer-reviewed journal, IEEE Access, is a neat visual that follows the virtual journey of a patient’s health data.

The image highlights the various physiological measures a wearable sensor can detect on an individual. The “central node” receives all of this information (through short-range communication) and outputs it to an external source (through long-range communication). Cloud storage, a remote data storage entity (as opposed to the storage we have on our individual laptops or smartphones), is often used in this setting, and it can be accessed from any device, simply through the Internet. Patient records housed in the cloud continues to grow with each tidbit of data gathered. And finally, within the cloud, we can then leverage data analytics to identify trends and machine learning capabilities to optimize treatment regimens for patients.

In this increasingly interconnected world we live in, IoT is the fundamental technology through which we, in the real world, interact with the cyber-world. We need to ensure, however, that we do not silo off those who do not have access to internet; certain technology capabilities remain expensive to implement and therefore, would not reach people living in less developed countries. Although technology continues to advance rapidly, it is something to keep in mind as we integrate, and become more dependent on, smart devices and the internet, especially in the healthcare industry.

Thanks for reading, as always!

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© 2020 by Christy Cheung
Design by Alison Suen