July 13, 2014

The barriers that stand in the way of full-blown adoption of a modern and mobile remote healthcare system require not only advances in technology but a willingness on the part of the healthcare community to change at an institutional level.

There is a palpable resistance to change in many healthcare organizations and medical practices. At its root is that deep philosophical idea, “don’t rock the boat,” and right after that comes, “if it ain’t broke, don’t fix it.” But healthcare is broken, and it will take a combination of Silicon Valley technology and entrepreneurial spirit, along with a full financial commitment on the part of healthcare providers combined with medical research to fix it. It appears all the above is happening.

Already, 3 million patients are using connected home medical monitoring devices, and that is expected to rise to 10.3 million in the U.S. alone in just three-and-a-half years. The total number of patients using connected home medical monitoring devices will reportedly skyrocket at a compound annual rate of 44.4 percent to 19.1 million worldwide.

These statistics include only patients that are being monitored by a professional caregiver, not personal health tracking applications, according to a 2013 mHealth and Home Monitoring Study from Berg Insight, a Swedish research firm that specializes in connected healthcare.

Implantable cardiac rhythm management (CRM) accounts for two-thirds of all patient users, followed by sleep therapy, with the still-nascent telehealth model taking a surprising third-place finish. Telehealth use, in fact, is far more robust in the U.S than in Europe at the end of 2013.

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The main driver in the states behind the rapid growth in telehealth and for most remotely connected medical monitors is the higher per-capita cost of healthcare. In the U.S., spending on healthcare was $8,900 per capita in 2012, while spending in the European Union (EU) that same year was $3,500. As a result, savings as a percentage of expenditures when using mobile solutions is far higher in the states than in the EU, according to Lars Kurkinen, a senior analyst with Berg Insight.

What may come as a shock to many in the healthcare industry is the fact that the majority – 70 percent – of remote monitoring in the U.S. and worldwide is still done over POTS (plain old telephone service) voice grade analog systems, PSTN (public switched telephone network) and LANs (local area networks). But  that is changing at a dramatic pace.

“The trend toward cellular will further be advanced by the forthcoming digitalization of PSTN networks, which will imply that analog PSTN modems will no longer work reliably,” Kurkinen said.

Cellular is now the standard for new medical devices, and Berg Insight estimates that 74 percent of all connections will be cellular by 2018, accounting for 14.1 million total connections, but that is still practically a grain of sand on the beach compared to the total population of the world.

Cellular is also the chief enabler of BYOD (bring your own device). Although cellular smartphones and tablets account for only 1 percent of all healthcare connections today, with 1.7 billion cellular users worldwide, cellular availability is much more prevalent. Cellular is a huge market that will entice add-on manufacturers to create hundreds if not thousands of unique medical diagnosis and monitoring devices to attach to these cost-efficient mobile tools that require no dedicated hardware or subscriptions.

Study after study indicates that when compared to traditional solutions remote monitoring produces better patient outcomes and reduces readmissions to hospitals. The icing on the cake? Patient satisfaction when using remote mobile solutions is at a much higher level than when traditional in-hospital healthcare services are served up.

On the demand side, in the U.S. at least, the impact of the slow but steady march away from fee-for-service to pay-for-performance is an added incentive to healthcare over mobile devices. In the U.S., Kurkinen noted, one can see this in the large number of RFPs for telehealth solutions being issued by hospitals.

“This is specifically related to hospital readmission reduction programs in the U.S. There is a shift in the market where many home care agencies are scaling back their programs or shutting them down. These programs are being replaced by much larger hospital-based programs that will begin to scale in late 2014 and 2015,” Kurkinen noted.

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On the supply side, medical device and pharma are using wireless connectivity to enable new services and bolster older services by deploying connectivity to existing devices – such as Merck’s electronic auto-injection RebiSmart, for delivery of its MS drug Rebif.

There is one roadblock that could, in theory, eventually limit the use of these BYOD devices as well as the potential market size for add-on device manufacturers. That roadblock is a lack of interoperability between medical monitoring devices, smartphones and tablets. The issue is being addressed by companies including Qualcomm Life and Apple with its HealthKit. These offerings enable software developers to let another company take care of the connectivity part, making sure that measurement data is collected from medical devices and can be transmitted to caregivers.

Expect connectivity platforms to become the “key enabler” for the exponential growth in mHealthcare software solutions, Kurkinen said.

No crystal ball is required to see mHealth’s future: As the market grows, many more of the major enterprise software companies like Oracle and its chief rival SAP, as well as players such as EMC, Microsof and, will offer their own connectivity platform solutions. And when they do, the entire healthcare community, from payers to healthcare providers to patients, will be the beneficiaries.

Ephraim Schwartz is a freelance writer based in Burlington, Vt. He is a recognized mobile expert and columnist, having spent 15 years as Editor-at-Large for InfoWorld, half of them covering the mobile space. Prior to that he was Editor-in-Chief of Laptop Magazine.

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