Point Of Care Sensors: 5G Powering Revolutionary Healthcare

Introduction  

We're all familiar with the concept of the Internet as the planet-wide network over which people communicate. What's not so well known is that machines of every kind and purpose, including medical sensors, can also use the Internet to exchange information. And, even though it's the exact same Internet, when carrying machine information, we tend to refer to it as the Internet of Things (IoT). And yet another designation, perhaps most relevant to our topic, is the IoMT, which stands for, you guessed it, the Internet of Medical Things.   

But whichever destination you choose, the Internet has profoundly strengthened medical research and practice and has provided unprecedented insight into costs, benefits and treatment efficacy itself.  

The present generation of medical devices generally present their outputs digitally. What that means is that they can still be read on the spot by healthcare workers. However, due to the existence of the Internet, they can be transmitted everywhere, with profound benefits, as we'll describe.  

In Electropages articles entitled Blood Sweat and Saliva Analysis: Next-Gen Medical Sensors and Microfluidic Sensors for Lab-On-A-Chip Technologies, we've presented introductions to the ever increasing numbers and types diagnostic sensors that can be employed in medical facilities and which, thanks to the IoT in its various forms, can also be used in remote settings. Indeed, the cost of utilizing the IoT has come down to the point that even in fixed settings, the IoT is often used because it's cheaper and more convenient than cabling.  

In this article, the focus will be on how the IoT allows diagnostic sensors to operate on remote or on point of care bases. Most of the examples we'll present will be based on the new, exciting cellular technologies rather than traditional methods such as WiFi and Bluetooth, which are still part of the picture but no longer the stars. 

The Nature of the Market   

Telit Cinterion's Carsten Brockman describes the new connected health care system, made possible only through IoT connectivity, diagrammed below. 

Image source: Telit Cinterion Video 2:34  

Smart Pharma and Contract Research Organizations (CRO) employ IoT powered MedTech devices to run decentralized clinical trials. Health IoT Providers communicate with caregivers through electronic health records. Based on results, Payers and Insurance companies can update their policies, and regulators can keep abreast of everything, again by means of the IoT.  

From the same Telit Centerion video, we learn that of the 65 million remote patient monitoring devices, a full 50% are connected via 4G or 5G cellular. The market is driven by Sleep Apnea, Cardiac Arrhythmia and the scourge of Diabetes. Brockman sees the following emerging remote use cases.  

• Decentralized clinical trials 
• Personalized medicine 
• Medical Drones 
• Wearable Vital signs; Home Hospital; Wireless Hospitals;  
• First Responder Communications 
• Care Robots 
• Remote Surgery  

Even now, remote monitoring has enabled improvement in critical metrics such as hospital readmission, ER visits and time in the ER.  

Selecting the Appropriate Mobile Technology  

As described in a National Institute of Health^[1] article, 5G cellular offers many advantages over 4G. Because 5G operates at far higher frequencies than does 4G, data transmission is far faster. Latency, the time it takes a signal to reach its destination, is far less. 5G transceivers also require less power, a big advantage for mobile devices. For mobile healthcare sensors, a typical IoT pathway will involve connecting the sensor to the user's smartphone via Bluetooth. Then, the smartphone's 5G pathway will transmit the information to a base station, from where it can connect to – anywhere.  

On the other hand, 4G is well established all over the world and is quite steady, while 5G is a fast-evolving technology. Another disadvantage of 5G is that signal degradation is a problem, and base stations need to be established every 250 meters or so. This is less of a problem for a hospital that wants to use 5G to eliminate cabling, for example, as they can easily establish their own network with as many base stations as needed. Telit Cinterion^[2] offers a wide range of devices to connect patients' medical sensors.  

Telit Cinterion's LN920. Image source: Telit Cinterion  

The LN920, for example, is powered by the Qualcomm Snapdragon X12+ LTE modem, and it supports LTE (4G) bands between 600 MHz and 3.7 GHz.   

Point of Care Diagnostic Sensors  

Moving inpatients to a central laboratory point is expensive, time consuming and may also be a serious hazard to gravely ill individuals. The sensors we've described in the earlier articles referenced earlier in this blog are all electronically based and can access the IoMT.  

Another great result of point of care (POC) sensors is that fewer patients need long-term hospitalization, as their conditions can be monitored from home. But this will require a big step forward in hospital connectivity systems, as detailed in the next section of this report.  

Of course, health care workers on the spot can still read the patient's glucose or blood pressure levels, but what they can't do is take measurements continuously, 24x7. But most critically, those readings go to a central point, and they can be compared to any other readings taken by other POC sensors, as well as inputs from sensors based in central labs.  

Hospital Connectivity  

As per Boston Children's Hospital CIO Heather Nelson^[3], it started with a need to strengthen the reach of its medical records system. As she explained, "When we were exploring options to update our electronic medical records system, we identified a need to advance connectivity to help our healthcare professionals access critical patient data seamlessly."  

With the proliferation of both static and POC electronic diagnostic sensors, there were literally thousands of devices that needed solid, instant connectivity, and a cellular system was the only answer.  Nelson went on to explain that although "WiFi has worked well, but we're looking to the future."  And that future included supporting "in-home patient care with 5G remote monitoring and AI-based prioritization where patient requests are prioritized in the workflow for faster decision making – sending the right specialist to the right patient at the right time."  

And often the answer includes hospitals setting up their own private 5G networks. Scott Arnold, chief digital and innovation officer at Tampa General Hospital as quoted in a Wall Street Journal^[4] article stated that "Speed and scalability of a network is going to become more demanding with new technologies that are emerging."   

While WiFi was great in its time, its time has clearly passed. As described by ATT^[5], use cases only possible with 5G include:  

• Much better sharing of data-intensive patient data 
• Incorporation of wearables from anywhere 
• AI-assisted diagnostics. AI is very data-intensive 
• Live streaming of procedures as they happen  

Cybersecurity is a Must  

Cybersecurity is needed to protect patient data from hackers, but there are other even more urgent necessities. Bad actors might otherwise gain access to a data stream emerging from a patient and falsify records, perhaps not letting the patient or their provider know of a critical issue. POC devices, such as infusion pumps, act on directions received over the IoMT to introduce needed fluids into a patient's body. A malefactor gaining control here can literally commit murder.  

John Riggi of the American Hospital Association^[6] notes that "Healthcare organizations are particularly vulnerable and targeted by cyberattacks because they possess so much information of high monetary and intelligence value to cyber thieves and nation-state actors. The targeted data includes patients' protected health information (PHI), financial information like credit card and bank account numbers, personally identifying information (PII) such as Social Security numbers, and intellectual property related to medical research and innovation."  

All internet-based systems are in danger from malefactors, but IoMT devices are even more so because of many under-protected "gateways" into the system, such as POC devices. Unfortunately, these devices often serve as unwitting portals through which attackers may gain access to the system. And as described in Forbes^[7],  "Undoubtedly, COVID-19 and the corresponding rise in staff working remotely have increased cyberattacks targeting the healthcare sector."  

Unfortunately, the healthcare panorama is a sprawling, diffuse and very poorly guarded system. Despite the many recent ransom attacks and other destructive intrusions, security is only now being treated as seriously as it must be.  

Challenges and Opportunities  

Many of the POC sensors on the market are not up to their job, because they are not accurate, precise or reliable enough. What's good enough to inform a runner of their heart rate may well be not good enough for serious diagnostic monitoring. Standards need to be established and adhered to.  

The old WiFi based systems need to be replaced, and here again, standards for the cellular systems are just emerging. System architects will need to decide between 4G and 5G. The former is a very solid worldwide system. The latter, though without complete world wide uniformity, offers tremendous advantages in speed and ultra low latency.  

And, of course, the largest challenge of all is cybersecurity.  

Wrapping Up 

For the modern healthcare hypersystem, needs include establishing communications between hospitals, patients at home, regulators, drug companies and medical researchers. Classical WiFi networks were great in their time, but the data bandwidths necessary to conduct the missions of modern healthcare systems are simply beyond their capability. Cellular systems have been established as the way forward.  

Remote medical sensors open up a whole new vista in medicine. Rather than taking one reading of a patient data point, any number of physiological data points can be monitored continuously. Better still, these data points can be monitored as the patient goes through the stresses and joys of daily life, and not subjected to the "white coat syndrome", the natural anxiety that most people feel when thrust into the cold, threatening world of the medical office.  

In addition to the garnering of better information, another tremendous boon is that patients can leave the hospital sooner, because their readings are still addressed. And, more and more, these reading and their combinations are being accessed by remote AI, which may well be able to detect intervention points.   

References  

1. 5G Technology in Healthcare and Wearable Devices: A Review. National Library of Medicine 
2. IoT-Enabled Remote Health Monitoring Solutions. Telit Cinterion 
3. Boston Children's Hospital rolls out a hybrid 5G network as it plans to unify on Epic. Health Care News 
4. Hospital CIOs Weigh 5G as Digitized Medicine Pushes WiFi to Its Limits. WSJ 
5. How is 5G used in healthcare delivery? ATT Techbuzz 
6. The importance of cybersecurity in protecting patient safety. American Hospital Association 
7. Healthcare Cybersecurity: A Global Imperative. Forbes   

Glossary of Terms  

• Point Of Care. Medical testing is done not at a central laboratory but rather at the patient's hospital bedside or at home. 
• Internet of Medical Things (IoMT). Yet another term for the Internet, used for medical applications.