Ugwu Okechukwu Emmanuel
ABSTRACT
There is a projected substantial effect of 5G on the healthcare sector, its suppliers and other sectors that use healthcare. 5G will have a large impact on the quality of health care received by hundreds of millions of patients and will fuel significant changes in the way in which health care is delivered. 5G will be an enabler of many new business models, but also a disrupter of old ones and will be a substantial enabler of a new era of “personalized health care.”
The phrase that most pithily captures the impact of 5G within the health care sector is the “personalization of health care.” The much greater ability to continuously gather patient-specific data and the ability to process, analyze and quickly return processed information and recommended courses of action to the patient will give patients greater ability to manage conditions on their own. The personalization of health care also means that physicians and other health care providers will—when they are required to administer care—be able to make ‘first time right’ diagnoses and tailor remedies more closely to a particular patient’s personal needs. The economic consequences of the personalization of health care are substantial. Better monitoring means a greater ability to reward providers on the basis of outcomes not “volumes.”
Within a foreseeable period of time, consumers and businesses will have a more immersive relationship with their digital devices, and this will allow them to obtain high-quality medical care in real time and at affordable prices. Rather than having computing equipment that is disparate and separate, the 5G world will allow us to enter an era where real-time health services will become the norm rather than the exception. That will bring patients closer to a science fiction concept of digital integration than ever before.
INTRODUCTION
By 2020, the 5G network is expected to support 50 billion connected devices and 212 billion connected sensors as well as enable access to 44 zettabytes (ZB) of data.(1) This will range from smartphones and tablets to smartwatches, cars, machinery, appliances, and remote monitoring devices.(2) All of these will generate a massive amount of “useful data” that can be analyzed. Indeed, researchers estimate that this connected ecosystem will make it possible to utilize a much larger percent of digital data (35 percent) than before (5 percent). Connected devices will enable people to enjoy more personalized, more immersive, and more enhanced experiences whenever and wherever they are. With the costs of devices and sensors coming down considerably, connectivity will be ubiquitous and unobtrusive. Rather than having to make a conscious decision to issue a computing command, people will have systems that take actions based on the predetermined preferences of that individual.
A wide array of networked sensors will link appliances, home security systems, energy grids, and entertainment systems to the internet. People will not need to be home in order to turn a security alarm on or off. They can change their thermostats from miles away. They can determine what foods are in short supply in their refrigerators. Connecting wireless sensors throughout their appliances will turn even the tiniest of devices into minicomputers. That will help individuals harness the power of the internet for a wide variety of tasks.
A recent study by IHS Markit on the economic impact of 5G finds that between 2020 and 2035, 5G technology will have an impact on global GDP that is roughly equivalent to adding an economy the size of India to the present global economy.
5G technology has three technological characteristics that will enable it to have a significant impact on the health care field. These are (a) low latency, (b) high reliability, and (c) the ability to support a plurality of devices and sensors, and to translate information from these devices and sensors into critical and meaningful data points. The effects of these characteristics will be felt equally in both the delivery of mission-critical services and in the personalization of health care.
Beyond enabling shifts in the point of care and in the quality and delivery of remote services, 5G has an important role to play in the delivery of mission-critical interventions. An example relating to the treatment of a stroke patient provided by Tas (2017) illustrates this. In this instance, ultra-reliable and low latency networks have a critical role to play—from the point where the patient’s monitoring device sends a distress signal to the ambulance, to the ambulance situation itself where high-resolution images and data on vital signs can be streamed to the hospital ahead of arrival. The ability to simulate a “live” experience and to ask the patient questions in real time not only provides for immediate treatment and diagnosis, but more effective treatment and diagnosis.
5G may also be a significant catalyst in fostering a trend that, by changing health care providers’ incentives, offers the potential for significant cost savings: health care provision may change from a “volume-based” model in which providers of health care are compensated for quantity, not quality, to a “value-based” model in which compensation is linked to the value delivered. Information is the key to making this transition from the volume-based world— in which there are arguably incentives to health care providers to inflate rather than contain costs— to the value-based world.
LITERATURE REVIEW
Impact of 5G on health care
The key lever through which 5G affects business models within the health care sector is through the potential that it (5G) creates for superior health informatics. Advances in health informatics, fuelled by 5G, will both facilitate a shift in the way health care is delivered and create new business opportunities.
The shift to value-based healthcare will also lead to substantial savings and productivity increases for hospitals and for health care systems, which may result in greater profitability.
More generally, three features of 5G are particularly critical to the goal of defining and monitoring the achievement of a desired set of outcomes and achieving those outcomes at lowest cost:
• 5G enables innovation at the “edge.” It involves a “distributed computing model that derives insights from the data generated by billions of devices.”(3) Distributed computing implies that computational activity can occur near the source—e.g., the patient—thus speeding up the “loop” of collecting information from the patient, process the information, computing any possible courses of action or recommendations, and providing feedback to the patient. This aspect of 5G should be very germane to the emergence of the type of high-quality health informatics that are required to comprehensively measure outcomes.
• 5G will not just improve the tracking of outcomes, but will improve the outcomes themselves. 5G’s superior latency, reliability and transmission speed will help in fostering preventative care, and in improving outcomes where critical interventions are required. These facets of 5G will help with improving outcomes and reducing the costs associated with achieving a given level of outcome (i.e., 5G will improve productivity).
• The superior security features of the 5G ecosystem will facilitate the informatics revolution and allay concerns health systems and health authorities have now in managing sensitive patient data outside the walls of the hospital. Orange Health care notes “the high reliability and security of 5G infrastructures should help to alleviate the legitimate end user and health professionals concerns about privacy and hacking around health data and services.”
Furthermore, 5G offers the potential for new business models to emerge at the intersection of health care and data analytics. Health care is of course highly specialized, and it is essential to maintain confidentiality of patient records as well as security of information. However, the potential for “big data” in health care not only offers growth opportunities for data analytics vendors, but it also offers an opportunity for health care providers to monetise the information that they have, provided security and privacy concerns can be met. This information may be of interest to pharmaceutical companies and medical devices manufacturers who are pursuing embedded analytics within their devices and service enabled drug solutions.
The wider availability and accessibility of information fuelled by 5G could encourage the growth of collaborations that cut across silos in the health care industry—for example, information on patient outcomes in response to certain treatments or changes in the patient’s environment may previously only have been available as part of a trial or experiment carried out within, say, a pharmaceutical company’s laboratory. But in the future, with the developments in monitoring and informatics discussed above, such information may be more readily gathered by a wider range of industry participants, and it may be compiled and centralized more effectively (e.g., by specialized health informatics vendors). In this environment, at least from a technological perspective, collaboration across silos such as pharmaceutical developers, equipment manufacturers and health care systems should be appreciably easier to achieve.
Some mission-critical medical functions require high reliability and availability with latency intervals that are down to a few milliseconds. 5G will make this possible and bring consistent, reliable user experiences to improve medical care. Today, there are a number of health applications that will benefit an array of industries that require high bandwidth and reliable connectivity, and these applications are part of the emerging 5G test cases. For Instance;
Imaging
One of the virtues of digital medicine is remote access to images and the ability to rapidly share information across geographic areas, therefore compressing time and distance. If a physician in one part of the country (or world) needs a second opinion, he or she can transmit the medical image or test result to another doctor and get that person’s view of the medical situation. This helps doctors gain access to much needed expertise and enables the health care system to overcome disparities based on geography, income, or class status.
This is especially the case in regard to rural areas or underserved urban populations. Patients in these settings typically do not have access to the latest medical expertise. Through digital technology, however, they can gain the benefits of specialists who practice far away. That reduces health disparities and helps to bridge the urban/rural divide that exists in most countries. Patients don’t have to travel physically in order to get access to high quality medical assistance.
High-speed transmission of X-rays or CT scans enables patients to quickly obtain second or third opinions. They will not be limited to specialists who live in their home city, but will be able to access a global network of medical professionals. For patients, this will expand the talent pool and bring highly responsive health expertise to small communities without much health infrastructure.
Diagnostics
The advancement in diagnostics is an important capability, as new applications will expand the use of monitoring devices and wearable medical equipment. For patients suffering from serious or chronic health issues such as cardiovascular disease, diabetes or cancer, remote monitoring devices can track vital signs and glucose levels and electronically transmit this information to health care providers. Rather than wait for an emergency to happen, this equipment and immersive connectivity provides an early warning system that helps physicians detect possible problems and get medical care to patients in a proactive manner. This capability is being used today with existing 4G networks and devices, but what is unique to 5G is the facilitation of machine type communications which will help to expand monitoring and provide real-time analytics that can improve health outcomes. These kinds of monitoring tools are especially useful for senior citizens. Many of these individuals lack mobility and are not able to travel to a doctor’s office or hospital. If the diagnosis is not very complicated, they can get medical help through video conferencing and telemedicine. Physicians and nurses can track vital signs, motion, falls, and speech slurring, among other things, in order to provide real-time diagnosis of people’s health problems.
Data analytics and treatment
Trusted data analytics offer concrete advantages in digital medicine. The opportunity to mine health data will grow as digital infrastructure becomes more powerful and will help providers and patients get the information needed to make informed decisions. Indeed, having the ability to assess data in real time will enable rapid learning on treatment effects. Through the use of data analysis, physicians can aggregate and analyze information in new and ingenious ways. They can use this information to uncover “actionable insights,” learn in real time, and use the accumulated knowledge to determine the treatments likely to be most effective. Alerts can inform physicians or even patients themselves when vital signs run outside acceptable ranges.
In addition, the use of 5G technologies has the potential to safeguard quality, and reduce overall medical costs.
Some examples of this are:
• The use of sensors and remote monitoring devices that help patients living in isolated areas gain access to top medical assistance. Using video conference facilities or telemedicine can reduce the geographic divide and bring high quality care to underserved communities.
• Newly-emerging point-of-care testing (POCT) can save money by avoiding costly hospital visits. Rather than going to a large medical facility, patients can take advantage of mhealth technologies, digital platforms, or remote monitoring devices. It is estimated that the POCT market will be $27.5 billion by 2018. (4) These devices increase patient accessibility by making technologies available at bedside or in the home.
• Home health therapies represent a way to deliver quality care without patients having to travel great distances to hospitals or medical facilities. They can transmit medical information electronically and have distant doctors provide advice on diagnosis and treatment.
• Research by the Veterans Administration (VA) found significant advances in chronic condition management via telemedicine. Its study of over 17,000 VA patients showed “a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrollment into the program.” (5) Its researchers concluded that telehealth was a “cost-effective way of managing chronic care patients in both urban and rural settings.”
• A study undertaken by the University of Virginia Health System found a 37 percent improvement in hospital readmissions after home visits and post-acute care assistance. (6) Monitoring real-time vital signs and medical needs helped that system decrease readmissions for a variety of different illnesses ranging from heart failure and strokes to pulmonary disorders. That translated into millions of dollars of medical savings.
• Analysis of congestive heart patients in Indiana found that remote patient monitoring reduced hospital readmissions. Only three percent of those whose biometrics were tracked daily and who had weekly video conferences with health providers were readmitted, compared to 15 percent of those not getting that kind of attention. (7) Nationally, the admission level for people with congestive heart failure is 21 percent. This helped those individuals plus the participating hospitals save considerable money on treatment, without compromising the quality of medical care.
• Diabetes is a major problem in many communities. The state of Mississippi found that 13 percent of its adults suffered from diabetes and 54 percent of those individuals are located in rural areas with limited access to quality care. However, after creating a Diabetes Telehealth Network with remote care management, medical authorities saw cost savings of $339,184 for 100 patients enrolled in that project and projected Medicaid savings of $189 million annually. (8)
• By keeping people out of hospitals, Health IoT has the potential to keep costs low and save money without compromising quality care. Not every medical problem warrants a visit to a doctor’s office or hospital. Routine issues can be diagnosed at a distance and that will offer patients greater alternatives to conventional care.
• Voice recognition software can streamline administrative operations. A study of this technology in hospitals found that it helped health professionals “provide care without being interrupted with data entry and querying tasks.”(9) The software enables people to record medical information without having to stop to enter data.
• Advancements in intervention management are coming online. Medical facilities can better manage care resources–highly valuable assets like operating theatres, electrocardiogram monitors, and other equipment.
The ability to monitor the use and status of massive amounts of equipment aids facilities in ensuring patient safety and efficiencies. Capability like real-time tracking of value assets enables better management along the supply chain.
5G and IOMT; Enabling the “Internet of Medical Things (IoMT)”
5G has several key properties that will enable a vast network of connected “things”—devices and machines that can speak to other devices and machines, with or without human intermediation. 5G facilitates this “Internet of Things” through:
• Greatly enhanced mobile broadband data rates that enable ever faster flows of greater amounts of information.
• Ultra-low latency and reliability—which is suitable for mission-critical services.
• Ability to significantly and efficiently scale to connect a massive number of sensors.
• Enhanced security, e.g., capabilities around biometric identification, which help safeguard the integrity of information.
The Internet of Medical Things (IoMT) “includes devices such as medical devices, wearables, remote sensors, and wireless patches that monitor and electronically transmit vital signs, physical activity, personal safety, and medication adherence.” 5G is a particularly effective catalyst for IoMT. 5G’s ubiquity, ultra-reliability and ability to support higher-bandwidth transmission, at much lower latency than today’s mobile networks will not just enable faster and greater flows of data, but will incorporate “back-end data centers, cloud services and remote file servers into a computational behemoth. There will be ‘computing at the edge,’ which means that computations can be performed near the source, on the device or sensor itself or in the cloud, depending on the immediate need. These 5G innovations will allow applications to quickly process content and provide an experience that is near real-time and very responsive.
In short, the innovations associated with 5G do much more than just move bits of data at ever-higher rates. Instead, the “computational behemoth” described above enables the network to assimilate and process large amounts of data; and to do so intelligently so that it can be turned back into individualized recommendations and actions for patients and their caregivers. Further, these 5G innovations will facilitate (through cloud computing) the sharing of that information. The ubiquity of 5G enables the proliferation of connected “medical things”. This property of “ubiquity” arises because 5G is not just an extension of existing 3G and 4G networks. It folds Wi-Fi and cellular mobile networks into a single seamless network. It is this ubiquity or seamlessness that supports the proliferation of connected devices and enables, for example, the continuous monitoring of patients. 5G’s security properties are critical to safeguarding the security and integrity of the information, thus lowering a critical barrier to the dissemination and harnessing of information.
The benefits of this connected “ecosystem” are significant. As West (2016) puts it, “these devices will provide never before seen telemedicine diagnosis and treatment services.” (10)
As a tangible example, consider a glucometer. Today most diabetics do not use their glucometer to understand their blood sugar levels, and the device does not store data in a way that lends itself to being analyzed by the user. Even the act of keeping a systematic log of results is something that requires a significant amount of discipline on behalf of the patient. People with diabetes thus receive feedback on their progress and suggestions as to the future course of action typically through the medium of physician visits. In the connected world, not only can the glucometer continually transmit data to another device or a server that records it, but with the development of artificial intelligence and machine learning, the patient can receive both feedback and guidance that is tailored to their current situation, lifestyle, and unique physiology.
These possibilities for improved and personalized health care are amplified by the fact that in the IoMT environment, the information from the glucometer will not be processed in isolation. Rather, the IoMT world will feature the information from the glucometer combined with information from other sensors and intelligent devices. A much more complete view of the patient’s health provides for much more powerful and potent actionable insights to be extracted from the data. For example, transient illnesses or infections may interact with an underlying long-term condition and create more complications for vulnerable patients than they do in the general population. A rich set of information will enable better monitoring and diagnosis of such interactions, and may be used to inform interventions or changes in the standard course of treatment.
CONCLUSION
The advent of 5G technology represents an important augmentation of the role of mobile technology in the wider economy. Mobile technology will go from a significant enabling technology to one that is pervasive and transformative in many uses across the economy, i.e., a “general purpose technology.” The health care sector provides an excellent illustration of this transition. The reliability and ubiquity of 5G networks, combined with the role of such networks in facilitating “computing at the edge”, will directly enable the personalization of health care. The personalization of health care means “more prevention” and “more precision”, improving patients’ quality of life, improving health outcomes and reducing costs to the health care system. 5G will enable substantial advances in health informatics and thus fuel both new business opportunities and significantly facilitate a perhaps-needed transition to “outcome-based” health care.
There are tremendous opportunities through 5G across a variety of sectors to connect the health care world in creative ways. The use of mobile devices, sensors, and remote monitoring equipment is going to grow and there will be a dramatic advancement in patients receiving imaging, diagnosis, or treatment through digital technology.
To ensure all of this becomes a reality, though, work needs to be done to facilitate an end-to-end system. Devices must connect to networks and the cloud in ways that are interoperable and secure. That will enable health providers and patients to receive the benefits of digital innovation for wellness and health care. If we can overcome these barriers, both health care consumers and providers will see substantial advances in medical treatment.
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