There have been a fair few articles predicting 2013 will be the year of telehealth, also known as remote monitoring. Partly of course there is a tradition for such pronouncements at the start of the year. This time, say its supporters, a favoured technology will receive its true recognition, take wings and change the industry.
There also have been a few research reports, taking a longer view on the same subject, predicting growth in such services over the next five years.
The thinking behind both types of report is the same. Both think they detect a shift in healthcare policies that will work in favour of telehealth and remote monitoring, most significantly in the US where the US Center for Medicare and Medicaid Services (CMS) has introduced readmission penalties, part of the Obama administration’s healthcare reforms.
The CMS, which controls federal health insurance for the poor and elderly in the US, is directed by 2010’s Affordable Care Act to link payments to hospitals to the number of patients who are readmitted within 30 days of their discharge.
The idea is to use this financial lever to improve care by incentivising hospitals not to readmit patients. This new regime started in October 2012.
Telehealth’s supporters argue this is a great opportunity since hospitals will want to cut readmission rates by monitoring patients in their own homes. However how this works is not straightforward. Remote monitoring does not actually reduce readmissions rather than just bring a likely return to hospital forward because a doctor or nurse has greater visibility of patient’s condition.
Theo Ahadome, the author of the InMedica report into the subject, agrees but argues in an email exchange between us that readmissions would be cut not by the monitoring itself but the change in behaviour it engenders.
“This allows the system to be reactive rather than a passive data collection hub. For example, if blood pressure is trending upwards a questionnaire pops up to understand more about what the patient has been doing or eating and provides feedback such as ‘cut down on this type of food’, and continue to monitor if the patient is adhering to that advice,” wrote Ahadome.
Incidentally, Ahadome told me that 25 percent of telehealth patients in 2012 were being monitored via cellular networks but that figure will rise to 50 percent of the total in 2016.
So really success will be driven by the quality of healthcare providers’ systems as much as by US government policy on readmission charges
Nevertheless the supporters of telehealth also point to the Whole Systems Demonstrator trial in the UK. The government is sold on the idea of remote monitoring. But so far independent studies have been more ambivalent
One study by the Nuffield Trust looked at telehealth’s impact on secondary healthcare and mortality. It found that among patients of COPD, diabetes or heart failure the use of a telehealth service was associated with lower rates of mortality and hospital admissions.
But cost savings were only “modest” from remote monitoring, the same study found. In addition, the preliminary findings of a second study found telehealth equipment to be expensive. In other words, results are more mixed than diehard supporters would have us believe.
Elsewhere, France has said all new sleep therapy patients must be remotely monitored from 2013 onwards. And in the US again, the Department of Health and Human Services (HHS) recently moved to strengthen the Health Insurance Portability and Accountability Act (HIPAA), the law that governs how doctors move patient data around, which obviously has repercussions for telehealth.
And finally the US Food and Drug Administration (FDA) is expected to shortly publish its final proposals for regulating mobile health devices, say some reports. This proposal is long-awaited (the industry has been waiting about a year for it to be made). Again it is a proposal with implications for telehealth.
These final two proposals in the US will probably get a dim response from the hard-line free-marketers who will say additional rules will suffocate their innovation and add costs to service deployment.
So at one level the state is welcomed but at another level its intervention is derided. But really the industry should not get too carried away by the myth of sweeping change coming from above. The perennial issues remain the same. How healthcare providers implement remote monitoring is still key. Which is not to say these wider issues might not prove important. They probably will but more significant will be the strategy of healthcare providers to build out their services, and the reaction of users.
The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members.