Medical devices such as asthma inhalers, IV infusion pumps, and CPAP machines are increasingly part of home healthcare, but are often misused or underused by patients and by their caregivers, leading to poor outcomes for patients.
There is often a lack of detailed knowledge of how devices are used, how effective they are when used properly and as intended, how often and how they are used for off-label purposes, how often and how they are misused, and how often they malfunction.
IoT-based monitoring and analysis can provide clinicians, regulators, insurers, and device manufacturers with realistic usage data that can then be used to accurately measure outcomes, and transform the next generation of medical devices.
At Home Medical Device Use
Devices developed and meant for use in a clinical setting are migrating to nonclinical environments such as the home or workplace. Home care is cheaper, more convenient, and allows for treatment in a familiar environment, while also avoiding the risks of cross-infection that comes with hospital care.
Incorporating IoT into medical devices used in non-clinical settings can provide a much clearer picture of their use, misuse, and other problems. Until now, devices could be used incorrectly or inefficiently, suffer malfunctions, or become dangerous for a long period of time before those problems were detected.
A few examples will show how varied the problems can be.
IV Infusion Pumps
Intravenous (IV) infusion pumps, originally designed for use in clinical settings, are increasingly being sent home with patients, for hydration, antibiotic delivery, parenteral nutrition, and postoperative pain management. Monitoring can keep track of dosages, ensuring that supplies do not run out, and be tied to such metrics as time of use, heart rate, temperature, and patient self assessments.
Infusion pumps are complex to use, and the models from each manufacturer have a different set of controls and prompts. Patients can accidentally alter the dosage or put in the wrong medication if they are on multiple medications. Continuous monitoring with IoT can indicate where errors are typically made, issue a warning to the physician if there are serious problems, and provide users with feedback that help them become better at using these complex devices.
Metered-dose inhalers (MDIs), first-line therapy for asthma, are frequently misused by patients. This misuse can lead to uncontrolled asthma, with life-threatening risks. In response, physicians often prescribe increased dosages or more powerful medications.
Correct MDI use requires physical dexterity, coordination between hand and lung, and proper inhalation. There is no real feedback to indicate that the process is being carried out effectively. Even those who are trying to use the device properly often miss one or more steps, or time things incorrectly.
Over time the most common trend is for a patient to underuse control medication, leading to excess use of rescue medication, and an increasing risk of a serious episode. Everyone tends to misremember how well they used their MDI when talking with their physician, making it hard for the physician to determine exactly where the problem lies.
New models of inhalers can measure how the device is being used, under what circumstances, and how much of the medication is actually reaching its desired destination. IoT monitoring of use can help clinicians tailor messaging, training, and device selection to the needs of the specific patient in a way impossible without clear, long-term knowledge of how the device is used.
An increasingly common home treatment is the use of continuous positive airway pressure (CPAP) machines for obstructive sleep apnea, a condition that exacerbates the effects of heart disease, atrial fibrillation, and high blood pressure. There is a significant learning curve in using a CPAP, with some initial discomfort. As a result, patient adherence to PAP therapy is quite bad, with fewer than 50 percent of patients using the device for more than four hours a night, despite this being the best therapy for sleep apnea. IoT monitoring can provide physicians with clear data on any problems with the use of the device, encouraging a discussion centered around its benefits.
The initial discomfort and lack of immediate benefit means that patients often end up not using the machines. As a result insurance companies have become wary of paying upfront for the purchase of these expensive machines, preferring a rent-to-buy model with significant monitoring to ensure proper and consistent use. They might also refuse to pay for replacement supplies, such as masks, filters, and tubing, if the data indicates that use has been inadequate. Patients can find this type of monitoring quite intrusive.
Physicians, Patients & Devices
The example of the CPAP reveals the complexity of the relationship between prescribing physician, device-using patient, and reimbursing insurer. Patients can become resentful at what they see as the intrusiveness of the insurance company or excessive monitoring by the physician.
Other patients who might initially have found using a CPAP difficult and unintuitive, and so stopped using it before its effectiveness became evident, can respond to the feedback (and the financial incentive), persevere, and improve their health.
These very human conflicts can be real obstacles in attempts to incorporate IoT into medical treatment. The additional information should support the therapeutic relationship, increase patient understanding, and improve the communication channel between patient and physician, rather than attempting to substitute for it.
After all, asthma sufferers want to stay out of the emergency room, infusion users want to get the correct dose of medication for their condition, and CPAP users want a restful night’s sleep. It’s just that medical devices are often anxiety provoking, cognitively demanding, and operationally opaque.
IoT has the potential to reduce health problems, but it needs to be incorporated with a clear understanding of them, so that home use of medical devices can be as effective and safe as possible.