I am providing the link to an article in MobiHealthNews with little commentary. The article can be found at: http://mobihealthnews.com/5797/nhs-wireless-health-needs-standards-interoperability/. My one comment is that it appears that his objectives for tele-medicine are similar to my own: provide medical care that keeps patients out of hospital and nursing homes.
The article is an interview with George MacGinnis who is with the Assistive Technology Programme at the NHS Connecting for Health in the UK. He was interviewed by MobiHealthNews at the Mobile Healthcare Industry Summit in London. I think it is well worth taking the time to read this interview. In addition, MobiHealthNews has included a video of the interview.
Showing posts with label Telehealth. Show all posts
Showing posts with label Telehealth. Show all posts
Thursday, December 17, 2009
Tuesday, December 15, 2009
Revamping the Revenue Generation Model in the Medical Device Industry
My fourth posting on this blog on 29 September 2009 was part of a multi-part examination of Medtronic's remote programming patent (US Patent # 7,565,197 that was granted in 21 July 2009). I suggested that the patent patent implied two directions in the development of medical devices:
Today, physicians, hospitals and device manufacturers receive the bulk of their payment when a device is implanted or replaced. Thus, the current business model of device manufacturers relies on primarily on product such as an ICD or CRT and leads.
However, the Medtronic patent suggests the possibility, maybe even the likelihood of strategic shift from a product to a licensing business model. This would suggest a business similar to software companies who charge a flat or yearly fee for the use of software. Instead of a replacement, the patient receives a software upgrade and the device company receives payment for the software upgrade. This is one step removed from a pure product to a service-oriented model, but it still treats the software as a product. Nevertheless, it provides flexibility to the medical device company in that revenue comes less tied to the sale of objects, and more tied to the services provided to the customer.
An even more innovative approach and more in-line with a service-oriented business model would be to have the software redefine the capabilities of the device itself while implanted in the patient. For example, upgrade an ICD to a CRT-D by changing software. I do not know the technical, implantation or leads-related issues of doing this, however, from a software standpoint, there should be nothing stopping a device manufacturer who has taken the common hardware design approach.
A pure service-oriented model would change on the basis for the services provided. Since I'm a technologist and not an MBA who has worked in the device industry for decades, I cannot define all the possible revenue-producing services medical devices with remote monitoring and remote programming could provide device companies. I can say that the services that medical device companies can provide medical care providers and their patients is becoming less and less tied to the devices themselves. So a more service-oriented perspective in the medical device industry seems warranted.
It seems apparent that for medical device companies to expand their services and patient-care and management capabilities with information-based services over the communications infrastructure, they are going to have to change the way they receive revenue. The current business model and means of generating revenue does not provide incentives to companies to expand into information based services given the current product-based revenue model currently in use. I suspect that in a relatively short time, Medtronic will propose a new revenue model. I shall be watching for the signs.
- The development of a single, common hardware platform based on a generalized processor, similar to TI's low power processor. (Add urls).
- Medtronic device capabilities would be defined primarily by software. Furthermore, the patent defines a capability for software to be downloaded to a device, thus defining the capability for updating the software on the device.
Today, physicians, hospitals and device manufacturers receive the bulk of their payment when a device is implanted or replaced. Thus, the current business model of device manufacturers relies on primarily on product such as an ICD or CRT and leads.
However, the Medtronic patent suggests the possibility, maybe even the likelihood of strategic shift from a product to a licensing business model. This would suggest a business similar to software companies who charge a flat or yearly fee for the use of software. Instead of a replacement, the patient receives a software upgrade and the device company receives payment for the software upgrade. This is one step removed from a pure product to a service-oriented model, but it still treats the software as a product. Nevertheless, it provides flexibility to the medical device company in that revenue comes less tied to the sale of objects, and more tied to the services provided to the customer.
An even more innovative approach and more in-line with a service-oriented business model would be to have the software redefine the capabilities of the device itself while implanted in the patient. For example, upgrade an ICD to a CRT-D by changing software. I do not know the technical, implantation or leads-related issues of doing this, however, from a software standpoint, there should be nothing stopping a device manufacturer who has taken the common hardware design approach.
A pure service-oriented model would change on the basis for the services provided. Since I'm a technologist and not an MBA who has worked in the device industry for decades, I cannot define all the possible revenue-producing services medical devices with remote monitoring and remote programming could provide device companies. I can say that the services that medical device companies can provide medical care providers and their patients is becoming less and less tied to the devices themselves. So a more service-oriented perspective in the medical device industry seems warranted.
It seems apparent that for medical device companies to expand their services and patient-care and management capabilities with information-based services over the communications infrastructure, they are going to have to change the way they receive revenue. The current business model and means of generating revenue does not provide incentives to companies to expand into information based services given the current product-based revenue model currently in use. I suspect that in a relatively short time, Medtronic will propose a new revenue model. I shall be watching for the signs.
Sunday, December 13, 2009
Essay: Economical Medicine
To my readers: I have been engaged in high-priority activities for my current client and have unfortunately neglected this blog. I plan on publishing a flurry of articles from now to the end of this year. Furthermore, I am re-initiating my review of patents and patent applications.
Preface
In this essay I discuss some of my observations regarding the US medical system. I discuss what I consider could be the impact of remote monitoring technology on US medical practice.
I hope that people outside of the United States read my blog. I provide my perspective as one US citizen about the US culture and medical practice. I hope that others may chime in, and provide their perspectives regarding the US medical system, their own medical systems (if citizens of another country) and provided me with their perspectives.
I argue that remote monitoring can provide high quality health care at a lower cost. Remote monitoring provides lower cost health care primarily by keeping people out of the hospitals. As a result, the huge infrastructure devoted to hospital will likely whither. Hospitals will always have a place, but they'll become smaller and targeted to providing critical services such as trauma care, critical care and post-operative recovery. People will spend less time in the hospitals, but physicians and automated care-givers will be able to monitor patients where ever they are located - mostly, away from the hospital.
But before I discuss my views on remote monitoring and it's place in economical medicine, I discuss my concepts of economical medicine.
Economical Medicine
My home is Chicago, Illinois, and over the last few years, I have seen a spat of new hospital construction. Admittedly, there are areas where there are too few hospital beds and services. I have been astonished by the amount of recent construction. It seems that the hospital are competing with each other to see who can provide the newest, most up to date hospital. Furthermore, many of these same hospitals purchase the most expensive scanning equipment available and build large testing laboratories.
The United States provides some of the worst and the best medical treatment available in the industrialized world. If you want something extra-ordinary performed, come to the US. Where the US fails is providing mundane care to the majority of its populace. Our outcomes for the extraordinary are fabled, but the US ranks 37 in the WHO health care rankings behind countries such as Costa Rica, Columbia, Dominica, besides the obvious ones such as France, Switzerland, Austria, Italy, etc.
A landmark study published in 2000 showed that the US has the most expensive health care system in the world based on per capita and total expenditures as a percentage of gross domestic product.
In 1998 the US spent $4,178 per person on health care in 1998. The study median was $1,783 and the closest competitor was Switzerland at $2,794. US spending as a percentage of gross national product was 13.6 percent. The countries closest were Germany (10.6%) and Switzerland (10.4%). And things since 1998 have only gotten more expensive in the US to the point where the US care costs have reached crisis proportions.
Yet in the midst of an attempt to repair the US crisis, members of the US Congress, including nearly every member of the Republican party, have demonized any attempt to make the cost of health care more reasonable. Particularly, when the costs of US health continued to increase at a pace that would eventually drastically lower the standard of living of the majority of Americans. Why is this?
The roots of the opposition are clearly political and rooted in the economic interests of primarily the US health insurance companies. Health insurance companies nearly own and operate many members of the House and Senate on matters of health care. And these health care companies decided to declare war against any and especially a strong public insurance option - e. g., anything close to Medicare for the rest of us. However, there is cultural resistance as well.
Culturally, Americans are profligate. We are a non-economical culture and that believes itself to have no limits. Our sense of limitlessness is our greatest strength and weakness, and it has been running out of control for a long time.
Americans build roads and cars instead of building trains and tracks. We built muscle cars with large and powerful engines for decades instead of fuel-saving vehicles. We built suburbs along our superhighways and commute long distances to work in vehicles that consume excessive amount of fuel. We built large houses and houses with little insulation that consume excessive amounts of fuel to heat and excessive amounts of electricity to cool and light. Growing up in this culture, my sense is that many Americans construe excess with the good life. That need not be case.
We have a medical system that costs too much, delivers too little, places undue burdens on it's practitioners such as malpractice insurance costs and excessive paperwork. In addition it has been perceived by a wide variety of players as a way to make massive, excessive amounts of money. Getting fairly paid for a medical service, product or drug is a good thing. Excessive payments can corrupt or bankrupt an entire system.
Lower Cost Does Not Necessarily Equal Lower Quality
Over the past several decades we have be privy to a revolution, a revolution in ubiquity of computer power. Compare the cost of an 1984 Apple Macintosh or a 1984 PC with one today. The costs are either comparable or lower, but the computational power has skyrocketed from then to now. Everything in the computational and communications sphere has increased while the cost has decreased. Supercomputers and supercomputer availability, rare in the 1980s and early 1990s, has exploded in the last decade. Sophisticated hand held computers with voice and data capabilities that dwarf the powers of 1990's desktop computer are available for hundreds of dollars.
Remote Monitoring
Remote monitoring is a minor outgrowth of the computing and data communications revolution. It makes some use of the continuing computer and telecommunications developments, but so far, relatively little. However, the potential is there as well as the interest in spreading the capabilities of the computing and communications revolution to the medical community. In fact, I believe that many computer scientists and engineers consider medicine one of the last frontiers to thoroughly swept-up in this revolution.
Medicine by nature is a conservative discipline. It deals with people's lives. In the US there's the added problem of the legal profession and malpractice insurance companies breathing down a physician's neck.
I believe that the medical industry finally fully leverages the capabilities of the computer and communications revolution, medical costs will be lowered, people will spend either no or little time in hospitals. Physicians will have the capability of tuning the dosages of medication in real time. Sophisticated computer systems that have made use supercomputer models will be able to determine the medical status of a patient in real time or near real time. These systems will be able to determine if a patient is showing signs of a pending medical crisis and requires intervention before the crisis appears.
All this can be available to the citizenry at a cost that would surprise you. This is the ounce of prevention on a grand scale.
I shall continue to discuss economical medicine in future articles and how leveraging the computational and communications revolution will contribute to providing better medical care at a lower cost.
Preface
In this essay I discuss some of my observations regarding the US medical system. I discuss what I consider could be the impact of remote monitoring technology on US medical practice.
I hope that people outside of the United States read my blog. I provide my perspective as one US citizen about the US culture and medical practice. I hope that others may chime in, and provide their perspectives regarding the US medical system, their own medical systems (if citizens of another country) and provided me with their perspectives.
I argue that remote monitoring can provide high quality health care at a lower cost. Remote monitoring provides lower cost health care primarily by keeping people out of the hospitals. As a result, the huge infrastructure devoted to hospital will likely whither. Hospitals will always have a place, but they'll become smaller and targeted to providing critical services such as trauma care, critical care and post-operative recovery. People will spend less time in the hospitals, but physicians and automated care-givers will be able to monitor patients where ever they are located - mostly, away from the hospital.
But before I discuss my views on remote monitoring and it's place in economical medicine, I discuss my concepts of economical medicine.
Economical Medicine
My home is Chicago, Illinois, and over the last few years, I have seen a spat of new hospital construction. Admittedly, there are areas where there are too few hospital beds and services. I have been astonished by the amount of recent construction. It seems that the hospital are competing with each other to see who can provide the newest, most up to date hospital. Furthermore, many of these same hospitals purchase the most expensive scanning equipment available and build large testing laboratories.
The United States provides some of the worst and the best medical treatment available in the industrialized world. If you want something extra-ordinary performed, come to the US. Where the US fails is providing mundane care to the majority of its populace. Our outcomes for the extraordinary are fabled, but the US ranks 37 in the WHO health care rankings behind countries such as Costa Rica, Columbia, Dominica, besides the obvious ones such as France, Switzerland, Austria, Italy, etc.
A landmark study published in 2000 showed that the US has the most expensive health care system in the world based on per capita and total expenditures as a percentage of gross domestic product.
In 1998 the US spent $4,178 per person on health care in 1998. The study median was $1,783 and the closest competitor was Switzerland at $2,794. US spending as a percentage of gross national product was 13.6 percent. The countries closest were Germany (10.6%) and Switzerland (10.4%). And things since 1998 have only gotten more expensive in the US to the point where the US care costs have reached crisis proportions.
Yet in the midst of an attempt to repair the US crisis, members of the US Congress, including nearly every member of the Republican party, have demonized any attempt to make the cost of health care more reasonable. Particularly, when the costs of US health continued to increase at a pace that would eventually drastically lower the standard of living of the majority of Americans. Why is this?
The roots of the opposition are clearly political and rooted in the economic interests of primarily the US health insurance companies. Health insurance companies nearly own and operate many members of the House and Senate on matters of health care. And these health care companies decided to declare war against any and especially a strong public insurance option - e. g., anything close to Medicare for the rest of us. However, there is cultural resistance as well.
Culturally, Americans are profligate. We are a non-economical culture and that believes itself to have no limits. Our sense of limitlessness is our greatest strength and weakness, and it has been running out of control for a long time.
Americans build roads and cars instead of building trains and tracks. We built muscle cars with large and powerful engines for decades instead of fuel-saving vehicles. We built suburbs along our superhighways and commute long distances to work in vehicles that consume excessive amount of fuel. We built large houses and houses with little insulation that consume excessive amounts of fuel to heat and excessive amounts of electricity to cool and light. Growing up in this culture, my sense is that many Americans construe excess with the good life. That need not be case.
We have a medical system that costs too much, delivers too little, places undue burdens on it's practitioners such as malpractice insurance costs and excessive paperwork. In addition it has been perceived by a wide variety of players as a way to make massive, excessive amounts of money. Getting fairly paid for a medical service, product or drug is a good thing. Excessive payments can corrupt or bankrupt an entire system.
Lower Cost Does Not Necessarily Equal Lower Quality
Over the past several decades we have be privy to a revolution, a revolution in ubiquity of computer power. Compare the cost of an 1984 Apple Macintosh or a 1984 PC with one today. The costs are either comparable or lower, but the computational power has skyrocketed from then to now. Everything in the computational and communications sphere has increased while the cost has decreased. Supercomputers and supercomputer availability, rare in the 1980s and early 1990s, has exploded in the last decade. Sophisticated hand held computers with voice and data capabilities that dwarf the powers of 1990's desktop computer are available for hundreds of dollars.
Remote Monitoring
Remote monitoring is a minor outgrowth of the computing and data communications revolution. It makes some use of the continuing computer and telecommunications developments, but so far, relatively little. However, the potential is there as well as the interest in spreading the capabilities of the computing and communications revolution to the medical community. In fact, I believe that many computer scientists and engineers consider medicine one of the last frontiers to thoroughly swept-up in this revolution.
Medicine by nature is a conservative discipline. It deals with people's lives. In the US there's the added problem of the legal profession and malpractice insurance companies breathing down a physician's neck.
I believe that the medical industry finally fully leverages the capabilities of the computer and communications revolution, medical costs will be lowered, people will spend either no or little time in hospitals. Physicians will have the capability of tuning the dosages of medication in real time. Sophisticated computer systems that have made use supercomputer models will be able to determine the medical status of a patient in real time or near real time. These systems will be able to determine if a patient is showing signs of a pending medical crisis and requires intervention before the crisis appears.
All this can be available to the citizenry at a cost that would surprise you. This is the ounce of prevention on a grand scale.
I shall continue to discuss economical medicine in future articles and how leveraging the computational and communications revolution will contribute to providing better medical care at a lower cost.
Friday, November 20, 2009
Remote Monitoring Equals Healthier Patients
I know I promised an article that discussed the Biotronik studies. However, I just came across a brief article that I wanted to share. It's a brief description of an article that shows the introduction of remote monitoring can substantially reduce hospital admissions. Here's the link: http://articles.icmcc.org/2009/11/20/remote-monitoring-yields-healthier-patients/.
This is the kind of article that provides additional, supporting evidence that demonstrates the benefits of remote monitoring: to patients and to the bottom-line of health care. Furthermore, as I remarked in http://medicalremoteprogramming.blogspot.com/2009/11/virtual-doctor-visit-washington-post.html, the people I've known have wanted to stay out of hospitals. So this should be considered a win all way around.
This is the kind of article that provides additional, supporting evidence that demonstrates the benefits of remote monitoring: to patients and to the bottom-line of health care. Furthermore, as I remarked in http://medicalremoteprogramming.blogspot.com/2009/11/virtual-doctor-visit-washington-post.html, the people I've known have wanted to stay out of hospitals. So this should be considered a win all way around.
Tuesday, November 17, 2009
The Virtual Doctor Visit: Washington Post
I grew up around elderly people. My parents were middle-aged when I was born, grandparents were elderly, many of my parents friends were elderly. I cannot think of one person who said that they liked being in a hospital. A continual fear of my parents, grandparents and my parents elderly friends was the fear of wasting way in either a hospital or nursing home. Death was a better alternative. Not that they wanted to die, but that they did not want to die in the confines of a hospital or nursing home.
This is an article published today (Tuesday, 17 November 2009) in the Washington Post that discusses remote monitoring as an alternative to a hospital admission. There's a trial underway to determine if remote monitoring can provide the kind of information that physician require to keep people from being admitted to the hospital. It's care in the home. Here's the link: The Virtual Doctor Visit.
Here's an update on the Digital Plaster trial: http://tech.kikil.com/2009/11/medical-debut-for-smart-band-aid/.
This is an article published today (Tuesday, 17 November 2009) in the Washington Post that discusses remote monitoring as an alternative to a hospital admission. There's a trial underway to determine if remote monitoring can provide the kind of information that physician require to keep people from being admitted to the hospital. It's care in the home. Here's the link: The Virtual Doctor Visit.
Here's an update on the Digital Plaster trial: http://tech.kikil.com/2009/11/medical-debut-for-smart-band-aid/.
Wednesday, October 21, 2009
Verizon's Offering at the Connected Health Symposium
Article from Mobihealthnews.com (@Connected Health: Verizon highlights partners) briefly describing the benefits and cost savings from tele-medicine. For example, Verizon claims that "IT healthcare solutions and services can help organizations save close to $165 billion annually, according to the carrier. The carrier also cites a report from the Insight Research Corporation that estimates $800 million per year could be saved if more treatment was shifted from physician’s offices to home health visits."
Of course, tele-medicine and the applications bring revenue to that Verizon (and other carriers), thus the cost savings amounts should be viewed sceptically. However, in general tele-medicine solutions nearly always provide cost savings over clinic and hospital visits. And they also provide an additional level freedom that improves quality of life.
I want to add this link that sounds a significant concern regarding the supply and demand for communications bandwidth in the near future. Here's the link: http://www.reuters.com/article/pressRelease/idUS121240+21-Oct-2009+PRN20091021. The title of the article is: "Are we ready for the Exabyte Tsunami? (Here's a link to explain an exabyte: http://en.wikipedia.org/wiki/Exabyte).
Of course, tele-medicine and the applications bring revenue to that Verizon (and other carriers), thus the cost savings amounts should be viewed sceptically. However, in general tele-medicine solutions nearly always provide cost savings over clinic and hospital visits. And they also provide an additional level freedom that improves quality of life.
I want to add this link that sounds a significant concern regarding the supply and demand for communications bandwidth in the near future. Here's the link: http://www.reuters.com/article/pressRelease/idUS121240+21-Oct-2009+PRN20091021. The title of the article is: "Are we ready for the Exabyte Tsunami? (Here's a link to explain an exabyte: http://en.wikipedia.org/wiki/Exabyte).
Thursday, October 15, 2009
Future-Market Analysis: Global Patient Monitoring
http://www.reuters.com/article/pressRelease/idUS78250+14-Oct-2009+BW20091014
Although I do not endorse any products or companies in this blog, I did come across the notice from Reuters about a market research study regarding the market for global patient monitoring. I thought that some of my readers might have an interest in the findings from study such as this, so I'm providing the link to the Reuter's press release. I believe that obtaining the results of this study will require a substantial payment, although I suspect that some of the data will become freely available when journalists review and discuss it. Anyway, I'm posting this for anyone who might be interested. I ask that if anyone obtains a copy of this study, please leave a comment regarding it on this blog. Thank you.
Although I do not endorse any products or companies in this blog, I did come across the notice from Reuters about a market research study regarding the market for global patient monitoring. I thought that some of my readers might have an interest in the findings from study such as this, so I'm providing the link to the Reuter's press release. I believe that obtaining the results of this study will require a substantial payment, although I suspect that some of the data will become freely available when journalists review and discuss it. Anyway, I'm posting this for anyone who might be interested. I ask that if anyone obtains a copy of this study, please leave a comment regarding it on this blog. Thank you.
2 Million Dollars Stimulus Grant To Fund Research On Wireless Patient Monitoring
http://www.medicalnewstoday.com/articles/167340.php
Wireless researchers and physicians from Rice University and The Methodist Hospital Research Institute won a $2 million Federal grant with the mandate to design and test next-generation wireless platforms and remote patient monitoring devices in Houston. This program should be worth watching.
Tuesday, October 13, 2009
Washington Post: David Steinhaus: Telemedicine Is Here
Recent article in the Washington Post (9/23/2009) discussing the value of telemedicine. David Steinhaus is an employee of Medtronic. Here's the link:
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/23/AR2009092303525.html
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/23/AR2009092303525.html
Monday, October 12, 2009
Savings from Telehealth
http://www.cataractoutsourcing.com/healthcare-it/telehealth-save-billions/
Supporting data to indicate that telehealth has both medical and financial benefits. Remote monitoring and programming are some of the technologies that support telehealth systems.
Supporting data to indicate that telehealth has both medical and financial benefits. Remote monitoring and programming are some of the technologies that support telehealth systems.
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