A Cambridge, Massachusetts, research lab is addressing some of modern medicine’s most overlooked issues with cutting-edge IoT technology and an open-source approach, weaving aging devices and deeply siloed data into an accessible web of medical information.
The Medical Device Interoperability Program, or MD PnP, in affiliation with Massachusetts General Hospital and Partners Healthcare, is a hub for research into making medical devices dramatically smarter by making it simpler for them to share the data they gather.
With more and more people being monitored by IoT devices in hospitals and monitoring themselves with Fitbits and Apple watches, there’s suddenly a lot more digital data than there was before in the world of healthcare.
One challenge is to gather and analyze that data from disparate devices so it provides medical professionals with more complete information about the condition of their patients. Another is to make that process simpler for the IT staff that has to set up the systems.
The heathcare field ratchets the usual difficulties of integrating all these systems up to a much higher level. There are too many device makers, too many technical hurdles, too many regulatory issues – and the penalty for getting something wrong is that people could die.
One of the main issues the lab tackles is alarm overload. Walk through any busy hospital ward, and one of the main ambient sounds that greets the ear is a chorus of beeps and boops from monitoring device alarms, like birds tweeting and whooping in a jungle canopy. And like biologists or National Geographic photographers, the healthcare workers who spend a lot of time in hospital wards eventually start perceiving the sounds as background noise, not something to be actually alarmed about. That, obviously, is a problem on the occasions where the alarm isn’t just going off because a patient’s blood oxygen dipped below the threshold for a millisecond or when the clip slipped off of a fingertip.
It’s not their fault, according to MD PnP lead engineer, Dave Arney. Traditionally, medical devices are a little bit “dumb,” whether they’re simply older technology or constructed to fulfill strict requirements such as: if the patient’s blood pressure reading EVER drops below a certain level, then alarm.
“All those alarms are almost certainly working exactly how they were intended to be used,” said Arney.
But Dr. Julian Goldman, the director of the MD PnP program, said, “If you were to rethink that environment today, you might say that maybe it should be conditional – maybe you should bring up a different alarm app for a patient in the ICU after surgery, and a different intelligent alarm app for a neonate,” he said.
Goldman and Arney think that a big part of the solution to alarm fatigue is intelligence and interoperability. Arney used the example of a pulse oximeter – a simple device clipped to a finger tip used to measure blood-oxygen levels – being connected to a blood-pressure cuff. If the oximeter knows that the blood-pressure cuff is taking a measurement at any given moment, it won’t alarm when the patient’s O2 saturation drops, since it knows that there’s a perfectly good reason for that to be happening.
Context-aware alarms, a la aviation, are what’s needed in medicine, according to Goldman. Many airplanes are equipped with systems that do things like sound an audible alarm if the pilot appears to be trying to land without lowering the landing gear.
“How is a plane so smart that it knows you’re trying to land with the landing gear up? Why doesn’t the alarm go off when the landing gear is up at 30,000 feet?” asked Goldman. “The point is when you integrate sensor data, your alarm becomes a lot more useful. It becomes trusted. That’s the kind of thing we need in health care. And to do that, you need to integrate data from many sources, and IoT’s capabilities add to that richness.
