The Role of Ubiquitous Computing in the Transformation of the Healthcare System

Abstract

Currently, keeping the financial balance in health services has been a challenge for governments and private companies. Factors such as population aging, medical inflation and the lack of adherence to treatments raise costs and stimulate debates around the world on how to maintain systems’ budget viability. During the last decades, we could observe the phenomenon of computation needing less hardware, becoming more portable and migrating to our offices, pockets, clothing, and finally, to our body, thus allowing us to envision a range of solutions for these problems. The only way for society to offer such quality services and overcome these challenges is through the solutions that the convergence of new technologies brings to us now. The applications of ubiquitous computing have the potential to immensely benefit patients, managers and the society that finances the health system.

1. Introduction

“The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it [1]”.

Our time is marked by cheap sensors and fast and powerful processors. These elements have the power to cause profound changes in our society and unleash great opportunities, which lead us to the Ubiquitous Computing field. Mark Weiser defined Ubiquitous Computing as computation (not necessarily computers) everywhere and everything. Although, at the moment, Weiser considers that computers were still “in a world of its own [1]”, he already envisioned a new threshold, when the technological advances of computing would overcome the computer to install itself in the most common objects of the daily life [1, 2]. In this sense, it is noteworthy to mention the Internet of Things (IoT) technology as an important element of the Ubiquitous Computing reality.

During the last decades, we could observe the phenomenon of computation needing less hardware, becoming more portable and migrating to our offices, pockets, clothing, and finally, to our body [3]. This spreading process brings in-depth transformations to all human activities and healthcare, and all its dimensions are being strongly impacted. Throughout the world, the healthcare systems, including governments and private companies, are facing challenges to keep the financial balance. Regarding this issue, there are two causes I would like to highlight: Population aging and the lack of adherence to health treatments [4].

1.1 Population aging

We can easily observe a fast change in the demographic profile of the world population. The drop of mortality added to the increase in birth rates in the 40’s and 50’s resulted in a rise of people aged 60 and older [5]. The phenomenon of the population aging can be observed in all the countries, even in regions with low- and middle-income [5]. These rapid and profound changes in the age pyramid also means transformations in various aspects of society, including family dynamics, social security and healthcare demands. Therefore, it is possible to affirm that society is experiencing “a longevity revolution” [5].

The longevity revolution is a gift to our generation and future ones. But, for enjoying all the benefits of this gift, is essential that society is prepared to offer to individuals a healthy and active aging process, allowing people to keep independence and quality of life as long as possible. Thereby, in order to elaborate appropriate plans to achieve such an important and challenging goal, it is crucial to understand the size and speed of the aging process in society. Figure 1 highlights that the percentage of persons aged 65 years and older increased from 6 per cent in 1990 to 9 per cent in 2019. According to United Nations projections, this estimate is expected to reach 16 per cent by 2050. Additionally, life expectancy at birth reached 72.3 years [6].

Figure 1.

Percentage of persons aged 65 years or over from 1990 to 2050.

Another interesting data from the United Nations report is the number of persons aged 80 years or older. In Figure 2, we can observe that this age group raised from 54 million in 1990 to 143 million in 2019. Moreover, the estimates indicate they will be 426 million by 2050 [6]. Therefore, we can expect the costs of healthcare to increase, owing to the strong correlation between population aging and healthcare expenditure, being this impact on health finances largely propelled by the prevalence of chronic conditions in elderly population [7, 8].

Figure 2.

Number (in millions) of persons aged 80 years or over from 1990 to 2050.

1.2 Adherence to health treatments

To start the discussion, it is pivotal to understand the meaning of adherence to health care practices. The term suffered an evolution, abandoning the simple idea of adherence to medication or even “the extent to which the patient follows medical instructions” [9] to include a wider range of individual behaviors. According to World Health Organization (WHO), the active search for treatment, immunization, self-management of risk habits and several other actions can be included in the list of indicators of adherence to healthy habits [9].

In fact, adherence is a very complex and multifaceted term, involving a diverse range of actions, behaviors and habits of the individuals. Thus, the task of finding an appropriate and complete definition for adherence already proves to be challenging, evidencing the possible difficulties to choose the most suitable indicators to measure it.

Despite these concerns and the risk of incurring in results with a certain degree of inaccuracy, it is important to understand the adherence and how to improve the levels of commitment and engagement of the patients, since a low adherence has negative impacts on the effectiveness and cost of health treatments [10].

Most of the attempts to measure adherence rely on patients’ reports, which tend to be incomplete and subjective, especially when the patient is non-adherent [10]. However, the recent technological advances give us the unique opportunity to develop extremely precise tools to evaluate how much the behaviors of the individuals draw near the healthcare professional recommendations and, finally, to elaborate strategies based on reality.

Thus, it is possible to realize the association between the transformation of healthcare demands and the possibilities of ubiquitous computing in promoting the transformation of healthcare paradigms. The emerging technologies that compose this new ongoing reality, known as ubiquitous computing, have the potential to cause great revolutions not only for patients, but mainly for managers and for the society that finances the health system.

2. Internet of things

Regarding Ubiquitous Computing paradigm, it is worthwhile to talk about the Internet of Things. The term was first used in 1999 during a presentation performed by Kevin Ashton about the application of Radio-Frequency Identification (RFID) in the supply chain. In this context, the Internet of Things was born in the industrial sector or, at least, strongly stimulated to meet the demands of the industry. However, the technology is spreading rapidly and affecting several sectors of human activity [11].

After this start, gradually, the Internet of Things has undergone a profound transformation and expanded to refer to the concept of object networks, including everyday objects, “that are readable, recognizable, locatable, addressable, and/or controllable via the Internet [12]”. The communication technologies used to connect these objects are not relevant to our definition. Further, it is crucial to enlarge the concept beyond electronic devices and other products with high added technology, such as vehicles or home appliances. The concept embraces less obvious things, as well as food, clothing and soil [12].

Figure 3 reveals that the expectation is that the number of connected objects continues to increase. Currently, there are already more than 12 billion of IoT connected objects worldwide, and this number should exceed 25 billion by 2025, hence representing an increase of 100%. Another interesting fact is that there is an inversion, at the moment, since there are more connected objects with consumers than with industry. The consumer’s objects are expected to grow 63%, whereas the objects of the industry are expected to grow 145% over the next five years. So, we can notice a vigorous movement of the productive sector to incorporate this new technology [13].

Figure 3.

Number (in billion) of IoT connected objects worldwide from 2020 to 2025.

Considering the IoT spending, it is expected that the amount will reach USD 1 trillion by 2022. The current values are near USD 750 billion and it is foreseen an improvement of 34% in the next two years, which proves how thriving this market is [14].

2.1 Internet of medical things

As previously mentioned, IoT is causing a revolution in society. Obviously, the healthcare sector is part of it and is reaping great benefits from the implementation of this technology. Interestingly, IoT originated the term Internet of Medical Things (IoMT), which describes connected medical devices. It is estimated that the overall IoMT market will reach USD 158 billion by 2022 [15]. In addition, people are taking the initiative to use smartphones, wearables or other devices to support the monitoring and management of healthcare. Figure 4 shows that most users are interested in information related to maintenance of good health and exercise level, for example, thus indicating how powerful IoMT can be in preventive medicine [16].

Figure 4.

Percentage of adults worldwide who currently use a connected healthy device or tool to manage their health and selected reasons.

These data highlight the role of IoMT in the transformation of the healthcare system to an individualized and patient-centered system (eHealth), in opposition to the current one based on hospitals and mass services [17, 18]. We are observing the growing number of smart and connected medical devices “able to generate, collect, analyze or transmit health data or images and connect to health care provider networks, transmitting data to either a cloud repository or internal servers [15]”. Accordingly, these devices represent a new territory with the possibility to create a fresh and innovative paradigm of connected system and data-drive healthcare. The upcoming changes have the potential to drop the costs and increase access to health care.

It is worthwhile mentioning that the COVID-19 crisis accelerated the adoption of IoMT due to increased pressure on the health system and high risk of contamination in hospitals. Remarkably, IoT improves efficiency in all the health systems through the integration of the network and the usage of all sorts of data in real time to better manage available resources, which is highly important at this moment of health emergency [17, 19].

Furthermore, numerous solutions able to reduce the circulation of patients in the hospitals are gaining attention, and there has been a rapid growth of technologies related to telemedicine and patient remote monitoring [17, 19]. Two main lines of application are here observed. First, the monitoring of COVID-19 patients to follow up the evolution of the disease and reduce the need for circulation of an infected individual. Also, there are examples of IoMT usage for monitoring of patients with chronic disease, because they are a risk group for COVID-19, but it is not possible to simply waive a regular medical supervision [17, 19].

3. Ubiquitous computing and healthcare: a bibliometric analysis

A useful tool to better understand the extension and importance of Ubiquitous Computing in healthcare is the assessment of academic publications on this topic. The efforts undertaken by Universities and Research Centers to advance the technology and develop new possibilities of application demonstrate the expectations that society deposits on it, and also exhibit the potential that the field has to advance propelled by investments in research and development.

A search was conducted in the National Center for Biotechnology Information, U.S. National Library of Medicine database using the terms [(ubiquitous computing AND (health OR healthcare)]. Publications from 2010 to 2020 were retrieved. The search returned 913 results. Figure 5 depicts the distribution of these publications in the timeline. Interestingly, an important growth between 2013 and 2015 is evident. Besides, there is a constant improvement in the number of publications every year. In turn, the amount of publications demonstrates that there is space to better explore the subject.

Figure 5.

Number of publications retrieved from the National Center for biotechnology information, U.S. National Library of Medicine database using the terms [(ubiquitous computing AND (health OR healthcare)]. Publications from 2010 to 2020 were considered.

4. Conclusions

Based on the information exposed, we can conclude that the healthcare systems are under an important pressure caused by the population aging. Even countries with low- and middle-income are experiencing the rise of life expectancy. Obviously, this indicates advances in many social aspects, but also shows that society must be prepared to offer healthcare and life quality for this growing population group. It is crucial to develop policies to help people stay healthy and living independently as long as possible.

However, to achieve this goal, the challenges related to the adherence to treatments must be faced. Despite the improvement of healthcare access, there is still a lack of adherence to healthcare treatments and healthy habits, including exercise, for example. Indeed, the low adherence impacts negatively the effectiveness and cost of health treatments.

At the same time, despite these important challenges for healthcare providers, we also have a very unique opportunity to come up with the evolution and convergence of technology. The concept of ubiquitous computing is deeply involved with the IoT technology and its applications. After all, the vision of computation everywhere and everything is becoming reality through this growing network of smart objects.

These new technologies are proven to be a new and prosperous economic sector, since the number of connected devices is rapidly rising, as soon as the respective spending. Besides that, for the first time in medical history, it is possible to understand all aspects of the elements able to interfere in the population’s health, from the functioning of the hospitals to individual behaviors in daily life. Finally, access to such information will transform the way we think and offer healthcare services.