Prescription drugs are a fact of life for millions of people worldwide. Some medicine is administered by healthcare professionals in clinics and hospitals; in other cases, it’s left to patients themselves to manage their own medication at home, particularly when it comes to long-term, chronic conditions such as diabetes or high blood pressure.
Either way, it’s vital that patients stick to the prescribed regimes, taking their medicine at the right times of day and in the right doses, as directed by their physicians.
Sticking to doctor’s orders in this way is often referred to by healthcare professionals as ‘medication adherence’. A lack of it (or ‘non-adherence’), meanwhile, can pose serious risks to health, says Sean Handel, senior vice president at digital medicine specialist Proteus Digital Health.
“Medication non-adherence leads to uncontrolled health conditions, excess hospitalizations, emergency rooms visits and office visits,” Handel says. He reckons it’s costing the US healthcare system around $290 billion annually – and the problem is acute, he adds:
“More than 50 percent of prescribed medications are not taken as directed and providers lack accurate, timely adherence data necessary to diagnose non-adherence and its root cause and then allow the patient and provider to respond quickly to poor adherence.”
With that in mind, Proteus Digital Health offers Proteus Discover, billed by the company as ‘the world’s first digital medicine service’. This involves an ingestible, sensor-equipped pill which, on reaching the stomach, sends a signal to an accompanying patch, worn on the skin. Patients can use the Proteus Discover app to keep track of the medication they’ve taken and to set up reminders. Their healthcare practitioners, meanwhile, can monitor their adherence.
Proteus Discovery is just one example of how healthcare IoT could help to ensure that patients get the medicine they need. Although sometimes hampered by compliance and risks concerns or lack of funding, the IoT has quietly slipped into healthcare environments.
Improving drug delivery and adherence through these technologies is just one area of focus, much of it driven by technology start-ups. And at this early stage there seems to be more traction around medicine adherence than the automation of delivery – in other words, smart devices that automatically deliver a dose of a drug to a patient without any other human intervention.
For instance, last year saw E Ink – best known for making the screens on Amazon Kindle e-readers – partner with the healthcare division of smartphone manufacturer HTC and packaging specialist Palladio Group to design ‘smart’ labels for medicines. These provide patients with a reminder when it’s time to take their medicine, information on the quantity of medication left in the package, and an update on the time at which medication was last taken. They can also request a refill in the case of a repeat prescription, simply by pushing a button on the product label.
According to Dr Fy Gan of E Ink, the smart packaging label can be applied on a range of packaging, “from paperboard cartons to prefilled syringes to pill dispensers” in order “to improve medication-taking behaviors.”
AdhereTech, meanwhile, makes smart wireless pill bottles for tracking adherence, which use cellular technology and sensors to remind patients if they miss a dose through an automated phone call or text message.
Automating drug delivery
But more complex solutions are coming to market that seek to automate drug delivery itself. For instance, Chrono Therapeutics has developed a device worn on the arm or torso that syncs with a mobile app and monitors nicotine levels in the patient’s body. It can then auto-administer nicotine before cravings kick-in, as part of smoking cessation programmes.
Meanwhile, Microchips Biotech has developed implants that can store and release precise doses of drugs over extended periods of time – for months and even years, the company claims. Each implants contains hundreds of ‘micro-reservoirs’; these are small, hermetically sealed compartments, each of which can store up to 1 microgram of a drug.
The implant is activated by a wireless signal that triggers the micro-reservoirs to release the drug on a pre-programmed dosing schedule. These implants can also be built with bioelectric sensors which release drugs in response to physiological or metabolic changes in the patient.
Other tech, meanwhile, promises to bring more precision to the drug delivery process; Injeq’s new IQ-Needle smart needle, for example, is used for lumbar punctures (otherwise known as spinal taps) and gives an alert as the needle tip reaches its target – the spinal fluid. This helps to avoid an overly deep puncture and unnecessary tissue damage.
And with other areas being explored – such as smart inhalers and smart insulin pens such as the award-winning KiCopen – this is clearly a rapidly evolving space.
Patient power and challenges
Last year, ‘citizen health hacker’ Tim Omer, who has diabetes, told Internet of Business how he re-engineered his continuous glucose monitor to deliver real-time blood glucose measurements on his Android smartwatch. He believes that IoT technologies are generally moving healthcare in a positive direction.
“As a patient, the more I understand, the more control I have to review and analyse and use systems to assist me, the better I can manage my condition,” he tells Internet of Business.
But there will be challenges ahead. In the UK, for example, last year’s Wachter Review of the National Health Service’s use of IT highlighted the difficulty of reform, even in relatively straightforward areas such as the implementation of electronic healthcare records.
And as Tim Omer points out, the sheer number of IoT device vulnerabilities could spell trouble for medical devices that, above all, needed to be trusted.
“Security and the accuracy of the service needs to be fully tested,” says Dr Ramin Nilforooshan, consultant psychiatrist and lead clinician for the Surrey Borders Technology Integrated Health Management (TIHM) project, in which people with dementia and their carers are being provided with wearables and other devices to monitor their health and wellbeing in their own homes.
These devices can, for example, detect if a patient has left the house, had a fall, is not eating or drinking normally or has used the bathroom more than usual. If the solution identifies a problem, an alert is issued that is followed up by a clinician or carer.
“We have received many positive reports from trusted users. Carers and people with dementia feel very supported with the idea of a monitoring system in place for them,” says Dr Nilforooshan. But when it comes to IoT drug delivery, he says, security could be the biggest challenge.
Other medical professionals, meanwhile, variously cite limited data usage, data integrity, information governance, network performance and regulatory requirements as potential barriers. But most still agree that the IoT has a lot to offer the health sector, improving patient care and outcomes.