Machines for living: M2M communication23 October 2013
If the full potential of M2M is realised, it could become the preferred mode of communication between patients and the healthcare system. Chuck Parker, Continua’s executive director, explains why he considers this technology critical to the future of healthcare.
In healthcare, machine-to-machine (M2M) communications represent a new way of delivering services to patients where they live, work and play. M2M takes advantage of wireless communications technologies that enable automated instructions between devices, such as initiate communications, stop communications or relay/accept data. For close-proximity communications, M2M uses forms of transport such as Bluetooth low-energy. Over longer ranges, when higher power is needed, M2M employs technologies such as Wi-Fi or LTE (long-term evolution, also known as 4G).
A familiar example of M2M from a user perspective is the purchasing interaction on a Kindle: once the user selects a book and confirms the purchase, the Kindle communicates remotely with Amazon to automatically manage the process of assigning charges to the user account, initiating the download and shut down communications when the download is complete. Not only is the purchasing process intuitive for users, it also requires little user input. The ease of transactions enabled by M2M becomes clear when contrasting the Kindle purchasing process with a telephone-based purchase, where the user has to know and dial the phone number, provide product and credit card information when requested, wait for the purchase to be processed, hang up, and wait days for the delivery.
An example of M2M-enabled healthcare is Qualcomm Life's 2net Hub and Platform. The 2net Platform is one of the first technology-agnostic data systems that enables end-to-end interoperability for medical devices, making information easily accessible for healthcare service companies, providers and caregivers. The 2net Hub is a compact plug-and-play gateway comprising a variety of short-range radios (Bluetooth, Bluetooth LE, ANT+ and Wi-Fi) that collect data from medical devices and send it wirelessly to the cloud-based 2net Platform.
Certified for universal device interoperability, 2net is in accordance with the design guidelines published by the Continua Health Alliance. These guidelines convene commonly used technology standards to define an end-to-end, plug-and-play architecture in personal connected health. As Continua's executive director, I view M2M as critical to the future of healthcare. Continua has already begun incorporating common standards for identifying users via M2M and these will be part of its next design guidelines release later this year (this includes RESTful, hData and OAuth standards). Future releases will include M2M data capture and relay standards as well.
Another recent example of M2M in healthcare was the mHealth Grand Tour, a diabetes charity endurance ride from Brussels to Barcelona in 13 days. The Grand Tour was a live demonstration of a novel, replicable M2M-enabled mHealth solution for tracking diabetes, and encompassed a live study comparing the impact of endurance exercise on blood glucose of riders with and without type 1 diabetes. The solution involved M2M data capture, with relay to riders and a back-end database via HMM's M2M module.
M2M offers three characteristics that are especially promising in healthcare, as follows.
1. Minimises patient input required for healthcare tracking and sharing of information
Making it easy for patients to interact with personal health devices is turning out to be important. Researchers at the Center for Connected Health published a study in the Journal of Diabetes Science and Technology (volume 7, issue 3, May 2013) that illustrates this point. They looked at measures of engagement in patients who had participated in a remote home-monitoring programme for diabetes management, comparing those who had used wireless-based data-transfer devices, a passive form of data collection that did not require patients to push buttons, with those who had used telephone modem-based transfer devices, which require more active patient involvement in data collection.
Measures of engagement included the frequency of blood pressure readings and data uploads, the time to the first blood pressure reading, and time to the first data upload. Help desk call data was also analysed. The frequency of measures and data uploads was significantly higher in the passive technology group, and it took this group significantly less time to make their first uploads. They adhered better to the programme. Furthermore, the passive technology group had better outcomes.
If keeping button pushes to a minimum can make connected health more successful, particularly in the areas of chronic disease management and health prevention, M2M should become a preferred mode of communications in healthcare.
2. Makes healthcare mobile
There's no question that connected healthcare works, and mobile technologies are coming to the fore. The concern that smartphone ownership could become a dividing line for healthcare access is beginning to seem like a thing of the past: as of Q1 2013, according to Google's 'Our Mobile Planet' report, smartphone penetration in the US is at 56.4% - and the US ranks only 13th globally. In first place, the United Arab Emirates boasts smartphone penetration of 73.8%.
According to the International Telecommunication Union, by the end of 2012 there were 6.8 billion mobile subscriptions, equivalent to 96% of the world's population. Overall, the developed world is reaching a saturation point of at least one mobile subscription per person. Growth is emanating from the developing world, especially China and India, and mobile penetration in developing nations is around 89% of the population.
Dr Joe Kvedar, a physician and founding director of the Center for Connected Health, recently blogged about the possibilities for mobile healthcare given the smartphone's particular ability to get our attention - every few seconds. According to Kvedar, people who own smartphones check them obsessively, sometimes up to 150 times a day, to seek new information or connections. If pressing a button is too much to ask, he suggested, perhaps we can take advantage of our smartphone obsession and use them as a home health hub.
"We can use them as a device to engage the consumer around health content," he wrote. "We can use them to display health-related information at just the right moment in just the right context. We can use the cameras to capture relevant health information (such as home test results). We can use them to message you in the moment with contextually relevant, motivating messages. Add to the list that we can harness the addictive properties of these devices to, perhaps, make health addictive." Enter M2M.
3. Offers inherent security and accuracy advantages over other forms of technology-enhanced healthcare
Users are often the weakest link in device and network security. With M2M, security is inherently tighter because users are removed from the equation. Devices automatically validate identities before each interaction. Furthermore, data accuracy is protected from typos or other user-generated errors that result in misinformation.
M2M, given its primary characteristics - reducing user input, supporting mobile healthcare and reducing security risk associated with users - has far-reaching implications for healthcare, as follows.
1. Potential for better adherence and outcomes with increased patient engagement
Adherence is the bane of every good therapy. Doctors prescribe a regimen that works, but patients fail to follow it through. Passive data collection will make it clear who's on track and create early opportunities to follow up and engage patients that are failing to adhere, since automated alerts can be set up to notify physicians or other providers when data is missing or otherwise outside expected parameters. Since M2M is capable of two-way communications, patients whose data is outside the norm can automatically receive a text, appointment request or other form of reminder to prevent serious lapses. The takeaway message is that M2M facilitates early, more appropriate follow-up. Furthermore, as interventions begin earlier in the course of treatment, new opportunities arise for prevention.
Of course, what works for one person may not work for another. In the future, it may be possible to include patients' technology preferences in their profiles to create a custom blend of communications most likely to increase voluntary health self-management.
As with many communications technologies, M2M also has the potential to improve resource management in healthcare. In the US and globally, resources are dwindling. With passive data collection and relay, M2M provides a way to manage a much larger population with clarity and improved clinical decision-making, better using available resources. The affordable care act (ACA) is bringing this issue into focus and may provide the impetus to adopt M2M-enabled technologies. The rapid addition of 50 million healthcare subscribers under the ACA simply cannot be well managed under the current system. Texas Medicaid is already moving towards technology-based healthcare delivery to reduce the ACA's impact, with final approval for reimbursement for remote home monitoring equipment and services expected in October.
2. Tighter security of patient identity
In healthcare, patient confidentiality is paramount. M2M's ability to reduce risks related to user behaviour - and thus any breach of confidentiality - will support its adoption.
3. Better population management and clinical research
In addition to better tracking and follow-up of individual patients, M2M promotes improvements in population management and more accurate, efficient clinical research. In any given health population, the ability to rely on timely, accurate data collection via M2M brings the possibility of accelerating the feedback loop between patients and the healthcare system to make quicker analyses of treatment response possible, and the ability to introduce new or more targeted treatment interventions more quickly.
In clinical research, M2M can reduce the time and cost associated with data collection, enabling exponentially larger studies and more rapid discoveries, as well as potentially faster commercialisation times for new therapies. Larger studies may also provide new insight into subpopulations of patients who respond better or worse to a given therapy, or whose disease progresses differently from the norm. Greater research capacity may uncover new information that leads to personalised therapies.
All of these changes have the potential to prevent and reduce hospital and doctor visits, creating more efficient care and a healthier population, thus lowering costs.
Today, intermediary technologies are necessary to allow M2M communications, but, in the future, personal health devices will communicate directly. They will also become more portable and will be geared for routine use. One example of this is Avery Dennison's Metria skin patch for monitoring vital signs.
With direct device communication and wearable products such as Metria, it will be possible for patients to adhere to health regimens and preventive programmes with minimal interaction.
Industry is rallying around M2M to develop technical standards, and this effort must be sustained. Without it, M2M will face an onslaught of proprietary solutions and a subsequent slowdown while the industry rushes to catch up. With a focus on developing the technical specifications for an M2M service layer, the organisation OneM2M is leading the charge. With continued support, M2M has a bright future in healthcare.