Analyst: Wireless health can't be homebound

By Brian Dolan

Perhaps the most engaging presentation at the New America Foundation and CTIA's Wireless Health IT event in the Senate's Dirksen office building was the one given by Michael Barrett, managing partner at Critical Mass Consulting and author of the well-known Healthcare Unbound report. Barrett began his talk with a rough timeline of healthcare dating back to before the 18th Century. He then went on to contextualize the wireless healthcare opportunity and outline some challenges this "revolution" still faces. Here's a synopsis of Barrett's timeline:

18th Century and before: Before society institutionalized healthcare, it was wireless. Doctors or caregivers would visit homes or places of work. These were "hands-on" care givers.
19th Century: Pioneering hospitals like Massachusetts General Hospital developed enormous places of care that led to the professionalization of healthcare throughout the 19th century.
1950s: The idea that care could take place outside of the home began to take hold: In 1950 40 percent of doctor visits still occurred in the home.
1965: Medicare includes coverage for home health--just barely. A "thread" still existed, though.
1980s: We began (already) to focus on aging baby boomers and found that enormous costs will be rung up because of them. Chronic care studies showed that "90 percent of diabetes care is self care" effectively.
1996: Kaiser launches an online health site for its members to instruct them and their family members on how to access care.
1999: The real beginnings of remote patient monitors, which began as wired devices connected to plain old telephony lines hit the market.
2002: Forrester Research authors a report called Healthcare Unbound, which recognizes a trend toward de-institutionalizing healthcare and returning it to its roots as a "wireless" anytime, anywhere field.

Barrett argued that technology enabled self-care contains an unavoidably populist dimension since it moves care closer to non-physicians. This revolution marks a sea change for the industry, while saving money and preserving quality. 

If last week's news from the CDC that more homes are going cutting the cord surprised you, this statistic should be even more so: Barrett noted that according to a survey from 2007 (nearly two years ago), 82 percent of adult americans had a cell phone, while only 78 percent have internet access. Barrett said the number of cell phone users outpaced the number of Americans with Internet access sometime in 2006, which should be some food for thought for those who think wireless devices won't be the platform of the so-called eHealth trend.

Barrett also cautioned that the mobile adoption curve flattens out in the coming years and he doesn't expect the remaining 18 percent of non-cell phone users to become mobile phone users. He didn't explain why. He did, however, warn that the remaining 18 percent of the population will still be a part of the wireless healthcare revolution he believes is underway, but it won't be through the mobile phone form factor we have come to know. The remaining 18 percent of the population will be reached through other wireless connected devices--a reference to An Internet of Things.

Barrett closed his presentation with a short list of challenges that still face wireless healthcare:

Only 3 percent of mobile users look to their mobile phones for financial transactions, which could be an indication of the percentage of people willing to use them for healthcare applications given the comparable sensitivity around the two activities.
Wireless networks need to work to mission critical perfection, which means network coverage, battery life and privacy cannot be concerns for end users and care givers.
Who's going to pay for this stuff? We have no idea. Medicare isn't even close but needs to figure it out.
We need to get past the Medicare homebound requirement, which only allow caregivers to send a nurse into a patiet's home if the patient is homebound. Wireless, obviously, cannot be limited to a homebound setting. We need to wrestle with this concept that medicine is only for the seriously ill. If we remove the homebound requirement, then costs will skyrocket. If we don't find a way to preserve quality but drive down costs, then we aren't going to be able to make it happen.

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