Internet Of Everything: It's All About The Ecosystem - InformationWeek
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IT Leadership // Digital Business
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12/18/2014
09:06 AM
Ed Featherston
Ed Featherston
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Internet Of Everything: It's All About The Ecosystem

A recent chat with my doctor revealed new insight on lifecycles of connected medical devices and the need for an integrated infrastructure to support future IoT devices.

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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Ed Featherston is a Senior Enterprise Architect and Director at Collaborative Consulting. He brings more than 35 years of information technology experience in designing, building, and implementing large, complex solutions. He has significant expertise in systems integration, ... View Full Bio
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soozyg
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soozyg,
User Rank: Ninja
12/26/2014 | 9:17:29 PM
Re: enough to go around?
As my doctor said, his ideal is an ecosystem for his implantables in his patients that simplifies his monitoring and analysis.

Makes sense. Patients and doctors definitely don't want any incompatiblity issues to complicate a medical situation.
zerox203
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zerox203,
User Rank: Ninja
12/25/2014 | 8:20:43 AM
Re: Internet Of Everything: It's All About The Ecosystem
The buzz definitely still outwieighs the reality when it comes to IoT. When we take a minute and look at it from a consumer standpoint, instead of a professional one, as Stratustician points out, it's not too hard to see why that is. The demand is not quite there yet. But you're right, too, Ed; the demand is not there in part because of the lack of standards - but it will be tough to get the standards in place before there's demand (all of this tying back to money). It's a bit of an interesting chicken-and-egg scenario. The consumer demand is critical. We'll start seeing smart steetlamps (etc.) when people start complaining how far behind city infrastructure is from what they have at home. 

I still think we'll wake up one morning and be there more suddenly than we realize. All the pieces are there. The network capability (bolstered by trends in SDN and Big Data). The devices (and the low cost of said). Even the newish trends in open (source) computing, networking, and virtualization standards speaks to the kinds of standards you're talking about, Ed. Somebody will be the OpenDaylight of IoT standards, and soon. I'd bet money on it. The context here definitely provides some great food for thought, though. There are plenty of niche cases besides pacemakers, and while that's true in any industry, the very nature of IoT mandates that we consider them carefully. Sounds like a great problem to tackle in 2015. Have a happy holiday and a happy New Year, everyone!
efeatherston
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efeatherston,
User Rank: Author
12/22/2014 | 10:08:34 AM
Re: enough to go around?
re: knowing market and customer base

Absolutely agree, and I am sure they do. I think whats important is the technologists ensure the lifecyles and risks associated are taken into account in design and build. In my pacemaker example, it is now 10 years old. The software and devices to communicate with current pacemakers need to be able to continue communicating with the older ones like mine as well so that the doctors do not need to keep many many devices around to communicate with all their patients devices. As my doctor said, his ideal is an ecosystem for his implantables in his patients that simplifies his monitoring and analysis.
soozyg
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soozyg,
User Rank: Ninja
12/19/2014 | 8:12:32 PM
Re: enough to go around?
need a customer base to sell these products.

I would think any company that is manufacturing parts for replacement surgery, knowing it is a specialty and therefore a smaller market, would do research to see exactly how big the customer base is.
efeatherston
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efeatherston,
User Rank: Author
12/19/2014 | 7:10:06 AM
Re: enough to go around?
It's a classic product life cycle issue for manufacturers, balancing life span vs market and market share. Implantable devices is a fairly narrow marketplace compared to other areas. You raise an interesting point about insurance covering costs, and I am sure even with coverage, there is limitations as to how frequently they will allow replacements.
efeatherston
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efeatherston,
User Rank: Author
12/19/2014 | 7:07:04 AM
Re: The doctor's story
Agreed, IoT is still in its infancy, and still searching for use cases that provide real value to the users. Your outdated firmware falls right into the point about product lifecycle. When they really start turning all my home appliances into 'smart' devices, a lot of thought, planning, and design needs to go into the fact that I don't replace my regridgerator or my stove every couple of years. Cars the same issue. Had one person in a tweet chat yesterday raise a possible solution to that I had not thought about, make the 'smart' components plug/play replaceable, so old version is unbplugged and replaced with a newer better one. Not sure it would be cost effective, but it was an interesting proposal to solve that dilemna.
soozyg
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soozyg,
User Rank: Ninja
12/18/2014 | 8:52:14 PM
Re: The doctor's story
I think a monitoring agency for any technology-based products and companies would be an ideal solution. The most difficult part, I would think, would be agreement on guidelines.
soozyg
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soozyg,
User Rank: Ninja
12/18/2014 | 8:50:07 PM
enough to go around?
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.

I could see how this could be a dilemma, but aren't there enough patients to go around? I guess not everyone has the insurance to cover all procedures and would therefore not do it.
Gary_EL
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Gary_EL,
User Rank: Ninja
12/18/2014 | 7:40:24 PM
Re: The doctor's story
This sounds very similar to the problems with online medical records. Many systems, no standardization except within the same hospital system. A temporary solution might be for every approved manufacturer to submit his protocols to a monitoriing organization. Once the device is accepted, the monitoring organization will agree to producce a device that can read and communicate with this device, and all other approved devices. Thus, the doc's office only would have to own one communications device.


The problems with pacemakes should, in this one respect, be much simpler than the IOT in general. There will be an almost infinite number of devices that will be on the IOT. But, there will be a smaller, and much more orderly universe of medical devices to track.

 

 
Stratustician
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Stratustician,
User Rank: Ninja
12/18/2014 | 2:08:34 PM
Re: The doctor's story
There are a few big organizations tackling the idea of standardization for IoT, which is good news since we might get to see some form of framework for building apps that can share commonalities and thus, hopefully, security standards.  I think the real issue is that very few devices right now provide significant value in the eyes of consumers or businesses.  Do I care if my appliances are smart if it means dealing with outdated firmware or potential security holes?  It's about the risk tradeoff.
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