You can't have a technology discussion today without the phrase "Internet of Things" (IoT), or better yet, "Internet of Everything" showing up. This makes sense, since the latest Gartner hype cycle report places "Internet of Things" at the peak of the hype cycle (ousting big data from the top spot.)

IoT is so pervasive I even had a conversation with my cardiologist this week about it. While I was in for the annual 10,000-mile checkup of my pacemaker, I mentioned that at the recent MassTLC Innovation UnConference, the topic of connected devices was hot (see my blog, MassTLC Innovation UnConference 2014 - Views from an UnConference Neophyte). This triggered a lively discussion with my doctor. Many of the points he made I found very applicable to the technology as a whole, and they provided insight into the Internet of Everything from the viewpoint of a healthcare professional.

Product lifecycle expectations
According to my doctor, based on current usage, my 10-year-old pacemaker has about five years left. I told him that at the MassTLC conference the topic of product lifecycle for devices in the IoT world was widely discussed. The expected lifecycle for these devices tends to be significantly longer than other IT technologies, putting a different level of consideration on the design and development of both the hardware and the software. My doctor noted that the lifecycle for implantable devices is a delicate balance for vendors and doctors. Doctors (and payers) do not want frequent surgeries replacing devices, whereas vendors who are developing new products need a customer base to sell these products.

[Wearables and biosensors could play a key role in improving healthcare by collecting crucial data so providers don't have to. Read Event-Driven Medicine Holds Great Promise.]

The gating factor, as with most mobile devices, is power -- the battery. My doctor noted that the current expectation for a heavily used pacemaker is seven or eight years before the battery runs out; he will not even consider anything less than that. Extending beyond that seven-to-eight-year period means increasing the size of the device, which creates other potential concerns. He also mentioned that for a time in the 70s, pacemakers were nuclear-powered with a small amount of plutonium. He removed one of those from a patient in the 90s, and it was still operational. Surprisingly, it wasn't the risk of radiation to the patient, but rather new rules and guidelines around disposal of hazardous waste, especially radioactive waste, that spelled the end for this option.

The lifecycle concern does not just apply to implantable devices. Think about cars or home appliances such as refrigerators. These are all becoming "smart" devices in the IoT world; most people don't replace cars or appliances every couple of years. The lifecycle of these devices is a key consideration when manufacturers and developers design and build their software as well as the software that interfaces to them. This led directly to our next topic.

It's all about the ecosystem
"Ed, ultimately, for me, it's all about the ecosystem," my doctor said, adding that this is the key deciding point when selecting the technology for implantable devices. The primary function of an implantable device such as a pacemaker doesn't really change: It monitors the heart rate, and if the rate goes out of defined boundaries, the pacemaker sends an electrical charge to correct the issue. With the base functionality in place, the physician's next priority is the data.

How is the data collected? How is it presented? What analytics are available to study trends in the data? Most doctors have a large number of patients; the last thing they want is multiple pieces of equipment communicating and extracting data from the devices, and other pieces of technology for performing analysis and presenting results.

The optimum solution for my doctor is an integrated ecosystem for implantable devices. He is looking for a single, easy way to retrieve, present, and analyze the data from these devices. We again used my current, somewhat archaic, pacemaker as an example: He has a device in the office that communicates with it. The device retrieves and presents the data in a nice consistent fashion. I also have a remote monitoring device. A third-party service calls me at regular intervals to check the status. This device uses an acoustic coupler modem (did I mention it's archaic?) and two wrist-strap electrodes that do the monitoring. That system provides a subset of the data my doctor gets from the device in the office. While the system does provide useful information, it is not ideal. In newer versions, the remote device provides exactly the same data in the same format as the device in the office.

The ecosystem challenge is not unique to implantable devices. The number of different "things" -- wearables, smart appliances, sensors, actuators -- is exploding. Currently, each of these devices exists in its own private ecosystem; there is no shared infrastructure. Standards are in their infancy. Control and sharing of the data is ill-defined and nebulous at best. (I raise an example of the data challenge here.)

If the Internet of Everything is to evolve from a hot, interesting technology to something that lives up to the hype, we must solve the ecosystem challenge. The plumbing -- the shared infrastructure -- needs to be established. Standards bodies are moving forward in defining the infrastructure, along with the pot of gold: the data.

Our job as technologists is to work with business and vendors to help identify the challenges, risks, and solutions that will address the needs of the ecosystem. Those businesses that deal with the ecosystem challenge first will reap the reward and get a headstart on competitors. There's an old expression: "May you live in interesting times." In the world of the Internet of Everything, these are definitely interesting times.

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