Now is the time for healthcare
providers to get into IoT
Opportunities and path forward

March 2021

Content
Executive summary

3

1. Current state of IoT in healthcare: what is changing now?

4

2. What are the next steps for healthcare providers?

7

Conclusions

10

Authors:
Dr. Ulrica Sehlstedt

Rebecka Axelsson-Wadman

Partner
Healthcare Life Sciences, Stockholm
sehlstedt.ulrica@adlittle.com

Principal
Healthcare Life Sciences and TIME*San Francisco
axelsson-wadman.rebecka@adlittle.com

Sean McDevitt

Agron Lasku

Partner
TIME, Boston
mcdevitt.sean@adlittle.com

Partner
TIME, Stockholm
lasku.agron@adlittle.com*TIME: Telecommunications, Information Technology, Media & Electronics

Executive summary
For quite some time, healthcare has been heralded as the next big opportunity for
the Internet of Things (IoT). More than ever, today’s IoT solutions havetremendous potential to enhance healthcare operations and generate overall
improvements to care outcomes, cost and efficiency alike. But that great
opportunity has, to a large extent, failed to materialize; thus, the adoption of IoT
within healthcare settings has been much slower than anticipated.
This is all changing dramatically, however, as healthcare providers increasingly
adopt telehealth solutions as a means to improve patient safety in today’s
COVID-19 “new normal.” Most of the technical challenges that inhibited early
healthcare IoT solutions have been overcome. New IoT solutions for healthcare
are smarter and, more importantly, tailored to the needs and requirements ofhealthcare organizations. With 5G being rolled out, now is the time for healthcare
providers to set their IoT roadmaps.

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1. Current state of IoT in healthcare: what
is changing now?
A big reason for the initially slow adoption of Internet of Things(IoT) in healthcare is that vendors underestimated the uniqueneeds of the healthcare industry, an industry often seen as
conservative, or slow moving. The reality, though, is that IoT is
a logical by-product of care providers’ primary focus on patient
safety and risk minimization; an error might, in the worst-casescenario, mean that somebody dies. Just like with new drugs
and medtech equipment, healthcare provider processes need to
be tested and validated intensively to ensure that patient safety
is not put at risk, something that vendors of new solutions often
fail to fully comprehend. Therefore, new technologies needto either fit within existing processes or generate significant
improvement to patient outcomes and/or care standards in orderto motivate changed ways of working.
The first push towards healthcare IoT happened well before
healthcare organizations and the technology were ready. But
this is now changing, and the factors that will enable healthcare
providers to successfully implement IoT solutions are falling into
place.
Healthcare organizations are now rethinking their ICT
architecture, moving away from legacy “homebrew” solutions tomore enterprise-based implementations, enabling ecosystems
and service-based design. Moreover, the global spread of
COVID-19 has forced healthcare providers to accelerate adoptionof telemedicine, eHealth and other remote technical solutions inorder to secure patient safety by reducing the risk of infection.
This will increase familiarity with digital tools and fast-track thedevelopment of new processes, leading to accelerated adoptionof IoT solutions more broadly.
In addition, payers and insurance companies are driving
healthcare organizations to rethink data management, throughgreater information-sharing demands. Payers are investing indata analytics and new technical solutions and are increasingly
ready to pay for preventative measures as well as shifting
focus of reimbursement models from procedures performed tooutcomes. This requires not only accurate and timely information
to continuously flow from healthcare providers to payer but also
data that is several orders-of-magnitude better and common
informatic adherence between organizations.

4

Moreover, device manufacturers are increasingly digitizing theirproducts and assessing app developers and software companies
to understand how to generate valuable data insights and easyto-use interfaces. Device manufacturers already understand data
safety and privacy requirements and are closer to care providers’needs and processes; thus, they can guide development
partners and healthcare partners alike in the right direction.
So attitudes towards using technology as an enabler to provide
better care are changing. Healthcare organizations are rethinking
their ICT infrastructure, while payers and insurance companies
are expecting better data. But what about the connectivity
required to fully leverage IoT solutions?

There are solid connectivity options available
The most common connectivity solution in most hospitals is
a combination of cable (e.g., for computers, critical medtech
equipment) and Wi-Fi (e.g., personal devices, non-criticalequipment). Most IoT use cases that have been widelyadopted in healthcare settings have been low-power trackand-trace solutions (e.g., RFID tracking of carts, trays andhandheld devices), generating efficiency improvements but
without significant impact on costs or improvement of patient
outcomes. Moreover, the mobile devices are very often
separated from the data-generating and gathering systems bystringent firewalls, meaning communication between themis severely limited. This setup restricts the number of medical“things” that can be connected. Indeed, if all the equipmentthat would be connected were to be connected by cable, there
would be room for little else. And anyone who has used Wi-Fi
in a crowded space knows the challenges involved. In a recent
study on network coverage in hospitals, 47 percent of hospital
staff reported poor Wi-Fi coverage, and 39 percent reported poor
cellular network coverage.

Use case: available in the field, on demand
The ambulance is often the first step in emergency care;
the better care that can be provided early on, the betterthe outcome. Hence, ambulances today are equipped withadvanced diagnostic and treatment tools (e.g., ECG monitors,
automatic ventilators, nebulizer and ultrasound).
But actual care specialists (e.g., stroke specialists) are
generally not physically available within the ambulance setting.
Implementation of telehealth solutions therefore have begun
to further improve delivery of timely care. These solutions
include videoconferencing as well as connected medical
devices that transfer measurements in near real time to aremotely connected specialist who, in turn, can provide onsite assistance or better prepare hospital reception. AR/virtual
reality (VR) solutions are also increasingly used in this context(e.g., ambulance staff can wear AR glasses that transmit
images in real time to doctors).
Figure 1:

The technical abilities required to enable the process are toa large extent shared with other telehealth use cases, whichemphasizes the need to have a cluster-based or more holistic
approach when looking at use cases and their required
architecture in order to place them into a common roadmap.
Technical development also needs to be considered, where,
although the abilities mentioned above can be established asof today, the technology of tomorrow enables even further
possibilities (see Figure 1). For instance, higher-resolution
data, both in volume and time, is enabled by 5G connections.
In another example, remotely controlled drones are being
piloted using 5G technology, with high-resolution video beingtransferred from an accident site to a control center and thento a moving ambulance to better plan the best mode of action
upon arrival.

Improving emergency response times

Step 1 – Connected hospital
The ambulance takes the patient to the nearest hospital, where specialists are available remotely and treatment canstart faster

Step 2 – Connected ambulance
High-resolution monitoring and video in ambulance are employed so that specialists can connect directly
to on-site care personnel, allowing treatment to begin even earlier

Step 3 – Connected drones
A video-enabled drone, equipped with medical devices, is sent to the patient or accident area before the ambulancearrives to enable planning of on-site actions and possibly treatment

Source: Arthur D. Little analysis

5But there are other technical solutions available that could meetthe needs of healthcare providers better than the setup often
employed today. While full 5G will enable a number of additionaluse cases in healthcare, it is not the silver bullet it has been
made out to be, so there is no need for care providers to wait
for 5G to become available before starting to build out their IoT
roadmaps. Private 4G and LTE network solutions available in themarket today cover the needs of a large set of use cases still notin broad use but that have the potential to reduce administrative
burden and improve healthcare operations.
A private network is essentially the use of cellular connectivity
over a specified space and for a specific set of users. Thatmeans that a certain capacity and speed can be guaranteed,as opposed to public networks (or Wi-Fi), which depend on thenumber of people using the network simultaneously. The ability
to maintain a stable connection for moving objects will vastly
increase the usability of IoT. For example, the Memorial Health
System Clinic in Springfield, Illinois, USA, leveraged an OnGo
private LTE network to provide reliable connectivity for COVID-19
triage tents, and Kaiser Permanente is reviewing an investmentin private LTE networks for hospitals within its plan and starting
to work with device vendors to ensure device compatibility.
An LTE private network built today can be designed to be easily
upgradeable to 5G when it is available. In fact, to be ready fora full 5G launch, organizations that want to reap the benefits
should start planning today. For further details on private
networks and 5G, see our Prism article “Realizing the potentialof the Internet of Things with 5G”.

Figure 2:38Personal health Personal healthdevices/wearables

But where should healthcare organizations begin? Oncepatient data comes into play, the level of complexity increases.
Therefore, many organizations choose solutions that connect
equipment but not patient data directly. To better track
admissions or patient movement, for example, care facilities canuse smart hospital beds rather than patient-tracking devices. The
smart bed reacts to the weight of the patient and transmits asignal that the bed is occupied, providing an easy way to monitor
occupancy in real time. When combined with information about
the patient occupying the bed (in a safe system), care staff can
track how often the patient gets out of bed, if the patient is in
the room, and so on.
While starting with a few use cases as test beds, it’s vital tokeep the bigger picture in mind. This allows organizations tobuild up the appropriate infrastructure, while also planning for
future requirements to ensure that infrastructure can scale
up. The big gains from IoT will not come from connecting a
few pieces of equipment, but rather when more “things” areconnected, more data is generated and more advanced use
cases and bigger gains are enabled.

Equipment condition andperformance monitoring Medical devices and equipment
 Smart hospital beds

4

Track and trace

Connected ambulance

7

Source: Arthur D. Little analysis

5
Data integration,
decision support andanalytics
6

Immersive media

 Medical training simulation with VR
 AR decision support/testing

Hospital environmental
condition monitoring Air quality
 Temperature Hazard sensing
 Lighting control

 Assets– Asset tracking– Equipment tracking– Smart medical cabinets
 Staff location

 Remote diagnostics(VR guided) Remote communication anddata transfer

6

While the world of IoT can seem complex and contain a myriadof solutions, most IoT use cases are built up around a number ofcore functionalities ranging from simple track-and-trace solutions
all the way to complex automation. These functionalities can, inturn, be leveraged to enable the key pillars of a smart hospital:
clinical excellence, patient-centric care and operational efficiency.
Figure 2 provides an overview of the different types of IoT
solutions relevant for care providers.

Different types of IoT solutions relevant for care providers

2
1

What are the IoT options for healthcare providers?

Telemedicine

 Remote appointments Remote diagnostics
 Remote monitoring Medication adherence

Robotics

 Remote robotic surgery
 Assisted living
 Rehabilitation

2. What are the next steps for healthcare
providers?
What should healthcare providers do to start building up IoT
capabilities? The starting point should be to look at what options
are available today, how technology is developing and mostimportantly, what needs can IoT solve for your organization?
What are your IoT goals? What are you looking to gain? How doyou get there? What will it take?
Arthur D. Little believes it is imperative to approach thepossibilities with a broad, long-term perspective. Since
healthcare adopts new solutions cautiously and slowly,
establishing a longer game plan is the only way to ensuresustainability. Thus, it is key to plan around a portfolio of use
cases to ensure that the infrastructure and processes being built
up will be suitable for all planned use cases as well as capable ofbeing scaled up for future applications.
Figure 3:

Six-step roadmap for healthcare IoT solutions
6. Build roadmap
5. Calculate the resulting businesscase(s) and make prioritizations
4. Assess scalability
3. Review impact to organization and processes
2. Review existing technical architecture and infrastructure
1. Assess potential of IoT use cases

Source: Arthur D. Little analysis

As Figure 3 illustrates, we propose a six-step approach to build
a cohesive roadmap instead of procuring IoT solutions to solve
single problems:

1) Assess potential of IoT use cases
What are the needs and pain points that you hope to solve?
This may range from practitioners spending too much time on
admin tasks instead of patient care, to equipment getting lost,to varying air quality issues in the clinic or hospital setting. Whichprocesses are seen as burdensome? Where do you need toreduce risk? The greatest potential of IoT in healthcare is theability to reduce time spent on menial tasks so that time can be
freed up for value-adding activities.
What solutions could address the pain points? Identify
different approaches and technologies and start looking at what
is readily available on the market (e.g., either in modularizedparts or as end-to-end solutions). Analyze how these could
interact or be adapted to solve the different use cases.
What would solving the pain points enable? How would
patient outcomes improve, costs be reduced or efficiency
improved if you managed to address those needs? What is thevalue of those improvements (e.g., enabling preventative care,keeping patients out of the hospital, improving care outcomesfor patients in hospital or reducing costs so that more patientscan be treated for the same cost)?

2) Review existing technical architecture and 		
infrastructure
What are the gaps between where you are today and what
you would need to support the use cases? Some use cases
will require new infrastructure investments, whereas others canbe implemented easily on top of existing systems. What would
it take for you to adopt the needed infrastructure (i.e., cost, timeand resource requirements)? How will it fit into your existingarchitecture and roadmap? Depending on the organization’s
current technical abilities, a large upfront investment might beneeded, or a different approach needs to be considered. If thesolution requires a large investment, how can you future-proof
it to ensure that your organization can leverage its investment
for use cases further ahead in your roadmap as well as for
immediate ones?

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3

Use case: from smart beds to hospital cockpit
One example of how connected equipment can add value
both in directly improving quality of care and indirectly
contributing to improving operational efficiency is the use ofsmart hospital beds.
Smart beds use contact-free sensing and real-time analytics tomonitor patients and thus improve care outcomes. Integrated
bed sensors can monitor a variety of patient data and vitals(e.g., weight, body temperature and heartbeat) and detectblood, oxygen and pressure levels. The beds also record
patient movement (e.g., if patients have left their bed and how
often nurses have turned them); some can communicate witha patient verbally (e.g., remind a patient to refrain from gettingup).
One such example is Multicare, an intensive care and therapy
bed designed by LINET, which helps prevent pressure ulcer
development through bed articulation, which increases
envelopment capacity in the sacral area.1 This is critical forpatients with medical conditions that prevent them from being
turned manually. The vascular position capability optimizes
venous return and reduces swelling (edema) and back pain.

Smart beds also eliminate the need for manual bed usage
tracking, freeing up time for hospital staff to focus on patientcare. With the tracking of hospital beds, hospitals gain insightand control on location, usage and security and can streamline
the flow of patients in and out of beds with minimized waitingtime.
GE Healthcare has taken this one step further, centering thesmart bed in a comprehensive, patient-conscious healthcare
network. The company has developed a “command center”(similar to an airline cockpit) to form a larger network of dataand oversight. A key feature is the “Wall of Analytics,” an arrayof real-time visuals, analytics and alerts from multiple sources
across the hospital. In 2017, Toronto’s Humber River Hospitalcollaborated with GE to open Canada’s first command center,
improving overall efficiency by 40 percent. The system hasenabled the hospital to deliver care to more patients withthe same number of beds and avoids a projected shortfall ofaround 50 beds by 2021.3

Real-time alerts from the smart bed on sudden changes
enable physicians to provide responsive care and intervene intime-sensitive scenarios, especially in the critical or intensive
care environment. A Harvard Medical School study found that
EarlySense, an under-the-mattress and bedside-monitoring
system that tracks patient’s vitals, reduced the rate of code
blue events by 86 percent and reduced the average stay of
ICU patients transferred from the medical-surgical unit by 45
percent.2

1
2
3

Multicare. LINET, 2020
Monegain, Bernie. “Harvard study assesses EarlySense.” Healthcare IT News, 20 March 2014
“Can NASA-inspired Command Centers help the hospital of the future? This hospital thinks so.” GE Healthcare, 22 December 2017

A specific point worth highlighting here pertains to IT security
and ensuring patient data safety. While a high level of IT security
and GDPR compliance often is built into the solutions readily
available on the market, they more seldomly adhere to the muchstronger and commonly country-differentiated patient data andmedical device regulations, such as HIPAA in the US. Thus,
when looking at potential solutions, you need to assess thegeographies for which the product is being developed. To makea product available to all geographic markets, several analyses
and certifications are needed, which will most likely require
additional product development.

83) Review impact to organization and processes
Would implementation of the use cases disrupt existingprocesses? To what degree? Implementing new technicalsolutions will naturally have an impact on an organization and its
processes. For healthcare providers, it is even more importantto minimize disruption and ensure that patient safety is notcompromised. Indeed, a small change to a high-risk process
can be more difficult to implement than a big change to asimple process, or a process with limited patient impact. Ifchanges to the process risk impacting patient safety, training
programs become vital and the time and complexity of change
management will be increased.

Is the outcome worth it? What can be done to mitigate
risks? It is obvious that it’s not worth taking a major risk for aminor improvement, whereas it’s a no-brainer to do so for asolution with a strong, positive impact and very low risk. But foranything not as clear-cut, how do you mitigate the risk and whatis that cost?

4) Assess scalability
Are the use cases easy to scale? Can the use cases be
combined in a logical way to enable better insights? Anothercrucial aspect to consider is how easy the use cases are toscale from a single pilot to covering multiple clinics, multiple
sites or connecting different types of equipment. There is also
scaling across multiple use cases to consider in order to ensurethat data generated from one use case can be combined withdata from one or multiple other use cases to enable actionableinsights.

6) Build roadmap
When can and should you start implementing each use case?
Build out a roadmap of the prioritized use cases – taking into
account when technology will be ready and when budgets are
expected to be available, as well as what rate of change theorganization can reasonably manage.
What impact are you expecting, what are key milestones andhow do you measure success? To best keep track of progressagainst the roadmap and measure the impact of implemented
solutions, organizations should be clear about their IoT program
goals as well as what KPIs to use to measure whether thegoals have been achieved. These should relate back to the pain
points that the solutions were expected to solve, along withthe expected operational and final outcomes identified in thebusiness case.

5) Calculate the resulting business case(s) and makeprioritizations
What budget is available for the assessed time period? Whatuse cases offer the best ROI relative to its business impact?
In order to make an informed decision, business cases need tocover all costs related to the implementation and managementof the new solution, as well as the gains to be made – including
both direct financial improvement and, more importantly, qualityof care and patient outcomes.
Which use cases should you prioritize? Given budgetary
restrictions, costs and impact of the use cases, decide which
ones to prioritize.

9Conclusions
While the expected near-term growth of IoT in healthcare
has often been inflated, its potential has not. Healthcareorganizations that succeed with IoT will have the potential toprovide expanded and better care at the same cost throughimproved patient outcomes, reduced cost and improved
efficiency.
While healthcare IoT adoption has historically been slow,
technical developments, increased usage of eHealth solutions
resulting from COVID-19, along with a push from medical device
providers, now enable the right type of solutions. But to achieve
successful implementation, several hurdles must be overcome.
And most importantly, the solutions must be adapted to thespecific needs of healthcare organizations.

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Successful IoT implementation is about more than just thetechnical solutions – more than anything, it depends on optimal
upfront planning ahead of implementation as well as apt change
management throughout and after implementation.
Arthur D. Little has experience with IoT and technology providers
as well as with hospital processes, operations and infrastructure.
We use this experience to help healthcare organizations develop
and implement actionable and impactful IoT roadmaps.

Contacts
If you would like more information or to arrange an informal discussion on the issues raised here andhow they affect your business, please contact:

Austria
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Gregory Pankert
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Kevin Lee
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Jesus Portal
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Yusuke Harada
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Guillem Casahuga
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sehlstedt.ulrica@adlittle.com

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Marcel Hominda
hominda.marcel@adlittle.com

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Vikas Kharbanda
kharbanda.vikas@adlittle.com

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Volker Pfirschingpfirsching.volker@adlittle.com

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duvaud-schelnast.julien@adlittle.com

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Martijn Eikelenboom
eikelenboom.martijn@adlittle.com

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Franziska Thomas
thomas.franziska@adlittle.com

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sehlstedt.ulrica@adlittle.com

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Philip Webster
webster.philip@adlittle.com

India
Vikas Kharbanda
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baranowski.piotr@adlittle.com

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Rebecka Axelsson-Wadmanaxelsson-wadman.rebecka@adlittle.com

Italy
Mario Nico
nico.mario@adlittle.com

Russian Federation
Alexander Ovanesov
ovanesov.alexander@adlittle.com

Now is the time for healthcare providers to get
into IoT
Opportunities and path forward

Arthur D. Little
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