Blood pressure data can be relayed wirelessly to healthcare providers. (Image: uaPieceofCake/Adobe Stock)

Devices to remotely monitor patients’ health have been around for more than twenty years, but their use is rapidly expanding now. As networking technologies such as LoRaWAN are maturing, and artificial intelligence is being embedded in “smart” sensors, the medical device industry is motivated to take advantage of these technological advances. And as the use cases for remote monitoring proliferate, technology is being developed to specifically meet those needs.

Several trends have been driving this innovation. First, as the Population Reference Bureau puts it, “The current growth of the population ages 65 and older, driven by the large baby boom generation, is unprecedented in U.S. history. As they have passed through each major stage of life, baby boomers (between ages 59 and 77 in 2023) have brought both challenges and opportunities to the economy, infrastructure, and institutions.” [https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/ ]

Some of those challenges and opportunities are driving telemedicine. There is a trend among this cohort to “age in place” at home rather than in an institution. Telemedicine is helping to make that a doable choice.

Also, people in this age group tend to need more medical care.

Then, along came COVID-19 and remotely connecting with healthcare providers skyrocketed.

It is also becoming clear that these systems can help people who live far from urban centers and in poorly served communities around the world.

Remote Patient Monitoring

To learn about one remote patient monitoring system (RPM), I interviewed Bruce Chatterly, CEO of Senet (Portsmouth, NH) and Sales Executive William Dos Santos, Telli Health (Miami, FL). The two companies have teamed up to offer a LoRaWAN-based RPM service that can reach communities virtually anywhere in the world.

Figure 1. Senet’s managed network services are built on a common cloud-based architecture designed to scale to support the billions of devices that will ultimately connect to the Internet of Things. (Image: Senet)

Telli Health distributes LoRaWAN-enabled devices such as blood pressure cuffs and glucometers to multiple individuals, possibly in a nursing home or remote village. Each device has a unique IMEI number so it can be tracked just like a cell phone. The data from these cuffs is fed to a low-cost LoRaWAN gateway. The gateway then transmits the data to the Senet cloud platform by means of a cellular, Ethernet, or Wi-Fi backhaul. The Senet platform receives the data, processes it, and then sends it to an RPM provider.

RPM providers are the ones who monitor the patients’ health by analyzing their data. They might have a nursing team or doctors on board. “There’s really no limit to what kind of service an RPM company can offer,” said Dos Santos. “They have patients come to their offices, provide them with our devices, and explain how to use them.”

“Our blood pressure monitor will explain to you how to use it, and then when the reading is complete, it will say ‘transmission complete.’ And there’ll be some words and numbers on the device that the patient can refer to — but they don’t have to think about anything else — they’ll have confirmation that the reading was sent,” said Dos Santos. “Think of it as your cell phone, where you sent a text message to your friend, and they’re getting it in near real time.”

Figure 2. Comparison of IoT communication methods. (Image: Senet)

The RPM provider receives the information, “the payload,” in a JSON packet, which has six or seven lines of data. It’ll have the IMEI of the device, the reading type, and if it’s blood pressure, the readings will be spelled out just as they would on a normal monitor. The healthcare professionals can then analyze the data and explain the results to the patient.

The Advantages of LoRaWAN

LoRaWAN has low bandwidth — it transmits data at very low rates. But that’s just fine for the small amounts of data that are typically sent at low rates for health readings. Low rates of data in short bursts means that the system uses very little power, which translates to extended battery life.

And importantly, the laws of the physics of wireless transmission, tell us that lower bandwidth means longer range — 3 to 10 miles outdoors for LoRaWAN.

These properties will allow Telli Health to deploy their gateways to patients in remote areas such as an indigenous reserve for example, or possibly a nursing home community. Then all their devices connect through one gateway. And even an old-fashioned dial-up modem would be enough to run the network.

Monitoring Devices Instead of People

Monitoring patients is not the only way that wireless networking can contribute to healthcare. Hadleigh Health Technologies and 3rd Stone Design (both of San Rafael, CA) have teamed up with Monnit® (South Salt Lake, UT) to create an IoT solution to remotely monitor medical devices and climate conditions in neonatal hospital wards in sub-Saharan Africa.

Sub-Saharan Africa has 27 deaths per 1000 live births, with 43% of global newborn deaths. A child born in sub-Saharan Africa is 10 times more likely to die in the first month than a child born in a high-income country, due in part to a lack of access to medical devices.

Figure 3. A medical device technician prepares to install the Hadli Monitoring System in an NICU in the United Republic of Tanzania. (Image: 3rd Stone Design and Hadleigh Health Technologies)

Sub-Saharan African clinics are under constant threat of entering a non-use cycle due to various factors. “There are many different reasons medical practitioners don’t use certain devices, ranging from insufficient training to incorrect infrastructure and outages preventing devices from getting continuous power,” said Alexsandra Brandt, product engineer at 3rd Stone Design. “Devices may be broken, but nobody is aware, and therefore they’re not available to fix them promptly.” Ultimately, many of these devices end up in “the local medical equipment graveyard,” Brandt said.

Working with Monnit engineers, the companies designed various medical device power monitoring prototypes. They landed on developing a sensor prototype that featured the Monnit ALTA® Wireless 5-Amp Current Meter to remotely monitor whether a medical device was on or off and how often it was used.

In a test project, the collaborative partnership focused on monitoring lower-cost medical devices rather than devices with embedded or integrated monitoring technology, such as x-ray units and CT scanners. The team focused on monitoring neonatal phototherapy devices — blue lamps that treat jaundice; radiant warmers; oxygen concentrators; and CPAP devices.

They installed the Hadli Monitoring System, an active, automated remote device monitoring system that captures and shares actionable IoT data enabling strategic support of medical devices. It includes:

  • The Hadli Device Monitor with the custom ALTA 5-Amp Current Meter.

  • A Wireless Humidity Sensor, based on the ALTA Wireless Humidity Sensor, which monitors climate conditions, including the temperature where medical devices are used.

  • A Cellular Gateway, based on an ALTA International Cellular Gateway, which aggregates, protects, and communicates data sent from the Hadli Device Monitor and Humidity Sensor.

  • A cloud data monitoring dashboard that uses an API to retrieve data from iMonnit IoT Monitoring and Sensor Management Software.

The wireless Hadli Device Monitor can be easily attached to practically any medical device and includes a removable power cord.

Some actual outcomes:

  • Within the first week of installation at a hospital in Malawi, Hadli alerted a technician that a CPAP was not in use. The technician confirmed the machine needed maintenance, and they fixed it on the spot.

  • Hadli sent an alert that oxygen concentrators were being used more than expected in a hospital in Kenya. Administrators found that walled oxygen was broken and that the concentrators provided backup at the perfect time.

  • Hadli alerted that one phototherapy unit at a hospital in Tanzania was constantly in use, and one was not. Medical personnel reported that the one not being used was located where phototherapy is not frequently needed, so they moved that unit to the room where the need was greater.

What Does the Future of Remote Health Monitoring Look Like?

While in its early stages, remote health monitoring is building out an infrastructure that will bring the resources of modern medicine to people who now have difficulty accessing them. This includes people living in remote areas, people with illness or handicaps who cannot easily travel, and people with low incomes.

This article was written by Ed Brown, editor of Sensor Technology. For more information, see https://senetco.com ; https://tellihealth.com ; https://www.hadleighhealthtechnologies.com ; https://www.3rdstonedesign.com ; https://www.monnit.com .