albert 2 oklahoma telemedicine
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Presentation by Dr. David Albert at the Oklahoma Telemedicine Conference 2014: Telehealth TransitionTRANSCRIPT
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The mCardiology Company
Oklahoma Telemedicine Conference 2014
David E. Albert, MDFounder and Chief Medical Officer
AliveCor
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Statements, opinions and results of studies contained in the program are those of the presenters/authors and do not reflect the policy or position of the Board of Regents of the University of Oklahoma (“OU”) nor does OU provide any warranty as to their accuracy or reliability.
Every reasonable effort has been made to faithfully reproduce the presentations and material as submitted. However, no responsibility is assumed by OU for any claims, injury and/or damage to persons or property from any cause, including negligence or otherwise, or from any use or operation of any methods, products, instruments or ideas contained in the material herein.
Disclaimer
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Disclosure Statement of Financial Interest
• Major Stock Shareholder/Equity
• Ownership/Founder
• Salary & Other Financial Benefit
• AliveCor, Inc.
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship Company
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Objectives
• Describe the current status of healthcare delivery in the US and OUS
• Describe how mHealth can help address some of the global issues
• Describe the current status of mHealth in the US and OUS
• Provide real-world examples of how mHealth is working
• Describe the potential in the future
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US Healthcare Expenditures
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Expenditures Continue to Increase
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Healthcare Problems Differ For the Developed
vs. the Developing World
• Developed world (especially the US) spends too
much on healthcare and doesn’t get its money’s
worth.
• Developing world spends too little and gets
exactly what it pays for (i.e., almost nothing).
• We must find solutions and technologies which
can address the problems of both… and that’s
not as crazy as it sounds!
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Population Growth (in the Developing World) Demands Action
to Improve Healthcare!
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Healthcare Globally Must Go from Reactive to
Proactive: Hygiene & Diet & Fitness & Vaccines, Etc.
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The challenge 2013Global HC workforce vs. disease burden*
57Countries below WHO critical
healthcare coverage threshold
4.3 millionWorldwide shortage of health workers
including doctors, nurses, and midwives
$2 billionAnnual cost just for training of needed
HC professionals in India aloneU.S., Canada, and Latin America have 37% of global healthcare workers and only 10% of global disease burden
*: Size of circles proportional to healthcare expenditures
Source: World Health Organization
Inadequate Healthcare Access
AliveCor Company Confidential Oct-14
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*: 1 exabyte = 109 gigabytes
Source: Cisco VNI Mobile 2011
92% CAGR
Health Data, like All Information, will be
Shared, Connected & Engaged
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And Exponential Change will bring a
New Paradigm to Healthcare
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Smartphones Introduced Apps & As the Late
Steve Jobs said, “That changed everything”!
• > 1 Billion Apple and Android devices sold to date worldwide
• Over 70% of US subscribers have a smartphone
• 100 billion app downloads from Apple’s iTunes Store & Android Market
• 5 years from now there will be no dumb phones but only smartphones
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Smartphones: The Global Technology Growth EnginemHealth: Bringing Smartphone Dynamics to Medicine
75
38
13
4 2.5
Telephone Radio TV Internet Smartphone
Years to reach 50 Million Users
500M
$26B
Users
Market size
mHealth by 2017
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The Smartphone Will be the World’s Healthcare
Portal
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p e w i n t er n e t .o r g 3
Demographic trends in smartphone ownership
As has consistently been the case since we began measuring smartphone adoption two years ago,
ownership is particularly high among younger adults, especially those in their twenties and thirties
(although a majority of Americans in their mid-forties through mid-fifties are now smartphone adopters)
and those with relatively high levels of household income and educational attainment.
Every major demographic group experienced significant year-to-year growth in smartphone ownership
between 2012 and 2013, although seniors—defined as those 65 and older—continue to exhibit
relatively low adoption levels compared with other demographic groups. Some 18% of Americans age 65
and older now own a smartphone, compared with 13% in February 2012.
Smartphone ownership by demographic group—
gender, age, race/ethnicity % within each group who own a smartphone
Own a smartphone
All adults (n=2,252) 56%
Gender
a Men (n=1,029) 59b
b Women (n=1,223) 53
Age
a 18-24 (n=243) 79cdef
b 25-34 (n=284) 81cdef
c 35-44 (n=292) 69def
d 45-54 (n=377) 55ef
e 55-64 (n=426) 39f
f 65+ (n=570) 18
Race/ethnicity
a White, Non-Hispanic (n=1,571) 53
b Black, Non-Hispanic (n=252) 64a
c Hispanic (n=249) 60
Source: Pew Re s earch Center’s Internet & Am erican Life Project, Ap ril 17-May 19, 2013 Tracking Survey. Interviews were conducted in English and Spanish and on landline and cell phones. Margin of error is +/-2.3 percentage points based on all adults (n=2,252).
Note: Percentages marked with a superscript letter (e.g., a) indicate a
statistically significant difference between that row and the row designated by that superscript letter, among categories of each demographic characteristic (e.g. age).
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p e w i n t er n e t .o r g 5
Smartphone ownership by income/age grouping % within each age/income grouping who own a smartphone (example: 77% of 18-29 year olds with an annual household income of less than $30,000 are smartphone owners)
Source: Pew Re s earch Center’s Internet & Am erican Life Project April 26 -May 22, 2011, January 20-February 19, 2012, and April 17-May 19, 2013 tracking surveys. For 2013 data, n=2,252 adults and survey includes 1,127 cell phone interviews. All surveys include Spanish-language interviews.
Trends in platform adoption
Since 2011, the proportion of cell owners who say they own either an iPhone or an Android device have
each grown dramatically. Android owners now represent 28% of all cell owners (up from 15% in May
2011), while iPhone owners now represent 25% of the cell owner population (up from 10% in May
2011). Meanwhile, the proportion of cell owners who say they own a Blackberry device has fallen from
10% in May 2011 to just 4% in our most recent survey.
77%
47%
22%
8%
81%
68%
40%
21%
90% 87%
72%
43%
0%
20%
40%
60%
80%
100%
18-29 30-49 50-64 65+
Less than $30,000 $30,000-$74,999 $75,000 or more
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Physicians & Mobile Computing
Devices
Source: QuantiaMD, Tablets Set to Change Medical Practice, 2011
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Physicians Support Mobile Monitoring
• Percentage who want to monitor patients at home
65% - Weight
61% - Blood sugar
57% - Vital signs (e.g. blood pressure,
heart rate, respiratory rate)
54% - Exercise/physical activity
36% - Calories/fat content taken in
36% - Pain level
35% - Sleep patterns
28% - Cardiac rhythm
17% - Bladder control
16% - Acid reflux/indigestion
13% - Digestive health
Source: PricewaterhouseCoopers HRI Physician Survey, 2010
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Patients Accept Ownership
and Responsibility
Source: IBM Report: The Future of Connected Health
Devices, March 2011
“Among those surveyed, nine out of ten (93 percent) are
satisfied or very satisfied with the basic functionality of their
devices. Although less than 10 percent are paying out-of-
pocket charges for their devices today, more than one-third
expect to do so within two years. Most users are willing to pay
for a device, but will not spend more than US$100 out of
pocket. An increasing number of consumers also
anticipate paying monthly fees in the future; while only 5
percent pay a monthly charge today, 35 percent expect to do so
in two years.”
AliveCor Company Confidential May 2011
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A Huge Opportunity To Do Good & Do Well!
mHealthinsights July 2013
The global mHealth market
opportunity and sustainable
reimbursement models
Mobile health (mHealth) is an attractive solution that leverages the ubiquity of mobile devices to address the prevalent problem of access to healthcare and rising costs. According to the International Telecommunications Union, overall mobile penetration rates will have reached 96% globally by 2013, 128% in the developed world and 89% in the developing world.1 The growing rates of mobile adoption, coupled with the pressing challenge of finding alternative ways to reduce healthcare costs, provide a ripe opportunity to expand the mHealth market.
In fact, a PwC and GSMA study predicts that global mHealth revenues will increase by nearly six-fold to $23 billion by 2017.2 Most of the market share will be in Europe and the Asia-Pacific regions with 30% of share each, followed by North America with 28%. Latin America and Africa are expected to have smaller markets with estimated shares of 7% and 5% respectively.3
mHealth has the potential to revolutionise the healthcare industry yet organisations are still uncertain how to capitalise on the technology. To make gains, healthcare organisations, payers, mobile operators and regulators should work together as part of an ecosystem to introduce consumer-centric, scalable business models that empower the patient and provide reimbursement for mHealth offerings.
Key mobile market opportunities
According to the PwC and GSMA report, Touching lives through mobile health: Assessment of the global market opportunity, monitoring services and applications are expected to represent 65% of the market in 2017, driven primarily by the rapidly ageing population in developed countries and the high levels of chronic disease in emerging markets.4
Highlights
PwC and GSMA predicts that global mHealth revenues will increase to $23 billion over the next four years
The market opportunity for mHealth is promising, yet conflicting financial incentives has created uncertainty on how stakeholders can capitalise
Reimbursement models are largely dependent on patient involvement and a gradual evolution of medical models that help familiarise providers and payers to new modes of care delivery
1 International Telecommunications Union, The World in 2013: ICT Facts and Figures report, http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2013.pdf 2 PwC and GSMA, Touching lives through mobile health: Assessment of the global market opportunity, February 2012. 3 Ibid. 4 Ibid.
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Global mHealth Market Relevance
US & Western Europe Empower consumers Improve effectiveness of existing
systems Reduce costs
Developing World Create health infrastructure Leap-frog bricks and mortar Provide accessible health solutions
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Outcomes are Improved When We Connect
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App-Drug Synergy will Enable Patient
Self-Management
• Diabetes: Sanofi iBGStar
• Hypertension: Withings BP
• Atrial Fibrillation: AliveCor ECG
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Smartphone & Cloud Computing Enable Global
Telemedicine
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Smartphones & Big Data Will Rely on CLOUD
COMPUTING To Create Connected Innovations!
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BIG DATA will allow innovation in everything
from weather to energy to medicine!
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H1N1 Virus
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1919 Spanish Influenza Epidemic
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The New Vectors of Social Virality
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Idea Epidemics can Literally Span the Globe in a Day
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Ideas Spread At the Speed of Light With No Control
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Atrial Fibrillation Chronic HeartFailure
Heart Flutter Coronory ArteryDisease
Hypertension
Cardiovascular Disease: A Large Market
Opportunity
6M
78M
3M
30M
47M
US Cardiovascular Annual Disease Expense $273 Billion
US patient population
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Growth in Heart Disease –
US population 2000 - 2050
Beller GA. Circulation. 2001; 103:2428 – 2435
Foot DK, et.alo. J Am Coll Cardiol. 2000; 35:1067 -1081
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Hypertension: The Statistics
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Summary of studies
investigating the prevalence of
atrial fibrillation in various
populations and age groups1
1Cairns J, Connolly J. Nonrheumatic atrial fibrillation: risk of stroke and role of antithrombetic therapy.
Circulation. 1991:84;469.
%
Age (years)
< 40 60 64 74 > 750
2
4
6
8
10
Prevalence of Atrial Fibrillation
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Thousands of Hospital DaysThe Lancet, 1993;341:1319.
Unspecified
Conduction Disease
Sick Sinus Syndrome
Premature Beats
Junctional Rhythms
Atrial Flutter
Atrial Fibrillation
Ventricular Tachycardia
Ventricular Fibrillation
Cardiac Arrest
0 400200 600 800 1000
Annual Utilization/Primary DiagnosisMore than $1.3 billion spent annually due to AF primary diagnosis
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Primary Healthcare Expenditures
Annual Economic Burden
0
5
10
15
20
25
30
35
40
Bil
lio
ns
of
$ U
S
HF AF VT/VF Brady
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5.0 million
6.5 million
Heart failure management
A Growing Medical Challenge
400,000 250,000
Annual
Incidence
Heart Failure
Prevalence
Annual
Mortality
U.S.
580,000 300,000Europe
Congestive heart failure worldwide markets, clinical status and product development opportunities. New Medicine, Inc. 1997:1-40.
Wilkerson Group Survey, 1998.
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mHealth Cardiology Solutions are Growing
Rapidly
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One Small mHealth Solution:
AliveCor Smartphone ECG
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The AliveCor Smartphone System is a Global,
Cloud-Based ECG Monitor
Patient Takes ECGVia Hands or Chest
ECGs Stored Locally
ECGs Securely Stored & Processed In the Cloud
ECGs Accessed Via HIPAA-compliant, Secure Login
ANYWHERE INTHE WORLD
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In-Flight Arrhythmia Diagnosis CASE
Patient Profile and History
• A male patient in his mid 20’s experiences
shortness of breath, palpitations, and chest
pain during an intercontinental flight. Physician
unable to diagnose rhythm with stethoscope.
Clinical Assessment Using the Heart Monitor:
• An ECG recorded with the Heart Monitor
showed runs of Ventricular Trigeminy
(Premature Ventricular Contractions every
third beat).
• Patient was instructed to see a doctor when
arriving at home and take the ECG to the
appointment
Value of the Heart Monitor:
• The Heart Monitor in this instance was able to assist the doctor in diagnosing PVCs.
• This allowed the plane to continue on its journey without an expensive emergency landing to care
for the patient.
• The patient was given the peace of mind that their symptoms were not life threatening and could
see their primary physician when arriving at home.
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AFib Screening & Stroke Risk Identification
Concord Hospital, University of Sydney, Australia (PI, Dr. Ben Freedman, Professor of
Cardiology and Deputy Dean of Medicine)
Presented at the American Heart Association in November 2012
109 patients evaluated with standard ECG and AliveCor 70 sinus rhythm, 39 AFIB Blind evaluation
Cardiologist A Cardiologist B AliveCor AF Algorithm*
94% 95% 97%
*AliveCor AF Algorithm in testing, not currently available for sale in the US or elsewhere
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Database Currently Contains Over a Million
ECGs- Following Them Over Time.
TachycardiaBradycardia
Heart Rate Distribution From Customer Database
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mHealth Transforming Heart Health By
Empowering Self-Care
Traditional ECG AliveCor ECG
Difficult to access Expensive Limited to institutions Appointment driven
Data driven Instantly available Accessible & affordable Consumer-centric
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Physician-Directed Patient Self-Management of Left Atrial
Pressure in Advanced Chronic Heart Failure
Ritzema J et al. Circulation. 2010;121:1086-1095
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Patient Self-Management Case Study
Patient with atrial fibrillation (AFIB), an erratic heart beat, on the drug Amiodarone which causes severe side effects
Patient buys the AliveCor device with subscription, using it on a daily basis for remote monitoring
Patient and physician adjust prescription dosage while monitoring ECG real time from home, eliminating side effects and controlling AFIB
Expensive hospital and office visits avoided Money saved for payors
Ubiquitous ECG monitoring can transform healthcare delivery, reducing cost while improving outcomes!
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Veterinary mHealth Opportunity
AliveCor Company Confidential Oct-14
• From dogs & cats to horses and
exotic animals, mHealth presents
opportunities to take state-of-the-art
care to the patients.
• Vets have always made house calls
especially for farm animals and
horses- they are true “mobile care
providers”
• Owners can source biometric data
as it’s always easier to “move data”
than to “move patients” , especially if
they are LARGE!
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Impact of Digital & Mobile HealthChanging the paradigm – creating a new S-curve
Extends reach of healthcare institutions to home & mobile
Cellphone-based disease management improves outcomes
Enabled by consumer electronics cost structures and channels
Physicians embrace mobile monitoring for their patients
Patients accept ownership and financial responsibility for
better health and wellness tools
Mobile health solutions present major business opportunities
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What’s Going to Happen to mHealth?
1. Consumerization is early but it’s coming to
cardiovascular and all healthcare.
2. Technologies like Smartphones & Cloud
Computing are enablers but Changing
Economics & Increased Personal
Responsibility are the Drivers!
3. Change creates Opportunity so embrace it!
THANK YOU!