IOT healthcare

Reengineering the Healthcare Process Using IOT

Abstract and Organizational Setting

With the beginning of the convergence of technologies which collectively form the internet of things, it brought a new opportunity to rethink products and services. Cisco estimates that internet of things will continue to develop into a 3.9 trillion-dollar industry in the manufacture of the internet of things devices over the next ten years (Kranz, 2018). Internet of things brings together people from traditional information technology network services along with software developers and electrical engineers. One key advantage of the internet of things is the ability to remotely diagnose and troubleshoot internet connected devices (Kranz, 2018). Internet of things has a strong history of being useful for providing utility companies such as those who provide oil and gas with analytics. Health care companies also need analytical processing. Despite all the technologies integrated into healthcare, the problem of too many alerts remains an issue. Runaway alarm and alerts from devices in the patient’s bed, monitor, or other electronic devices which are now are most often treated by people who ignore them. Nurses currently work around these persistent alerts by muffling these devices under blankets (Wachter, 2015). In one hospital intensive care unit, a dumb waiter made a sound very similar to the critical arrhythmia alert when the dumb waiter reached the floor with food trays (Wachter, 2015). Not only can technical skills be rethought, but social and business processes often regarded as soft skills can also be re-engineered. Rather than focus on the technology behind internet of things can provide, this paper focuses on business processes that can overcome the risks associated with the internet of things startup companies. In a similar manner that application programming interfaces form a common

3 / 37

language to bring intelligence to the internet of things devices, revised business processes can bring about results which can unify people around problems. Currently there are four major barriers to job enrichment that are discussed in this paper which are problems caused by the supervisory system, technical system, the personnel system, and the control system. The control system such as complying with organizational policies poses a problem because there is a difference between how an organization operates during disaster recovery and how it operates on a day-to-day basis. Should an employee see something that is not right, because of inflexible quality-control measures, the employee may not have the discretion to quickly solve the problem. The technical system causes a problem in production line technology is highly programmed and standardized. This limits the amount of the freedom the employees have in troubleshooting problems that must be elevated to a supervisor. The personnel system causes a problem because the system constrains formalized job descriptions that are rigidly defined and provide limited flexibility. The supervisory system can be a problem because the system determines the amount of autonomy and feedback the subordinates can receive. These problems might be addressed when using methodologies such as Six Sigma, Lean, Scrum, and Agile. Utilizing these business strategies with the internet of things devices can bring reduced labor, lower costs, increased productivity, and improved quality.

4 / 37

Supply Chain in Healthcare Processing

While healthcare is a service, six sigma Agile processing, and Lean processing can also be useful to healthcare as it is to tangible products. Designing quality systems to aid health care is like delivering other business services where it is important to be mindful of certain requirements of the product. When starting off with a business project, it is important to ask questions such as: What questions do I want to answer? Why is this an issue? For physicians to guide patients towards the best healthcare systems depends, in part, on the decisions made by physicians. Computer systems with the ability to cultivate patient gathered data and distill the information through an organized workflow can help guide the provider to insights that would result prescribing the correct drug in the correct dose to the correct patient at the correct time (Arthur, 2016). Data gathering and information gathering is different because information contains the contextual information that is not included in data (Nelson & Stagger, 2018). Currently smart home sensors can offer health-related data, but since these solutions often come from different applications there is no conformity in the products analyzing making understanding and using this data to assist doctors in their decision making more difficult for providers. The goal of this paper is to introduce the reader to the concepts of a platform uniting the facets of silo applications into a united application, providing insights in an accessible format. An organized assembly engaged in an open-source community effort to offer support to a unified functionality an ecosystem of existing sensors and providing encouragement to stakeholders to build IOT sensors with IOT development tools can greatly help within the cultivation of information. Isaiah 41:13 says “For I am the Lord your God, who takes hold of your right hand and says, ‘Do not fear; I will help you”. General George Patton said “Never tell

5 / 37

people how to do things. Tell them what you want done and they will surprise you with their ingenuity in getting there.” A collaboration team transforms data into wisdom, making patient encounters with providers more beneficial. There is a proverb which says “Tell me, I forget. Show me I remember. Involve me, I understand.” People in true teams feel like they own their jobs, meaning they feel responsible for finding the best methods of performing excellent work at the highest standard. When the stakeholders take part in this project they would understand where the data is coming from and could apply it to help the community.

The Current Process

Figure 1: Diagram shows a business process spider diagram of current telephone process

The re-engineering process is the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical measures of performance which may

6 / 37

include cost, quality, services, and speed. The existing process for reporting patient information is untimely and unreliable, and therefore it needs to be re-engineered to make it more efficient. For example, a person might not be able to discern they are undergoing medical trauma which might include a stroke, a heart condition, or an asthma attack. Linda Mortiary, an oncology registered nurse, describes her encounters with a cancer patient. She says,  

Starting with their first visit, our patients are instructed to call us with any questions they might have including symptom management concerns, education needs, and any lapse in disease or treatment understanding. Our telephone triage efforts involve performing verbal assessments, triaging symptoms, as well as navigating patients through their cancer journey. … Information provided by a triage nurse is not fully beneficial to the nurses because we are not able to use all five senses to assess a patient’s condition over the phone. We’re not directly observing the patients, so as well as verbal clues --- we need to be listening to nonverbal clues like being short of breath or a hesitancy in their tone of voice (Pirschel, 2018).  

The capabilities of the medical clinic are the mechanisms to derive value to the patients in ways that would improve their care. It is important to consider the investments made and how to receive the best return on investments based on their goals such as budget. They need to design a plan and execute the project that may cause the best results (Barros, 2016). Shareholders in the health community realized that even as of ten to fifteen years ago, the health professionals today have a disadvantage. There was a time when patients had to get treatments that lasted a long time through injections and IV medications. Now, because of the use of improved treatments that take less time to administer, such as the use of non-infused chemotherapy, the nurses might not be

7 / 37

able to have the same connection (Pirschel, 2018). Once the connection between the nurse and the patient is established, getting data from telephone calls is another reason why it is difficult for nurses difficult to do as Linda Mortiary reports:

Our nurses need good assessment and management skills, can elicit adequate information from the patient, have current knowledge about disease states and treatments and be knowledgeable about specific patients they’re speaking with. It’s important to acquire information through verbal clues. And recently, electronic medical records have improved our ability to know our patients and review their histories and treatment statuses before or during a call (Pirschel, 2018).

The stakeholders might not ask questions about why health is gathered like this because they are assuming that nothing can be done differently. In order to find truth, often there is a need to uncover obsolete, erroneous, or inappropriate assumptions. With technology it is possible to compensate for the lack of time. It can help the provider better understand the patient, particularly when the patient is timid or unaware of what is happening. Business analysts and the using a community approach, processes in healthcare with creative thinking can develop methods, providing healthcare in a way that increases patient satisfaction, improves the overall quality of care, reducing medical error and health-care time efficient, ensuring more care availability for more patient-provider interaction. To step toward better, faster, cheaper healthcare there are several steps that the community needs to do. First, the inter-professional workforce is needed to step out of their offices and see how the processes really work. As they do so, they need to ask questions about “why” processes are performed in a certain way to resolve the root causes (Arthur, 2016). Biases need to be put aside to enable a cross-functional

8 / 37

view of the patient process workflow. Although it would be unseemly to follow them around from place to place exposing themselves to which might be contributing to the patient’s health problems. Internet-of-things devices could log useful information for the healthcare provider in a more confidential manner. To adequately form a partnership with stakeholders who create devices, developers need a firm grasp of what the requirements are to ensure widespread adoption. Do software application developers understand their customer’s problem? Also, do enough people care enough about the problem for this to become a big business? Are people willing to care about our potential to involve their friends? (Blank & Dorf, 2012). Hearing these use case stories which are spread through word-of-mouth can help the application developers help people understand their product as well as for advertising purposes. The effort into planning determines the quality of the outcome achieved. By putting forth the effort into planning, the product would be of such quality the goals of the community would be met and the community members could be proud of the impact of the outcome. It is important to find out more about the three stakeholders who depend on the project to be a success, the application developer, the healthcare practitioner, and ultimately the patient. It is helpful to identify the stories that pique the health provider and the patient’s curiosity and move them to consider a change (Konrath, 2014). It is important to hear user stories are helpful in determining why this project exists, the requirements describe to develop the how to bring this product to life (Rose, 2018). Understanding the difference, the product makes in the customer’s lives is essential for healthcare providers and application developers who invest into the process of determining whether the service makes good sense for their companies or themselves. “My heart is stirred by a noble theme as I recite my verses for the king; my tongue is the pen of a skillful writer.” Psalm

9 / 37

45:1.

“Despite the growing move towards participatory health and collaborative care, for most healthcare organizations, the current health IT infrastructure does not foster interoperability for the patients and healthcare providers so they can communicate efficiently and effectively” (Nelson & Staggers, 2018). Professor Andreas Holzinger of the Medical University of Graz reports that

Clinicians and patients have very different perceptions about the value of (patient gathered information). As it becomes easier to collect large amounts of data that might be clinically relevant, clinicians are at increased risk of data overload, likely to discourage potentially useful” (patient gathered data). Clinicians are at increased risk of data overload, likely to discourage them to adopt potentially useful (patient gathered information). To make (this data) useful for clinicians, we need to make it easy and not time-consuming to act. The most pressing question is what is interesting and what is relevant to make the explanation useful for diagnosis and treatment” (Choe et al., 2018).

To summarize stakeholder’s attitudes towards the prospect of patient gathered data, the application developers are enthusiastic about building a portfolio of software applications that could help people, this work excites patients who are able to have a way to learn about their health. However, the healthcare providers are skeptical because the doctors are not sure if they can trust the data gathered by patients. When an ambulance takes a patient to a hospital or when the patient has multiple companies involved in their care, he might notice that he must repeat tests such as having multiple blood lab draws which might do the same thing. Healthcare providers do not trust the data gathered by others because should there be a mistake, then the

10 / 37

provider can be held liable. Over 54% of the tests were lost in transit from one health care provider to another during a referral as a result of a lack of coordination in the United States, the United States pays some of the highest health care costs per head, with costs being around $8745; Canada pays nearly half this amount, their paying only $4506 per person in adjusted United States dollars (Braunstein, 2014).  

Figure 2: A line graph of the percent that each country spends on healthcare over its total gross domestic product.

Nearly 90% of the 3.3 trillion dollars spent on health care are for people with chronic and mental health conditions. There are 145 million Americans live with a chronic condition, which is nearly half of the people in the United States (Braunstein, 2014). An example of a chronic condition is cancer. With an aging world population, observers are likely going to see the percent of people with a chronic disease increase. To help solve this complex logistics problem patients need devices to help us coordinate care. The solution may be forming a collaboration to deliver IOT devices. While some may argue that the federal government and others have control now over

11 / 37

the devices, this might not be true because as it stands, many IOT devices are under the strict control of their manufacturer to interpret what the federal regulators have asked. Open source algorithms can serve as a tool to switch the controls over from a job shop to a Lean business model with an enthusiastic community behind our work. The inefficient present controls are costing us too much. Jay Arthur says in his book Lean Six Sigma for Hospitals, that an estimated 50 patients out of a hundred will suffer some sort of harm during their hospital stay. He notes that this is worse than one sigma. He describes the damage such as leaving surgical instruments embedded in patients, and he gives a graphic case-study where a six-year-old was killed when an oxygen tank was drawn to the strong magnet within the MRI machine, crushing the six-year-old’s skull. A 2016 study conducted by researchers at John Hopkins School of Medicine led by Dr. Martin Makary called for changes in death certificates to better count deaths by medical errors by reviewing cases of death in 2015 and writing an open letter to the Center of Disease Control. Dr Martin’s letter urges the Center for Disease Control to consider revising protocols to help decrease the rate of death because of medical mistakes which cost the lives of 250,000 Americans. Mistakes are the third leading cause of death in 2014 behind heart disease and cancer, both of which took the lives of 600,000 Americans. Accidents do not “just happen,” - there are underlying reasons. Processes, procedures, and systems cause the most errors, not human-beings. It is possible to eliminate mistakes and errors by changing processes. Systems have complexity. It is quite likely that there are many factors which can contribute to a problem. Individually these factors are not a problem but because these factors interact, they cause a problem. Real system is path dependent, so they must be in a specific state before the error occurs (Beyer, 2016). While quality efforts other than six sigmas focus on spectacular players to

12 / 37

make spectacular plays, in Scrum anyone and everyone can focus on making fewer mistakes. Good companies focus on not making mistakes: not just wasting time or material, not making errors in product or service delivery. To gain a position of maximizing the time the contributors give, it is important to have disciple, structure, and a strong foundation for solid decision. While most companies operate between three and four sigmas, which means that they make between approximately 67,000 and 6,000 mistakes per million chances while 3.8 means that a process is getting it right 99 percent of the time (Chua, 2018). The community seeks to use these methods to improve even beyond these numbers through international collaboration because the consequences can be dangerous to humans. Like a diet, six sigmas, as alluded to in its name, is about numbers (Chua, 2018). When a person goes on a diet, people generally do not say, “I’m going to lose some weight until I look good,” and hope for the best. Instead they should say, “I am at 200 pounds right now and I’m hoping to get down to 180” (Chua, 2018). When defined in anything but numbers, the goal quickly becomes subjective and fuzzy. Numbers bring clarity (Chua, 2018). What makes six-sigma different from other quality initiatives that try to promote continual improvement is that they are not very systematic. They lack directives. Some just focus on the product, not how they get there (Chowdhury, 2001). When an attempt is made to identify bad “biscuits” already made, you are already too late. Instead of just getting rid of the bad end products, you try to solve why the bad results are occurring. In a biscuit factory other quality improvement programs instructs to oil the machine and toss out the burnt biscuits. Six Sigma teaches to take the whole machine apart and find out why it's making the occasional burnt biscuits. This allows a fix the problem before the process continues for the next task (Chua, 2018). Instead of patching leaks, build a better boat. A person does not need to pay for constant