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10 November 2017
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Q. What is the 'Internet of Things' and how does it impact on general practice?

A.The Internet of Things (IoT) consists of web-enabled devices such as thermostats, fridges, lights, cars and security cameras that share information over the internet. In the healthcare domain, the devices would include patient monitors and delivery mechanisms; for example, glucose monitors and insulin pumps. At a general practice level, there may be medical devices such as ECG machines, spirometers, glucose monitors and vaccine fridges that communicate with the local network and potentially with the internet.

The IoT is part of living in the connected world. The Apple watch will monitor your heart rate for cardiac arrhythmias, and with your permission, send the data to Stanford University. A smartphone held by a person with dementia who wanders can be used to track their location. A security camera can be used to check who is outside your front door.

IoT in healthcare is growing rapidly. Patients with different chronic illnesses can be enabled with devices to help to monitor and control their illnesses. This can be really empowering at the patient level, but a bit overpowering at the clinician level. The algorithms and workflow to manage large amounts of data from remote monitoring devices are a work in progress.

One of the major worries about IoT is security. The medical devices you run in your practice may be using out-of-date operating systems and be a security risk. Webenabled devices often have poor inbuilt security and are open to hackers. In the Summer of 2017, hackers compromised a web-enabled fish tank in a North American casino to break into the network and probe for vulnerabilities. In 2016, the Mirai botnet launched a 'denial of service' attack that severely impacted the internet. Mirai used zombie IoT devices such as security cameras and fridges to send malicious traffic to targeted servers.

So, what are the lessons for GPs? Ensure your networkenabled medical devices have up-to-date and patched operating systems. Talk to your medical device supplier and check if any updates are needed. Stay away from consumer smart devices, such as lights and thermostats in the practice. There is no way to know if these are secure and you risk a hacker attack on your practice network and patient information. I think we should continue to encourage IoT monitoring and treatment devices for patients, but be realistic on how much review of clinical data is possible at a doctor or nurse level. There is no stopping the expansion of IoT, but GPs should hasten slowly.