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.

One service that intrigued Malkary was Living Independently, marketed
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.

The big driver for HHA adoption of remote RPM will be
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.

One specific paper in the Vodafone report (pdf) focuses on managing diabetes
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.

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."