The smart home of the future is one dominated by sensors, transmitters and intelligent data analyses that work to improve the lives of those dwelling within. Increase the scale by a degree of magnitude and you have smart communities or cities: an aggregated body of information and infrastructure systems that aims to deliver services efficiently and – if implemented carefully – address issues of disparity and access in healthcare and other settings.

In some ways, individuals are already taking the first steps toward these types of connected ecosystems with the adoption of consumer smart home devices such as connected thermostats, fitness trackers and personal assistants, said Jennifer Kent, senior director at Parks Associates. However, she said, the idea that these tools could become links to community-wide systems and the potential benefits such an outcome would bring are mostly foreign concepts to the average smart home device owner.

"Consumers aren't all that familiar with the terms that we use, like smart cities, smart communities, and what [they] necessarily [mean] from a big-picture perspective. That's really industry terminology," she said. "What they are interested in and aware of are applications that affect them, or that they have interacted with in their daily lives. Much of what's going on in smart cities is still sort of at the infrastructure level, trial level, so consumers haven't really seen a lot of it. But healthcare, actually, is one of the places that consumers are starting to interact with [the Internet of things] ... especially coming out of the COVID-19 pandemic."

Roughly 30% of consumers now have at least one smart home device, Kent said, and the majority of those have been self-purchased, based on the immediate benefits they provided to individuals. To go further, many stakeholders hoping to promote smart cities, such as utilities providers, are subsidizing or freely supplying such devices to consumers – an approach that Kent said will likely be necessary to help connected health devices reach many individuals.

"Consumers have an expectation that healthcare should be reimbursed or payed for by insurers [and] the government payers, ... so the model's a little more difficult on the healthcare side," she said.

"You really need insurers and government payers to be in the loop, and to really see efficacy of these devices in order to get them into consumers' hands. [Right now] you wind up seeing this big split in the market between these consumers who have gone out and purchased a smartwatch, a smart fitness tracker, a digital weight scale, a connect blood pressure cuff for their own management and own empowerment, versus those who have gotten them provided to them for something specific – tracking their diabetes, monitoring them after discharge from a hospital."

Another major hurdle from the consumer adoption point of view is data privacy and security, noted Skip Newberry, president and CEO of the Technology Association of Oregon.

He illustrated the issue by pointing to a long-running smart home project being conducted in his state by Oregon Health and Science University's ORCATECH, which provided IoT devices and systems to aging individuals so that they could continue to live in their own residences. While early implementations of smart homes and communities were primarily stymied by the maturity level of the technology (both device costs and the ability to coordinate and compute massive amounts of data), the program's primary roadblock among participants has shifted as of late to concerns regarding the use of their data.

"[ORCATECH's] concept is really incredible, but the technology needed to get to a point where it was cost-effective from a deployment standpoint, and the ability of the folks to collect and make sense of the data, had to be efficient. Those were a couple of initial hurdles," he said. "As the program evolved, it became more of a focus around data privacy. There was a greater awareness socially around 'Well, there's potential harm around sharing too much data, and we should know as consumers how our data is being used.'"

Kent said that her group had seen similar concerns among consumers, and that more than anything consumers want to be in the know regarding exactly how their information is being used. As such, those with concerns are much more willing to buy into the concept if they're told what kind of data is being collected, who it is being shared with and, if possible, whether identifiable information will be anonymized before use.

"There are pretty strong laws on privacy protections for health data specifically – although some of that's been waived during the pandemic," she noted. "I'd honestly argue that the bigger challenge with health data is that it's really siloed right now and it doesn't integrate in ways that are really helpful oftentimes. Because of that, healthcare is farther from the consumer perspective than it really should be."

Winning over consumers and building these connected systems within singular homes has been a challenge on its own, but the difficulty is amplified when connecting all this data to broader community-wide systems. Here, Sokwoo Rhee, associate director for cyber-physical systems innovation at the National Institute of Standards and Technology, stressed that healthcare players must be prepared to work with governments, public organizations and stakeholders across several industries to achieve efficient data flow and the benefits it brings.

"When you talk about smart health or want to do any smart health projects, you should not look into it from the lens of the health [by] itself – you should look at the lens of infrastructure," he said. "What are the required components to make this happen? You have to identify the actors or the stakeholders in each sector, and you have to essentially create your own ecosystem to make it work. It's not an easy job to pull off, but it really creates a lot of opportunities if you make it happen."

Rhee, Kent and Newberry will be speaking more about these topics and others regarding data-connected communities during an Accelerate Health digital session titled "Smart Cities, Healthier Communities." The session will begin at 2:05 p.m. E.T. on Tuesday, September 29.