Techno chances – a new era for e-health
NHS reform is driving the evolution of new models for electronic healthcare. Peter Kruger explains how e-health is opening up new roads of market access for the medical devices industry.
Much is currently being said about the emergence of e-health and its role in the healthcare delivery of the future. As medical technologies and the healthcare market evolve, the NHS, the industry and the patient are all being encouraged to embrace and exploit new technology. So what is e-health, and what opportunities does it provide for the medical devices industry? According to the Department of Health, e-health is the electronic enabling of the health and social care services to:
• empower individuals and their families to manage their own health;
• improve the co-ordination and integration of care delivery;
• allow population health initiatives, e.g. mapping notifiable diseases.
The power of wireless technology lies in its ability to separate a system’s activities from its physical infrastructure. Once in place, a wireless network can be expanded by simply issuing more connected devices to various locations. This fits well with the current NHS trend of freeing up hospital beds by pushing as many components of the care process as possible to the periphery of the healthcare networks.
As with online banking, where credit checks are based on a small number of key factors, it is believed that e-health can monitor a patient’s general state of health through a relatively narrow range of vital signs. This could radically change the nature of e-health provision and open up the market.
Single condition monitoring
Current e-health services mostly follow the model shown in Figure 1. A device to monitor a condition (usually heart disease) is provided directly to the patient, sometimes supported by a subsidy from an insurance company. An e-health vendor such as Card Guard or Vitaphone supports the service with its own clinicians, who work in the vendor’s call centre.
The e-health vendor has its own database, and the only interaction between the NHS and the vendor is the latter passing on address and location details in cases where the patient needs to be hospitalised – for example, Vitaphone sends GPS data to the hospital if a subscriber has a heart attack.
This model is designed to provide care for patients already within the healthcare system. While it may be able to detect that a patient is about to suffer a relapse, it is not designed for preventative healthcare – which limits its value in the new community-based healthcare system.
New healthcare providers
Any company entering the e-health market is faced with a choice between working with the NHS or marketing devices and services direct to the patient. Rolling out a service directly to the patient creates an immediate revenue stream. However, this often falls far short of the tens of thousands of users the company would have access to if it partnered with the NHS. Broomwell Healthwatch has approximately 1000 patients who subscribe directly to its service – fewer than it will serve through a deal with just one NHS primary healthcare trust.
However, a company dealing with the NHS will have to devote a significant amount of resources to ensuring that its service conforms to the NHS’s standards and operates with its IT systems. The e-health service provider may have to compromise its business model to such an extent that its service is no longer attractive as an OTC e-health product. It may even end up customising its service for an NHS patient database that ultimately fails to work.
This dilemma is not unique to the healthcare IT market. As a general rule, a company should ensure that it is not dependent on one customer for more than 30% of its business. For wireless healthcare, of course, the NHS is the dominant market sector. However, companies such as Hunter Kane (see below) have found alternative routes into the healthcare market.
The power of data
Some existing vendors at the edge of the healthcare networks are hardly recognised as e-health service providers – for example, the systems (based on ECG technology) designed to help people breathe better and so reduce their blood pressure. HeartMath and its resellers, such as Hunter Kane in Europe, have supplied this product as part of a stress management programme marketed to corporate users. They have built a market at a time when the NHS has been financially unable to purchase devices and services to support preventative healthcare.
HeartMath is one of several devices in the fitness and well-being market that capture ECG data. While these data, in terms of quality, fall short of what a healthcare provider would expect from hospital-based ECG equipment, when combined with vital signs and activity data they can be used to provide an accurate assessment of a person’s state of health. Such services can be hosted offshore and provided direct to the consumer.
An ECG analysis provider might also market its service direct to the users of devices that produce ECG and activity data, using fitness as a platform for a more comprehensive remote monitoring and diagnostic service. This would accelerate the development of the new e-health model.
Another key component of the new model is disease and epidemic monitoring. This is primarily the domain of large IT vendors such as IBM and Oracle. However, even large systems need clients to collect data. For example, Oracle is partnering with Toumaz, a start-up offering vital signs monitoring technology.
Get yourself connected
For medical device companies marketing wireless-based e-health products, some aspects of the new e-health model may seem confusingly at odds with the familiar image of an e-health system: a wireless device installed in the home of an elderly person. However, many healthcare devices are now being used to help younger people remain well, or to monitor long-term conditions.
If these trends continue, the healthcare market will see an increasing number of suppliers that are currently only active at the periphery of the market expanding their e-health related product range.
Peter Kruger is Principal Analyst with Wireless Healthcare. For more details, see www.wirelesshealthcare.co.uk.