In recent years, hospitals and health systems in the U.S. have shifted their business models dramatically. From electronic patient records to a changing insurance industry, physicians, caregivers, and administrators have navigated and embraced a tidal wave of changes. Today, one of the core drivers of healthcare industry transformation is Machine-to-Machine (M2M) technology. Put simply, a tiny sensor is revolutionizing everything.
Wireless communication opens up completely new possibilities and application areas for medical technology. Healthcare's M2M adoption, sometimes called telehealth, is the use of medical devices and communication technology together to monitor diseases and symptoms. According to market research firm IHS Technology, the global telehealth market is expected to grow by more than a factor of 10 from 2013 to 2018 as medical providers increasingly employ remote communications and monitoring technology to reduce costs and improve the quality of care (Figure 1). For perspective, 95 million Americans used mobile applications for health in 2013.
Adopting telehealth applications and devices is no longer an optional exercise. It is a "must have" for the industry. "Amid rising expenses, an aging population, and the increasing prevalence of chronic diseases, the healthcare industry must change the way it operates," said Roeen Roashan, Medical Devices and Digital Health Analyst at IHS Technology. "Telehealth represents an attractive solution to these challenges, increasing the quality of care while reducing overall healthcare expenditures."
How it works
With M2M, the machines do all the talking. M2M communications employs a device (sensor) to capture an "event" (heart rate), which is relayed through a network (wireless, wired, or hybrid) to an application (software program), translating the captured event into usable information (patient requires attention).
Real solutions to critical problems
There are 5,724 hospitals in the U.S., according to the American Hospital Association. While hospital occupancy rates continue to slowly decline, there is no question that one of the primary problems facing the industry today is the challenge of keeping people out of the hospital. According to the most recently published numbers, there was an average of 111.8 inpatient hospital admissions per 1,000 people in 2011, down from an average of 123.2 in 1991. This data paints the picture of the ongoing shift from inpatient to outpatient care.
However, hospitals have to be more thoughtful than ever regarding whom they choose to send home. The Affordable Care Act penalizes hospitals for readmissions (patients who are discharged and then checked back into the hospital within a certain timeframe). The goal is to release patients as soon as possible and open up beds, while ensuring those patients don't need to return. The best way to do that is via remote health monitoring, and M2M is the critical component.
The factors driving M2M adoption
The need to monitor patients remotely is driven, at least in part, by an aging population ("Baby Boomers" get older every day) and the growth of chronic illnesses. Additionally, the ubiquitous adoption of wireless technology in our personal lives has accelerated the acceptance of remote devices in healthcare. As people dump their landlines in favor of wireless phones, the path to mobile health monitoring is wider and increasingly more passable. This culture shift in the U.S. allows M2M healthcare applications to enter the mainstream and gain wide acceptance as an alternative to hospital stays. Forty-eight percent of respondents in a 2012 survey by the Economist Intelligence Unit said that mobile health applications and services will improve the quality of healthcare they receive.
Looking at the issue from the economic side, last year healthcare providers remotely monitored about 308,000 patients worldwide for Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), diabetes, hypertension, and mental health conditions, according to a report from InMedica. By 2017 that number should spike to 1.8 million patients, the research firm predicts. This growth in remote patient monitoring will save the world's healthcare systems up to $36 billion by 2018, according to a projection by Juniper Research.
The benefits of M2M adoption go far beyond cost savings. Everyone, especially the patient, wins when M2M technology is utilized. "In addition to reducing costs, cloud connected wireless sensing solutions are improving the quality of healthcare services as well as supporting the latest innovations for aging in place, self-management of chronic conditions, and general wellness," says Mareca Hatler, ON World's Director of Research.
Real-world example from the heart
According to the American Heart Association, nearly 5 million Americans are living with heart failure, and there are almost 600,000 new cases diagnosed each year. Prior to the development of wireless connectivity, patients wore the device on their person to capture exceptions in health (such as irregular heartbeats). Clinicians could access device data after the body-worn external controller unit was physically plugged into and transmitted via a local Internet connection. This limited the patient's mobility and continuous reporting could not occur.
The ReliantHeart HeartAssistRemote Monitoring System, HeartAssist5, is an M2M-enabled device that allows patients to feel more secure about their heart health at home or while traveling. It was developed through a collaboration with Numerex, and utilizes the secure, cloud-based, fully hosted, highly scalable, and integrated Numerex FAST platform. The HeartAssist5 Conquest Controller, currently used by more than 100,000 patients, continuously receives data from the device. It transmits in bursts to a controlled and secure data center monitored by technicians (think home security system). This data can be viewed by physicians remotely, helping to avoid unnecessary trips to the hospital. In cases of concern, the device provides an alert to the patient's caregivers, allowing for proactive response and possibly better results for the patient.
The device is currently available in Europe and under evaluation by the FDA in the U.S. The healthcare industry can expect to see results in more freedom for the patient, better use of the caregiver's time and the healthcare system's resources, and improved clinical efficiency. Most importantly, it enables earlier patient intervention when a heart event occurs.
That is just one example; more advanced M2M healthcare technology developments are expected in the future. According to a report by research firm ON World, 18.2 million health and wellness Wireless Sensor Networks (WSNs) will be shipped worldwide in 2017, generating $16.3 billion in annual revenue. Although disposable body-worn wireless medical sensors have barely begun to see usage in healthcare, research firm ABI is predicting they will rise to prominence very quickly. By 2018, ABI analysts predict disposable Medical Body Area Network (MBAN) sensor shipments will hit five million.
Just around the corner
M2M solutions for medication dispensing are poised to become big business in the near future. Today, pillboxes with embedded sensors report to a doctor if the patient is taking their medications on time and correctly. The device knows if a pill has been removed from the box and helps prevent accidental overdose. The device also can be programmed for family members to receive alerts if a loved one has forgotten to take their medicine.
Excitement was high at the December 2013 mHealth Summit, the largest gathering focused solely on the intersection of health and mobile information technology, where state-of-the-art devices currently in development were showcased. Some examples of what to look for over the next few months include:
- A personal emergency response pendant with clinically validated and patented automatic fall detection algorithms
- A digitally enabled cap for standard prescription bottles that allows for continued compliance monitoring and even alerts patients when it is time to take a dose
- A mobile phone "house call" service, which lets patients call a doctor who will actually show up to the house, office, or hotel within two hours
Another area getting much attention in recent months is the Home Health arena. M2M technology can monitor the on-time rate of a home healthcare worker, the completion of tasks, and even monitor a patient's movements if their health requires it.
By 2017, solutions for chronic conditions, such as blood glucose management and cardiac/ECG monitoring, will make up 60 percent of the revenue for cloud-connected WSNs in the healthcare industry. That will increase exponentially as more and more general wellness remote devices are developed.
Going forward, I predict the healthcare industry will morph into a Bring Your Own Device (BYOD) mentality. Smartphone apps and mobile health devices will become the norm for both patient and caregiver. And because M2M solutions aren't data hungry, video will become a key factor in healthcare management. Networks will continue to get stronger and faster, allowing for innovations that used to be only imagined in science fiction. Every week we hear of something new that we hadn't thought of before. That's a very exciting industry in which to be involved.
In the end, it's always going to be about a good combination between the health of patients and economics. We want to keep hospital beds open for those who really need them. We want to see an overall improvement in the health of our society within a decade. M2M can make that happen, giving people the chance to get treated more cost effectively. Numerex is excited about taking the mobile health industry to exciting new heights and enabling the Internet of Things (IoT). A tiny sensor can change everything.
 American Hospital Association. "AHA Hospital Statistics, 2013 Edition."
 Avalere Health. Analysis of American Hospital Association Annual Survey data, 2011, for community hospitals. U.S. Census Bureau: National and State Population Estimates, July 1, 2011.