30/11/18
Author: Professor Luc De Witte, Pitch-In Academic Lead for health and wellbeing, the University of Sheffield.
In the broadest terms, it seems obvious that any technology that promises to improve the delivery of care or extend the coverage of our care systems will be appealing. In recent years we’ve seen the Internet of Things (IoT) promoted as one such ‘saviour technology’, alongside AI, big data, robotics and blockchain.
IoT could allow the coverage provided by our care systems to be extended to people, places and times that are beyond the reach of current provision.
The idea of IoT is, on the face of it, quite straightforward: networks of interconnected devices share data about the people, things and places around them; the data are aggregated and analysed; and these analyses are then used to improve the state of people or their environments. It’s not too difficult to see such networks as comparable or complementary to conventional care systems, which are built on cycles of monitoring, consideration and intervention.
IoT, so the argument goes, would allow the coverage provided by these care systems to be extended to people, places and times that are beyond the reach of current provision. Moreover, the potential of this technology is not limited to ‘patient-facing’ systems, but could encompass, for example, resource usage monitoring in clinics, personalised waymarking in hospitals or more efficient heating control in care homes.
The use of IoT raises a number of serious practical and philosophical questions about the future of care provision.
By their very nature IoT systems will tend to generate data in large volumes and at high rates and, if we’re not to overwhelm already stretched health and care workers, some degree of automated data processing seems inevitable, possibly up to and including full automation in certain contexts. And this naturally leads us to consider some of the questions that the use of this technology raises:
To what extent and in which areas are we comfortable with automated care processes? Does automation degrade the notion of care (and carer-givers) or extend (or even enrich) it? Are our existing organisations ready to provide ‘data-driven care’, or is this a wholly new discipline that will need time for its own methods and models to develop?
How do we design, construct and deploy these systems in appropriate, inclusive, acceptable and trustworthy ways? How do we validate the behaviour of systems and ensure that they operate in a reliable and consistent manner? How do we incorporate the technology as services into the existing work practices of the care organisation? How do we enable these services and the technology that underpins them to evolve with the care organisation and the changing needs and expectations of its ‘customers’?
What safeguards, regulations and legislation are needed to ensure the safety of users in terms of their physical, mental and cognitive wellbeing, but also in terms of data security, integrity and privacy?
How can we evaluate these systems in ways that are rapid enough to ensure most benefit is gained from the technology yet rigorous enough to maintain quality control? What is the value proposition, on both the supply-side of provider and demand-side of user? What sort of economic models are required to ensure systems are developed, deployed and maintained for a reasonable length of time, especially where users come to depend and rely on them? How is this new ‘medtech marketplace’ to be regulated, if at all?
As in other sectors of the economy, any efficiency savings brought about by automation and greater self-care will almost inevitably be construed in terms of redundancies among care staff: is this an inevitable consequence of ‘progress’ and the need to streamline services, or is it something we should resist?
The challenge becomes one of understanding the implications and guiding the introduction of IoT... which is where Pitch-In plays a role.
In summary, the use of IoT raises a number of serious practical and philosophical questions about the future of care provision. Nonetheless, the possibilities suggested by IoT for more efficient and effective care are so exciting – and the difficulties faced by the sector are so grave – that we cannot afford simply to ignore or dismiss it.
Along with other new digital technology, IoT seems likely to be incorporated into our care systems in one way or another, and so the challenge becomes one of understanding the implications and guiding its introduction for the benefit of all. And this is where the Pitch-In programme plays a role: it provides a mechanism to bring together technology providers, the health and care sector professionals, academics and service users themselves to explore these issues through projects that address practical problems. While it is probably too much to expect that we will find answers to all the questions, at least we will have made a serious start.