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Remote patient monitoring, a type of telehealth, is finally starting to become a factor in U.S. healthcare. The reasons, as usual, have to do with money. Medicare now penalizes hospitals financially if too many of their patients wind up back in the hospital within 30 days, so some organizations are monitoring high-risk patients at home to head off complications. And the emergence of accountable care organizations (ACOs) and value-based reimbursement gives providers a fresh incentive to monitor patients with serious chronic conditions between visits.

Don't let all those people wearing Fitbits and Nike FuelBands mislead you, though. Remote monitoring in the clinical world remains far from a mass-market trend. The focus of this monitoring effort falls on the sickest 5% of patients, the people who generate nearly half of healthcare costs. That means a lot of attention on people with heart disease, diabetes, hypertension and other chronic conditions. But as healthcare delivery moves to a population health management model, where hospitals and physician practices get paid based on keeping people healthy instead of doing procedures, remote patient monitoring will be applied to a broader group of people.

More than half of 43 accountable care organizations recently surveyed by Spyglass Consulting Group are either deploying RPM or thinking about doing so. Yet big doubts remain: 71% of the survey respondents are uncertain how to integrate the monitoring data into their clinical care processes and systems, and 58% worry that RPM technology lacks support for the clinical analytics and decision support tools needed to act on the data.

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Today, RPM action is mostly around home-based monitoring devices, as opposed to mobile and wireless devices that continuously monitor patients wherever they go. Mobile applications for chronic diseases do exist, but with a handful of exceptions, these chronic-disease apps aren't connected to providers or integrated with provider health records, so patients don't have strong incentive to use them.

However, experiments are underway. For example, software vendor WellDoc has a mobile application for diabetes management that's been approved by the Food and Drug Administration and must be prescribed by a physician. Three large, self-insured employers -- Ford, Rite Aid and Dexcom -- are covering the apps as a prescription benefit. Meanwhile, in-home monitoring technology itself is becoming wireless and migrating to mobile devices, blurring the line between in-home and mobile monitoring.

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download the October 2013 issue of InformationWeek Healthcare.