Continua Health Alliance

“Strategic Intelligence Monitor on Personal Health Systems”

Workshop – IPTS, EC
April 2009

Mario Romao
Co-Chair, EU Policy WG, Continua Health Alliance
Senior Manager, Healthcare Policy, Intel Corporation

Extended team: Stelios Tsintzos, Medtronic; Brigitte Piniewski, Oregon Medical

Laboratories; Luis Perez, Telefonica; Christine Claus, Intel; Petra Wilson, Cisco; Vesa
Pakarinen, VTT; Charles Lowe, Telehealth Solutions; Chuck Parker, Continua Health
Alliance

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 The Continua Health Alliance Mission

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 Personal Telehealth
Health & Wellness
IMPLANT
PULSE
OX

BLOOD-
• Weight loss
PRESSURE
CUFF • Fitness
Cell Phone
• Email / chat / video
PEDOMETER Digital • Appt scheduling
Healthy Home • Personal Health Records
family HOME AUTOMATION
& CONTROL PC
Disease Management
FITNESS • Vital sign monitoring (RPM)
EQUIPMENT
• Medication reminders and
MEDICATION
TRACKING
Personal Health System compliance
• Trend analysis and alerts
• Connect with family care
Elderly
givers
Internet
Aging Independently
• An adult child helping their
Personal elderly parents age gracefully
Health
Weight loss Records Disease
in their own home.
and fitness Healthcare management • Basic life monitoring as
coaching Professionals service
appropriate (ADL)
Family
care givers
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 Open
Promoter Members International

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 Contributors Over 180
Members!
 Alcatel Lucent  Dynastream Innovations Inc.  Lifescan
 Alere  Ember Corporation  Southern Nevada Wellness
 Logic
 Allion Test Labs, Inc.  Empirica GmbH  Stichting IMEC – Nederland
 LS Research, LLC
 All Medicus Co., Ltd.  Ericsson Nikola Tesla d.d.  Stollmann E+V GmbH
 MEDCEL
 American Heart Association  ETRI  STMicroelectronics
 MedHelp International
 Analog Devices  EuroTech, Inc.  TaiDoc Technology Corporation
 Medixine Oy
 Andago Ingenieria s.l.  Fairbanks Scales  Tanita Corporation
 MedSignals
 AppsHub, Inc.  FitLinxx  TechnoGym
 MedTech Systems Inc.
 AT4 Wireless  Foundation for Research and  Tekoa Technologies Inc.
Technology  Microlife Corporation
 AT&T Mobility  Telbios, SpA
 France Telecom R&D, LLC  Midmark Corporation
 AViTA  Telecom Italia SpA
 Freescale Semiconductor  Misys Healthcare Systems
 BiancaMed  Telefonica S.A.
 Frontline Test Equipment  Monitray, LLC
 BIOSPACE Co., Ltd.  Telehealth Solutions Ltd.
 Fujitsu Limited  Motorola
 Bluegiga Technologies Oy  Telus Communications Company
 Fullpower Technologies  MIR- Medical International Research
 Boston Scientific  Terumo Corporation
 GC Healthcare Corp.  Murata Manufacturing Co., Ltd.
 Cambridge Consultants Ltd.  Textronics Inc.
 GenerationOne, Inc.  Neusoft Medical Systems
 Capital Health  The Scottish Centre for Telehealth
 GlaxoSmithKline  Nippon Telegraph and Telephone
 Card Guard AG  Toshiba Home Appliances Corporation
Corporation
 Cardiff University  Google Inc.  Toumaz Technology Limited
 Nitto Denko Corporation
 Cardiomedix Inc.  H3System Co. Ltd  Triage Wireless Inc.
 Novo Nordisk
 CELS, Ltd.  Hitachi, Ltd.  TSB Soluciones
 Nuubo (Smart Solutions Tech)
 Centre for Global eHealth Innovation  Home Guardian, LLC  TTA
 ON Semiconductor
 Cerner Corporation  Honeywell HomMed LLC  Tyco Electronics
 Oregon Medical Labs
 Chiptech Limited  Hosiden Corporation  Tynetec Ltd
 Oregon Scientific Inc.
 Christus Health  Industrial Technology Research  UnitedHealth Group
Institute  PA Consulting Group
 Chunghwa Telecom Co., Ltd.  Pfizer  University of Miami - Miller School of
  Infineon Technologies Medicine
Claricode, Inc.  Precor Fitness
  INFORSON Co., Ltd.  Verizon
Computerized Screening, Inc.  Proskauer Rose LLP
 Innomed Medical Zrt.  VivoMetrics, Inc.
 ConnectBlue AB  Proteus Biomedical, Inc.
  Institute for Infocomm Research  VTT Technical Research Centre of
Continuity Health  RMD Networks
  Institute of Biomedical Finland
Convergence Wireless, Inc.  Ryoyo Electro Corporation
 InterComponentWare, Inc.  Westchester Institute for Human
 CSR plc  Sensor Technology & Devices Ltd
 Intramed A/S Development
 CYPAK AB  Shimmer Research
 KDDI  Whole Health Management
 Cypress Semiconductor  SHL Telemedicine
 Konami Sports and Life  Zarlink Semiconductor
 Dell  Shorewood Packaging
 Lamprey Networks, Inc.  Zensys
 Digi International  Silicon and Software Systems
  LAXTHA Inc.
Dossia Consortium  Smartlife Technology Ltd
  LG CNS
Dovetail Health  Sony Electronics Inc.
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 Duodecim Medical Publications
 Guidelines  Certification  Recognizable Logo

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 Version One Design Guidelines

After two years of work from more

than 175 companies around the
world, Continua Health Alliance is
proud to announce the formal
release of its Version One Design
Guidelines and the Continua
Certification Program

Continua Version One Guidelines

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 1st Continua Certified Product
Congratulations to Nonin Medical, Inc.!

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 Version One Device Connectivity Standards

Pulse
Oximeter
• 11073-10404 = Pulse Oximeter
• 11073-10406 = Pulse / Heart Rate PC
Pulse / • 11073-10407 = Blood Pressure
Blood Pressure • 11073-10408 = Thermometer
• 11073-10415 = Weighing Scale
• 11073-10417 = Glucose
Personal
Weight • 11073-10441 = Cardiovascular Fitness Monitor Health System
Scale • 11073-10442 = Strength Fitness Equipment
• 11073-10471 = Independent Living Activity
• 11073-10472 = Medication Monitor
Glucose Cell Phone
Meter

Cardiovascular
and Strength
Fitness Monitor
Bluetooth Medical
Independent Set Top Box
Device Profile Specification
Living Activity

Medication
Monitor Aggregator
USB Personal Healthcare
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Device Class Specification 9
 Version One Health Record Standards

Healthcare Provider

Electronic Health
CDA/CCD-based Record System
Disease
Personal Health Monitoring (PHM) Labs
Management
Specification
Service

Home-based Remote
Patient Monitoring
(RPM) System

XDR Transport Specification

Patient

Vital Sign Devices EHR / PHR

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 First Public Interoperability Demonstration
Harvard Medical Auditorium 10/27/08
Device Interface Heart Failure & COPD XHR Interface
EHR

Wireless Pulse Oximeter

Telehealth
Service

Weighing Scale PHR

Obesity & Diabetes

Telehealth
Service

EHR

Blood Pressure Monitor

Telehealth
Service
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 Ecosystem Development

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 Working Group Structure

Board
Of
Directors Over 1,400 members
participating
in the various
Executive
Working Groups
VTM
Director
Administration

Test & Employer HR Policy

Use Case Technical Marketing Regulatory
Certification Benefits Strategy
WG WG WG WG
WG WG WG

Latin
Expert Group PR & Australia EU Japan U.S. U.S.
Sub- America
NHS, AAFP, Marketing Policy Policy Policy Policy Payer
Committees Policy
ATA, AHA… agency WG WG WG WG WG
WG
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 PHS market now and in the future: enablers
and drivers

Health Cost Burden

National Action
Increasing costs of the
old model of health care Economic pressures force
become a national crisis nations to demand new
health solutions

Connected
Personal Health
New Knowledge
A new path to personal
Modifiable lifestyles are key wellness, citizen
drivers for population productivity, and
health and disease sustainable health costs

Enabling Technology

Telehealth devices,
personalized biometrics,
Perspective Shift device interoperability

From treatment of disease

to proactive nurturing
of personal wellness

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 PHS market now and in the future: the
perfect storm
• The challenge:
– In Europe the number of people aged from 65 to 80 will rise by nearly 40%
between 2010 and 2030, and by 2050 more than a quarter of the European
population is expected to be over 65 years (EC, WHO)
– In England 15.4 million people, including 60 percent of those over age 60,
suffer from a long-term condition. LTCs account for 72 percent of all
inpatient bed days, 65 percent of all outpatient appointments and 52
percent of all GP appointments. LTCs consume 69 percent of England’s
primary and acute care budget (NHS England)
– In 2005, 12 percent of the total workforce in the Netherlands worked in the
(health)care sector. This percentage should become 25 %, to fulfill the
need in 2025. (Goudriaan et al, 2005).
– Almost half of all Americans – 133 million people in 2005 – have at least one
chronic condition, and the medical care costs of people with chronic
diseases consumes more than 75 percent of US medical care costs (CDC)
– … etc…
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 PHS market now and in the future: the
potential for transformation
• The area of telehealth/home health monitoring is predicted to grow
very rapidly, from a $3B market in 2009 in North America and Europe to
an estimated $7.7B in 2012 (Data Monitor, 2007)
• Number of telehealth subscribers worldwide will increase to 55.5
million by 2016, representing a forecast CAGR of almost 72%, (InMedica,
2008)

• There is increasing evidence to support the value of remote monitoring

for patients with chronic diseases, including:
– 35-56% reduction in mortality;
– 47% reduction in risk of hospitalization;
– 6 days reduction in length of hospital admission and
– 65% reduction in office visits;
– 40-64% reduction in physician time for checks and
– 63% reduction in transport costs
(Cleland et al 2005; Lee R, Goldberg et al, 2003; Scalvini S et al., 2001; Elsner et al, 2006; Van
Ginneken et al 2006)

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 PHS market now and in the future: the
potential for transformation
• US could generate net savings of $197 billion dollars over 25 years
through telehealth-enabled monitoring of patients with CHF, diabetes,
COPD, and chronic skin ulcers (Litan, 2008)
• US Veterans Administration: over a four year period, more than 30,000
patients enrolled in the VA’s remote monitoring program showed a
19.74% decrease in hospital admissions and 25.31% reduction in BDOC
(Darkins et al, 2008)

• The focus on wellness:

– Poor health lifestyles dramatically increase population risk for disease;
– The costs of waiting to intervene until after disease is present are
staggering;
– Low risk populations can remain healthy by modifying personal health
behaviours;
F. Wang et al, 2004; B. Piniewski,2006; L. Yen et al.,2006; D.W. Edington, 2008; C. Herman et
al.,2006

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 PHS market now: actors

• Continua membership shows across the board interest

both from supply and demand sides:
– Medical devices
– Fitness
– IT
– Pharma
– Health care providers
– Health insurers
– Telecommunications
– Sensors
– Internet
– Applications (PHR, EHR, desktop)

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 PHS market in the future

• The individual / home as the hub

• Convergence consumer / healthcare
• Consumer health / PHRs fitness - sometimes with
public incentives
• Support public health and corporate wellness programs
• Rewards for keeping people healthy
• Greater integration among wellness, health and social
care
• Best-of-breed plug and play
• Increased connectivity, evolutionary, scalable, service
driven offerings

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 PHS market in the future:
the continuum of life and care
Infant Amateur Diet/Fitness Worried Chronic Acute Elderly Living
Athlete Focused Well Patient Recovery Independently

CONTINUUM of LIFE

The Continua Health Alliance “connected health and care” vision blurs the frontiers
across solutions for healthcare, wellness and ageing independently. The individual
truly becomes the hub for wellness and health management.

CONTINUUM of CARE GIVERS

Fitness
Wellness Home
Coach The Family Nursing Doctor/NP/Nurse
New Parents Professional

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 PHS market in the future: public health and
employer programs
• Step 1
– Identify & define modifiable health and standardize it across populations by
referencing health to an indicator such as TCHOL/HDL
• Step 2
– Move from self-reported data to a sensor-based approach that wirelessly uploads
objective data to track Lifestyle Performance Indicator responses to specific health
modifying efforts
• Step 3
– Objectively monitor Lifestyle Performance Indicators to predict an individual’s trend
toward disease before onset of symptoms or signs and associated costs

Pre-Disease Disease
Lifestyle Performance Indicators Heart Disease
Triglycerides (TG) Stroke
High Density Lipoproteins (HDL) Diabetes
TG/HDL Lifestyle Burden Alzheimer's D
Low Density Lipoproteins (LDL)
Kidney Failure
Total Cholesterol (TCHOL)
TCHOL/HDL Liver Disease
Insulin Many Cancers
Glucose Cognitive Decline
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 PHS market in the future: disease
management

12/07/21 The Innovative Care for Chronic Conditions Framework (WHO) 22

 PHS market in the future: disease
management
Real-time, two way
communication

Improved quality of care

and Personal
Social connection
Health
prepared

Systems
He team
t ne y
p ar u ni t

•Vital sign collection and management

alth
rs
mm

•Integration with:
car
Co

• survey results
e

mo • educational content
ed t iv • video conferencing
rm
o ate
inf d • Data rich health management systems
Patients and families
• Connection to:
ICCC, WHO • friends and caregivers
Greater information sharing
• healthcare advice and information
• Safe and friendly environment
adapted from Intel

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 PHS market in the future: ageing
independently

Feeling safe Supporting cognition

“Since I fell I’m a lot more
afraid of falling”
“You have to challenge
your mind and brain” Connected PHS
ecosystems enabling:
M
U U
IN
NT
CO
Environments B O
DY
Supporting • Basic ADL monitoring
D-
of choice I N physical activities
“Despite my lack of mobility I can
turn on garden lights with this TH
E
M
“I want to move easily,
be independent”
• Health information
remote control”

• Disease management
Meaningful &
useful life
Bringing
healthcare home
• Social interaction
“It would be great to maybe “People think that doctors
have an exhibition of my
work sometime”
can cure everything-
that’s not true”
• Beyond home support
• Virtual residential
Enabling Help care homes
social interaction getting care
“I don’t like to be alone” “We know the pharmacist very well,
it’s easy to get my medicine”

Global ageing experience project, Intel

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 PHS market in the future: the coalescence of
market segments

Multiple providers / service oriented

Wellness Biometrics
Management/Support Device / Testing
Systems
Systems / Sensors Glucose
Meter
Weight
Scale
Bio-metric/
Weight
Behavioral Cholesterol Spirometer

Blood-Presser Responses HDL/LDL HRA/Health

Administrative
Cuff Triglycerides
Blood- Assistant
Fitness, Pressure
nutrition, stress Blood
management… Sugar

Person Fitness
Lung Air

Pulse
Centered Volume
Equipment

Healthcare
provider Oximeter

Wellness
Resting Body Fat Center
Disease Heart Rate %
Gait
management analysis
service Pedometer Body Fat
Information Analyzer
Systems
Medication
Activity
Tracking
Hub

PHR/PHA
Classes
Elderly Family
monitoring care
services givers
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 Business cases to follow-up on RPM and disease
management {Not comprehensive}

• England
– Whole system demonstrators (three sites: Cornwall,
Newham, Kent); 6,000 users; telehealth and telecare
• Northern Ireland
– Implementation of RPM covering 5,000 users
• West Lothian
– Implementation of RPM covering 400 users
• AOK, Deutsche BKK
– German statutory health insurers covering heart disease
• Veterans Health Administration (US)
– 30,000 users covering multiple diseases

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 Innovation models: some considerations

• Telehealth
– Moving past initial pilots requires the creation of a shared vision and belief
in the impact of telehealth, training and education support for nurses,
patients and carers, and access to secure funding streams/reimbursement
models.
– The implementation of telehealth is likely to require a significant change
in working practice and training on its use.
– There may be an initial increase in workload and transition period before it
is integrated into practice and the benefits realised.
– It is recommended that there are change management tools developed to
support this transition
– There should be appropriate training and education for healthcare
professionals as part of their continued professional development).
– As with most new innovations champions should be appointed to ensure
that projects are driven through. Additionally, identifying “super users”
and early adopters to raise awareness of technology and associated
benefits can help to drive innovation at all levels of the organisation.

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 Thank You

Thank you!
admin@continuaalliance.org

www.continuaalliance.org

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