Wireless Technology Poised to Transform Health Care
New companies continue to develop exciting applications, but will consumers and the health care field accept the costs and risks to privacy?by Andrea Jackson
After a decade driven by the work of a small group of early-stage companies and visionaries within the health care and telecommunications worlds, wireless health exploded into mainstream consciousness in 2009. Despite the rapid increase in awareness of its value, proliferation of supporting technology and industry optimism about the potential market, significant challenges stand in the way of widespread adoption. Wireless technology can enable dramatic change in the way health care is delivered, but health care providers, hospitals, payers, regulatory agencies and most importantly, patients themselves must be willing to use the technology and pay for its implementation.
What is Wireless Health?
Wireless health can be broadly defined as any health care application or service that uses wireless communication to gather and transmit health information. Wireless health is enabled by cellular and wireless Internet technologies and an increasing array of body-worn and implanted sensors that communicate with a "body area network" via low-power radios. Wireless health applications range from enterprise-level patient monitoring and asset tracking systems in hospitals, to remote patient monitoring and disease management solutions for the chronically ill, to consumer health and fitness products. The term can also refer to the infrastructure and devices that support these applications.
In their simplest form, wireless health companies offer services that leverage existing, commoditized technology to address serious health care problems. An estimated one-third to one-half of patients in the U.S. do not take their medication as prescribed, often leading to worsening health and hospitalization costing an estimated $290 billion a year.1 A number of clinical trials found simple, automated text messaging services such as CareSpeak's MediM, which send messages to the user's cell phone, can significantly improve adherence to medication regimens and dramatically improve health outcomes.
At the other end of the spectrum are new wireless technologies, such as Proteus Biomedical's Raisin System. Currently in clinical development, the system uses pills embedded with tiny sensors which, as they pass through the digestive system, react with stomach acids and send a low-power radio signal to a body-worn device. Timing of the event and physiological changes, such as heart rate and respiratory rate, are recorded. The technology allows physicians to monitor compliance, as well as examine the need for dose adjustments based on a patient's unique reaction to the medication.
The Promise of Wireless Health
Wireless health solutions promise to improve the quality, efficiency and continuity of care while lowering costs and extending access to health care outside the clinical setting. In developed nations such as the U.S., a major driver of interest in wireless health is the push toward preventive care. Focus is turning to developing systems that target high-risk groups and the chronically ill through wellness programs and remote monitoring systems. With more than half of Americans suffering from one or more chronic diseases, making up an estimated 75 percent of annual health care spending, there is plenty of demand for new modes of care.
In developing nations, where access to medical care is often severely limited, the low cost and growing ubiquity of cellular networks allows health care practitioners to provide remote advice to patients who are unable to reach clinics. The mHealth foundation expects that by 2012, more than half the population of the developing world will have a mobile phone. Less than one percent will have access to a hospital.2 Basic care, such as medication reminders and information about managing disease, can be delivered by text message at very low cost. Nurses and public health workers in rural areas can collect information from patients using wireless devices such as GE's new low-cost, portable Vscan ultrasound, and then send that information to more experienced medical staff in other locations to get advice on how to treat patients. In fact, with fewer regulatory barriers and more incentive to expand their health care systems, the developing world is moving faster than the U.S. to implement wireless health solutions.
Where is Wireless Health Today?
While the proliferation of mobile connectivity and advances in sensor and low-power radio technology provide for the possibility of constant, real-time monitoring of health conditions and feedback about their management, it will be many years before the vision of wireless health can be reached. Several challenges stand in the way.
Choosing the Correct Technology
Companies in the wireless health space face decisions surrounding the technologies they should incorporate into their systems. Although organizations such as the Continua Health Alliance have brought industry members across the world together to work on interoperability guidelines, the diverse and evolving technology has made consensus difficult, an issue that is often cited by investors as a reason to defer entry into the space.
Hospital-based systems and home health solutions typically use Wi-Fi, while solutions that are intended to be carried with users at all times use cellular. Companies that want to take advantage of cellular connectivity must decide whether to design an application that will work with the user's own cell phone or develop a proprietary mobile device. With four major carriers and nearly 900 handset models on the market in the U.S. alone, it is challenging to develop a one-size application. On the other hand, if a company decides to develop its own device, they not only face the challenges of designing and building it, but also resistance to adoption from users who are reluctant to carry an additional piece of equipment. Companies that use sensors to collect information must also decide which low-power radios, such as Bluetooth Low Energy or ANT, their sensors will use to transmit data.
Regulatory and Privacy Issues
Both the Food and Drug Administration (FDA) and the Federal Communications Commission (FCC) have jurisdiction over aspects of wireless health solutions, complicating the approval process. There are also many unresolved questions regarding which parts of a wireless health application or device will require FDA approval. If an application provides wellness advice based on information downloaded from a wireless blood-glucose meter to an iPhone, does the application need approval by the FDA? What about the iPhone itself? FDA officials hint they may seek authority to regulate smart phones used in wireless medical device solutions.3
Cost and Reimbursement
The U.S. health care system is slow to adopt new technologies, and success for many health care products is predicated on the ability to gain reimbursement codes. CardioNet, the first public pure-play wireless health company, is a prime example of this pitfall. The company's Mobile Cardiac Outpatient Telemetry (MCOT) system is three times more effective in diagnosing arrhythmias than traditional Holter monitors, thus dramatically improving patient care and reducing the costs associated with incorrect diagnosis. Despite this, in September 2009, Highmark Medicare Services slashed reimbursement for CardioNet and other MCOT services by nearly 35 percent. The change in reimbursement sent the company's stock tumbling, and CEO Randy Thurman has since said CardioNet is "unable to sustain operations" as a standalone company.4
Fortunately, the growing pressure to incentivize outcomes-based medicine is expected to work in favor of wireless health solutions. Although many of these products cost more to develop and implement than traditional alternatives, improvements in long-term outcomes are expected to provide dramatic savings in the future. Solutions such as WellDoc's Mobile Diabetes Management program are being implemented by insurance providers and employer health plans in hopes that improving monitoring and feedback early on will slow the progression of costly chronic diseases. Clinical results are promising. Other solutions in development will tackle problems such as high re-hospitalization ratesï¿½an issue which accounts for an estimated 17 percent of Medicare spending.5 Remote monitoring using "smart band-aids" that can recognize changes in fluid levels around the heart, or shoe sensors that recognize changes in gait and blood flow to feet, will help monitor known issues and identify new problems before acute events occur.
Hospitals and clinics are also recognizing the benefits of wireless health solutions. Radio-frequency identification (RFID) and wireless bar-coding solutions like PatientSafe Solutions' PatientTouch System enhance patient safety by ensuring health care workers have correct information about a patient at their fingertips and can provide appropriate medication, care and follow-up. Remote presence systems such as InTouch Health's iRobots allow doctors to "visit" patients in multiple hospitals without spending travel time. And remote monitoring systems such as AirStrip Technologies' OBSERVER allow doctors to check in on their patients' vital signs via their smart phone.
Meanwhile, many wireless health solution providers have gone directly to consumers in hopes they will be more willing to pay for solutions than their insurance providers. Thousands of applications have been created for smart phones in the past year from diet and fitness applications to those that integrate personal medical devices such as glucose meters. The fitness market, which includes products such as the Nike+ running tracker and BodyMedia GoWear fit activity monitors, represents an estimated 90 percent of wearable wireless sensors on the market today. Zeo is making waves in the direct-to-consumer category with its Personal Sleep Coach, putting a technology once reserved for sleep clinics in the home bedroom.
Driving Customer Adoption
One key value proposition of wireless health is the empowerment of patients to be more involved in managing and making decisions about their own health care. Anywhere, anytime monitoring means patients can have feedback on a real-time basis, rather than waiting for their next doctor's appointment, and can make informed decisions about management of day-to-day changes in health. However, it remains to be seen to what degree consumers will embrace this more active role. And although privacy issues surrounding data storage and transmission seem to be less of a concern today, they still play a role in certain patient segments.
Widespread adoption also requires a shift in the mentality of health care providers. Many solutions rely on computer algorithms or independent monitoring centers to deal with collected data, but these devices and services have the potential to drive an onslaught of information toward health care practitioners. The doctor-patient relationship will no longer be confined to the walls of the clinic. Wireless health solutions will dramatically alter the way health care is delivered, and change the consumer's relationship with health care practitioners.
Despite the challenges to implementation and adoption, the potential benefits of wireless health are overwhelming, and it is clear the market is responding. Reports of investments in the space climbed dramatically in 2009, a trend which is expected to continue this year. Industry analysts expect 2010 to see a doubling of the worldwide wireless health market, up to an estimated $50 billion. Meanwhile, governments and global health organizations are showing more interest in supporting growth in wireless health. The changes we will see in 2010 will pave the path toward a future in which wireless health is no longer a separate industry, but an integral part of the mainstream health care system.
1“High Costs Seen in Medication Nonadherence: Study.” Modern Healthcare 11 August 2009: n. pag. Web. 19 May 2010.
2Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. Washington, D.C. and Berkshire, UK: UN Foundation — Vodafone Foundation Partnership, 2009.
3Dolan, Brian. “FDA May Regulate iPhone Health Apps.” mobihealthnews 12 February 2009: n. pag. Web. 19 May 2010.
4Wall Street Journal 2009: n. pag. Web.
5Jencks, Stephen F., M.D., M.P.H., Williams, Mark V., M.D., and Coleman, Eric A., M.D., M.P.H. “Rehospitalizations among Patients in the Medicare Fee-for-Service Program.” New England Journal of Medicine 360 (2009): 1418-1428. Print.
Andrea Jackson (’08) is program manager at the Wireless-Life Sciences Alliance, a trade organization dedicated to accelerating the adoption of wireless health. Previously, she was marketing manager for the Lifecomm project in Qualcomm's Health and Life Sciences group.