Australian Unity Improves Clinical Outcomes with “Internet of Knees” Using AWS IoT

Compliance with a physical therapist’s prescribed rehabilitation plan is important to a patient’s successful recovery from total knee surgery, but up to 50 percent of patients don’t stick to their plans, according to a peer-reviewed study published in the Journal of Medical Internet Research. Australian Unity subsidiary Remedy Healthcare provides home physical therapy rehabilitation services to thousands of Australians every year following joint replacement, and the company’s goal was to improve adherence to prescribed exercises and improve patient outcomes. Traditionally, the therapist visits the patient once per week, but the monitoring of exercise prescription between visits is difficult, especially in locations where therapists are in short supply. So Remedy Healthcare wanted to develop a remote, interactive software application that would help physical therapists more frequently monitor the progress of a patient’s rehabilitation and recovery.

Using a suite of offerings from Amazon Web Services (AWS), Australian Unity built the “Internet of Knees” (IoK). The IoK is a solution that tracks knee flexion by collecting data from sensors attached to a patient’s thigh and calf. The sensors relay data to a mobile app so that physical therapists can remotely monitor patients’ frequency of exercise and functional progress. Patients who use the IoK report that their motivation has significantly increased, and physical therapists report that they save time and gain increased patient visibility. Using AWS, Australian Unity was able to build the solution quickly and efficiently, and the company gained the scalability it needs to expand the solution globally and adapt it for other patient scenarios.

Founded in 1840, Australian Unity is a member-owned well-being company delivering health, wealth, and care services. For the last 12 years, its subsidiary Remedy Healthcare has provided in-home healthcare and telehealth for nearly 100,000 Australians.  

A patient recovering from knee surgery can require at least 7 weeks of home rehabilitation. Remedy Healthcare, while seeking a solution to improve patient compliance, also wanted to accelerate patient recovery and broaden access to home rehabilitation in remote areas. Finding a solution became even more urgent during the COVID-19 pandemic, when social distancing made it difficult for physical therapists to see patients in their homes.

In 2018, Australian Unity began looking at solutions incorporating the Internet of Things (IoT). It tried a series of different vendors to help develop the IoK but found them lacking in stability, capability, or support quality.

Ultimately, Australian Unity found AWS IoT Core, which organizations can use to connect IoT devices to the cloud without the need to provision or manage servers. In about 1 month, the company developed a proof-of-concept device using AWS IoT Core and received feedback from its physical therapists. Based on this feedback, the company pivoted from its original concept to a mobile app on AWS. “Using AWS, we could test the IoT functionality of our mobile app within days of setting up our account,” says Jacek Kowalski, Australian Unity’s chief data scientist and general manager of analytics. “We didn’t have to worry about required hardware and software infrastructure, so we could stay fully focused on the business problem. Our small team was totally in control of the development process.” Australian Unity estimates that it built the IoK two to three times faster than it could have using an on-premises solution. 

To use the IoK, a patient receives a mobile phone with the IoK app installed and Bluetooth sensors that attach to the patient’s upper and lower leg. The solution uses AWS IoT Core to connect the patient’s device to the cloud and collects near-real-time data from the sensors as the patient exercises, sending the information to a central portal. The data loads using Amazon Data Firehose, a simple and reliable way to load streaming data into data lakes, data stores, and analytics services. A fast-retrieval database is critical for the physical therapists to access all of the time series data that patients provide while exercising, so Remedy Healthcare turned to Amazon Relational Database Service (Amazon RDS), which makes it simple to set up, operate, and scale a relational database in the cloud. A physical therapist can play back the data later—using a leg avatar that interprets the data to simulate the patient’s movements—and generate graphs with helpful metrics that show a patient’s pain, perceived exertion, and range of motion over time. “I can experiment with different services without committing to licensing software for a long time or buying hardware,” Kowalski says. “If a solution is suitable, we use it. If not, we shut it down.”

Since the initial rollout of the IoK, patients have reported nearly 100 percent motivation to do their exercises and nearly 86 percent confidence that they are using correct techniques. “It’s been well established that compliance is the key to successful and fast recovery,” says Kowalski. “We have strong expectations that the IoK will lead to improved clinical outcomes.” Now, without traveling and with a reduction in physical contact, physical therapists have full insight into what their patients are doing. And if everything is not going according to plan, the app alerts the physical therapist. Plus, Remedy Healthcare expects to be able to double the number of patients it serves without increasing its workforce.  

Australian Unity anticipates recuperating the cost of development in just 18 months, and it can control other costs due to the scalability of the solution on AWS. “We can scale up or down depending on demand, which typically is different at night versus during business hours,” says Kowalski. The ability to scale will also help Australian Unity take its solution to other markets and facilitate its plans to expand into postoperative hip rehabilitation and the monitoring of other vulnerable parts of the body. For example, the company is planning an “Internet of Spines,” which will use sensors embedded in its prototype vest to monitor people who perform manual labor and give them feedback to help prevent back injuries. 

Australian Unity is planning a full rollout of the IoK in early 2022. The company will then prioritize the addition of machine learning to its program using Amazon SageMaker, which helps data scientists and developers to prepare, build, train, and deploy high-quality machine learning models quickly. Physical therapists will ultimately be able to assess the quality of exercises and optimize the program for each patient through the analysis of specific factors that will help personalize rehabilitation programs. “AWS has all the components that we need and more capabilities than we could dream of,” says Kowalski. “The speed and functionality are absolutely amazing. It’s highly unlikely we’ll ever reach a limit.”