The Internet of Things in Autoimmunity
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How can the Internet of Things (IoT) help us challenge the invisible epidemic of autoimmune disease? Learn how healthcare is evolving in the age of connected devices, and how both recent and future innovations are improving patient experience & outcomes for those with chronic and autoimmune diseases. Click through to view the slides from DrBonnie360's recent presentation at the Healthcare IoT Summit in San Francisco!
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The Internet of Things in Autoimmunity
- 1. How Can the Internet of Things Help Us Challenge the Invisible Epidemic of Autoimmunity? Your Autoimmunity Connection/DrBonnie360 for
- 2. Autoimmune Disease Stats Autoimmune diseases affect approximately… • 50 million Americans • 16% of the US population • 1 in 6 US adults … more prevalent than cancer & cardiovascular disease combined. A top 10 cause of death in women under 64 years of age. 100+ autoimmune diseases, yet 6% of NIH funding Total autoimmune disease financial burden estimated ~$100+ billion. 80% of dollars spent on healthcare (~$1 trillion per year) spent in treatment of chronic disease. tincture.io
- 3. What is driving the mIOT? REMOTE MONITORING Increased remote patient monitoring through tele-home healthcare will help drive global market at a CAGR of 24.55% by 2020. SMART TECHNOLOGY The smart pills segment is expected to reach $6.93 billion by 2020, growing at a CAGR of 23.62%. NORTH AMERICA North America is the largest contributor to the global smart healthcare market with a value of $20.46 billion in 2015. Key Market Figures Technavio
- 4. What is difference between digital health and IOT? Individual feedback loops System wide feedback loop
- 6. The Story of Wendy Wonderwoman
- 7. Meet “College Wendy” Your Autoimmunity Connection/DrBonnie360 for
- 10. College Wendy’s IoT SENSORS INTERNET OF THINGS (IoT) MEDICAL PROVIDERS
- 15. Issues & Challenges 14% 41% 26% 19% 14%19% 36% 31% 16% 34% 28% 18% 19% 34% 32% 15% SECURITY CONCERNS LEGACY SYSTEMS AND/OR EQUIPMENT (e.g., no connectivity or embedded sensors) PRIVACY CONCERNS TECHNOLOGY IMMATURITY (e.g., large-scale analytics) Accenture 2017 Extensive Barrier Moderate Barrier Minimal Barrier Not a Barrier
- 17. mIOT in Chronic Disease Company What How Alivecor Cardiac; 1st FDA-cleared EKG with AI for Apple Watch; Recognizes Normal Sinus Rhythm & Possible Atrial Fibrillation 1) KardiaMobile: open Kardia app on smart phone, place fingers on electrode, see results instantly 2) KardiaBand: replaces Apple Watch band; evaluates HR changes & activity levels; sends notifications to record EKG Omada Health Geared towards populations at risk of diabetes, stroke, heart disease with their digital behavior change program for building healthy habits, including weight loss and reduced risk of chronic disease Track weight, food, activity; Connect with Omada health coach & other participants; Personalized daily & weekly challenges and timed reminders Propeller Manage asthma and COPD; Understand asthma conditions in neighborhood (“Air” by Propeller) Sign up online; Attach sensor to inhaler (connects to smartphone app ); Record when & where symptoms occur; Receive reminders for medications Lark Personalized coaching platform tailored for specific chronic diseases Lark coaches offer 1:1 support and respond within 2 seconds; Programs include: wellness lifestyle coaching, diabetes prevention and/or management, & hypertension management
- 18. mIOT in Chronic Disease Company What How Muse Makes meditation easier; Meditation helps alleviate symptoms of stress, depression, anxiety and improves focus, performance, QOL. Brain-sensing headband guides meditation through sounds based on real-time state of brain (e.g., as mind wanders/activity increases, sounds intensify). After a session, review data and set goals Proteus Proteus Discover uses an ingestible sensor and wearable patch to measure medication treatment effectiveness & helps physicians improve clinical outcomes Patient takes medication w/ ingestible sensor; Signal sent to wearable patch; digital record sent to mobile device and Proteus cloud for provider access Science37 Streamlining the process of clinical research; bringing trials to patients and local healthcare systems NORA (Network Oriented Research Assistant) connects patients to trial PI's and the Science37 team; NORA is a phone app that connects to computers and smart watches
- 19. The Internet of Things in Chronic Disease Management
- 20. Meola, Andrew. “What is the Internet of Things (IoT)?” Business Insider, Business Insider, 19 Dec. 2016, www.businessinsider.com/what-is-the-internet-of-things-definition-2016-8. “The IoT Empowers People with Chronic Diseases to Achieve Quality of Life.” Case Study: Medical, Kore: The People Powering IoT, 6 Dec. 2017, cdn2.hubspot.net/hubfs/338908/Doc/Livongo_Case_Study.pdf?t=1488557837557. Cousin, Mathias, et al. “Devices and Diseases: How the IoT Is Transforming Medtech.” DU Press, Deloitte, 11 Sept. 2015, dupress.deloitte.com/dup-us-en/focus/internet-of-things/iot-in-medical-devices- industry.html. Learn More About IoT: Explore Existing Resources
- 21. IoT Reshaping Healthcare “Accenture 2017 IOHT Survey.” Accenture 2017 Internet of Health Things Survey, Accenture Consulting, 2017, https://www.accenture.com/us-en/insight-accenture-2017-internet-health-things-survey Brucher, Luc, and Safaa Moujahid. “The Internet-of-Things: A Revolutionary Digital Tool for the Healthcare Industry.” Inside Magazine Issue 15, 2017, www2.deloitte.com/content/dam/Deloitte/lu/Documents/about- deloitte/Inside/lu_inside15-full.pdf. Damani, Samir, et al. “Aligning Stakeholders in a New Healthcare Ecosystem.” Vidamint, 28 Nov. 2017. https://www.minthealth.io/news Davis, Ben. “10 Examples of the Internet of Things in Healthcare.” Econsultancy, 13 Mar. 2017, econsultancy.com/blog/68878-10-examples-of-the-internet-of-things-in-healthcare/. Dimitrov, Dimiter V. “Medical Internet of Things and Big Data in Healthcare.” Healthcare Informatics Research, vol. 22, no. 3, 2016, p. 156., doi:10.4258/hir.2016.22.3.156. www.researchgate.net/publication306022306_Medical_Internet_of_Things_and_Big_Data_in_Healthcare
- 22. Gomez, Jorge, et al. “Patient Monitoring System Based on Internet of Things.” Procedia Computer Science, vol. 83, 2016, pp. 90–97., doi:10.1016/j.procs.2016.04.103. http://www.sciencedirect.com/science/article/pii/S1877050916301260 Krawiec, RJ, et al. “No Appointment Necessary: How the IoT and Patient-Generated Data Can Unlock Healthcare Value.” Deloitte University Press, Deloitte, https://www2.deloitte.com/insights/us/en/focus/internet-of-things/iot-in-health-care-industry.html Reh, Greg, et al. “Will Patients and Caregivers Embrace Technology-Enabled Health Care?” Deloitte Insights, Deloitte University Press, 30 Aug. 2016, dupress.deloitte.com/dup-us-en/focus/internet-of- things/digitized-care-use-of-technology-in-health-care.html. IoT for Patients & Caregivers
- 23. Join Me DrBonnie360’s mission is to create a digitally connected world of personalized care for autoimmune patients. AtYour Autoimmunity Connection, we consult with startup companies and entrepreneurs who are bringing new products and services that will improve all aspects of autoimmune care. +1.310.666.5312 drbonnie360@gmail.com www.drbonnie360.com @DrBonnie360 facebook/YourAutoimmunityConnection
Editor's Notes
- Welcome and thank you CES just ended with lots of new gizmos and gadgets connected in a way to create a smart home, and now smart health. How might these new tool of the IOt help us overcome the invisible epidemic of autoimmunity?
- What is the The Invisible Epidemic of Autoimmunity 50 M Americans with 100 different kinds of autoimmune disease Takes an average of 3.5 years and 5 doctors to get a diagnosis Vague symptoms include GI discomfort, fatigue, itchy skin, joint pain The pre-autoimmune period can last xx years. May be different for different people. At the same time that the Invisible Epidemic of Autoimmune Disease is increasing, so is the use of IOT in healthcare.
- The estimates of the growth of the IOT in healthcare vary. According to Accenture the value of IoHI will top 163 Billion by 2020 with a compound annual growth rate of 38.1 % between 2015 and 2020. Within the next five years, the healthcare sector is projected to be the #1 in top 10 industries for IOT development. Accenture states that healthcare organizations invests on average 10% of their annual it budgets on iohT solutions. Specifically, other research shown here suggests that remote monitoring smart technology will drive the global market at CAGR of 24.55% by 2020, while smart pills is expected to reach 6.93 Billion by 2020 growing at CAGR of 23.62%. and the North American am Either way, the growth of IOT could be a powerful way to solve the growing problem of chronic disease management.
- Having been in the digital health arena for 8 years, as I began to look at early IOT I products wondered how it was different. In digital health we talk about individual feedback loops such as a tracking sensor giving data to the user that helps change behavior. In IOT we have the connection of intelligent sensors, devices and software to computer networking systems using Bluetooth, WE-FI, RFID or M2M wireless tech to turn system level data into information. This technology serves to close the system level feedback loop. we think about systemic level feedback loops Or A collection of distributed devices, the networks to connect them and the software that enables the devices to collect and exchange data.
- Let’s look at a specific example using Wendy Wonderman who decides she wants to improve her sleep. The event is middle of the night awakening. The sensor is the aura sleep ring or others that will help her log her sleep. This data is uploaded to the cloud where it is analyzed using machine learning, artificial intelligence and xx. It is not just Wendy’s data, but population data from others. These population based algorithmns suggest that she darken the bedroom, lower the temp and turn off all screens a few hours before bed.
- Let’s meet Wendy Wonderwoman We will look at her experience in college, then as time passes and the IOT becomes more sophisticated how the IOT can help Wendy as a middle aged woman with kids and then as an elderly person living alone.
- Let’s discover how the IOT can help Wendy in college? She has an acute episode of abdominal pain along with joint pain goes to student health. They can not find out the cause. Next she sees an internist, then a gi doc, looking at her stomach issues then rhematologist examining her joint pain. What do her doctor appointments look like e.g., Without IoT 1. Judy travels to medical office/examining room. 2. PA takes bp with cuff, notes reading in EHR. 3. MD reads data, compares to previous data in EHR (graphed maybe), talks to patient about lifestyle (salt, weight, etc.), asks patient to return in 6mos. 4. MD prescribes bp drug from a chart of bp drugs. 5. patient picks up Rx 6. patient makes 6mo appt, returns, repeats process, but with discussion of drug dosage, compliance and side effects. 7. patient has symptoms: e.g. postural fainting. Patients contacts med offic and goes through the same loop as above. 8. MD changes dosing or drug Frustrated she joins several patient communities to learn more. She sees discussions about functional medicine and wants to try it, so she sees a functional medicine doc who orders another set of blood tests. Issues of collaboration and coordination Connectivity- little/challenging communication between out of network specialists and in network specialists
- Inspired by the patient communities while also learning about QS, Wendy decides to start tracking. In addition to sleep, shown here with an aura ring, she uses a Muse headband to track her brain waves, a smart scale to track her weight, another sensor to give her and help her close the feedback loop Sensors Brain Wave- Muse Heart- Alivecor (done – watch) Posture- Lumo Sleep- Aura ring (done) Smart scale
- Next she invests in a smart mirror that she just saw at CES. In her smart mirror, she sees the weather, the traffic, her current weight, bp and a reminder to exercise. The system has multiple devices, including a toothbrush and shower, that can act as a hands-free, mobile-free, interactive and private personal care assistant. The features include touchless interaction, voice commands, facial recognition, AI, AR and smart lighting. The system has a private network for all devices
- Being able to access data regularly from daily life can help clinical decision making. Healthcare professionals can obtain patient data and increase patient engagement in their treatment. Let’s look at how Wendy’s treatment is improved with IOT 1. Patient goes to office. 2. PA measures bp, doc reads, compares 3. MD discusses lifestyle, gives patient IoT BP device 4. BP device sends measures at predetermined times (upon waking, after meals, end of day, etc.) patient may add measures for times of stress 5. MD receives analysis of patient's BP behavior, showing postural, dietary and other correlations 6. MD chooses drug and dose more effectively without patient return to office But there are issues of connectivity and security Functional medicine folks still paper based Coordinating between multiple conventional specialists and functional is hard EHR data is still siloed Genomics is early- she does 23 and me Micorbiome interested in research that she learns about from a patient community Signs up for an IOT clinical trial (Use Science 37 and AoBiome) Coaching
- After many doctor appointments, With time, Wendy finally get a diagnosis of ’s Crohn’s and celiac disease from her GI doc, and RA from her rhematologist. and symptoms advance. She needs a personalized approach to monitor, understand, prevent flares and maximize her well being. She used genomic testing to gather personalized information to guide her lifestyle modification via exercise, sleep, nutrition, xx and xx More advanced microbiome testing also aids in guiding her supplement decisions. The microbiome immunity project New, better and improved biomarkers Luckily for her so does our technology and IOT. Sensors are More sophisticated both in terms of how they work and what they can track Sensors Invisible tatoos- on palm or on the nail Optical sensors look at the difference in skin color to help tell how internal organs are doing as well as sense xx and xx. (summarize google patent) Electroceuticals put inside the neck near vagus nerve using minitiarized implrantable devices that change precise electrical signals in nerves to treat a range of chronic disease starting with arthritis she is using it for reduction of inflammation and pain management. Optimizaton and personalization, but not preventive
- As AI and predictive e analytics give data more meaning the range of services available go from a smart house of talking widgets to a virtual platform of home services. More self tracking between appointment gets more sophisticated with newer watches and a more sophisticated bathroom, which is the center of the data hub. The mirror continuous blood pressure monitoring, heart rate and measures of inflammation. There is also information on environmental sensors, giving Wendy clues as to her epigenetic inputs.. The phone has become a passive medical device with new chips, hardware and light applications turning phones into diagnositcs, which for Wendy includes Osteoporosis screening from the phone, along with hemoglobin and other health information. The batthroom scale is Wendy’s home data collection extends to her connected appliances such a smart refrigerator, There is even a smart refrigerator that tells how much was eaten .. Wendy’s talking refirg can contact her favorite local grocer to have her foods delivered. Tracking food could become a common metric like blood pressure nd heart rates. Blockchain decentralized EHR, Coaching
- Seamless feedback with caretakers and family members Predictive: Care will be based on thousands of biomarkers, genes, transcriptome, proteome, sometimes called “all *-omics medicine”. We will be able to measure many more variables (thousands or millions per sample or more) and make decisions based on complexity no human doctor could Genomics is now done on population so that there are large datasets Microbiome science advanced include microbiome therapeutics Metabolomics AI and blockchain and voice activation Multi omic studies are possible due to advances in seuencing, data analytics Machine learning bsed systems biology Movement, Personalized nutrition is easier Research kit is used by more pharma companies, 23 and me doing research and develop their own drugs Science 37 siteless clinical trials Now Wendy is the CEO of her own health with IOT acting as supporting/enabling tech Still Wendy is now older, living alone. Her sight and hearing are not what they used to be. But the IOT can help her maintain independence by improving safety and comfort in home. The IOT can track Wendy’s daily routine alerting her kids and emergency services if needed. Monitor water and electricity usiage, movement around the home and house temp are all indicators of activity. Emotional robotic dog that recognizes faces and fesponds to touch. Uses AI to remind Wendy to take her meds and do her balance exercise along with others to prevent falls Seamless feedback with caretakers and family members
- Sensors are almost invisible part of life giving both reactive and proactive health stats such as weight, blood pressures, measures of inflammation as wel as suggestions for mobility exercises. Telemedicine and the IOT is no longer novel, but also part of everyday. Blockchain Seamless tech closes both the personal feedback loop and poplation feedback loops at scale. Personalized preventative health coaches Ending: She is hopeful for the next generation due to Healthcare tailored to your lifestyle. Telemedicine is readily available Physicians work in multidisplinary teams where care is continuous, affordable and preventive Patient the CEO of their own health with the IOT as supporting/enabling tech The IOT is an enabler for personalized autoimmune care. The data is owned by the patient, it is secure and private. Sharing the data is easy across silos and xx Care is designed with the patient in the center. Prevention with lifestyle tracking along with coaching are mainstream. Research is faster and better and more personalized. N of 1 trials are common Schools teach healthy lifestyles including nutrition and exercise. Better biomarkers find autoimmune disease earlier. Functional and conventional medicine are seamless making it easy for the patient to get the best of all. Treatment is earlier because prevention is emphasized. Learning system of large datasets enables xx and xx. Better diagnostics and sequencing Personalized nutrition and supplements that work Remote autoimmune centers of excellence
- As you can appreciate from Wendy’s story, There are still many challenges to making this vision of the IOT work. Overall, privacy and security rank high on the challenges. As shown here, an Accenture study indicates that zz % of folks
- This visual shows the variety of start-ups harnessing the power of IOT in healthcare. Note some of the different categories include remote monitoring, clinical efficacy, along with brain sensors, sleep monitoring and others.
- All of these are pieces of autoimmune puzzle