mHealth and Home Monitoring – 5th Edition

Some of the most common conditions being monitored today are chronic diseases including cardiac arrhythmia, hypertension, ischemic diseases, sleep apnea, diabetes, hyperlipidemia, asthma and chronic obstructive pulmonary disease (COPD). These conditions cause substantial costs and reduce both life expectancy and quality of life. Berg Insight estimates that more than 200 million people in the EU and the US suffer from one or several diseases where home monitoring can become a treatment option. Applying information and communication technologies in the healthcare industry can lead to decreased costs, more efficient care delivery and improved sustainability of the healthcare system. However, the rate of adoption is still slow and wireless technologies have only just begun to penetrate the market. Berg Insight estimates that the number of patients using home monitoring systems with integrated connectivity was about 2.8 million worldwide at the end of 2012. The figure comprises all patients that were using dedicated devices for remote monitoring. Patients using their personal mobile phone, tablet or PC for remote monitoring are not included in this figure. Berg Insight forecasts that the number of home monitoring systems with integrated communication capabilities will grow at a compound annual growth rate (CAGR) of 26.9 percent between 2011 and 2017 to reach 9.4 million connections worldwide.

The number of devices with integrated cellular connectivity increased from 0.73 million in 2011 to about 1.03 million in 2012, and is projected to grow at a CAGR of 46.3 percent to 7.1 million in 2017. Several companies have developed integrated solutions for monitoring multiple chronic diseases and other conditions. The six leading providers of telehealth systems include the major technology and electronics companies Bosch, Honeywell and Philips, as well as the smaller more specialised providers Tunstall, Cardiocom and Numera. These six companies together account for 75.8 percent of the installed base of telehealth hubs. The main market segments for medical devices with integrated connectivity are cardiac rhythm management, sleep therapy and ambulatory ECG monitoring.

Furthermore, connectivity is gaining momentum in several other segments such as blood pressure monitoring, glucose monitoring and medication adherence. In these segments, vendors such as Medtronic, Biotronik, St. Jude Medical, CardioNet, LifeWatch, ResMed, Philips Respironics, Fisher & Paykel Healthcare, Omron, Telcare, Vitality, DayaMed and Vitaphone today market wirelessly connected solutions. Implantable cardiac rhythm management devices is by far the largest segment, accounting for 65.0 percent of remotely monitored patients. However, the number of connected sleep therapy devices is increasing at a faster pace and is expected to constitute the largest segment of connected medical devices by 2017. The major telecom industry players such as Qualcomm, AT&T and Orange have operated business units dedicated to mHealth for several years. Continuous exploration and experimentation with pilot projects has enabled these companies to build industry-specific capabilities while devising their long-term strategies. The efforts are now materializing in the launch of mHealth platforms that can be leveraged by medical device OEMs, healthcare organizations and mHealth app developers to facilitate the development of patient-centric mHealth solutions. In addition to wireless communication, the mHealth platforms often comprise highly secure hosting, remote device management capabilities and integration tools for connecting with medical devices, back-end IT systems and apps.

The adoption of out-of-hospital wireless monitoring in healthcare is driven by a wide range of incentives, related to everything from demographics and technology development to new advancements in medical treatment. However, there are a number of barriers, including resistance to change among healthcare organizations and clinicians, misaligned incentive structures and the financing of wireless solutions by what is at large an underfunded healthcare sector. Several catalysts are nevertheless speeding up the rate of adoption – in particular incentives from payers and insurance companies as well as national health systems that demand remote monitoring. In the US, the progressive increases of readmission penalties set by the Centers for Medicare & Medicaid Services (CMS) will drive hospitals to adopt telehealth solutions for monitoring of post-discharge patients. In the UK, the positive results from the Whole System Demonstrator project led the National Health Service to issue a mandate for 100,000 additional patients to be monitored using telehealth solutions by the end of 2013. In France, a new mandate on compliance monitoring will ensure that all new sleep therapy patients will be remotely monitored from 2013 onwards.

Telephony Industry in North America

Table of Contents

Table of Contents . i
List of Figures viii
Executive summary .1
1 The challenge from welfare diseases..3
1.1 Introduction ..3
1.1.1 The ageing world population3
1.1.2 Metabolic syndrome and lifestyle related diseases..4
1.2 Common chronic diseases ..5
1.2.1 Cardiac arrhythmia6
1.2.2 Hypertension.7
1.2.3 Ischemic diseases.7
1.2.4 Sleep apnea..8
1.2.5 Chronic respiratory diseases9
1.2.6 Diabetes ..12
1.2.7 Hyperlipidemia 13
1.3 Healthcare providers and reimbursement systems ..14
1.3.1 Healthcare in Asia-Pacific16
1.3.2 Healthcare in Europe ..17
1.3.3 Healthcare in North America ...20
2 mHealth strategies of mobile operators 23
2.1 Mobile telecoms in healthcare services24
2.2 mHealth market segments 25
2.3 Business models ...28
2.4 mHealth strategies of mobile operators in North America 30
2.4.1 Verizon Communications 32
2.4.2 AT&T 33
2.4.3 Sprint ...36
2.4.4 KORE Telematics 37
2.4.5 GreatCall..38
2.4.6 TELUS .39
2.5 mHealth strategies of mobile operators in Europe 41
2.5.1 Vodafone .43
2.5.2 Deutsche Telecom..45
2.5.3 Orange Group .46
2.5.4 Telefónica 48
2.5.5 KPN.51
2.5.6 Telecom Italia ..52
2.6 mHealth strategies of mobile operators in Asia-Pacific .53
2.6.1 NTT DoCoMo ..55
2.6.2 SK Telecom .56
2.6.3 Telstra ..57
3 Enabling technologies and initiatives61
3.1 Wireless M2M technology .61
3.1.1 Chipsets, modules and terminals63
3.1.2 Device design and machine integration..66
3.1.3 M2M device value chain..67
3.1.4 eDevice launches the HealthGO platform for remote patient monitoring ...68
3.1.5 Qualcomm launches 2net on the European market ...70
3.1.6 Wireless M2M module vendors in the mHealth market ..72
3.2 Mobile handsets75
3.3 Personal health record initiatives ...81
3.3.1 Microsoft HealthVault ..81
3.3.2 Dossia personal health platform .83
3.3.3 PatientsLikeMe 83
3.3.4 Epic Systems ...84
3.4 Industry associations.84
3.4.1 Continua Health Alliance.85
3.4.2 The Bluetooth SIG Medical Working Group 86
3.4.3 American Telemedicine Association ...87
3.4.4 CTIA .87
3.4.5 GSMA ..87
3.4.6 mHealth Alliance .88
3.4.7 Telecare Services Association 88
3.4.8 West Health.88
3.4.9 Wireless-Life Sciences Alliance...89
4 Home healthcare monitoring.91
4.1 Trends in health monitoring...92
4.1.1 Going digital, going wireless ...92
4.1.2 Distance disease management...95
4.1.3 Outsourcing of health monitoring...96
4.2 Medical monitoring devices...97
4.2.1 Cardiac rhythm management .98
4.2.2 Remote ECG monitoring .99
4.2.3 Blood pressure monitoring ...101
4.2.4 Blood coagulation monitoring...102
4.2.5 Sleep therapy monitoring ..103
4.2.6 Home sleep diagnostics103
4.2.7 Blood oxygen monitoring ..103
4.2.8 Air flow monitoring104
4.2.9 Glucose monitoring ...104
4.2.10 Lipid monitoring 106
4.3 Regulatory environment ..107
4.3.1 Regulatory environment in Europe ...108
4.3.2 Regulatory environment in the US108
4.3.3 Regulatory environment on other major markets.110
4.3.4 International standardisation .111
5 Physiological monitoring solution providers ...113
5.1 Cardiac rhythm management ..115
5.1.1 Biotronik 115
5.1.2 Boston Scientific116
5.1.3 Medtronic..117
5.1.4 Sorin Group ...119
5.1.5 St. Jude Medical119
5.2 Remote ECG monitoring .120
5.2.1 CardioComm Solutions.121
5.2.2 CardioNet..124
5.2.3 Corventis...125
5.2.4 Curvus ...125
5.2.5 LifeWatch ...126
5.2.6 Mednet ..127
5.2.7 ScottCare ...128
5.2.8 TZ Medical .129
5.2.9 Zenicor ..129
5.3 Blood pressure monitoring..130
5.3.1 Omron Healthcare .130
5.3.2 A&D Medical ..132
5.3.3 Microlife .132
5.3.4 Rossmax133
5.3.5 IEM133
5.3.6 Medisana ...134
5.4 Coagulation monitoring ...134
5.4.1 CoaguSense ..135
5.4.2 Helena Laboratories ..135
5.4.3 International Technidyne Corporation...136
5.5 Sleep therapy monitoring 136
5.5.1 Fisher & Paykel Healthcare ...137
5.5.2 Philips Respironics138
5.5.3 ResMed .140
5.6 Home sleep diagnostics ..141
5.6.1 Cadwell Laboratories 143
5.6.2 CareFusion 143
5.6.3 Compumedics...144
5.6.4 Natus Medical 144
5.6.5 NovaSom ...145
5.6.6 Watermark Medical ...145
5.7 Blood oxygen monitoring 146
5.7.1 Covidien 146
5.7.2 Masimo..147
5.7.3 Nonin Medical ...147
5.7.4 Opto Circuits .148
5.8 Air flow monitoring...148
5.8.1 Clement Clarke International .148
5.8.2 iSonea ...149
5.8.3 Medical International Research.150
5.8.4 Ndd Medizintechnik ...150
5.8.5 nSpire Health .151
5.8.6 Sibelmed...151
5.8.7 Vitalograph151
5.9 Glucose level monitoring .152
5.9.1 Abbott Laboratories ...153
5.9.2 Bayer Healthcare ...154
5.9.3 Johnson & Johnson ..155
5.9.4 Roche 155
5.9.5 DexCom.156
5.9.6 Voluntis..157
5.9.7 Telcare...158
5.9.8 Welldoc..158
5.10 Lipid monitoring ...159
5.10.1 Apex Biotechnology ..159
5.10.2 Biomedix USA ...159
5.10.3 CardioChek ...160
6 Medication and integrated monitoring solution providers ...161
6.1 Telehealth solution providers..161
6.1.1 Bosch Healthcare ..162
6.1.2 Honeywell HomMed ..163
6.1.3 Tunstall Healthcare Group165
6.1.4 Cardiocom .167
6.1.5 Philips Healthcare.167
6.1.6 Numera..169
6.1.7 Alere ..171
6.1.8 Aerotel Medical Systems ...173
6.1.9 American TeleCare 174
6.1.10 Authentidate ..175
6.1.11 BodyTel .175
6.1.12 Care Innovations...176
6.1.13 H2AD .177
6.1.14 Ideal Life 177
6.1.15 Grandcare Systems ...178
6.1.16 Medic4All...179
6.1.17 SHL Telemedicine.180
6.1.18 Swissmed Mobile..181
6.1.19 Telehealth Solutions ..182
6.1.20 Vitaphone..182
6.2 Medication compliance monitoring .184
6.2.1 Vitality 184
6.2.2 Innospense 186
6.2.3 Medicpen ...186
6.2.4 Compliance Meds Technologies..187
6.2.5 DayaMed...188
6.2.6 Medsignals189
6.2.7 Proteus Digital Health 189
7 Market analysis and forecasts .191
7.1 Analysis of the medical monitoring device market..191
7.1.1 Medical device market revenues and forecast .192
7.1.2 Connected medical devices ..193
7.2 Trends and forecasts for connected devices..193
7.2.1 Cardiac rhythm management comprises the bulk of RPM connections..195
7.2.2 Sleep therapy will be the largest remote monitoring segment in 2017 199
7.2.3 New device categories will drive growth of cellular ECG monitoring ...201
7.2.4 Telehealth enters a strong growth phase.203
7.2.5 Wireless connectivity gains momentum in several market segments ..206
7.3 Market drivers and barriers..210
7.3.1 An ageing population 211
7.3.2 Increasing welfare disease prevalence .211
7.3.3 Focus on disease prevention 211
7.3.4 Substitutes to medical monitoring212
7.3.5 Resistance to change 213
7.4 Potential market catalysts 214
7.4.1 Increased monitoring during clinical trials214
7.4.2 Incentives from insurance companies and payers ...215
7.4.3 National health systems demand remote monitoring...215
7.4.4 New clinical evidence on cost effectiveness .216
7.4.5 Non-prescribed monitoring and healthcare consumerism ...217
7.5 Recommendations for mobile industry players ...217
Glossary..221

List of Figures

Figure 1.1: Population by age group (EU, North America and Japan 2010–2030) 4
Figure 1.2: Direct and indirect costs of chronic welfare diseases in the US and EU .6
Figure 1.3: Number of people suffering from chronic welfare diseases (EU/US 2008) .9
Figure 1.4: Percentage of population diagnosed with chronic welfare diseases .11
Figure 1.5: Total and per capita healthcare spending by country (2009)14
Figure 1.6: Share of population covered by private health insurance by country ...17
Figure 1.7: Healthcare expenditure per capita by country (US$, World 2009) 19
Figure 1.8: Healthcare spending by type of service and product (US 2010) ...20
Figure 2.1: Use of mobile telecoms in the delivery of care ..25
Figure 2.2: mHealth market segments .26
Figure 2.3: mHealth business models ..29
Figure 2.4: Mobile operators by number of subscribers (North America Q2-2012) .31
Figure 2.5: AT&T mHealth solutions .34
Figure 2.6: Mobile operators by number of subscribers (EU27+2 Q2-2012) ..42
Figure 2.7: Mobile operators by number of subscribers (APAC Q2-2012) ..54
Figure 3.1: Cost versus time diagram for wireless technology integration ..64
Figure 3.2: Examples of wireless M2M modules..65
Figure 3.3: Examples of wireless M2M terminals.66
Figure 3.4: System architecture for an end-to-end M2M solution67
Figure 3.5: M2M device value chain overview..68
Figure 3.6: HealthGO and HealthGO+ by eDevice ..69
Figure 3.7: Smartphone shipments by vendor and OS (World 9M-2012) 77
Figure 3.8: Leading mobile app stores (Q3-2012) 80
Figure 3.9: Examples of HealthVault-certified devices .82
Figure 3.10: Examples of Continua-certified devices ...85
Figure 3.11: Selected members of the Continua Health Alliance, by industry.86
Figure 4.1: Examples of methods for uploading health monitoring data.93
Figure 4.2: Medtronic CareLink monitor and pacemaker .98
Figure 4.3: MCT sensor and monitor from CardioNet 100
Figure 4.4: Blood pressure monitor from Omron Healthcare.101
Figure 4.5: Glucose meters from LifeScan and Roche ...106
Figure 5.1: Major suppliers of physiological monitoring solutions (2011) .114
Figure 5.2: HeartCheck devices from CardioComm Solutions..123
Figure 5.3: Examples of home sleep therapy companies and products ...137
Figure 5.4: SleepMapper mobile application..140
Figure 5.5: Examples of home sleep diagnostics companies and products .142
Figure 5.6: Brands used by major diabetes monitoring companies ..152
Figure 6.1: Telehealth hub form factors ..161
Figure 6.2: Examples of telehealth hub solution providers 162
Figure 6.3: The Honeywell Genesis DM telehealth monitor with peripherals.164
Figure 6.4: Numera Home Hub..170
Figure 6.5: The Vitality GlowCaps system ..185
Figure 6.6: Medido medication dispensers 186
Figure 6.7: The CleverCap dispenser .187
Figure 6.8: The DayaMed MedPod .188
Figure 7.1: Medical device market revenues by segment (World 2011–2017)..192
Figure 7.2: Connected home medical monitoring devices (World 2011–2017) .194
Figure 7.3: Home medical monitoring connections by segment (World 2012).195
Figure 7.4: Implantable cardiac rhythm management vendor market shares (2011)196
Figure 7.5: Market shares for remote monitoring of CRM implants (Q4-2012)..197
Figure 7.6: Connected cardiac rhythm management devices (World 2011–2017) 199
Figure 7.7: Connected sleep therapy devices (World 2011–2017) 201
Figure 7.8: Connected ECG monitoring devices (World 2011–2017) ... .203
Figure 7.9: Installed base of telehealth hubs by region (2012)..203
Figure 7.10: Telehealth hubs (World 2011–2017) ...204
Figure 7.11: Telehealth hub vendor market shares (Q4-2012) ...205

Telephony in North America

North America North America Fixed Lines In Service, `000, % Y-o-y

• $ 250
• Industry data
• February 2013

Yearly, From 2003 To 2016
By Business Monitor International
Source: BMI

• Industries : Telephony
• Countries : North America

North America North America Fixed Lines In Service, `000

• $ 250
• Industry data
• February 2013

Yearly, From 2002 To 2016
By Business Monitor International
Source: BMI

• Industries : Telephony
• Countries : North America