June 15, 2015

Remote Patient Monitoring in Healthcare

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Remote monitoring in healthcare is an increasingly important and financially significant part of the U.S. health IT marketplace. The devices have shown great potential to decrease costs and improve outcomes, but challenges remain before wider adoption can have a greater impact on overall population health.

Remote Patient Monitoring Market

The remote patient monitoring (RPM) marketplace, according to a recent report from Grand View Research, was valued at over $487 million in 2014, and estimated to grow to $1.2 billion by 2022. This expansion will be driven mainly by an increasingly geriatric population in the United States, Canada, Japan, and greater demand in the emerging markets of China and India.

Another factor in the growing remote device market is the burgeoning telemedicine/telehealth marketplace, valued at $17.8 billion in 2014 according to a May 2015 report from Research and Markets. The report projected healthcare IT industry giants Mckesson, Philips Healthcare, GE Healthcare, and Cerner would dominate the telehealth marketplace, and each of these companies have substantial investments in the remote patient monitoring and greater medical device marketplace further supporting the link between the two segments. The combined telehealth/remote monitoring marketplace could grow to as much as $43.4 billion by 2020, according to a January 2015 report from BCC Research.

Also, it’s likely that none of these estimates account for the growing popularity and interest in personal fitness trackers and consumer health wearable devices such as Jawbone and FitBit. Our own original research revealed that in a survey of 900 U.S. adults, 57.1 percent would be more likely to use a fitness tracking device if it would decrease their health insurance premiums — one could almost consider such discounts as dividends, or insurance companies returning the savings to policyholders as some firms distribute a portion of profits to shareholders.

Remote Patient Monitoring Applications

The possibilities for different types of and uses for remote monitoring devices in healthcare are seemingly endless — our 2015 business technology trends report identified a number of key areas that are related: mobile technology, wearable technology, and the greater Internet of Things (IoT) marketplace. The most promising and widespread applications for remote patient monitoring devices today include:

  • Cardiac patients: Pacemakers, implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices.
  • Asthma patients: Devices that remotely monitor and report rescue or relief inhaler usage, or even what’s being called a Pervasive Asthma Monitoring System (PAMS) that combines “peak flow meter and spirometry readings with evidence based factors such as wheeze and adverse effects.”
  • Management of diabetes and hypertension: Continuous glucose monitoring (CGM) devices, pulse oximeters and other wearable continuous blood pressure monitoring devices.
  • Memory care and falls: GPS, WiFi, or RFID-enabled tracking devices for roaming or lost Alzheimer’s or dementia patients, and gyroscopic sensors that can detect steps and changes in angular velocity and linear acceleration that could identify a fall and notify a caregiver — a natural evolution of services like Life Alert’s that help seniors who have fallen and can’t get up.
  • Clinical trials: Using smartphones and networks like Apple’s ResearchKit, researchers are using various innovative forms of remote patient monitoring applications to provide larger, potentially more randomized pools of participants for their clinical trials.

A recent five year remote patient monitoring case study of the St. Jude Medical Merlin.net technology shows the potential of such technology. Analyzing data from over 90,000 patients with pacemakers, ICDs, and CRTs, showed that remote monitoring with systems like St. Jude Medical’s “eliminates 10 hospitalizations and 119 hospital days [resulting] in cost savings of more than $370,000 per 100 patients annually.” Across the study’s 90,000 participants, over $333 million in unnecessary hospitalizations and hospital days were prevented. Still, despite the potential for considerable savings over the long-term, there are a number of challenges preventing remote patient monitoring from being more widely used.

Remote Patient Monitoring Challenges

  • FDA approval: According to language in section 201(h) of the Federal Food, Drug, and Cosmetic Act, remote patient monitoring devices, medical software, and other new healthcare technologies can be classified as 510(k) medical devices and subject to FDA approval “if they are intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease,” which is a factor in the next challenge.
  • Cost: A 2010 report from AdvaMed found that nearly 80 percent of the average $31 million cost to bring a low-to-midrange concept 510(k) device to market was directly attributable to the regulatory approval process. This high cost to market can mean that these devices have to be sold for thousands of dollars to recoup the investment, particularly for managing conditions that aren’t widespread enough to provide economies of scale.
  • HIPAA: If any of the data stored or transmitted by remote patient monitoring devices is accessed or possessed by a HIPAA covered entity (which, of course, is typically the point), it can be considered protected health information (PHI) and subject to HIPAA patient privacy constraints, which introduces an additional layer of complexity in order to maintain compliance. Ensuring data security when remotely transmitting from patient to provider is key. If a breach occurs then, is it the provider’s fault? It’s potentially a $50,000 question.
  • Meaningful Use Stage 3: While this is listed underneath the “challenges,” this could be more of an opportunity for device manufacturers. The inclusion of requirements in the proposed Meaningful Use Stage 3 rule for more than 15 percent of unique patient records to include ‘patient-generated health data’ seems to be a natural opportunity for device manufacturers to pair with EHR vendors so data from RPM devices can flow smoothly into providers’ EHR systems.

In the coming years, remote monitoring, telehealth, and related systems are likely to improve outcomes and reduce costs at healthcare organizations around the world, but particularly at those in North America and regions with higher elderly populations. We will continue to monitor these and other technology trends here on the TechnologyAdvice blog, and publish original studies via TechnologyAdvice Research.

Do you use remote patient monitoring in your practice? Have an opinion on remote patient monitoring and how it can/can’t impact patient care? Let us know in the comments.

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