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Bluetooth Low Energy for Remote Patient Monitoring: Security and Reliability Considerations

6 minute read

The Internet of Things (IoT) is being leveraged across myriad industries to support business outcomes and enhance operations. One major area of growth for IoT leveraged in the healthcare industry, also known as connected health, is remote patient monitoring (RPM).

Remote patient monitoring pairs devices with the internet via connectivity that collects patient data, analyzes it, and then reports those analytics to a care provider. The patient-used devices typically include glucometers, pulse oximeters, cardiac rhythm monitors, thermometers, blood pressure cuffs, and scales, though the breadth of devices varies.

The ability for patients to leverage these devices can allow patients to receive at-home care for greater monitoring and better outcomes without the need to physically visit a doctor, clinic, or hospital. These same RPM devices that collect patient data can be used alongside electronic patient diaries, such as eCOA and ePRO, to support decentralized clinical trials.

Connectivity Choices for Remote Patient Monitoring

Connectivity is a critical component of the RPM infrastructure. Devices can collect data, but without transmitting the data, the solution's communication and analytical interface sides are useless. Mobile connectivity is required in these RPM use cases because devices are sent to patients ready to work out of the box and do not require complicated setup – including connecting to a user’s own personal wireless connection. Requiring individual wireless connectivity would simply not work in these use cases beyond the complication of making it each end user’s responsibility to set up a connection. Some patients may not have wireless connectivity in their homes. It would also be incredibly difficult to ensure a secure connection through individual wireless setups.

With mobile connectivity being the option for RPM solutions, that still leaves cellular or non-cellular connectivity. Cellular, of course, includes 4G LTE, 5G, and certain low power wide area (LPWA) networks. The costs of cellular can be prohibitive, however, due to hardware and usage costs – as well as sometimes platform fees. It can be more challenging to procure cellular connected health devices, as well, because there are fewer options to choose from. Device development is an option, but that’s a lengthy and costly process.

Oftentimes, it is more cost-effective and more hardware options are available via non-cellular mobile connectivity. Take, for instance, the connected scale – a patient might only need to use the scale once a day. When it is not in use, the device is not communicating with the network in a way that the network is pulling data from the device and draining its battery and running up usage costs.

In many RPM use cases, the device collecting data is referred to as a peripheral device. It collects data but does not analyze it. Rather the data is transmitted to a central device, such as a smartphone, tablet, or computer, which then processes the data.

These peripheral devices leveraging cellular connectivity are not entirely necessary, which is why many of these peripheral devices will connect using short-range, non-cellular connectivity, such as Bluetooth Low Energy (BLE).

What is Bluetooth Low Energy?

BLE leverages the technology of the original Bluetooth connectivity technology, designed for the steady transmission of data across short distances, which categorizes it as a short-range connectivity technology.

What distinguishes BLE from standard Bluetooth is that it is leveraged for intermittent data transmissions, versus consistent data communication, and it transmits smaller packets of data.

Much like LPWA networks, BLE stays in sleep mode until it participates in a data exchange. This helps maintain a device’s battery life, supports lower complexity devices that are not consistently exchanging data, and thus also helps overall with managing usage costs and bandwidth requirements.

BLE can be used with either central or peripheral devices. It meets the needs of RPM by providing mobile connectivity and also supporting the lower complexity devices that can benefit from a longer battery life, which puts less responsibility on the end user (the patient) for charging. It also allows widespread device usage due to devices using less data.

Concerns with Bluetooth Low Energy

All IoT applications have potential security issues. By its very nature of connecting devices to the internet, this creates challenges. Devices can be hacked, networks can be infiltrated, and data can be compromised or exposed – it is all part and parcel of any internet-related use case.

RPM is particularly sensitive to data privacy and protection due to exchanging patient data between devices and the network. While once a device is authenticated to the network, the main vulnerability of BLE is no longer an issue.

The pairing process is where the security challenges primarily lie. This is the process before authentication where keys and input/output information is exchanged. During this phase, attackers can gain entry, and the two main security attacks that can occur are passive eavesdropping or man-in-the-middle attacks.

BLE is no more or less secure than cellular and it is cost-effective and offers more diverse hardware options. Any IoT deployment will have security concerns, but those can be easily managed by choosing a partner to help build end-to-end security.

Pairing with an Expert to Mitigate Security Challenges

Understanding security vulnerabilities and building solutions to manage these challenges is an important reason why organizations might choose to utilize a proven IoT partner for deploying, managing, and scaling connected health applications.

KORE has developed its Connected Health Telemetry Solutions (CHTS) designed to help secure, reliable connections between devices, networks, cloud, and analytical interfaces. KORE CHTS pairs with BLE Secure, which fully encrypts data transmission between devices and the gateway to mitigate security vulnerabilities.

Want to learn more about the KORE Connected Health Telemetry Solutions? Reach out to our Connected Health team! 

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