We live in extraordinary times. It feels like everything around us is moving so fast. It’s only when you pause for a moment and look back, that you realize how far technological advances have taken us. The Earth still moves at the same speed, but we’ve shrunk it in so many ways, connecting people through information and ideas in a relative blink of an eye.
In December of 1995, the International Data Corporation (IDC) reported the number of Internet users to be 16 million, or 0.4% of the world’s population. Twenty years later approximately 40% of the world’s population has an Internet connection. The first billion was reached in 2005, the second billion in 2010, and we just hit the third billion in 2014. Amidst the rising tide of a fully connected world and the proliferation of mobile communications, we find ourselves at the dawn of the Internet of Things—disrupting industries as diverse as manufacturing and shipping, to retail, transportation and healthcare.
It’s predicted that some 4.9 billion “things” will have been connected over the internet this year, with that number quintupling to 25 billion by 2020. Gartner estimates that the IoT market will support total services spending of $69.5 billion in 2015 and $263 billion by 2020. A new McKinsey Global Institute report states: “Our bottom-up analysis for the applications we size estimates that the IoT has a total potential economic impact of $3.9 trillion to $11.1 trillion a year by 2025. At the top end, that level of value—including the consumer surplus—would be equivalent to about 11 percent of the world economy.”
I know what you’re thinking; it’s what everyone is thinking. There is a lot of hype around IoT. Hindsight is always 20/20, but seeing 12 months in front of our face is an entirely different matter. In this foggy landscape filled with high corporate valuations, and talk of bubbles conjuring Dot-com déjà vu, we find ourselves wandering, searching for clues as to what are reasonable expectations and what is overblown. It makes this next tidbit from the McKinsey report all the more interesting.
“Our central finding is that the hype may actually understate the full potential of the Internet of Things—but that capturing the maximum benefits will require an understanding of where real value can be created and successfully addressing a set of systems issues, including interoperability.” That is quite a hedge. As Yogi Berra so eloquently put it — “It's tough to make predictions, especially about the future.”
The great promise of the Internet of Things is a digitally interconnected world of streamlined efficiency. (Think “The Matrix” but without the human enslavement by robot overlords.) Everything will "talk" to each other, from Big Data in The Cloud, to smart cars and homes, all in a harmonious symphony of digital sublimity. But we all know the future won't be without hiccups. Without question, smart implementation is crucial for continued success down the road.
RFID, RTLS and Smart Devices
Wireless asset tracking and environmental monitoring tags are not new technology, but the sensors and tag readers are being used as a bridge for connecting the Internet of Things, until the near future when the devices themselves are smart enough to communicate without an external sensor. Arguably, one can think of tagging things with these sensors as a way of making them “smart”. If it seems like buzzword appropriation, it kind of is. Asset tracking with wireless tags has been chugging along before the term IoT began basking in its current media hype, but it’s now factored into this rapidly evolving tech universe.
These tags are typically classified into two groups with regards to hospital operations: Active and Passive. In healthcare, active tags are referred to as RTLS (Real Time Location System) and passive tags are referred to as RFID (Radio Frequency Identification). Technically, passive RFID systems can be deployed to provide real time location data, but that is another topic for another day. We will stick to the industry standards for this discussion.
Passive tags are basically battery-less antennas waiting to be found by a reader, while active tags require a power source and broadcast a signal, transmitting identifying information. It gets even more confusing, when you consider the different communication protocols that RTLS tags can utilize. Depending on the supplier, systems can communicate via Bluetooth, infrared, Wi-Fi, ultrasound or a combination of the technologies, but the important thing to remember is that RFID and RTLS sensors are tools that can be used to solve problems. The tool is not in-and-of-itself a solution; and like most tools, it needs to be used correctly and properly maintained.
IoT in Healthcare
Here’s a real-world example of what we’re talking about (with the names being changed to protect the innocent.) St. Elsewhere is a hospital that bought an RTLS system a few years ago for equipment tracking, temperature monitoring, inventory management, and patient/staff tracking. The results were less then stellar due to three factors that were overlooked. The first, and most significant, was thinking that sensor data would solve underlying, deeply embedded workflow problems. Knowing where assets are, or knowing that a refrigerator is out of range, doesn’t help much unless a specific person is responsible for correcting the problem in a specific amount of time.
The second factor was overinflated expectations with respect to sensor accuracy. Wi-Fi RTLS systems determine location using triangulation between the Wi-Fi access points. Changes in the environment and Wi-Fi network can significantly impact system accuracy. How many times would it take for a nurse to abandon a system that sends them to a location to retrieve a device that isn’t actually there? Imagine if your GPS gave you inccorect directions, even just a few times in a row. It wouldn't be too long before you busted out one of those old roadmaps from the glove compartment.
The third factor was the gross underestimation of the manpower required to maintain the RTLS system. Recall that active RTLS tags are powered and require batteries, and all those batteries must eventually get replaced (in this case every 12-18 months). Adding 5,000 new devices (tags) that require annual preventative maintenance for preemptive battery replacement is time consuming; as is keeping up with lost and damaged tags. In this case, it was too much to keep up with, so the RTLS system was all but abandoned. Money spent and wasted, because of poor implementation, understanding and oversight.
As RFID and RTLS technologies evolve, they will become smaller and integrated into devices, eliminating the need for external tags. That will certainly help with the overhead issue, but the robots haven’t replaced us yet—any IoT solution will still be dependent on efficient workflow, accountability and real-time communication between the people doing the work. This is how IoT will eliminate day-to-day inefficiencies and deliver the real value that McKinsey believes will unleash the full potential of the market.
The Internet of Things is altering our industrial landscape, changing the rules of the game. As we gaze collectively on this new digital horizon, let’s not forget that the goals are still the same. For healthcare, that still means improving patient care and reducing cost and the implementation of new technology must always strive to support those outcomes.