6/26/2009

Continua Health Alliance

Healthcare Unbound

Chuck ParkerExecutive DirectorThe Continua Health Alliance

6/26/2009 2

Remote Patient Monitoring:enablers & drivers

ConnectedPersonal Health

A new path to personal wellness, citizen productivity, and

sustainable health costs

Perspective Shift

From treatment of disease to proactive nurturing of personal wellness

New Knowledge

Modifiable lifestyles are key drivers for population

health and disease

Health Cost Burden

Increasing costs of the old model of health care become a national crisis

National Action

Economic pressures force nations to demand new

health solutions

Enabling Technology

Telehealth devices, personalized biometrics, device interoperability

6/26/2009 3

RPM Market: The Need

• The challenge:

– 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)

– Up to 60% of all medication prescribed is taken incorrectly, or not at all (National Council on Patient Information & Education).

Source: Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services and U.S. Department of Commerce. Last Updated: January 6, 2008

National Health Expenditures, Aggregate and Share of Gross

Domestic Product (GDP), 1960-2017

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RPM Market: the Need 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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RPM Market: the Need 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

6

Technology Out Paces Biology

Private and Confidential, Oregon Medical Laboratories

6/26/2009 7

• Many diseases can be broken down into non-modifiable and modifiable contributors

• Non-modifiable contributors– Age, gender and genes

• Modifiable contributors– Lifestyle choices

• Today, poor lifestyle choices increasingly are the largest contributors to common adverse health outcomes

Address 60-80% modifiable Adverse Health

Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women. NEJM 2001 Sep 13;345(11):790-7.Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22

Actual Goal

Non-modifiable Contributors to Disease

Modifiable Contributors to Disease

91% Diabetes 83% Heart Disease

69% Cancer

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Goal: Realize Peak Health Potential

Time Peak Health Potential Line

Min

Hea

lth

Max

Non-modifiable & Unpredictable Health

Modifiable & Predictable Health

Actual Health Experience

Poor nutrition, inactivity, Stress…

Unpredictable Event/Accident

Death

• Goal – Experience peak health potential throughout life for a high quality of life at minimal

costs• Reality

– Average individual is experiencing much less of full health potential than expected at a high financial & quality of life cost

• Cause– Adverse health events such as stress, poor nutrition, inactivity… are causing the

population to fall away from their peak health potential

Max

Cost

s

Min

Health Expectations

Adapted from Oregon Medical Labs

6/26/2009 9

RPM 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

6/26/2009 10

RPM market in the future: the continuum of life and care

AmateurAthlete

Diet/FitnessFocused

WorriedWell

Elderly LivingIndependently

ChronicPatient

AcuteRecovery

Infant

CONTINUUM of LIFE

CONTINUUM of CARE GIVERS

Doctor/NP/NurseHome

NursingProfessional

The Family

FitnessWellness

CoachNew Parents

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.

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WeightScale

PersonCentered

Device /Systems / Sensors

Biometrics Testing

HRA/Health Administrative

Assistant

Classes

Information Systems

Fitness Equipment

Wellness Management/Support

Systems

Blood-Presser Cuff

Glucose Meter

Spirometer

Pulse Oximeter

Medication Tracking

Pedometer

Cholesterol HDL/LDL

Weight

Blood-Pressure

Blood Sugar

Resting Heart Rate

Lung Air Volume

Triglycerides

Body Fat %

Body Fat Analyzer

Bio-metric/BehavioralResponses

Multiple providers / service oriented

Wellness Center

PHR/PHA

Fitness, nutrition, stress management…

RPM Market: the Market Segments

ActivityHub

Familycare

givers

Elderlymonitoring

services

Diseasemanagement

service

Healthcareprovider

Gait analysis

6/26/2009 12

Continua Use Cases

• To organize its work, Continua segmented the market in three large use cases:

Health & Wellness• Weight loss• Fitness• Email / chat / video• Appt scheduling• Personal Health Records

Disease Management• Vital sign monitoring

(RPM)• Medication reminders and

compliance• Trend analysis and alerts• Connect with family care

givers

Aging Independently• An adult child helping their elderly parents

age gracefully in their own home.• Basic life monitoring as appropriate (ADL)

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Continua Use Cases

• Disease management market: – evolve the current models of care; chronic and post-acute– connect patients, families and healthcare providers to the right

information at the right time– more informed decision-making– empowering people to take a more active role in their own care– e.g.: Northern Ireland, West Lothian (UK); AOK Cardio Integral (DE)– mostly led by public healthcare administrations; statutory health insurers

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Continua Use Cases

• Health and wellness market:– health conscious and worried well– fitness and lifestyle trackers, PHRs– employer programs and occupational health (HRA)– national public health programs, screening– e.g.: Diabetes Prevention DEHKO (FI); metabolic syndrome – mandatory

HRA (JP); 10K Steps a Day; Nike Plus; Google Health; MS HealthVault; Dossia

– mostly privately driven; a few national programs

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Continua Use Cases

• Ageing independently market: – residential care, independent living facilities, individual homes– support ADL, fall detectors, bed occupancy, medical reminders, …– personal emergency response services– e.g.: Tunstall, Philips Lifeline, GE Quiet Care – driven by a mix of social care providers, group housing, individual

subscribers

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PC

PersonalHealth System

Cell Phone

Set Top Box

Aggregator

Version One Device Connectivity Standards

WeightScale

PulseOximeter

Independent Living Activity

Cardiovascular and Strength

Fitness Monitor

MedicationMonitor

GlucoseMeter

Pulse /Blood Pressure

Bluetooth Medical Device Profile Specification

USB Personal Healthcare Device Class Specification

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

Version One Health Record Standards

Home-based Remote Patient Monitoring

(RPM) System

Vital Sign Devices

Patient

Electronic Health Record

System

EHR / PHR

Labs

Healthcare Provider

Disease Management

Service

XDR Transport Specification

CDA/CCD-based Personal Health Monitor (PHM)

Specification

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V2 Use Case DevelopmentM1: Decompose UC into requirements

ExitSuccessful review (E2E Arch, TWG, UCWG)

M2: Select Standards

ExitSuccessful TWG Ballot, BOD approval

M3: Identify gaps between standards and requirements

ExitTWG, UCWG presentation

M4: Develop Guidelines

ExitTWG review and ballot

M5: Create Test Procedures and complete review

ExitSuccessful TCWG review

M6: Update Test Tool

ExitPass Tool Test

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Service (WAN

) Interface

Netw

ork (LAN)

InterfaceD

evice (PAN)

Interface

Electric Health R

ecord (XH

R) Interface

Application Hosting Device

LAN Device

V2 Use Cases Underway

PAN DeviceWAN Device

HealthRecordDevice

Physical Activity Monitor

Medication Monitor

Electrocardiogram (ECG)

Insulin Pump

Final link in end-end connectivity

Portable XHR Media Extension

Low Power Radio

V1 Extensions (e.g., Multiple device users, enhanced device authentication)

6/26/2009 20

Thank You

Thank you!

admin@continuaalliance.org

www.continuaalliance.org

6/26/2009 21

The Continua Health Alliance Mission

6/26/2009 22

RPM market now: Current Participants

• 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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Personal Telehealth

Healthyfamily

Health & Wellness• Weight loss• Fitness• Email / chat / video• Appt scheduling• Personal Health Records

Internet

Weight lossand fitnesscoaching

HealthcareProfessionals

PersonalHealthRecords

Disease Management• Vital sign monitoring (RPM)• Medication reminders and

compliance• Trend analysis and alerts• Connect with family care

givers

Aging Independently• An adult child helping their

elderly parents age gracefully in their own home.

• Basic life monitoring as appropriate (ADL)

Elderly

Diseasemanagement

service

Familycare givers

DigitalHome

Cell Phone

PC

Personal Health System

PEDOMETER

BLOOD-PRESSURE

CUFF

MEDICATIONTRACKING

HOME AUTOMATION & CONTROL

FITNESSEQUIPMENT

IMPLANTPULSE

OX