DIGITALIZATION IN MEDICINE: THE INTERNET OF MEDICAL THINGS (IOMT) - ARICENT
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Digitalization in Medicine: the
Internet of Medical Things (IoMT)
Ludovica Visciola (Altran Switzerland)
www.altran.comI. Background
The Internet of Things (IoT), a term likely coined by Kevin Ashton in 19991, is the
extension of the Internet to smart devices, a concept that was discussed as early as
1982 when a modified Coke vending machine at Carnegie Mellon University became
the first internet-connected appliance2. In the past years, the Internet of Things has
gradually expanded to the medical field and taken the name of Internet of Medical
Things (IoMT). In 2016, Dimitrov D.V. estimated that by 2020, 40% of IoT-related
technologies will be health-related, creating an up to $117 billion market3-4. In 2017,
already 80 million wearable sensors were used in the healthcare market 5.
II. The advance of wearables
Wearable technologies are disrupting the healthcare industry with a rapid increase in
the usage of technologies like Fitbit all the way to FDA approved medical devices.
Wearable Market6
15%
48% 15%
12%
5% 5%
Apple Watch Xiaomi Fitbit Samsung Garmin Other
Thanks to the IoT, many wearables have moved from wellness to real-time patient
monitoring7. Indeed, people with health conditions could use a wearable device to
track the status of their disease on a daily basis as well as collecting an incredible
amount of data on their health. By having access to their own medical information,
patients will have a better visibility on their conditions, will be able to share their data
www.altran.comwith their health providers and hopefully it will be easier to make informed decisions
on treatment options.
One of the applications that is gaining traction for wearables is the detection and
monitoring of heart diseases such as Atrial Fibrillation (Afib). Afib is the most
common serious abnormal heart rhythm disease, with a current estimation of over 10
million adults living with the condition in the European Union, a number that is
projected to reach 18 million adults by 2060 8. Atrial fibrillation patients have an
abnormal heart rhythm characterized by rapid and irregular beating of the atria which
can lead to increased risk of heart failure, stroke and dementia. The high prevalence
of the disease, coupled with the difficult prognosis, make Afib a good condition to
tackle with wearables.
Worldwide top 5 wearable companies, unit market share
evolution from Q4 2017 to Q4 20189
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Q4 2017 Q1 2018 Q2 2018 Q3 2018 Q4 2018
Apple Xiaomi Huawei Fitbit Samsung Others
III. The Apple Heart Study
The first large real-world clinical study assessing the capabilities of a wearable
device to help in health monitoring is the Apple Heart Study. The results of the trial,
which saw the collaboration of Apple and Stanford University, were presented during
the 2019 American College of Cardiology conference in New Orleans.
www.altran.comAn optical sensor at the back of a standard Apple watch, detects the pulse waveform to passively measure heart rate. The hypothesis was that the detection of a pulse irregularity may be useful to identify Afib and guide subsequent clinical evaluation. The Apple Heart study enrolled 419‟297 US participants aged 22 years or older with no history of atrial fibrillation or atrial flutter. The participants were asked to download the Apple Heart study app on their iPhone and Apple watch, after which their pulse was measured regularly. Detection of five of six repeat irregular pulses within a 48- hour period triggered a notification to be sent via the app. Participants receiving the notification were asked to contact a study doctor through the app. A video consultation would ensue, during which the physician would determine whether the participant should wear an ECG patch for as long as seven days. Of the 419‟297 participants, 2‟161 (0.52%) received a notification and patches were sent to 658 of these patients. In the end, 34% of those who received a notification and wore the ECG patch had Afib. Interestingly, 57% of the patients who received a notification said they had contacted a health provider outside the scope of the study, and 28% were started on a new medication. The positive predictive value for the pulse notification was of 84%, supporting the hypothesis that the Apple watch can correctly identify Afib among those notified 10. At this stage, Marco Perez, MD (Stanford Medicine, Palo Alto, CA, USA), one of the primary investigators of the study, stressed that more information is still needed especially regarding cost-effectiveness, before he would recommend use of this technology to everyone11-12. IV. Conclusion The Internet of Medical Things is revamping healthcare services by allowing patients to be in control of their medical history and benefit from continuous monitoring, as well as by providing physicians with fast and accurate historical data on their patients. Furthermore, one of the best parts of digitalization in healthcare will be the possibility for patients to be monitored and advised from anywhere in the world, winning over the limitations of traditional pen and paper records, accessible only by www.altran.com
few. Once security and privacy issues are solved, the sky is the limit with wearable
technologies.
.
V. References
1. Ashton K., “That „Internet of Things‟ Thing”, June 22, 2009 -
https://www.rfidjournal.com/articles/view?4986
2. “The “Only” Coke Machine on the Internet”, Carnegie Mellon University -
https://www.cs.cmu.edu/~coke/history_long.txt
3. Dimitrov D.V., Medical Internet of Things and Big Data in Healthcare, Healthc Inform Res. 2016;
22(3): 156-163
4. Bauer H, Patel M, Veira J. The Internet of Things: sizing up the opportunity [Internet] New York
(NY): McKinsey & Company; c2016.
5. Trends in Medical Affairs - https://www.slideshare.net/pmpconnect/trends-in-medical-affairs-
91130171
6. IDC Worldwide Top 5 Wearable Device Vendors Share by Unit Shipments, 2017 Q1 https://cdn-
images-1.medium.com/max/1600/1*PhGbplvE2yZLxNQlyBZBWg.png
th
7. The Role of Connected Wearable Devices in Healthcare, May 16 2019,
https://www.iotforall.com/connected-wearable-devices-healthcare/
8. Conen D., Epidemiology of atrial fibrillation, European Heart Journal 2018; 39(16): 1323-1324
9. Perez S., IDC: Apple led wearable market in 2018, with 46.2M of the total 172.2M devices shipped,
March 2019: https://techcrunch.com/2019/03/05/idc-apple-led-wearables-market-in-2018-with-46-2m-of-the-
total-172-2m-devices-shipped/
10. Turakhia M, Perez M et al. Results of a large-scale, app-based study to identify atrial fibrillation
using a smartwatch: the Apple Heart Study. Presented at the 68th American College of Cardiology
Scientific Session, New Orleans, Louisiana; March 16-18, 2019. Abstract 19-LB-20253.
11. Maxwell Y.L., Apple Watch may detect Afib in the general population, but at what cost?, NEWS
th
ACC 2019, March 16 2019, https://www.tctmd.com/news-acc-2019-apple-watch-may-detect-fib-
general-population-what-cost
th
12. “Apple Heart Study identifies Afib in small group of Apple Watch wearers”, March 16 2019,
American College of Cardiology, https://www.acc.org/latest-in-
cardiology/articles/2019/03/08/15/32/sat-9am-apple-heart-study-acc-2019
About the author:
Ludovica Visciola holds a Master degree in Life Sciences and Technology with a specialization in
Neuroscience from the École Polytechnique Fédérale de Lausanne. She is a consultant specialized in
medical affairs for cardiovascular technologies in Life Sciences within Altran Switzerland, which has been
involved in the development of connected healthcare ecosystems from device/apps to data storage
solutions. Check our showcase: https://www.altran.com/ch/en/industries/life-sciences/
Altran ranks as the undisputed global leader in Engineering and R&D services (ER&D), following its
acquisition of Aricent. The company offers clients an unmatched value proposition to address their
transformation and innovation needs. Altran works alongside its clients, from initial concept through
industrialization, to invent the products and services of tomorrow. For over 30 years, the company has
provided expertise in life sciences, aerospace, automotive, defense, energy, finance, railway and
telecommunications. Combined, Altran and Aricent generated revenues of €2.916 billion in 2018, with
some 47,000 employees (300 in Switzerland) in more than 30 countries.
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