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Continua Health Alliance:Advancing Information Technology in
the Personal Health Solutions Ecosystem
By Chuck Parker, Executive Director, Continua Health Alliance
Conflict of Interest DisclosureChuck Parker, Executive Director,
Continua Health Alliance
Has no real or apparent conflicts of interest to report.
3
Technology Out Paces Biology
Private and Confidential, Oregon Medical Laboratories
Our evolutionary ability to store fat cannot support our current sedentary high-calorie activities
2/24/2010 4
Remote Patient Monitoring
Objectives:• What is Continua?• Market influence and implementation• Use case driven• Interoperability
– Approach– Constraining– Protocol
• Market and political drive
2/24/2010 5
The Continua Health Alliance Mission
6
Connected Healthcare Monitoring Market
• The challenge:– 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)
– 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
2/24/2010 7
Need for Transformation
• Area of connected health/home health monitoring is predicted to grow from a $3B market in 2009 in North America and Europe to an estimated $7.7B in 2012 (Data Monitor, 2007)
• Number of connected health 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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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
DeathDeath
• 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
9
• 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
2/24/2010 10
Remote Patient Monitoring: enablers & drivers
2/24/2010 11
Remote Patient Monitoring
Objectives:• What is Continua?• Market influence and implementation• Use case driven• Interoperability
– Approach– Constraining– Protocol
• Market and political drive
2/24/2010 12
Remote Patient Monitoring: Standards
• Continua founded to organize and push market in one direction
• Structure (Working groups) is to model real-world Use Cases from industry and healthcare
• Process then deconstructs requirements and selects best industry standards
• Then vet processes and fill holes either with direct work within SDO’s or add definitions and refinements
• Ballot and then publish program and guidelines
• Strongest Value of Continua though is the Certification program for interoperability of devices
2/24/2010 13
Guidelines → Certification → Recognizable Logo
Industry competitors could discuss without Anti-trust
Unified Political drive to encourage adoption
Single voice for industry
Access to market research dataAccess to pre-publication drafts of
the design guidelinesInternal and external education
and training
Test and certification toolsRight to use certified logo upon
completion of successful certification
Web-based environment (repository, collaboration tools)
Reference source codePlugFests
Ecosystem Development
Wednesday, February 24, 2010
Developer Resources
Market Intelligence Safe Environment
Certification
2/24/2010 15
Remote Patient Monitoring
Objectives:• What is Continua?• Market influence and implementation• Use case driven• Interoperability
– Approach– Constraining– Protocol
• Market and political drive
2/24/2010 16
Continua Domains
• Continua segmented the market in three large Domains:
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)
2/24/2010 17
Domain 1: 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
2/24/2010 18
Domain 2: 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
2/24/2010 19
Domain 3: 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
2/24/2010 20
PC
PersonalHealth System
Cell Phone
Set Top Box
Aggregator
V 1 Interoperability Standards - Protocol
WeightScale
PulseOximeter
Independent Living Activity
Cardiovascular and Strength
Fitness Monitor
MedicationMonitor
GlucoseMeter
Pulse /Blood Pressure
USB Personal Healthcare Device Class Specification
Bluetooth Medical Device Profile 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
V 1 Data Standards - Syntactical
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
22
Use Case Development
M1: 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
V1.5 (Spring 2010)
• Advanced Medication Monitor
• Peak Flow Monitoring Device
• Upload Health Information on the WAN
• Sneaker-Net xHR Interface
• Insulin Pump Monitor Device
• Errata from V 1
• Low Power Radio
V2 (Winter 2010)
• Clinical Coding for HRN
• ECG and Respiration Monitoring
Device
• Physical Activity Monitoring Device
• Ultra-Low-Power Body Area
Network
• Low-Power LAN
• Clinical Coding for xHR
• Device and Patient Authenticity
• Controlled Information Sharing
• Disease Management Multiple Users
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Service (WA
N) 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)
2/24/2010 24
Remote Patient Monitoring
Objectives:• What is Continua?• Market influence and implementation• Use case driven• Interoperability
– Approach– Constraining– Protocol
• Market and political drive
2/24/2010 25
Working Group Structure - Internal
BoardOf
Directors
Use CaseWG
TechnicalWG
Test & Certification
WG
WellnessSolutions
WG
VTMAdmin
Expert Group
NHS, AAFP,ATA, AHA…
Sub-Committees
PR & Marketing
agency
Marketing WG
Regulatory WG
PolicyStrategy
WG
AustraliaPolicyWG
EUPolicy
WG
JapanPolicyWG
LatinAmericaPolicyWG
U.S.PolicyWG
ExecutiveDirector
More than 2,000 membersParticipating in the various
Working Groups
Testing and
CertificationLab
2/24/2010 26
V1 Interoperability - Semantic
• Use of HL7 and SNOMED CT for semantic understanding
• V 2 will have further implementation and conditional understanding
2/24/2010 27
Interoperability in Three-tier Approach
• Continua constrains the outputs at the device level. (PAN interface)– Reduces device overhead and intelligence
requirements– Reduces power requirements– Reduces development time– Reduces connection complexity
• Intelligence is at the Hub / Manager– Understands what it is communicating with– What data to expect– May issue commands to send certain data
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Continua Reference Device Classes
WANDevice
LANDevice
PANDevice
ApplicationHosting Device
Health RecordDevice
LAN “Sharing” Device:to represent a device as a
LAN Device in the Continua Ecosystem
PAN “Adapter” Device:to represent a device as a
PAN Device in theContinua ecosystem
V1 Certification Process
SDO TransportCertificate
TestSuites
ContinuaCompliance
Testing
Test Plans
ContinuaCertification
& Logo
Logo
Test Report
Members
TCWG Test Lab
Test Admin
2/24/2010 30
Remote Patient Monitoring
Objectives:• What is Continua?• Market influence and implementation• Use case driven• Interoperability
– Approach– Constraining– Protocol
• Market and political drive
2/24/2010 31
Working Group Structure - External
BoardOf
Directors
Use CaseWG
TechnicalWG
Test & Certification
WG
WellnessSolutions
WG
VTMAdmin
ExpertGroup
NHS, AAFP,ATA, AHA…
Sub-Committees
PR & Marketing
agency
Marketing WG
Regulatory WG
PolicyStrategy
WG
AustraliaPolicyWG
EUPolicy
WG
JapanPolicyWG
LatinAmericaPolicyWG
U.S.PolicyWG
ExecutiveDirector
More than 2,000 membersParticipating in the various
Working Groups
Testing and
CertificationLab
2/24/2010 32
RPM market in the future
• Personal Connected Health • The individual / home as the hub• Convergence consumer / healthcare• Mobile health / Personal Health Records
fitness - sometimes with public incentives• 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
Health App Growth iTunes
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End-to-end demo – Vancouver Q2 2009
Device InterfaceDevice Manager
XHR InterfaceSender Receiver
EHR
PHR
Pulse Oximeter
Glucose Meter
Disease management
platform
Roche Accu-Chek 360
LNI Android-based G1 Cell phone 20601 manager
WAN
Wi-fi or 3G
IP network
Web services
xHR
Based upon proposed
protocols for Continua WAN
2/24/2010 35
RPM market now: Current Participants
• Continua membership shows across the board interest both from supply and demand sides:– Medical devices– Governmental Agencies– Fitness– Pharma– Health care providers– Health insurers– Telecommunications– IT– Integrators– Applications (PHR, EHR, desktop)
Promoter Members
Open Open InternationalInternational
More Than More Than 228 Member 228 Member Companies!Companies!
Contributor Members
7 Layers AG24eight, LLCAdvanced Digital InstituteAir ProductsAlcatel LucentAlereAllion Test Labs, Inc.All Medicus Co., Ltd.American Heart AssociationAnalog DevicesAnalogic CorporationAndago Ingenieria s.l.AppsHub, Inc.ASE Consulting LimitedAstraZenecaAT4 WirelessAT&T MobilityAttrezzature Medico Sanitarie SRLAuthentidate Holding Corp.AViTAAwarepointBiancaMedBiocomfort Diagnostics GmbH BIOSPACE Co., Ltd.Bluegiga Technologies OyBoston ScientificBroadcom CorporationBrunel UniversityBXI Health Systems, LLCCambridge Consultants Ltd.Canada Health InfowayCardiff UniversityCEA - LETI
Centre for Global eHealth InnovationCerner CorporationChiptech LimitedChristus HealthChunghwa Telecom Co., Ltd.ConnectBlue ABContinuity HealthConvergence Wireless, Inc.CSR plcCYPAK ABDellDELTADenso CorporationDossia ConsortiumDuodecim Medical PublicationsDynastream Innovations Inc.eflow Inc.Elbrys NetworksEmber CorporationEmpirica GmbHEricsson Nikola Tesla d.d.ETRIEuroTech, Inc.Fairbanks ScalesFitLinxxFlextronics Design SRLFrance Telecom R&D, LLCFreescale Semiconductorfrog design, inc.Frontline Test EquipmentFujitsu Limited
GenerationOne, Inc.GlaxoSmithKlineGoogle Inc.Hill-RomHitachi, Ltd.Holst Centre (IMEC)Home For Life SolutionsHoMedicsHoneywell HomMed LLCHosiden CorporationHospira, Inc.HTCI2BC – Insitute of Innovation for Human WellbeingiFoundry Systems Singapore Pte LtdiMetrikusIndustrial Technology Research InstituteInfineon TechnologiesINFORSON Co., Ltd.Innomed Medical Zrt.Innovation Centre ScotlandInstitute for Infocomm ResearchInstitute of BiomedicalInsung Information Co., Ltd.InterComponentWare, Inc.Intramed A/SKai Sensors, Inc.KDDIKorea Electronics Technology InstituteLaird TechnologiesLamprey Networks, Inc.LAXTHA Inc.
Contributor Members Continued
• Product Development Technologies (PDT)
• Proskauer Rose LLP• Proximiti Communications, Inc.• Red Embedded Design• Renesas Technology America• ResMed Corp.• RF Technologies• RMD Networks• RTEmd• Ryoyo Electro Corporation• Sagemcom• Sensor Technology & Devices Ltd• Shimmer Research• SHL Telemedicine• Shorewood Packaging• Sigma Designs• Silicon and Software Systems• Silicon Laboratories, Inc.• SK Telecom Americas• Smartlife Technology Ltd• Sony Electronics Inc.• SterlingTech, Inc.• Stollmann E+V GmbH• STMicroelectronics N.V.• Sumitomo Electric Networks, Inc.• Sybase iAnywhere• T-Mobile USA• TaiDoc Technology Corporation• Taiyo Yuden Co., Ltd.• Tanita Corporation• TechnoGym
38
LG Electronics Inc.Lifescan LifeWatch AGLogicMarvell International Ltd.McLaren Applied TechnologiesMedApps, Inc.Medgate AGMedHelp InternationalMedixine OyMicrolife CorporationMindTree LimitedMotorolaMIR- Medical International ResearchMTI Ltd.MTS Medication TechnologiesMurata Manufacturing Co., Ltd.NEC Access Technica, LtdNestleNeusoft Medical SystemsNippon Telegraph and Telephone CorporationNordic Semiconductor ASANorth End TechnologiesNovo NordiskNuubo (Smart Solutions Tech)ON SemiconductorOregon Medical LabsOregon Scientific Inc.Orthosensor, Inc.PA Consulting GroupPfizerPolymap WirelessPrecor Fitness
Tekoa Technologies Inc.Telbios, SpATelecom Italia SpATelefonica S.A.Telehealth Solutions Ltd.TELUS Health SolutionsTextronics Inc.Toshiba Home Appliances CorporationToumaz Technology LimitedTSBTTATyco ElectronicsTynetec LtdUnitedHealth GroupUniversity of Applied Sciences Technikum WienUniversity of Miami - Miller School of MedicineValentia TechnologiesVerizonVigNet Inc.Vitaphone GmbHVivoMetrics, Inc.Vocollect Healthcare Systems, Inc.Vodafone Group Services Ltd.VTT Technical Research Centre of FinlandWaldo NetworksWelch AllynWind RiverWipro TechnologiesYellow Digital Health LabZarlink SemiconductorZeroG Wireless, Inc.Ziehm Medical LLCZyXEL Communications, Inc.
Industry Liaisons
39
40
Thank You
Thank you!
Chuck ParkerExecutive Director
www.continuaalliance.org
2/24/2010 41
Remote Patient Monitoring
• Additional Content
2/24/2010 42
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
Healthcare provider
Gait analysis
2/24/2010 43
Remote Patient Monitoring
• Additional Technical Content
WA
N-InterfaceLA
N-Interface
PAN
-Interface
xHRN
-Interface
Application Hosting Device
LAN Device
Continua E2E Reference Topology
PAN Device WAN DeviceHealthRecordDevice
Embedded Apps Could subsume PAN interface and expose WAN interface
PAN Interface IEEE PHD State Machine
• Agent states shown, Manager is similar
• Configuration state transmits all static data one time for efficiency
• Operating state is where measurements are transmitted
Disconnected
Connected
Transport connect indication Transport disconnect indication
Unassociated
Associating
+ entry / TxAssocReq
assocReq
RxAssocAbortOr
TxAssocAbort
TxAssocRsp(rejected)
Associated
RxAssocAbort
TxAssocAbort
RxAssocRelReq/TxAssocRelRsp
RxAssocRsp(accepted-unknown-config)
RxAssocRsp(accepted)
Operating
Configuring
Sending Config
TxConfigEventReportReq
RxConfigEventReportRsp(accepted-config)
Waiting Approval
Disassociating
+entry / TxAssocRelReqassocRelReq
RxAssocAbortTxAssocAbort
RxAssocRelRsp
RxConfigEventReportRsp(unsupported-config)
RxAssocRelReq/TxAssocRelRsp
WAN Interface Goals
• Minimal Payload Translation– Keep the device readings consistent with
PAN (e.g., same nomenclature)• Minimal Payload Transformation
– Manager should not be forced to deal with the complexity of transformations from one payload model to another
• Support for all 3 Continua Domains– Health and Fitness, Aging Independently, and
Disease Management• Extensibility• Minimize divergence of standards
WAN Recommendations
• HL7 v2.6 messages using IHE PCD-01– Initially constrained to IEEE 11073-20601 and 104xx
nomenclature for personal health devices– Can be extended to support IEEE 11073–10101
terminologies and core components of the-10201 information model for clinical devices
• Web Services transport based on WS-I Basic Profile– Work with HL7, WS-I, and IHE ITI on further
Web Service Profiles– TLS for Security
• Define placeholder for alarm, alert, control, and command messages but defer message contents for later versions
WAN Proposed Protocol Stack
48
Device Intermediary Remote Monitoring Management System
2/24/2010 49
Personal Connected Health
Healthyfamily
Health & Wellness• Weight loss• Fitness• Email / chat / video• Appt scheduling• Personal Health Records
Internet
Weight lossWeight lossand fitnessand fitnesscoachingcoaching
HealthcareHealthcareProfessionalsProfessionals
PersonalPersonalHealthHealth
RecordsRecords
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
DiseaseDiseasemanagementmanagement
serviceservice
FamilyFamilycare giverscare givers
DigitalHome
Cell Phone
PC
Personal Health System
PEDOMETER
BLOOD-PRESSURE
CUFF
MEDICATIONTRACKING
HOME AUTOMATION & CONTROL
FITNESSEQUIPMENT
IMPLANTPULSE
OX
Example Application
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Example Application
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Mobility Topics
• Interoperability standards (Continua)• Clinician acceptance (workflow, data
overload)• Policy (reimbursement, regulatory)• Liability (indemnity)• Privacy (identifiers)• Security (encryption)• Consistency of cell coverage• Cost• Business models
A Perspective on the Ecosystem
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