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Article: Making Digital Technology Work Towards Safer Water Systems

Digital technology holds the key to the future of the NHS – including the remote IoT monitoring of water temperature (using systems such as LinkThru from Cistermiser). However, obstacles inevitably stand in the way of implementation. Let’s consider how busy facilities managers can embrace the potential.

In the summer of 2016, the NHS came under the biggest cyber attack in its history. The Wannacry virus was part of a worldwide attack against organisations of all sizes. It froze staff out of their computers and brought the NHS, temporarily, to a halt. It was the highest profile example of how devastating an attack against NHS systems can be, and poured cold water on those who envisaged a bold digital future for the NHS.

Technology forms a central plank of the future strategy of the NHS. The Five Year Forward View envisages a world in which technology is crucial to the effective delivery of the healthcare system. Achieving that is no small matter. Actions often

fail to reflect bold ambitions, which was why the Secretary of State for Health & Social Care back in 2016 was reluctantly forced to admit that the NHS would miss its targets to become paperless by 2017. What was standing in the way was a heady cocktail of expense, risk and the age-old suspicion of innovation.

Counting the Cost

The frustration for those who would like to see a digital and connected NHS, is that the technology often exists, but is not being used. For water temperature measurements, for example, cloud computing platforms give operators the ability to monitor temperatures in real-time, streamline operations, improve safety and manage finances – but these systems come at a price. A cash strapped NHS Trust is always likely to ask the question: can we afford it? They are already struggling to manage the basics and often rely on donations and fund-raising efforts to buy the latest equipment. The Royal National Orthopaedic Hospital in Stanmore made headlines in 2016 when it revealed that it had been forced to rely on crowdfunding to equip wards. Managers may see the value but often feel that the barrier of the initial cost is too hard to overcome.

Against that, though, they should calculate the savings new technologies can bring. These come in a number of forms:

  1. Reduced inspection: Advanced cloud-based platforms reduce the need for teams to organise routine inspection. Instead they can constantly monitor temperatures and use as-needed maintenance operations to reduce the ongoing cost and manpower.
  2. Early identification of problems: The ability to flag issues early and take prompt remedial action also delivers savings through lower maintenance requirements and a longer lifespan for key equipment.
  3. Regulatory compliance: The ability to gather, store and present real-time data on water temperatures and equipment condition makes it easier to demonstrate regulatory compliance and avoid costly fines.

The initial cost of next-generation IoT water temperature monitoring systems is much lower than many people might assume. Software packages can be relatively affordable and are accessible via the cloud. Hardware can easily be retrofitted to monitor pipes with minimal change to existing infrastructure.

The return on investment, on the other hand, is significant and ongoing. Given the challenges that the NHS faces in a world in which budgets are falling in real terms and demands are growing, that could prove crucial – perhaps even to its very survival. It is being asked to do more with less, and more than a few commentators have questioned how long it can continue. To survive, it must make sizeable gains in efficiency across the board. Systems such as remote water temperature monitoring can offer incremental gains to help the service meet goals which, at first glance, might seem unachievable.

Fear of Failure

Another key consideration is the operational risk of new technologies. These come in two forms. The first is the strain on existing IT infrastructure and the second is the growing menace of cyber security. The Wannacry attack was just one of

many ransomware attacks against healthcare targets around the world. The year 2017 saw a significant rise in disruptive ransomware activities. In May that year, Kaspersky revealed than ransomware attacks had increased by 250%, with targets in the US being the most severely affected. In 2016 a report warned that 28 NHS trusts may have been hit by ransomware according to a report on the Digital Health Website. Ransomware attackers view the NHS – and other healthcare organisations around the world – as being ripe for attack. They hold a huge amount of personal data and defences may not

be as robust as organisations which are used to facing down constant cyber-attacks. The race to embrace digital technology may also make it more vulnerable.

Let’s take the idea of how a ‘connected hospital of the future’ might approach water temperature control. They will move away from old fashioned manual temperature recording and move towards sophisticated IoT real-time monitoring using wireless connectivity. However, it will be vulnerable to system outage and a ransomware attack. The more data a healthcare organisation stores in the digital realm the more vulnerable it will be to a denial of service attack.

Shared Data

When hospitals turn to the cloud they complicate the issue of security. Sets of data are now shared across more than one platform, which means responsibility for its safety is also shared. By allowing data onto the cloud a hospital surrenders a certain amount of control over how it will be secured. They will be reliant on the security of a third-party provider.

The use of IoT technology also drives managers to consider endpoint security. Multiple connected devices create a security challenge that existing firewalls are not always equipped to cope with. It is imperative that all devices which connect into the central system are as secure as they possibly can be. They must keep all endpoints up to date one faulty endpoint to allow the attacks to gain a foothold. According to Endpoint Security Provider, Duo, healthcare organisations are logging into twice as many apps as the average user, creating a wide attack vector. They are more likely to choose Internet Explorer 11, while other users will go for Chrome and 22% browse dangerously on unsupported versions of IE. They are also twice as likely to have Flash installed which can be used as a point of vulnerability for hackers.

Security, therefore, is an issue that healthcare professionals need to get to grips with and urgently. To do so, they will need to ensure all endpoints are secure and that cyber defences are constantly updated to cope with the latest types of attack. Staff education will be critical. Managers must ensure that all staff follow strict security protocols and that clear guidelines are in place about what devices can and can’t be used.

Digital technology, then, is truly transformative. It can reduce the administrative burden on staff; it can cut costs and improve oversight. However, challenges remain, especially surrounding IT and infrastructure, security and awareness.  But by adopting the right approach managers can capitalise on the true power of the digital revolution.

Building Confidence

IoT water temperature monitoring solutions such as LinkThru use stand-alone radio signalling (using the proven Sigfox wireless network) to transmit constant 24/7 low-cost data recordings to a secure cloud-based portal. This undoubtedly builds confidence with NHS specifiers and overcomes a major hurdle when implementing this powerful new technology.

Temperature profile and flow event information is sent to a dedicated software platform with no requirement to integrate or interfere with any on-site IT infrastructure or local networking systems. Security of TMU wireless communications is delivered by an array of protective features including anti-replay, message scrambling and sequencing.

For more information about IoT monitoring from Cistermiser, please visit

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