continua health alliance healthcare unbound · – low risk populations can remain healthy by...
TRANSCRIPT
6/26/2009
Continua Health Alliance
Healthcare Unbound
Chuck ParkerExecutive DirectorThe Continua Health Alliance
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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
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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
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Technology Out Paces Biology
Private and Confidential, Oregon Medical Laboratories
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• 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
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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
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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
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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)
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Thank You
Thank you!
www.continuaalliance.org
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The Continua Health Alliance Mission
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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