Internet of Healthy Things Redux: Chapter 6, Some Healthy Disruption*

Listen to this blogpost in Dr. Kvedar's voice:

0:00

*Thanks to Tara Menon and Gina Cella for their help editing this piece.

This year, I have been blogging about the 10th anniversary of my first book, The Internet of Healthy Things (IoHT). While taking a trip down memory lane, it has been fun to: 

• Assess how well my coauthors and I did in predicting the future.

• Wonder what the people we interviewed are doing now. 

• Recall the companies we highlighted and ponder where they are today.

This reflection motivated me to commit to posting about a different chapter regularly throughout the year and to ask you, my valued readers, to grade us.

If you haven't had a chance to read (or listen to) the first six installments, you may do so here (but go ahead and finish this one first!).

Ten years ago, the arguments in Chapter 6 of The Internet of Healthy Things felt daring. The book outlined a future where consumer-focused, technology-driven care models would transform traditional healthcare. A decade later, we have enough evidence to determine which predictions became reality and which ones stalled.

This chapter’s core claim was that the center of gravity in healthcare would shift toward consumers. That part held true. Remote care is now an ordinary part of clinical operations. The U.S. telehealth market reached roughly $42.5 billion in 2024, and analysts expect annual growth of about 23.8% over the rest of the decade. Recent reports estimate that the global telehealth market would exceed USD 100B in 2024, with projected annual growth by about 10-25%, depending on the source. For many U.S.based health systems, virtual visits are not a backup plan, they’re simply part of the front door. Wearables followed a similar trajectory. More than 36% of U.S. adults used a wearable health device in 2022, and forecasts predict over 100 million U.S. adults using wearables in 2025, rising to more than a third of the population by 2027. Chapter 6 anticipated a consumer seat at the table. Reality delivered it. 

The chapter also predicted a disruption to traditional care delivery. On that front, we were largely on target. Remote patient monitoring (RPM) advanced from “promising innovation” to “routine infrastructure.” By 2025, RPM usage is expected to reach 71 million Americans, about one-quarter of the U.S. population. Medicare RPM services grew from ~160K in 2019 to ~5.5M in 2023 (over 3,000% growth). Clinicians have adapted to responding to data flows instead of relying solely on episodic encounters. Home-based care options have developed into significant clinical pathways. Chapter 6 identified this as a major inflection point. In hindsight, it was.

However, our predictions missed the mark in both scale and durability. We thought that once tools were available, consumers would quickly adopt them. The data shows a different picture. Engagement remains patchy. Although wearable use increased, only about 26.5% of those willing to share data with their clinicians actually did. Many see health technology as a fad rather than a regular part of care. Continuous data didn’t necessarily lead to continuous care. Instead, the system encountered typical constraints: patient attention, clinician capacity, workflow, and reimbursement issues. In this chapter, we recognized these barriers but underestimated how long they would last.

In this chapter, we also overestimated the appetite for organizational transformation. Even now, many health systems rely on traditional workflows and struggle to implement digital tools consistently. A 2025 study of US hospitals found that RPM service availability increased substantially over five years but continued to be offered in only a minority of hospitals, with marked variation by hospital type and performance. A decade of pilots, press releases, and vendor demos hasn’t created the seamless ecosystem the authors envisioned. I’ve heard far too many colleagues bemoan “pilot paralysis,” with many programs still operating as pilots or disease‑specific initiatives rather than fully integrated services. Telehealth itself shows uneven adoption progress. National claims data indicated telehealth use slightly declined in early 2025, dropping from 14.9% to 14.5% of patients with a telehealth claim between January and February. While growth occurred, it was not with the unstoppable momentum the chapter predicted.

Retail health tells a similar story. The chapter correctly predicted that Walgreens, CVS, and other retailers would compel the industry to rethink convenience. They did. However, the turbulence that followed—store closures, shifting strategies, and the struggle to scale operations—was harder to predict. Retailers proved to be powerful disruptors, but not always stable ones.

That said, the most lasting insight of this chapter was its framing of long-term opportunity. It argued that organizations adopting connected, consumer-centered models would be well-positioned for the coming decade. That claim still stands. The technology arrived on time. The culture, incentives, and workflows did not. Progress was real but uneven.

A decade later, it’s clear we understood the direction of travel. The magnitude and timing simply defied easy prediction. Innovation didn’t sweep through healthcare. It seeped in, patchwork style. The tension between traditional care and the connected, consumer-driven model continues to define the system. That interplay will shape the next decade just as surely as it shaped the last.

What has your experience been in this regard?