Trends in Telehealth

Alex Gerwer Principal Partner AKN

The Big Picture
Changing Needs
1900-1950 1950-2000 2000-2050 Infectious Diseases Episodic Care Chronic Care

Partnership for Solutions


Chronic disease is gaining increasing global attention....

Source: Nobel J. and account for 80% of all hospital bed days and 96% of home care visits. Norman G.5 times as much to serve compared to others. Emerging information management technologies and the future of disease management.htm People with chronic disease cost 3. Disease December 2003.cdc. .The Impact of Chronic Disease Chronic. 6(4): 219-231. Source: http://www. or 25 million people. disabling conditions cause major limitations in activity for more than one of every 10 Americans. Eight out of ten older Americans are living with the health challenges of one or more chronic diseases.

BUY? Fewer are buying as health management becomes increasingly strategic. WILDCARDS! 5 . MAKE. ASSEMBLE. CLINICAL AND ECONOMIC ROI: Round one is over. BEHAVIOR CHANGE: DM is moving from a medical to a social model. PROVIDERS: Care providers have woken up to DM opportunities and threats. Round 2 has just begun. they are promoting the Chronic Care Model and the medical home. away from specialization. behavior change has become the Holy Grail. disappointing results from recent demo projects make future direction unclear. TECHNOLOGY: DM in your home and your pocket. INTEGRATION: The 50 year tide is shifting toward integration.9 Chronic Disease Megatrends MAGNITUDE: We are just scratching the surface of chronic disease challenges. DM wins. MEDICARE: While Medicare has endorsed the need for chronic disease management.

Broadband -.11. DSL. etc. eHEALTH APPLICATIONS Electronic Health Records (EHRs) Personal Health Records (PHRs) Remote patient monitoring Fitness/wellness/prevention Self care support Physician/patient secure messaging Home telehealth/telecare Decision support systems e-Prescribing e-Disease Management e-Clinical Trials Predictive modeling Computerized Physician Order Entry Quality evaluation web sites Patient reminder systems etc.802. satellite Digital cameras. Voice recognition etc. Bluetooth. RFID. etc. video Wireless -. 6 .Technologies are Converging CONSUMER TECH INFRASTRUCTURE Internet Smart houses Personal communications devices -PDAs. cell phones.cable.

Focal Points for Convergence Home Networks. EHRs CONSUMER eHEALTH Home Network Smart Phone PHR/ EHR 7 . Smart Phones.

Future Care Delivery Models Will Be Integrated Around Patients’ Homes & Communities 8 .

The Most Significant U. HAH Initiative is at Johns Hopkins 9 .S.

Lifemasters. 2005 Available Market based on Wachovia Capital Markets Formula Industry Revenues 20 08 .000 $15.000 $35.000 $25.The $30 Billion Potential DM Market is Barely Penetrated Disease Management Market Penetration (millions) CCIP Expansion $40.000 $10.000 $20. President of DMAA and Chair.000 $0 96 19 19 Healthplans and Self Funded Employers CCIP Phase 1 FEHBP Plans Start Adding DM Medicaid Market Opens with FL 97 98 00 01 99 02 03 04 05 06 07 20 19 19 20 20 20 20 20 20 20 Available Market Source: Chris Selecky.000 $5.000 $30.

. thereby improving access to healthcare services within the community where it is applied.Definition of Telehealth • Telehealth can be considered the act of connecting consumers to healthcare providers through the use of a collection of technologies with the goal of meeting a diversity of healthcare needs in a wide variety of settings across a population.

Telehealth vs Telemedicine Source: Dena Puskin. HRSA .

Telehealth vs Telemedicine “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to support • Medical diagnosis • Ongoing patient care • Remote patient monitoring “Telehealth” encompasses a broader definition of remote healthcare that does not always involve clinical services • Health-related distance learning .

sound.Definition of Telemedicine • Healthcare services provided at a distance • Only the service moves. teleconsultation. images or other forms needed for the prevention. teledermatology. treatment and follow-up of patients. diagnosis. telesurgery and teleophthalmology . • Wide variety of telemedicine services: teleradiology. telepathology. telemonitoring. through text. neither the patient nor the health professional moves • It involves secure transmission of medical data and information.

Teleradiology to Home Monitoring Years to mainstream adoption Benefits high moderate low Source: Gartner. Hype Cycle for Telemedicine. 2008 (June 2008) .

2010 . Q1.Drivers for Telemedicine Source: Triple Tree mHealth Report.

“Techy” Consumers are Connected

“Techy” Consumers are Connected

Clinicians Engage in Telemedicine

Adoption and Awareness

Source: Triple Tree mHealth Report; Q1, 2010

Telemedicine: Unit Growth .

Telemedicine: Revenue Growth .

Strong Growth for mHealth .

diabetic.g.) • safety and security (e. cardiac.g. cardiac. … • home-assisted caregiver (e. diabetic. asthma.g.g. video call center) • Video chat & infotainment • personalized packages at home ( e. video call center) • Chronic diseases management (CDM) tools Stay longer autonomously at home Economization of health cost by prevention & follow-up of diseases . avoiding hospitalization or emergency care) • Real-time clinical feedback • Overcome mobility issues Main requirements: • Personalized diseases-based packages at home (e. etc.) • Video call with doctor/nurse • Home assisted caregiver (e. family members. etc. motion & gas sensors) HEALTH TELEMONITORING Goals: • Help patients with chronic illness to manage their disease(s) • Reduce the need for and cost of medical care (e. asthma.g.g. independent @ Home • Stay active in society • Quality of Life • Better healthcare Main requirements: • TV-centric solution • video call with doctor. friends.The Home Telemedicine Model ELDERLY CARE Goals: • Feel secure.

g. able to be sold on retail as packs and to be installed at home by the End-user him-/herself (or by e.The Concept – Mass deployment of home-based services for elderly and ill people – Automatic capture and storage of vital signs at home & update of medical information with patient-specific alerts – Integrates broad-range of medical devices and home control & surveillance with End-user or remote control capability – Safety and secure online services – Modular and simple line of products. nurses as well as loved ones . non-invasive devices ready-to-use packs. nurse/caregiver) – Easy accessible medical records for doctors – Videoconference on TV with doctor.

Remote Patient Monitoring Targets •CHF •Diabetes •Hypertension •COPD/Asthma •Obesity •Alzheimer’s disease .

Clark. J Wiley & Sons. New York. Medical Instrumentation: Application and Design. 1998 . et al. John W.. JG Webster . 3rd ed.. Ed..Parameters Monitored at Home Source: J.

Home Monitoring Devices .

Home Monitoring Devices .

Home Monitoring Devices Source: Park Associates .

diabetic..Health Peripheral & Home Devices Example of Future Packages Chronic Patient cardiac. asthma. . Home GW Health HUB EGG Blood Pressure Weight Scale Spirometer Family & Elderly Packs General range for check-up + Regular monitoring + online daily support on TV Home GW Health HUB Blood Pressure Weight Scale Panic Button Options for any pack Set-top Box Video Surveillance Surveillance Sensors PDA Cell phone ..

Benefits of Telemedicine Patients – Timely access to locally unavailable services – Improved triage when patient transfer required – Improved quality of care – Reduced readmission for same diagnosis – Improved chronic disease management – Spared burden and cost of unnecessary travel .

Benefits of Telemedicine Health professionals – Access to consultative services – Each consultation is inherently educational – Access to continuing medical education – Reduces sense of isolation .

Benefits of Telemedicine Rural communities – >85% of patients remain in local community – Care in the community (lower cost) environment – Enhanced healthcare and local economic development Society – Lower cost of care – Improve outcomes – “Green” technology .

Benefits of Telemedicine Source: Triple Tree mHealth Report. 2010 . Q1.

ARRA Outcomes / best practices .Challenges to Telemedicine • • • • • • • • • • • • • Reimbursement/initial costs / funding (anti-Stark Law) Infrastructure / network costs Re-engineering practice / clinical acceptance Evaluating cost effectiveness / value added Financial sustainability Malpractice Licensure / credentialing / privileging / practice scope HIPAA / data privacy / security Interagency alignment related to policies / regulatory Integration with EMRs / health information exchange Over-abundance of information about telemedicine Health reform.

2010 .Challenges to Telehealth Source: Triple Tree mHealth Report. Q1.

such as the VA. and in limited small studies of non-closed systems .Does Telemedicine “Work?” • Answer depends on clinical service. and implementation • We believe that telemedicine: • can improve access in rural communities • can improve quality of care • does not necessarily improve productivity (depends upon the workflow design) • has been shown to be cost-effective in closed systems. Kaiser. setting.

Home Telehealth. Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics. Telemedicine and e-Health. 14(10): 1118-1126 . 2008. et al.Remote Monitoring and Telehealth Source: Darkins A. and Disease Management to Support the Care of Veteran Patients with Chronic Conditions.

Remote Monitoring and Telehealth • 10% of Medicare beneficiaries account for 66% of Medicare costs • VA Care Coordination and Home Telehealth • 19% reduction in readmission for the same diagnosis • 25% reduction in length of hospital stay .

Savings Due to Telemedicine .

Consumer Willingness to Pay .

Business Overview Payer Pays for the health contracted services to the The Provider on behalf of End-user. Content Provider/ 3rd Party Service Provide customized services for the End-user on behalf of and under supervision of The Provider. Content Provider and 3rd Party Service as well as hosting the application platform The Provider Operates the service on technical and business level.e. . i. including the acquisition/partnership of/with other players services and handling the commercial items for the end-users. He/she uses the services provided by The Provider. health insurances Telecom/ IT Provider Provide telecommunications infrastructure for End-users. I. End-user Consumer or patient at home participating in the care program paid by the Payer. Integrates the health/care knowledge and technology modules for business communication and community services.e.

Application Overview .

Conceptual Model: Base Features The Provider’s services: • Personal Health Record (PHR) • Physiological database • Chronic Disease Management (CDM) • Other online services (web-based) Health Link API Clinical Portal • Physiological data • Security / Automation data Care Plan Health Link .

& network-centric applications b) Allow 3rd party service implementation/integration. gas sensor.Requirements • Applications: a) Remote Patient Monitoring b) Browser-based applications c) Video-call application d) Customer Management System e) Personal Alarm System (home security & safety) Devices: a) Health sensors (e.) Platform: a) Multi-services platform allowing hybrid services. i.g.g. e. surveillance cameras.e. where the service interface is exposed as a remotely accessible interface c) Infotainment & entertainment platform • • .g. support of home. weight scale. etc.) b) Set-top box & home gateway c) Home security devices (e. etc. blood pressure.

common IT platforms.The Telemedicine Market is Migrating. proprietary IT.. non-interoperable data – Low unit volume. • From – High unit prices rooted in the industry's early focus on medical device markets and business models – Proprietary devices. low margins per unit – Competition based on value-adds and service 46 .. and interoperable data – High unit volume. moderate margins per unit – Competition based on vendor lock-in through high switching costs • To: – Low unit prices as the technology evolves toward consumer markets and consumer business models – Interoperable devices.

Persistence Impacts Telemedicine • Persistence refers to the always on / always connected nature of networked devices • Persistence creates new opportunities for servicebased businesses – – – – – – Real-time data Add-on sales Software updates Device diagnostics Usage statistics Community • Central to business model .

New Infrastructure: Telemedicine • Telemedicine infrastructure would ideally provide: • A standards-based home network gateway which serves as a “wireless base station” for any in-home healthcare device • Limited roaming charges for mobile networked devices to “stay connected” anywhere in the world • A platform that gives developers access to families of devices and allows them to write applications that integrate with these devices • A way to bill for services which allows all service providers to share in revenues • The evolution of this infrastructure is being driven by several different forces • A variety of companies are developing home gateways • Several Mobile Network Operators are developing robust development platforms to support networked devices and associated services • It is believed that individuals efforts will ultimately result in best practices and standards .

Sensor Interface Architecture .

Functional Requirements: Communications • Allows system node to connect with other external nodes in support of: – data communications – person-to-person communications • Should accommodate a range of devices and formats • Should manage bandwidth for other resources in system node: – separate details of what to communicate from how to do this – support demand-driven allocation of bandwidth .

Extending Hospital-Like Connectivity Centralized Applications Key Requirements: • Multiple applications & devices . voice. medical device .no user retraining EMR • HIS • Voice • Meets security requirements for HIPAA compliance • Non-technical staff installable Distributed Users • WAN & LAN transport independent • Can be remotely managed Physicians • Clinics .

Remote Access Points WAN Plug-Play Client LAN Local Connectivity Client VPN To Datacenters PEF Distributed Policy Enforcement Firewall Engine Access Forwarding Enterprise Secure Wi-Fi Enterprise Secure Wired LAN/WAN/Internet Priority Per User/Device/Session Dynamic Policies via Controller .

com/developerworks/websphere/techjournal/1001_hanis/1001_hanis.html .Solution Architecture Source:

Community Architecture Source: Dena Puskin. HRSA .

Consumers Want Single Source .

mHealth Companies Look to MNOs • Technology resources • Device management and diagnosis • Managed services • One-stop global deployment • Commercial resources • Participate in the sales and marketing of services • Finance sales with up-front subsidies • Design connectivity fees to match the nature of the particular offering • Facilitation of systems • Accommodate patient mobility • Manage device and service diversity on a network level .

Provider of Choice for Consumers .

Q1.Who Will Drive Adoption? Source: Triple Tree mHealth Report. 2010 .

Enhancing Telemedicine Adoption Eliminate the rural requirement under Medicare Fund remote monitoring and home telehealth Fund store and forward telehealth in lower 48 Eliminate the credentialing barrier under Medicare Ensure Medicaid coverage across the states Ensure that any plan receiving federal dollars covers telehealth .

com (562)726-4256 .Thank You Alex Gerwer asg_akn@yahoo.