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 device4. BP device sends measures at predetermined times (upon waking, after meals, end of day, etc.) patient may add measures for times of stress5. MD receives analysis of patient's BP behavior, showing postural, dietary and other correlations6. 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)
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,
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
AI and blockchain and voice activation
Multi omic studies are possible due to advances in seuencing, data analytics Machine learning bsed systems biology
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.
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.
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
The Internet of Things in Autoimmunity
How Can the Internet of Things
Help Us Challenge the Invisible
Epidemic of Autoimmunity?
Your Autoimmunity Connection/DrBonnie360
Autoimmune Disease Stats
Autoimmune diseases affect
• 50 million Americans
• 16% of the US population
• 1 in 6 US adults
… more prevalent than cancer
& cardiovascular disease
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
80% of dollars spent on
healthcare (~$1 trillion per year)
spent in treatment of chronic
What is driving the mIOT?
healthcare will help
drive global market at a
CAGR of 24.55% by
The smart pills segment
is expected to reach
$6.93 billion by 2020,
growing at a CAGR of
North America is the
largest contributor to
the global smart
healthcare market with
a value of $20.46 billion
Key Market Figures
What is difference between digital health
Individual feedback loops
System wide feedback loop
mIOT in Chronic Disease
Company What How
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
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
Track weight, food, activity; Connect with Omada
health coach & other participants; Personalized
daily & weekly challenges and timed reminders
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
Personalized coaching platform tailored for specific
Lark coaches offer 1:1 support and respond within 2
seconds; Programs include: wellness lifestyle
coaching, diabetes prevention and/or management,
& hypertension management
mIOT in Chronic Disease
Company What How
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 Discover uses an ingestible sensor and
wearable patch to measure medication treatment
effectiveness & helps physicians improve clinical
Patient takes medication w/ ingestible sensor;
Signal sent to wearable patch; digital record
sent to mobile device and Proteus cloud for
Streamlining the process of clinical research;
bringing trials to patients and local healthcare
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
The Internet of Things in
Chronic Disease Management
Meola, Andrew. “What is the Internet of Things (IoT)?” Business Insider, Business Insider, 19 Dec.
“The IoT Empowers People with Chronic Diseases to Achieve Quality of Life.” Case Study: Medical,
Kore: The People Powering IoT, 6 Dec. 2017,
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-
Learn More About IoT:
Explore Existing Resources
“Accenture 2017 IOHT Survey.” Accenture 2017 Internet of Health Things Survey, Accenture Consulting, 2017,
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-
Damani, Samir, et al. “Aligning Stakeholders in a New Healthcare Ecosystem.” Vidamint, 28 Nov. 2017.
Davis, Ben. “10 Examples of the Internet of Things in Healthcare.” Econsultancy, 13 Mar. 2017,
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.
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.
Krawiec, RJ, et al. “No Appointment Necessary: How the IoT and Patient-Generated Data Can
Unlock Healthcare Value.” Deloitte University Press, Deloitte,
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-
Patients & Caregivers
DrBonnie360’s mission is to
create a digitally connected world
of personalized care for
Connection, we consult with
startup companies and
entrepreneurs who are bringing
new products and services that
will improve all aspects of