The Internet of Things in Health

Opportunities and Challenges

Joseph C. Kvedar, MD

Professor of Dermatology, Harvard Medical School

Senior Advisor, MGH Center for Innovation in Digital Healthcare 

Immediate Past Chair, American Telemedicine Assn

Co-chair AMA DMPAG

Editor-in-Chief npj Digital Medicine
Ratio of providers to patients
Wearablesfor health?
Tracking for

motivated individuals Chronic disease 

management

NOT useful for tracking for non-motivated individuals

Two categories of wearable benefits
United Healthcare Motion

• Eligible members get subsidized access 

to smart watches and fitness trackers

• Participants earn up to $1000 annually 

for meeting daily program goals
Chronic disease management

 Apple watch and atrial fibrillation detection

 Titrating blood pressure medication

 Managing diabetes

 Managing congestive heart failure
Connected Cardiac Care
Blood pressure and diabetes

Average drop of HbA1c: 1.5

69% achieved a drop in BP

AUTOMATING HEALTHCARE

Data Aggregation/ Normalization 

New Sensors

Analytics Engagement

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+ +
AUTOMATING HEALTHCARE

Data Aggregation/ Normalization

New Sensors

Analytics Engagement

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

+ +
DATA AGGREGATION BARRIERS

Normalization

Integration

Frictionless data capture

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AUTOMATING HEALTHCARE

Data Aggregation/ Normalization 

New Sensors

Analytics Engagement

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

+ +
ANALYTICS BARRIERS • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

For healthcare it is not good enough 

to say “people like Joe did X, therefore, 

Joe will likely do X”

We have to take predictive analytics 

down to the individual level
AUTOMATING HEALTHCARE

Data Aggregation/ Normalization 

New Sensors

Analytics Engagement

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

+ +
ENGAGEMENT BARRIERS

Consumer centric 

design Personalization

Fitting into 

everyday life

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Sentinel effect
Barriers to IoT device and app adoption

Statesimplement their own health data privacy frameworks

Ensuring interoperability and proper EHR integration

Hacking into healthcare system database – establish network security
Barriers to IoT device and app adoption

Insufficient funding and resources to implement or maintain security systems

Lacking capacity and resources to identify security requirements adequately 

Lack of consistent policies, practices and regulatory frameworks
Recommendations for US Government

and Congress to remove barriers

Create federal framework for privacy to reduce complexity of compliance 

and confusion

More education for providers and health systems

Increase funding forstaff capacity to implement requirements and processes
Recommendations for US Government

and Congress to remove barriers

Solicit feedback on successful privacy and security processes; collect use cases

Empower AGs to take enforcement action when privacy laws are violated

Ensure transparency and explainability on the use of AI to ensure outputs 

are secure, trustworthy, clinically appropriate and reliable
FDA – an Entrepreneur’s Perspective

Understaffed and poor response times

Need to fit in a box – no innovative thinkers 

Culture is to say no
Barriers/Solutions - CMS

CMS does not consistently deal with SaMD* from a coverage/payment perspective

It is presently considered an indirect practice expense so essentially a loss to 

providers

Not covered as DME either

Acknowledge that SaMD is a medical device and treat it assuch for coverage/payment 

Proactively help stakeholdersidentify which benefit categories are appropriate for SaMD

*includes prescription digital therapeutics, AI, and mobile medical apps
Author of 2 Books

> The Internet of Healthy Things

> The New Mobile Age

Available at Amazon.com

Website

Joekvedar.com

LinkedIn

@JoeKvedar

Twitter

@jkvedar

Instragram

@drkvedar

Contact Me

jkvedar@mgb.org

Connect with me