November 17th 2011
£995 / $1740 / €1245
Online, PDF
Telemonitoring technology has been hailed as a major breakthrough in changing the operating dynamic of health provision. Patient monitoring, observation and diagnosis, no longer rooted in the consulting room, provides 24- hour surveillance and timely clinical interventions when conditions deteriorate. And telemonitoring products are delivering these services across a range of chronic conditions such as asthma, diabetes and heart disease.
So, what are the issues....?
Telemonitoring is a fledgling market. Most widely adopted in the US and some European countries, it is still in pilot stage development in the majority of markets. As with all new technologies, there is a time for bedding in and evaluating effectiveness in large scale patient populations. While telemonitoring has been shown from a technical perspective to work, the sector is dogged by a number of issues which will need resolution if the market is to fully develop.
This report from Espicom examines the sector in depth. It looks at the companies and technologies involved and examines the topical issues such as cost-effectiveness, patient compliance, technical standards and the need for more clinical evidence, which are impacting its development.
The report answers key questions
A complete analysis for evaluating this key emerging medical technology area |
The cost-effectiveness claim: a two edged sword
The global economic downturn presents its own challenges and opportunities for the telemonitoring industry. With the need to address deficits, most countries have reduced spending on new healthcare projects and healthcare capital expenditure, meaning there is less money available for the implementation of new technology. However, at the same time there is a long-term pressure on healthcare providers to find new, cost-effective ways to manage their patients and reduce the burden of potentially preventable diseases – two areas where telemonitoring can help considerably. The key focus is on chronic disease, the progression of which can often be slowed or even reversed with proper care and management, before the patient requires more expensive medical care.
Claim and counter claim – the debate develops
In September 2011, an article, entitled “Integrated Telehealth and Care Management Program for Medicare Beneficiaries with Chronic Disease Linked to Savings”, was published in the healthcare policy journal, Health Affairs. The study looked at the economic impact of using remote patient monitoring for high-cost Medicare beneficiaries with CHF, COPD and/or diabetes. Bosch’s Health Buddy telemonitoring programme was associated with spending reductions of approximately 7.7 to 13.3% (US$312 to US$542) per intervention patient per quarter over the two-year period studied.
Conversely, two larger, randomised studies of telemonitoring for HF patients published in 2010 did not show clinical or cost-effectiveness for telemonitoring over their entire study groups, while a 2011 study of children with asthma found no improvement in their clinical outcomes with telemonitoring.
The Role of Patients
Current telemonitoring technology is reliant on the patient’s ability to use the technology and discipline to take the home measurements. Poor patient compliance is not a telemonitoring issue – it affects many areas of health care – but the selection of patients for whom the technology is suitable may, in the short-term, limit the patient population for whom it will be effective. Easy-to-use technology which includes motivational tools and feeds back information to the patient are valuable to the technology adopters. In the future, the automation of monitoring through implants, for example, will remove the inconvenience factor and improve compliance.
Emerging markets – leap-frogging the technology gap?
Chronic disease may be seen as mainly a problem for developed countries, but the WHO estimates that only 20% of cases of chronic disease occur in high income countries. In most countries, the poorest people are the most at risk of developing chronic respiratory diseases and are also most likely to die prematurely from these diseases because of their greater exposure to risks and decreased access to health services.
Telemonitoring may help to enable providers to offer remote healthcare to patients living in rural areas or where there is little healthcare infrastructure. This is particularly the case with mHealth, as the use of mobile communications is ncreasing rapidly in the developing world and emerging markets, although not all have access to the advanced technology required for telemonitoring.
Indeed, some observers argue that for regions with poor terrain or limited health infrastructure, telemonitoring may find a niche as the principal means of practically managing patients.
Unintended consequences…
There are clinical concerns that in some situations the analysis of telemonitoring results meant that some patients were being over-treated for their condition.
For example, a 2008 pilot study of the telemonitoring of 27 COPD patients by NHS Lothian in Scotland, UK, found that, while patients were generally positive about the technology, clinicians had concerns about false positive symptom scores and difficulty in interpreting physiological data. It was noted that costly, and potentially harmful, over-treatment (reflected in a large increase in antibiotics and steroid prescribing) could be seen along with the cost of increased staff workload.
A larger 256-patient randomised, controlled clinical study of COPD telemonitoring is now taking place at NHS Lothian, but this example illustrates the need for robust clinical data to support wider adoption of the technology.