Who Will Be Remote Monitoring's Early Adopters?
Health economist, Jane Sarasohn-Kahn notes today at iHealthBeat, the current turbulence in the remote patient monitoring in a review of Spyglass Consulting's new report (previous post here). Sarasohn-Kahn reports reimbursement, licensure, clinician resistance and lack of demonstrable
return on investment as the most formidable impediments to remote monitoring market adoption.
by ADT Tyco under a portfolio called, “Home Health Security.” [previous post here] This
monthly monitoring service offers a basic, two-way personal response
system and outfits the home with sensors and actuators that monitor the
resident's daily activities, including everything from using the toilet
to opening the refrigerator.
According to the product's Web
site, the activation fee is $199, and monthly monitoring costs $79.95.
While this cost clearly is not affordable for most seniors, there will
be a segment of people who might pay for this service themselves – or
could be subsidized by their children who might live sufficiently far
away from their aging parents to justify this monthly cost.
The lack of reimbursement for remote monitoring seems to be slowly giving way.
pay-for-performance programs in Medicare, which will begin to be
implemented by 2007. “A lot of organizations are investing to position
themselves for reimbursement,” according to Malkary.
The trial
of all trials to watch is being conducted by the Department of Veterans
Affairs, which is analyzing 6,000 patients using many modalities for
RPM. The VA is trying to figure out what works and at what the cost
benefit is. The VA's investment of $21 million has been significant.
The program is focusing on congestive heart failure, diabetes,
depression, hypertension and chronic obstructive pulmonary disease, and
it covers veterans residing in 30 states in order to take into account
for state licensure barriers. So far, the patients enrolled in the
program have shown a 30% reduction in hospitalizations and ED visits.
Sarasohn-Kahn also mentions a recent report published by Vodaphone that (not surprisingly) argues for adoption of mobile phones in health care. Sounds familiar – see this recent post.
in a younger population that is accustomed to using SMS in daily life.
This trial was particularly successful in demonstrating efficacy and
compliance in what is traditionally seen as a difficult-to-manage
patient population. Several trials in the UK found that the use of SMS
reminders reduced the number of missed physician appointments with
doctors by 26% to 39% and missed hospital appointments by 33% to 50%,
amounting to annual savings of about $457 million to $649 million.
In
reviewing the UK's positive experience with text messaging and health
care, we should remember that these savings would accrue to the UK's
National Health Service. The fragmentation of the U.S. health care
system is one of the unspoken – but formidable – barriers that have
prevented the universal adoption of telehealth since the inception of
the plain old telephone system.
So where will the early adopters of remote monitoring come from? Sarasohn-Kahn nails it with the following, “it might be the niche consumer end-user market – such as baby boomer
customers subsidizing their parents' independent living service – that
will be the early adopters of remote patient monitoring. After all, as
Tim Sanders' titled his book, Love is the Killer App.”
Could SAW RFID Tags Serve Health Care?
SAW stands for Surface Acoustic Wave technology that is used in a type of passive RFID tag that's been around since the 1970s. SAW tags use piezoelectric crystals with “reflectors” at predetermined intervals to represent a tag's data. The tags can be read from as far away as 20 meters, and can provide up to 2 foot positioning accuracy. Unlike some other tags, these can be read while mounted on metal and liquid containers. SAW tags are very small, can be read with very low power levels (<1 mWatt), and can withstand harsh environments (gamma radiation, high temperature). Oh, and they also transmit their temperature.
There were no SAW RFID tags that I saw at HIMSS 06. The biggest RFID take-away for me at HIMSS was that there is no “best” RFID system or technology; it's all about matching the application to the technology. The cool thing about the SAW tags pictured at right (from Sandia Labs) is their size and resistance to gamma radiation and high temperatures. According to the bug put in my ear by Brad Sokol, this technology is well suited to tracking surgical instruments and medical devices like consumables and implantable devices.
When imagining workflow automation through medical device connectivity, what about the autoclave as a medical device? The tracking system could track all the instruments (plus catheters, guide wires, and implantables) in a surgical suite – down to which one's are in the sterile field – ensure their sterilization, and even report their temperature. Sounds like just the thing ASP, 3M, Tuttnauer, Kimberly Clark, or Steris might want to do to differentiate or add value.
There's a new market study from IDTechEx, looking at SAW RFID tags here.
millimeter range. First- generation technologies did not meet open
standards for use by many service products. However, second-generation,
surface acoustic wave (SAW) tags are technically improved, lower in
cost, can store sufficient data, and operate at frequencies used by
conventional RFID chips. Chipless RFID can operate to more than a 10 m
range with 256 bits of data. Tags can be materials based or consist of
transistorless circuits. Transparent polymer transistor circuits are
now available from Philips, PolyIC, OrganicID, and Motorola, among
others.
Here's a technical paper from Sandia (pdf) for you RFID rocket scientists. And for us mere mortals, this paper (pdf) from vendor RFSAW, provides a nice general introduction to SAW-based tags.
