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

The Continua Health Alliance Mission



Personal Telehealth

Health & Wellness
Cell Phone


Healthy family

Digital Home

• • • • •

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



Personal Health System


Personal Health Records Healthcare Professionals

Aging Independently
• An adult child helping their elderly parents age gracefully in their own home. • Basic life monitoring as appropriate (ADL)

Weight loss and fitness coaching

Disease management service Family care givers


Promoter Members

Open International



                                       Alcatel Lucent Alere Allion Test Labs, Inc. All Medicus Co., Ltd. American Heart Association Analog Devices Andago Ingenieria s.l. AppsHub, Inc. AT4 Wireless AT&T Mobility AViTA BiancaMed BIOSPACE Co., Ltd. Bluegiga Technologies Oy Boston Scientific Cambridge Consultants Ltd. Capital Health Card Guard AG Cardiff University Cardiomedix Inc. CELS, Ltd. Centre for Global eHealth Innovation Cerner Corporation Chiptech Limited Christus Health Chunghwa Telecom Co., Ltd. Claricode, Inc. Computerized Screening, Inc. ConnectBlue AB Continuity Health Convergence Wireless, Inc. CSR plc CYPAK AB Cypress Semiconductor Dell Digi International Dossia Consortium Dovetail Health 09/14/10 Duodecim Medical Publications                                      Dynastream Innovations Inc. Ember Corporation Empirica GmbH Ericsson Nikola Tesla d.d. ETRI EuroTech, Inc. Fairbanks Scales FitLinxx Foundation for Research and Technology France Telecom R&D, LLC Freescale Semiconductor Frontline Test Equipment Fujitsu Limited Fullpower Technologies GC Healthcare Corp. GenerationOne, Inc. GlaxoSmithKline Google Inc. H3System Co. Ltd Hitachi, Ltd. Home Guardian, LLC Honeywell HomMed LLC Hosiden Corporation Industrial Technology Research Institute Infineon Technologies INFORSON Co., Ltd. Innomed Medical Zrt. Institute for Infocomm Research Institute of Biomedical InterComponentWare, Inc. Intramed A/S KDDI Konami Sports and Life Lamprey Networks, Inc. LAXTHA Inc. LG CNS LG Electronics Inc.  Lifescan  Logic  LS Research, LLC  MEDCEL  MedHelp International  Medixine Oy  MedSignals  MedTech Systems Inc.  Microlife Corporation  Midmark Corporation  Misys Healthcare Systems  Monitray, LLC  Motorola  MIR- Medical International Research  Murata Manufacturing Co., Ltd.  Neusoft Medical Systems  Nippon Telegraph and Telephone Corporation  Nitto Denko Corporation  Novo Nordisk  Nuubo (Smart Solutions Tech)  ON Semiconductor  Oregon Medical Labs  Oregon Scientific Inc.  PA Consulting Group  Pfizer  Precor Fitness  Proskauer Rose LLP  Proteus Biomedical, Inc.  RMD Networks  Ryoyo Electro Corporation  Sensor Technology & Devices Ltd  Shimmer Research  SHL Telemedicine  Shorewood Packaging  Silicon and Software Systems  Smartlife Technology Ltd  Sony Electronics Inc.                                

Over 180 Members!
Southern Nevada Wellness Stichting IMEC – Nederland Stollmann E+V GmbH STMicroelectronics TaiDoc Technology Corporation Tanita Corporation TechnoGym Tekoa Technologies Inc. Telbios, SpA Telecom Italia SpA Telefonica S.A. Telehealth Solutions Ltd. Telus Communications Company Terumo Corporation Textronics Inc. The Scottish Centre for Telehealth Toshiba Home Appliances Corporation Toumaz Technology Limited Triage Wireless Inc. TSB Soluciones TTA Tyco Electronics Tynetec Ltd UnitedHealth Group University of Miami - Miller School of Medicine Verizon VivoMetrics, Inc. VTT Technical Research Centre of Finland Westchester Institute for Human Development Whole Health Management Zarlink Semiconductor Zensys


Guidelines → Certification → Recognizable Logo



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
09/14/10 7

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



Version One Device Connectivity Standards
Pulse Oximeter Pulse / Blood Pressure Weight Scale Glucose Meter Cardiovascular and Strength Fitness Monitor Independent Living Activity Medication Monitor

• 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

PC Personal Health System

Cell Phone

Bluetooth Medical Device Profile Specification

Set Top Box

USB Personal Healthcare Device Class Specification


Version One Health Record Standards
Healthcare Provider

Disease Management Service Home-based Remote Patient Monitoring (RPM) System

CDA/CCD-based Personal Health Monitoring (PHM) Specification

Electronic Health Record System


Patient Vital Sign Devices

XDR Transport Specification


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

Wireless Pulse Oximeter

Weighing Scale

Obesity & Diabetes




Blood Pressure Monitor



Ecosystem Development



Working Group Structure
Board Of Directors

VTM Administration

Executive Director

Over 1,400 members participating in the various Working Groups

Use Case WG

Technical WG

Test & Certification WG

Employer HR Benefits WG

Marketing WG

Regulatory WG

Policy Strategy WG

Expert Group NHS, AAFP, ATA, AHA…


PR & Marketing agency

Australia Policy WG

EU Policy WG

Japan Policy WG

Latin America Policy WG

U.S. Policy WG

U.S. Payer WG

PHS market now and in the future: enablers and drivers

HealthC Burden ost
Increasing costs of the old model of health care become a national crisis
09/14/10 14

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…
09/14/10 15

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,

• 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)
09/14/10 16

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,

• 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



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)



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



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

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.

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



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
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 Objectively monitor Lifestyle Performance Indicators to predict an individual’s trend toward disease before onset of symptoms or signs and associated costs

• Step 2

• Step 3

Lifestyle Performance Indicators
Triglycerides (TG) High Density Lipoproteins (HDL) TG/HDL Low Density Lipoproteins (LDL) Total Cholesterol (TCHOL) TCHOL/HDL Insulin Glucose

Heart Disease Stroke Diabetes Alzheimer's D Kidney Failure Liver Disease Many Cancers Cognitive Decline

Lifestyle Burden

PHS market in the future: disease management


The Innovative Care for Chronic Conditions Framework (WHO)


PHS market in the future: disease management
Real-time, two way communication
Improved quality of care and Social connection

Personal Health Systems

e car alth He team

Co mm par u ni t tn e y rs

mt oiv ated
fi ron Patients and families em d

Greater information sharing

•Vital sign collection and management •Integration with: • survey results • educational content • video conferencing • Data rich health management systems • Connection to: • friends and caregivers • healthcare advice and information • Safe and friendly environment
adapted from Intel



PHS market in the future: ageing independently
Feeling safe
“Since I fell I’m a lot more afraid of falling”

Supporting cognition
“You have to challenge your mind and brain”

Environments of choice
“Despite my lack of mobility I can turn on garden lights with this remote control”


DY Supporting BO DN I physical activities M
“I want to move easily, be independent”


Connected PHS ecosystems enabling: • Basic ADL monitoring • Health information • Disease management • Social interaction • Beyond home support • Virtual residential care homes

Meaningful & useful life
“It would be great to maybe have an exhibition of my work sometime”

Bringing healthcare home
“People think that doctors can cure everythingthat’s not true”

Enabling social interaction
“I don’t like to be alone”

Help getting care
“We know the pharmacist very well, it’s easy to get my medicine”

Global ageing experience project, Intel



PHS market in the future: the coalescence of market segments
Multiple providers / service oriented
Wellness Management/Support Systems Weight Scale Weight Blood-Presser Cuff Fitness, nutrition, stress management…

Device / Systems / Sensors Bio-metric/ Behavioral Responses

Biometrics Testing Glucose Meter

Cholesterol HDL/LDL Triglycerides Blood Sugar

Spirometer HRA/Health Administrative Assistant


Healthcare provider

Pulse Oximeter

Person Centered
Resting Heart Rate Body Fat %

Lung Air Volume

Fitness Equipment

Disease management service

Wellness Center Body Fat Analyzer

Information Systems

Pedometer Medication Tracking PHR/PHA

Gait analysis

Activity Hub

Classes Elderly monitoring services 09/14/10 Family care givers 25

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



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.



Thank You

Thank you!