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mHealth and Home Monitoring

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Abstract for H2AD 2013

BERG INSIGHT ABSTRACT

Lars kurkinen, Senior Analyst

([email protected])

Johan Fagerberg, Senior Analyst

([email protected])

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Published in January 2013

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ABOUT BERG INSIGHT

Berg Insight offers premier business

intelligence to the telecom industry. We

produce concise reports providing key facts

and strategic insights about pivotal

developments in our focus areas. Our vision

is to be the most valuable source of

intelligence for our customers.

ABOUT THE AUTHORS

Johan Fagerberg is co-founder and an

experienced analyst with a Master’s degree

in Electrical Engineering from Chalmers

University of Technology. He has during the

past 17 years published numerous articles

and reports about location-based services,

mobile broadband and wireless M2M

markets.

Lars Kurkinen is a Telecom Analyst with a

Master’s Degree in Strategic Management

from the Aalto University School of Science

and Technology, Finland. He joined Berg

Insight in 2010 and his areas of expertise

include mHealth, mobile financial services

and wireless M2M.

MHEALTH AND HOME MONITORING ABSTRACT FOR H2AD

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Index

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 population ................................................................................ 3 1.1.2 Metabolic syndrome and lifestyle related diseases .............................................. 4

1.2 Common chronic diseases .......................................................................................... 5 1.2.1 Cardiac arrhythmia ................................................................................................ 6 1.2.2 Hypertension ......................................................................................................... 7 1.2.3 Ischemic diseases ................................................................................................. 7 1.2.4 Sleep apnea .......................................................................................................... 8 1.2.5 Chronic respiratory diseases ................................................................................ 9 1.2.6 Diabetes .............................................................................................................. 12 1.2.7 Hyperlipidemia .................................................................................................... 13

1.3 Healthcare providers and reimbursement systems .................................................. 14 1.3.1 Healthcare in Asia-Pacific .................................................................................... 16 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 services .................................................................... 24 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

ABSTRACT FOR H2AD MHEALTH AND HOME MONITORING

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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 initiatives ................................................................................ 61 3.1 Wireless M2M technology ......................................................................................... 61

3.1.1 Chipsets, modules and terminals ........................................................................ 63 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 handsets ........................................................................................................ 75 3.2.1 Smartphone vendors and operating systems ..................................................... 75 3.2.2 Application stores provide a new channel to the market for developers ............ 78 3.2.3 Medical applications............................................................................................ 79

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


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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 diagnostics .................................................................................... 103 4.2.7 Blood oxygen monitoring .................................................................................. 103 4.2.8 Air flow monitoring ............................................................................................ 104 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 US .................................................................... 108 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


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5.1.2 Boston Scientific ................................................................................................ 116 5.1.3 Medtronic .......................................................................................................... 117 5.1.4 Sorin Group ....................................................................................................... 119 5.1.5 St. Jude Medical ................................................................................................ 119

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 Rossmax ............................................................................................................ 133 5.3.5 IEM .................................................................................................................... 133 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 Respironics ............................................................................................ 138 5.5.3 ResMed ............................................................................................................. 140

5.6 Home sleep diagnostics .......................................................................................... 141 5.6.1 Cadwell Laboratories ........................................................................................ 143 5.6.2 CareFusion ........................................................................................................ 143


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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 Vitalograph ........................................................................................................ 151

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


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6.1.1 Bosch Healthcare .............................................................................................. 162 6.1.2 Honeywell HomMed .......................................................................................... 163 6.1.3 Tunstall Healthcare Group ................................................................................ 165 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 Medsignals ........................................................................................................ 189 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


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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 monitoring .................................................................... 212 7.3.5 Resistance to change ........................................................................................ 213

7.4 Potential market catalysts ........................................................................................ 214 7.4.1 Increased monitoring during clinical trials ........................................................ 214 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


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Index

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 ..................... 10 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 solution ............................................ 67 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


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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


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1 INDUSTRY RESEARCH ABSTRACT

Executive summary

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.



The challenge from chronic diseases

1.1 Introduction

During the last 50 years, the major cause of death in the Western world has shifted from

infectious to non-infectious diseases, mainly cardiovascular diseases, metabolic diseases and

cancer. The shift in disease panorama is mainly due to improved living conditions and

nutritional status of the population as well as new and improved treatments. Introduction of

vaccinations and antibiotics has attributed to this revolution. Today, life-style related diseases

are an important factor leading to illness and death.

The same pattern can be found in other areas of the world, such as China and India, when

the living conditions improve and medical treatments are made available. The World Health

Organization has concluded that by 2030, non-communicable conditions will cause over

three quarters of all deaths globally. Non-communicable diseases commonly reduce the

quality of life for many years before death results. They are associated with enormous costs,

both directly through medical treatments and consumption of healthcare as well as indirectly

by loss of productivity. Most of these diseases are related to lifestyle: smoking causing

cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease, obesity

and inactivity causing type 2 diabetes and cardiovascular disease.

1.1.1 The ageing world population

Population ageing is the process by which older persons become a proportionally larger

share of the total population. It was first experienced by the more developed countries, but

the process has become evident in the developing world as well. In 1950, there were about

200 million persons aged 60 or over throughout the world. Fifty years later, the number of

persons aged 60 or over increased about three times to more than 600 million. Meanwhile,

the total population increased 2.4 times. The demographic transition associated with

population ageing has a substantial impact on economic and social conditions, for instance

regarding the viability of intergenerational social support and social security systems.

Population ageing also results in rising demands for health services and higher medical costs

since older people are normally more vulnerable to chronic diseases.



Figure 1.1: Population by age group (EU, North America and Japan 2010-2030)

Million people EU27+2 Canada USA Japan

2010

All ages 514.0 34.0 310.0 127.0

Aged 65+ 88.8 4.7 40.2 29.4

Share, 65+ 17.3 % 13.8 % 13.0 % 23.1 %

2020

All ages 527.0 38.0 341.0 123.0

Aged 65+ 106.0 7.0 55.0 35.9

Share, 65+ 20.1 % 18.4 % 16.1 % 29.2 %

2030

All ages 534.0 41.0 373.0 115.0

Aged 65+ 126.0 9.6 72.0 36.7

Share, 65+ 23.6 % 23.4 % 19.3 % 31.9 %

Source: Berg Insight

1.1.2 Metabolic syndrome and lifestyle related diseases

Many non-communicable diseases are associated with the metabolic syndrome, defined as

obesity, elevated blood glucose levels, elevated blood lipids (hyperlipidemia), high blood

pressure and decreased sensitivity to insulin. The prevalence of metabolic syndrome in the

Western world is 20–30 percent and is steadily increasing. It is rapidly increasing in populous

countries such as China and India. There are more than 400 million obese people in the

world, defined as body mass index above 30 kg/m2 and the rates are rising. In the US, one in

three adults are obese and another third of the population is overweight (BMI 25–30 kg/m2).

In most Western countries, 10–20 percent of the adults are obese, while the level is less than

5 percent in Korea and Japan. Many Asian countries show a high growth rate in obesity.

Simplified, the rise of the metabolic syndrome is the result of three factors: an aging

population, excessive calorie intake and inadequate exercise. The two latter are avoidable, as

is smoking, which is also associated with the metabolic syndrome. However, people often do



not adjust their lifestyle until it affects their quality of life considerably and it is then often too

late to reverse the effects. The metabolic syndrome is thus constituted of what is most often

chronic diseases or risk factors. Frequent or continuous monitoring of blood pressure, blood

glucose, blood lipids and heart activity improves the management of these diseases.

Smoking is a major cause of cancer, respiratory and cardiovascular disease. Many countries

have banned smoking in restaurants and public areas and tobacco taxes are being

increased. In most Western countries, smoking is declining although it is still common.

Moreover, as the effects of smoking are seen after several years of exposure, smoking-related

diseases are expected to increase, as cases of cancer and cardiovascular disease diagnosed

today are the results of smoking habits decades ago. In developing countries, the number of

smokers is increasing.

1.2 Common chronic diseases

This report focuses on monitoring of chronic diseases including cardiac arrhythmia,

hypertension, ischemic diseases, sleep apnea, diabetes mellitus, hyperlipidemia, asthma and

chronic obstructive pulmonary disease (COPD). These conditions cause substantial costs

and reduce both life expectancy and quality of life. Thus far, these conditions have attracted

most attention for home monitoring.

The economic burden of a disease is the total economic impact that the disease has on

society as a whole as well as on individuals and families. The total economic burden can be

separated into direct and indirect disease-attributable costs. Direct costs are the costs of

medical management of the disease and comorbid conditions, including inpatient care,

outpatient care and drug treatment. Indirect costs are loss of work productivity and premature

mortality, or other costs that arise from the disease.



Figure 1.2: Direct and indirect costs of chronic welfare diseases in the US and EU

0 20 40 60 80 100 120 140 160 180 200

Hypertension

Diabetes

COPD

Cardiac arrhythmia

Asthma

Sleep apnea

€ Billion

Direct

Indirect

Source: Berg Insight



Medication and integrated monitoring

solution providers

6.1 Telehealth solution providers

Telehealth solutions enable remote monitoring and disease management for patients at home

or in assisted living facilities. The dedicated stationary telehealth hub is currently the

dominant form factor with a market share of more than 90 percent. However, the number of

solutions featuring more portable form factors is growing. This trend is partly driven by the

use of tablet hardware in the design of telehealth hubs. Furthermore, products that combine

mPERS and telehealth capabilities in one portable device are emerging. Most providers have

traditionally offered their customers only one form factor, but there is a trend towards offering

a variety of options to cater to the specific needs of different patient populations.

The market for telehealth solutions has been around for over a decade. Bosch and Honeywell

are today the leading providers followed by Tunstall, Cardiocom, Philips and Numera. There

are also numerous smaller vendors and many new companies are entering the market, either

with proprietary hardware designs, tablet-based solutions or by leveraging telehealth hub

platforms developed by companies such as eDevice and Qualcomm.

6.1.13 H2AD

H2AD is a French provider of telehealth services that was founded in 2004. The company’s

offering comprises telemedicine and telehealth services, health data hosting and remote

patient monitoring. The telemedicine and telehealth services are call center services delivered

on a 24/7 basis by a group of doctors, nurses and engineers that provide medical advice and

assistance. The company markets its health data hosting service as a secure, flexible and

reliable hosting service tailored for healthcare organizations. A part of this offering is the D2P

platform that enables cloud-based storage of electronic medical records. A cornerstone of

H2AD’s remote patient monitoring service is the Twitoo telehealth hub, which has been



developed in collaboration with Telit, Sdataway and Locatis. Twitoo is a stationary device that

can connect with medical monitoring devices via Bluetooth and transfer the data to H2AD’s

remote server using an embedded M2M module. The Twitoo device is compatible with a

range of monitoring devices such blood pressure meters, scales, oximeters, thermometers

and spirometers designed by companies including A&D, Nonin and MIR. H2AD offers the

Twitoo device and associated services to both consumers and healthcare service providers.

Consumers can purchase the device together with a four-year service contract for € 30 per

month.

Berg Insight: Viktoriagatan 3, S-411 25 Gothenburg, Sweden Tel (46) 31�711 30 91 www.berginsight.com

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Abstract mHealth H2AD 2013 … · and reports about location-based services, mobile broadband and...

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Transcript of Abstract mHealth H2AD 2013 … · and reports about location-based services, mobile broadband and...