The Internet of Things is expanding by the day—and changing HTM in the process.

By Chris Hayhurst

What exactly is the IoT? It’s been described as a technology on par with artificial intelligence, while others don’t consider it a technology at all. A vast network of connected objects? An “amalgamation” of devices and applications? However one defines the Internet of Things, in healthcare it’s largely about what it provides. Today, without it, the health system would cease to function. Hospitals would close; patients would die.

“A great example of what the IoT can do is in what we’ve seen with COVID,” says Ken Olbrish, group product manager with Santa Barbara-based Arthrex California Technology. Prior to the pandemic, Olbrish explains, the prevailing model for medical device repair typically relied on hands-on access: If a device had a problem, the hospital’s clinical engineering team would respond to it, and if it turned out it was something beyond their expertise, they’d bring in a technician from the manufacturer or a third-party service organization. 

“But when COVID hit, all of a sudden there were travel restrictions, so facilities were limited in terms of the capabilities they had available,” he says. Thanks to the IoT—Olbrish describes it as “connectivity with intelligence”—organizations still had access to the support that they needed.

At Arthrex, Olbrish explains, “we can remote in and track down the device, and our support team can instantly know, in real time, all the information they need to respond to an issue.” The company, he notes, has historically been a leader in the production of orthopedics and sports medicine devices, but in recent years has expanded its portfolio to cover everything from radiofrequency devices to endoscopic camera systems. 

With an Internet connection and their proprietary software, Arthrex’s engineers can access the logs on a device and can even field automated alerts from a product to proactively identify emerging problems before their customers notice them.

“From our standpoint,” Olbrish says, “the IoT allows us to do all kinds of things. It makes it possible for us to provide fleet management services, and it lets us push out software and firmware updates to individual customer sites. It helps with turnaround time and installation, and once a device is out there, it makes it much easier to keep things up and running.”

Connect Everything

Infusion pumps, digital stethoscopes, implantable pacemakers, hand hygiene-monitoring systems—when it comes to healthcare in 2020, they’re all part of the Internet of Things. Also known as the Healthcare Internet of Things (HIoT) or the Internet of Medical Things (IoMT), the health sector’s version of what in the consumer market includes digital “smart” products like thermostats and doorbells is now, by some estimates, a $70 billion industry. 

“The medical device world has probably lagged a little bit compared to some other industries,” Olbrish says. (One recent report predicts the global IoT market overall will top $1.5 trillion by 2024.) “But I think that’s to be expected. When there are patients involved, you don’t want your technology to put anyone at risk.” 

The industry’s cautious approach has paid off in gradual and incremental improvements in all aspects of care management and delivery, Olbrish adds. “Ten years ago, no one would have thought you’d need IoT technology in a hospital bed, but now that we have it, the advantages are obvious.” Better exchange of data, better care to patients, better support for clinicians from HTM and other departments—“all of those pieces are rolled into these technologies. It’s easy to see why the IoT will continue to grow.”

One frontline HTM pro who can personally attest to the IoT’s growth in healthcare is Jay Charley, a VISN20 biomedical engineering technician with the VA Puget Sound Health Care System in Seattle. “Almost everything is being connected to the network now, and whether it’s patient data or system data, something is always being collected,” Charley says.

For his department, Charley notes, the top priority related to IoT management is data security. “In the VA, a lot of our systems are behind firewalls, so it’s not as simple as getting connected to the network. You have to know how to program the systems into the firewalls and make sure they’re only talking to the correct devices and not every last thing that’s out there.”

That can be a challenge, Charley says, especially when it comes to the VA integrating its health systems with technologies managed by other agencies in the federal government. During one recent week, for example, his department was focused on a Cerner electronic health record integration with the Department of Defense (DoD). “The DoD uses different types of firewalls that we haven’t been trained on, and then the old firewall system that we have in my group—most of us know how to use it and how to troubleshoot it, but some people don’t.”

A second related challenge involves getting access to the various systems “to process the connectivity right,” Charley says. “We can request access, but those requests have to go through another department.” They also usually have to find time when all parties involved—the networking side and the security side—“can jump on a call together and try to hash out any issues,” he says.

Despite the significant hurdles preventing easy IoT expansion, Charley agrees with Olbrish that connectivity between devices has its advantages. His job, for example, requires that he cover all VA healthcare facilities in the Pacific Northwest, including sites in Alaska, Oregon, and Idaho. “If I’m up in Anchorage and there’s an issue in Seattle, I can just get a hold of the vendor and they can remote into the system and look at it that way,” he says. “Or if somebody onsite isn’t up to speed on the whole system, they can just reach out to the manufacturer and [the manufacturer] can log in and take care of the issue.”

IoT connectivity also allows him and his colleagues in HTM to “have a better hold on what’s out there,” Charley says. “We can remote in and troubleshoot from a distance, and a lot of the work we used to have to do manually is now all automated so we can do it much faster.” That includes transferring patient data like scan images into the EHR, he notes. “With everything networked, all we really have to do now is keep our systems updated.”

Keys to Future IoT Expansion

As he looks ahead to the coming years, Charley says, he sees plenty of room for growth in not only the IoT but in the ways connectivity is achieved. “A lot of what we have right now is wired, but future installations are more likely to be wireless, which means these devices won’t be tethered to a wall.” He also foresees faster connection speeds and security improvements using methods like two-factor authentication.

Success moving forward with the IoT, Charley predicts, will likely require that HTM professionals embrace as much training as they can get through their employers, the vendors they work with, and national organizations like the Association for the Advancement of Medical Instrumentation (AAMI). “I think we need to be preparing for the next level—to really be thinking about how what we do can make the entire health system work better.” In his own case, Charley notes, he’s “not just taking care of that medical system,” whatever the networked device might be. 

“Now I’m actually responsible for the infrastructure that houses that system—the virtual machines, the whole virtual cluster, things like that.” For his department at the VA, at least, all of that is “brand new,” Charley adds. “This isn’t something we knew how to do when we came into the profession. It’s something we’ve had to learn and we’re continuing to learn.”

Like Charley, Olbrish believes that HTM pros are going to have to work to keep pace with the IoT. “It’s difficult,” he notes, “because the technology evolves so rapidly. It’s changing all the time and you can easily fall behind.” He recommends those possessing traditional HTM knowledge bolster their IT skills as much as possible. 

An ex-HTM pro himself, he also recommends being “ever-vigilant about cybersecurity protections” and not relying on vendors to keep machines safe. “They might tell you they’re secure and that you don’t need to worry about anything, but you should be the expert on your organization’s network. How secure your systems are is really up to you.”

The IoT, Olbrish adds, “has a very promising future, but it’s also delivering lots of opportunities right now.” As long as HTM professionals and others in healthcare are careful to manage the risks associated with it, “I think it will continue to provide tremendous benefits to the industry and, most importantly, to patients.”

Chris Hayhurst is a contributing writer for 24×7 Magazine. Questions and comments can be directed to chief editor Keri Forsythe-Stephens at [email protected]

Proceed with Caution

Every year, ECRI publishes its “Top 10 Health Technology Hazards,” a list of what its experts deem are the most important safety issues involving the use of medical devices and systems. The included warnings are always different, but in 2019 and 2020, several served to highlight the hazards of the IoMT.

Topping the 2019 list, for example, was “Hackers can exploit remote access to systems, disrupting healthcare operations.” Once an attacker infiltrates a vulnerable remote access system, they “can move to other connected devices or systems” to install malware, steal valuable data, or take control of computers and devices for other malicious purposes, ECRI explained. 

For its 2020 list, there was a similar warning—this time related to “cybersecurity risks in the connected home healthcare environment.” Noting that remote patient monitoring is becoming more and more common and that deployments often rely on patients’ home networks, ECRI recommended “assessing system security during device procurement,” among other measures.

Separately, earlier this year, ECRI published a series of evaluations of IoMT security systems. If your organization is considering purchasing such a system, it’s important to begin with a proof of concept, says Chad Waters, senior project officer at ECRI’s Health Devices Group. 

“The primary goal should be to test the discovery and identification of devices,” Waters says. “You should also evaluate how it fits into your organization’s HTM workflow. How does it present the information about medical devices risks to your analysts, and how well does it integrate with existing tools within your environment like [computerized maintenance management systems] and [security information and event management] systems?”

Another buying consideration, according to Waters: Decide whether you want the solution to actively configure your network and “protect” your devices.”