Increased use of remote monitoring in the healthcare sector requires interoperability of healthcare data on electronic platforms.

By Jeppe Pilgaard Bjerre

We are living longer. And that's a good thing. However, this also presents new challenges as the elderly segment of the population grows, since the greatest load on the hospital system comes from the elderly. This is often due to a need for treatment of chronic illnesses. For our healthcare system to be able to meet the challenges associated with this growing load, we need to approach treatment in new, more effective ways.

Patient supervision via remote monitoring

One way to do this may be through "in-home hospitalization", whereby a citizen's health can be monitored using a remote monitoring system. This would have a number of positive effects: It is less stressful for citizens to remain at home instead of staying at a hospital. Meanwhile, more hospital beds will be available for use by those citizens who genuinely need them. This also means that health data may not always need to be measured by healthcare personnel; instead, citizens may be able to do so themselves.

In the future, there will thus be an increasing need for a system in which it will be possible for health data to be exchanged from measuring devices all the way up to the systems used by treatment providers. Among other things, this will require that new devices be capable of easily being connected to existing solutions, and that it be easy to send data to various treatment providers, all while ensuring that data is trustworthy and accurate.

We need to be able to trust our healthcare data

Trust in the data we come into contact with every day will become only more essential when we consider the extent to which it can affect our very existence to a greater or lesser degree. One place in which inaccurate data could have severe, far-reaching consequences is in the healthcare sector. For that reason, there can be no doubt as to how critical it is that healthcare data be handled in a manner that filters out faulty data while ensuring that data streams are easily accessible to relevant parties.

Seen from another perspective, a system is necessary in which there is no reliance on suppliers of complete solutions in order to ensure continuous operation, should it be the case that an individual party no longer can or wishes to render a service under the terms previously agreed upon.

The challenges of having so many parties in a large system include the increasing difficulty of keeping track of who supplies and services any given part of it, compared to having a single supplier. On the other hand, there is a risk of becoming "locked into" a single supplier, meaning that all components of the system must be purchased from that one supplier. In doing so, smaller suppliers that may produce a single component superior to the equivalent from a large supplier are automatically rejected.

Patient, woman, health, sphygmography, sphygmomanometer
With an aging population, it is important that elderly
people can monitor their own health at home using remote monitoring. This
requires interoperability of health data between electronic platforms.

Interoperability is key

This is where interoperability - i.e., the capability of systems to communicate and work with each other - comes into the picture, as we consider the requirements of large healthcare data systems. This is particularly true for measurement devices. Here, the ability of measurement devices to communicate data in a standardised way is a major advantage, since all those who provide components for the system can be certain of the way they should expect data to be provided, as well as how that data will be structured. However, it would be naïve to believe that this is an easy task. There are very many different devices in existence, and at least as many different types of data to process - as well as a number of different communication interfaces.

Fortunately, there are already numerous tools that can help to solve such challenges. Standards ought to serve as a foundation here. Standards can be quite difficult to get into, at least initially. This is especially true of the standards related to healthcare data.

Nonetheless, it is very much worth the effort, since this contributes to the ability of other actors to clearly see what any given system supports. In this regard, it is important to remember that (e.g.) blood sugar measurements are not merely numbers, but data sets that also contain context for these measurements, such as what was eaten since the last measurement, where on the body the measurement was taken, a time stamp, etc. All of these parameters must be considered in any given solution in order to ensure that data is generated uniformly. This is not only important to ensure that manufacturers know how their communication technologies should be constructed, but also to ensure that buyers of these systems can easily see whether or not a device will be compatible with their existing infrastructure without requiring changes.

Fortunately, there is already an extensive series of international standards regarding the manner in which such systems can be constructed. For devices, for example, there is the ISO/IEEE 11073 family, which covers some common instruments like thermometers, glucose meters, and blood pressure meters. Linking these together with (e.g.) Bluetooth or NFC, both of which have standards for handling healthcare data, results in a standardised solution for the lower links of the measurement chain, built on top of well-defined components.

If only it were enough to make use of these sound standards to have everything work perfectly - this is certainly a nice thought. But unfortunately, that is not how things work in the real world. It would be naïve to believe that an ecosystem for healthcare IoT is easy to build, since developing medical devices is costly and time-consuming when compared to common consumer electronics. The total plug-and-play idea is a lovely one, but we have yet to reach a technological point where this is realistic; certainly not when we consider patient journal systems.

More unified platform offerings

There are at least some good offerings for platforms that can solve a number of these challenges. One such offering comes from Qualcomm Life in the United States, with their 2net mHealth Platform. It covers a significant portion of the measurement chain without the need to manage a figurative ocean of suppliers. This can shorten the planning and implementation periods while offering the advantage of support for a large portion of the system in a single place. However, this does result in a situation where a large portion of the system comes from a single supplier, making part of a public system reliant on a large, international company group.

At the other end of the spectrum, there are solutions like Continua. Continua is an international organisation working to construct a framework for healthcare data interoperability by profiling existing international standards into a unified guideline, as well as supplying tools to ensure that a given device complies with these standards. This is not a perfect solution, but an offering that would make systems more open, allowing even small businesses to contribute solutions for large systems, given that the interfaces between individual portions of the system would be extremely well defined by open standards.

As developers of electronics, we perhaps do not have such great opportunities to affect the world at large. We do, however, have a responsibility to ensure that the products we help to develop are based on well-thought-out assessments of how a product ought to be in order to solve a given problem as best as possible. Once in a while, we can exert a bit of pressure to bring some greater visions into our designs, thereby also contributing to long-term developments.