Yet many bureaucratic barriers to implementing such technologies still remain. The FDA has been slow to approve most wireless health devices because of concerns about privacy, security, and data loss. Hospitals and insurers are hesitant to adopt them because they’re concerned about increased short-term costs.
Physicians, meanwhile, are concerned about data quality, liability, and expense. “There’s not much incentive for providers to take in monitored data,” says Ronald Dixon, a physician and director of the virtual practice project at Massachusetts General Hospital. “The monitoring service gets payment, but there’s no incentive for me to pay attention to it. I want to help the patient, but [in the current system] I’m not getting paid to do so.”
In the past, new medical technologies were likely to be deemed worthwhile if they improved care. That may no longer be true unless they significantly decrease costs as well. Even if wireless monitoring produces some savings down the road, as it almost surely will, hospitals and insurers may not feel it justifies the up-front expense.
“All of the innovations around monitoring have to be at worst cost-neutral, and at best cost-effective,” Dixon says. “They’re only going to be taken up by a relatively small portion of the population if they’re expensive.”
The managed-care giants are the big wild card when it comes to how widely these technologies will be adopted. Medco, the health-care company and pharmacy benefits giant, wouldn’t comment on whether it had any interest in such an approach. Others are cautiously entering the game. United Healthcare, for example, recently approved reimbursement for a device made by Watermark Medical that can detect obstructive sleep apnea in a patient’s own bedroom, eliminating the need to spend the night in a sleep lab.
Kaiser Permanente, headquartered in Oakland, California, operates a more integrated system of hospitals and health-care plans. Because spending on prevention saves its hospitals money, the company tends to be more forward-thinking. It is already studying how monitoring technologies—including Proteus’s smart pills—might be best put to use. “We’ve been doing experiments with various prototypes to see how it would integrate with our system,” says Faye Sahai, Kaiser’s executive director of innovation and advanced technology.
Wireless technologies could ensure that doctors are seeing the most urgent patients first, but they could also impose time-consuming new tasks. Those range from watching pulse and respiration rates to checking blood-glucose levels to monitoring the amount of fluid in a patient with chronic heart failure. Even with smart-phone access to all a patient’s data, doctors don’t have much time to sort through it. Any work flow incorporating such technologies will require an integrated alert system that won’t intrude on doctors’ already crammed days.
A few companies have built monitoring centers that review patient data, interpret it, and send it to the prescribing physician. But such setups are still relatively rare, and there’s a huge opening for businesses to compile and distill what some people in the field refer to as the “data tsunami.” “At the end of the day, it’s going to be smart intermediaries that package the information and put it in the physician’s hands, and then you have to rely on the physician to do what’s appropriate,” says Qualcomm’s Don Jones.
Ultimately, the infrastructure for wireless health monitoring is more likely to be built in Europe and even in developing countries long before it happens in the United States. Until there’s a change in the fee-for-service model used by most U.S. insurers—until there’s a financial incentive for prevention, and a system that compensates physicians for time spent keeping their patients out of the hospital—health monitoring technologies will remain a niche market.