Adapting Existing Conduits to Secure Data From Smart Devices in Plastic Surgery

Abstract

S mart devices are those equipped with sensors and enabled for network connectivity, context awareness, and autonomous computing. Designed to enhance data collection and decision making, they fall under the purview of the internet of things (IoT). 1 Their use cases in plastic and reconstructive surgery are limited only by imagination, and the underlying technology is quickly emerging as a new frontier for surgical innovation. We recently explored use of a smart device to remotely monitor perfusion of microsurgical free flaps at our institution, but clinical translation proved difficult from a data security standpoint. Borrowing from successful implementation cases in nonsurgical specialties, we propose a solution that makes use of existing electronic health records (EHRs) infrastructure to overcome this challenge.Unsurprisingly, we are not alone in pursuing plastic surgery-specific applications for smart devices. Use of smart implantable Doppler devices capable of continuous, real-time, remote monitoring of microsurgical free flaps has been reported, with promising results in the clinical setting. 2 However, a recent investigation found that most smart devices remain in preclinical stages of development, and surgical IoT innovation lags behind that of nonsurgical fields considerably. 1 Data protection requirements stemming from smart devices' network connectivity, which leaves them vulnerable to breaches by malicious actors, often delay clinical application. 1 Overcoming these obstacles will require close collaboration between clinicians and engineers in the development of smart devices, ideally making use of existing infrastructure that safeguards patient data.One solution that has been successfully implemented uses EHR as a conduit for data transfer from smart devices. Genes et al. 3 have described a workflow based on the software development platforms HealthKit and ResearchKit (Apple Inc., Cupertino, CA), which integrate with EHR to allow patients with asthma to share peak expiratory flow rate data via a smartphone application or Bluetooth-enabled peak flow meter. Clinicians can even predefine alert thresholds to enable prompt intervention for abnormal readings. 3 More recently, Lewinski et al. 4 demonstrated the feasibility of a similar workflow for patients with diabetes mellitus using a Bluetooth-enabled glucometer. Developments in IoT are ongoing, and EHR vendors are eagerly embracing improved data format standards, such as the Fast Healthcare Interoperability Resources, which facilitate integration of EHR and mobile applications for secure, real-time data gathering. 5 These integrated frameworks allow for seamless data transfer to EHR without needing to store anything on a smart device, smartphone, or intermediate cloud service (Fig. 1). In doing so, they greatly mitigate the risk of data breaches, clearing a path for more ubiquitous clinical use of smart devices.In summary, we expect that data security will remain a challenge in the development of smart devices for use in plastic surgery, both in and out...