Remote Patient Monitoring

IBM Healthcare and Life Sciences Innovation Team

Enabling Homecare with Remote

Monitoring Technology

Kathy Schweda

WW Business Segment Leader

Pervasive Healthcare Solutions

12 June 2006

© Copyright IBM Corporation 2006


IBM Healthcare Innovation Engine: Evolution to Personalized

Healthcare

Automated

Systems

Personalized Health Care

Lifetime Health Management

Pre-symptomatic Treatment

CDI

Information

Correlation

1 st Generation

Diagnosis

Source: Kathy Schweda

Rules Based Clinical Response

Clinical Decision Support

Remote

Monitoring

In-Pt Automated Vitals

Clinical Trial Data Collection

Chronic Disease Mgmt

Traditional HC

Patient Reported Data

Episodic Treatment Electronic Health Records Information Augmented

Non-specific

(Treat Symptoms)

Data and Systems Integration

Organized

(Error Reduction)

Evolutionary Practices

Personalized

(Disease Prevention)



Definitions

Telehealthcare – Broad spectrum of remote services delivered outside of the traditional healthcare institutions using telecommunications such as phone, broadband or wireless technology.

Telemedicine – Form of telehealth that describes the direct provision of clinical care for diagnosing, treating or follow up with a remote patient

Remote Patient Monitoring (RPM) – Form of telehealth that uses sensing technology and telecommunications to deliver monitored data to clinical professionals from remote patients



Market Intelligence:

Disease Management

Remote Patient Monitoring



Scientific Literature Search identifies Savings:

Cardiac, Diabetes, Obesity, Asthma…

Clinical trial of an Internet-based case management system for secondary prevention of heart disease: results indicate that fewer cardiovascular events occurred …. resulting in a gross cost savings of $1418 US dollars per patient. With a projected program cost of $453 USD per patient, the return on investment is estimated at 213%.

For diabetics healthcare costs per individual are estimated to be $950 less per year for well managed vs. unmanaged patients (1)

$450 lower healthcare costs per person per year in lower healthcare costs for active vs. obese/sedentary individuals (3)

For high-risk and high-cost asthma patients, …analysis revealed that the most cost-effective alternative for reducing ER visits was a peak flow-based selfmanagement plan. The peak flow-based self-management program had an incremental cost-effectiveness (C/E) ratio of $ 60.57 per ER visit averted compared to usual care/NAP…The PFB-AP was also the most cost-effective in reducing asthma hospitalization costs with an incremental C/E ratio of

$300 per hospitalization prevented, compared with usual care (4)

(1) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11176811






MI Sources

Advisory Board 3/16/06: Telemedicine takes hold as means to reduce costs, ED visits

 president of the American Medical Association says the technology can “greatly enhance the patient-physician relationship” by providing patients with around-the-clock access to medical advice







A study by Kaiser Permanente compared two groups of 100 patients and found that patients who used telemedicine technology reduced hospitalizations by 200 days between May 1996 and November 1997.

Similarly, a telemedicine program run by the Eddy Visiting Nurses Association reduced ED visits by 29% and overall hospitalizations by 37%.







Meanwhile, the number of companies manufacturing telemedicine equipment has tripled to

15 over the last three years, and according to the American Telemedicine Association, the U.S. Department of Veterans

Affairs hopes to double the number of patients using telemedicine at home to 20,000 by next year.

The AP notes that several states, especially those with vast rural areas, are moving to reimburse providers for telecare provided to Medicaid beneficiaries (Choi, AP/Long Island

Newsday, 3/12).



MI Sources Cont’d

Forrester 1-19-06 Integrated Health Management Will Dismantle Disease

Management’s Information Barriers

by Jennifer Gaudet with Eric G. Brown, Will McEnroe







By 2007, two-thirds of all employers plan to offer benefits that include DM — a big leap from the 45% that do so today (see Figure 1).1

Forrester surveyed 18 health plans about their investments in DM-related technologies and found that 13 of them will grow their budgets for DM technology in 2006 (see Figure 2).

The Medicare Health Support programs — the Center for Medicare & Medicaid Services (CMS)initiated projects that intend to demonstrate the value of DM — have further focused national attention on the topic

Frost & Sullivan 9/27/05 Growth in Flexible Patient Monitoring Solutions by

Nathan H. Cohen



$100M Market by end of 2006 for Remote Patient Monitoring





Reduce volume of acute patient visits

Maximize medical treatment at low cost



Growth in Employer Disease Management Activity



Health Plans Investment in Disease Management



Digital-ready consumers are more prevalent than you might think

Digital-Ready Consumer Defined:

•Either a broadband connection or a home network,

AND

•Any two-way, wireless communication device (cell)

Approaching

Age

Under 50

Digitalready

33%

Boomer vanguard 50 - 59 29%

60 - 64

65 - 69

21%

15%

Today’s seniors 70 - 74

75 - 79

8%

6%

80+ 2%

Base: US consumers

Source: Forrester’s Consumer Technographics® 2005 North American Benchmark Study



Who Pays?

Forrester Research: Who Pays For Healthcare Unbound

The $34 Billion Market For Personal Medical Monitoring

by

Elizabeth W. Boehm with Bradford J. Holmes, Eric G. Brown, Lynne “Sam”

Bishop, Sara E. McAulay, and Jennifer Gaudet



Insurers Aren’t Eager To Pick Up The Tab For Healthcare Unbound A recent survey sponsored jointly by the American Telemedicine

Association and AMD Telemedicine identified only 34 telemedicine programs receiving funding from health insurers.



To date, only five states — California, Kentucky, Louisiana, Oklahoma, and Texas have passed legislation mandating reimbursement of telemedical consults that would be covered if treatment occurred in the traditional face-to-face mode.

Spyplgass Consulting: Healthcare Without Bounds 04-2006

 65% of organizations interviewed have invested in Remote Patient

Monitoring



71% using RPM have received State/Federal Grants



Why are Organizations Investing in RPM Solutions

Source: Healthcare Without Bounds – Spyglass 4/06



Business Value

Reduction in costs for chronic condition management:

 chronic condition acute care

 long term chronic care by primary physician

 hospitalization

Reduction in costs for care of elderly:



Rehab, nursing and long term care

Improved Clinical Outcomes

Improved Health & Wellness



Mobile Monitoring – business driver summary:

Demographics





Aging Population

Chronic Conditions Increasing

Costs



Escalating

Resources



Less Available Beds



Staff Shortage: Physicians, Nurses, Allied Professionals (RT, PT, LT)

Outcomes





Unmonitored patient leads to acute and rescue events

Self reported results prone to errors:



No data





Bad data

Adjusted/Altered data

Technology

 Current Devices and Communications Support Remote Monitoring



Three Precepts Predict Technology Penetration

To succeed, technology’s benefits must be:

1.

Commensurate with costs

2.

Obvious extensions of an existing behavior

3.

More visible than the technology

Source: Forrester HC Unbound 8/05 Boehm



One Patient, One System ( Future )

Overview of Flexible Monitoring

ER Monitor

Transport

Monitor

ICU/Bedside

Monitor

Patient

OR

Monitor

Remote

Monitor

PACU

Monitor



Forrester Forecast for Total Healthcare Unbound Market:

Money to be saved; Money to be made; Reimbursement Models to change

CURRENT SPEND ON CHRONIC CARE-$1T = 75% of 1.4T annual US HC Spend



Interoperable Vision for Home Healthcare



Any Medical Device



Any Communications Hub



Any Place



Any Time



Telemedicine:

Examples in the

Market



The Home Healthcare Ecosystem is Complex

SENSORS CONNECTIVITY

AGGREGATION

COMPUTATION

Cholesterol

Monitor

Weight

Scale

Home sensing & control

Bloodpressure

PC

Bed / Chair

Sensors

Glucose

Meter

Personal

Health

System

Thermometer

Implant

Monitors Pulse

Oximeter

Cell Phone

Spirometer

Baby

Monitors

Ethernet

Medication

Tracking

PERS

Set Top Box

Pedometer

Consumer

Electronics

Fitness equipment

Aggregator

SERVICES

Healthcare

Provider

Service

Disease

Management

Service

Diet or Fitness

Service

Personal

Health

Record

Service

Implant

Monitoring

Service



Open Standards Will Harmonize the Ecosystem

•Device communications standards (IEEE, ISO)



Wired/wireless

•Data transaction standards for interoperability

(HL7, ANSI; IHE Pt Care Device activity )









BP transaction = x

Glucose transaction = y

Weight transaction = w

Alerts and messaging

•Device Application Standards (Java, JavaSoft)



Applications to manage communications/device adapters

•Branding/ Certification of Devices (Consortium-like WiFi – MedFi?)



Certification of interoperability



May support and populate the standards bodies

•Security and Privacy Standards (HIPAA)





Encryption

Authentication

•Regulatory Compliance (FDA, FCC)

 Level playing field for device manufacturers



Telemedicine Solutions- Proprietary Architectures

Honeywell HomMed

McKesson Telehealth Advisor RPM (Remote

Patient Monitoring)

Philips Motiva

ADT

CyberNet

Carematrix

Partners Telemedicine: Tele-dermatology

Vitaphone

CardioNet

Lifeline

BodyMedia

Xanboo iMetrikus

BodyKom by TeliaSonera

Health Hero

Ayaa

Medic4all / TelcoMed



Examples of Available Homecare Solutions

Mitsubishi International Corporation

HomeCare Support (2003)

Vital Sign Monitors

Internet connection

Pulse Oxi meter

Wireless Data Receiver AD9030T

Blood Pressure

Glucose Meter

TV Phone Heath Monitor Conference

Medic4All Services International

WristClinic™

Body Weight &

Fat

ECG Monitor

NTT I-see TV Phone

Pedometer



Medication Compliance Examples

Bang & Olufsen Medicom, Denmark

“Helping Hand”

Bluetooth

Honeywell HomMed

MedPartnerTM Medication Reminder

RFID Technology

SWEDEN

IPP: Intelligent

Pharmacuetical

Packaging



Tele-healthcare Summary

Literature and experience support improvements in patient care and reduced costs

Traditional telemedicine relies on existing wireline and broadband infrastructure

Limits ability to monitor patients outside of the home



Use Case: Chronic Condition Management – Personal Care Connect

BT

Data

Server

Patient Diary

 Monitoring device collects patient data

 Data is sent to mobile hub via Bluetooth pairing

 Data is automatically sent to server but can also be inspected on hub

 Data is processed on server and inspected by physician

 Custom Features can be built such as entering data into a patient diary on the hub

 Care plan is determined by physician based on medical data analysis



Infrastructure and integration details

Patient

Sensor Data

Client

Wireless

Sensor / Client

Gateway

Hosting middleware

Internet

Device Domain / Network

“Gateway”

Operator

Internet

Provider

Networks

IBM

Software

IBM /Partner

Software

Portals &

Applications

Bluetooth

GPRS

Database

Internet Network

Server

Monitoring and

Data Mining

Applications

Personal

Wireless Gateway

Stakeholders

 Provider

 Payer

 Family

Caregivers



Application Portal Examples: Elder Care Provider screen



Medication reminder



Medication taken



Standards Used by Component

Medical Device



Wireless sensor agents : Bluetooth

Hub



Wireless sensor agents : Bluetooth



WebSphere client for VPN secure data transfer between hub and server-

APACHE Open Source



J2ME/CLDC 1.0 or 1.1/MIDP2/JSR82 (OSGI - stationary hub)

Server



WebSphere server components to accept and persist secure data-

APACHE Open Source



HTTP 6.0



IBM benefits from standards-based approach:











The Fastest Time to market and Highest Value impact

The Easiest to maintain and most Responsive to changes

The Highest ROI in terms of technology, hardware and personnel

Extremely Scalable and Reliable solutions adaptable to existing IT infrastructures

Minimizes the Complexity of the ecosystem

Customers Benefit:

• LOWEST COST OF OVERALL OWNERSHIP

• LOWEST-RISK INTEGRATION APPROACH

• GREATEST OPPORTUNITY FOR SUCCESS



Summary of Pilot Engagements: Personal Care Connect

Project

Elder care community pilot

Renal Study

Juvenile

Diabetes

Study

IBM Disease

Mgmt

Asthma

Partner

Municipality in Europe

Academic

Medical

Center -

Europe

Children’s

Medical

Center-US &

Clinical ISV

Objectives

Targeted

Disease(s)

Remote monitoring to improve care of the elderly in a community setting including medication compliance.

Goals: Decrease costs through Reduction of doctor visits, nursing home/hospital admissions.

Improved resource management – focus home visits on those patients with acute need.

Remote monitoring of pediatric patients suffering renal failure.

Goals: Reduction in rescue events between dialysis. Improved health through medication management between dialysis.

congestive heart failure

Hypertension

Pre-diabetic kidney disease

Demonstrate real-time, objective delivery of children’s glucose data into the PHR

Goals: Reduce ED and admissions for children with diabetes. Reduce risks of associated illness through better glucose management.

juvenile diabetes

IBM CHQ w/ selected

Disease Mgmt firm

Academic

Medical

Center -USA

Demonstrate incremental improvements in health of employees with chronic conditions through remote monitoring.

Goals: Further reduction in claims cost for selected employee populations –

$36M saved in 2004 on 15K employees -$2400/em

Proof of concept to successfully monitor and control Chronic Asthma with available monitoring technology and a patient diary congestive heart failure diabetes

Asthma

Biomedical Devices blood pressure cuff medical weight scale patient UI for medication compliance

20 families using the system with positive response to the technology blood pressure cuff – pediatric medical weight scale glucose meter future: injection registration device medical weight scale

Glucose meter

Pulse Oximeter

Spriometer

Analog Peak Flow Meter

Status

Phase 1 completed with excellent adoption – next phase in home dialysis patients

Integration testing of PCC to

PHR, Payer collaboration, then kick off

4Q’06

Decision on employee population and pilot definition by 7/20

Defined pilot with selected patients to start

4Q 2006



Pilot Results: University Hospital of

Heidelberg

September 2005 to present



Section Pediatric Nephrology of the University Hospital Heidelberg

Dialysis Center for Children and Adolescents

General Population

8 million

Study Population:

•

50

children with chronic renal insufficency

•

30

children and adolescents in dialysis treatment

•

90

children and adolescents after kidney transplantation



Pilot Project with Heidelberg:

Clinical survey at the Pediatric Nephrology

Content

• Test persons: 80 patient weeks with teenage dialysis patients

• Duration: 20 weeks survey + 4 weeks technical and organisational preparation

• Measurements: blood pressure, weight, 1x a day

Data-

Recordation,

Data-

Transmission,

Visualisation

Expansions

• Recordation of the blood pressure and weight measurements via Bluetooth and transmission to the mobile phone

• Mobile Health Server receives data and archives it into an internal database

• Visualisation of the patients data of different periods via Web-

Interface

• Integration of additional sensors for additional measurements

• Connection to Electronic Medical Patient Record Systems

• Connection to Hospital Information Systems



Results of the Pilot Project

Medical Results

• Patients and Parents:

• Very high acceptance

• Easy handling

• Consistent use

• Major relief from responsibility for therapy management

• Medical Practitioners:

• Helpful tool for ambulant therapy

Documentation of hypo-/hypertensive crises

Taking corrective action with fluid balance

Technical

Results

• Total availability

• Reliable transfer of data

• Easy handling

• Robust against temporary interruption of network infrastructure

(GSM/GPRS, Bluetooth)



Remote Monitoring in Action



Pilot Results: Denmark Eldertech



.... the ”Interactive Citizen Home” innovation partnership with the

University and Municipality of Aarhus in Denmark

Leverages PCC solution developed by

IBM Research and HCLS Solution

Development…

BT

… in unique 3-way innovation partnership with

Center for Pervasive Healthcare (academia)

City of Arhus, attracting public R&D funding

…

WPS

GPRS xDSL

PCC

Server

Browser

… to enhance quality of life for elderly citizens through assisted living and communication

…

… automate data monitoring and alerts..

… and enable unified service delivery for a large care provider..

... while extending the strong position of IBM/Acure in healthcare to the wider area of eldercare in a project led by BCS Strategy & Change and involving IBM Research, Software, Systems and Lenovo .

Pilot Extended operation

Pilot evaluation

Research Workstream

2005 2006



Eldertech in Action



Innovations



One Patient, Many Monitoring Scenarios, One Record

Flexible Monitoring

ER Monitor

Transport

Monitor

Patient

Remote

Monitor

PACU

Monitor

ICU/Bedside

Monitor

OR

Monitor



Pulmonary Gas Exchange Monitors

J Clin Monit Comput. 2002 Apr-May;17(3-4):241-7.

Related Articles, Links



Monitoring pulmonary function with superimposed pulmonary gas exchange curves from standard analyzers.

Zar HA , Noe FE , Szalados JE , Goodrich MD , Busby MG .

Department of Anesthesiology, University of North Carolina at Chapel Hill, 27599-5136, USA.

OBJECTIVE: A repetitive graphic display of the single breath pulmonary function can indicate

changes in cardiac and pulmonary physiology brought on by clinical events. Parallel advances in computer technology and monitoring make real-time, single breath pulmonary function clinically practicable.



High Quality Remote Cardiac Monitoring

Telzuit: BioPatch Wireless Holter Monitor

WristClinic™

Medic4all/Telcomed



Future: Bluetooth enabled

Medtronic

CardioNet

GE



Implanted Glucose Meter – link to RPM in the future

C – Glucose Sensor

D – Wireless transmitter to Insulin Pump (and

RPM communications hub in the future)

A – Insulin Pump

B – Insulin Delivery Canula



IHE – Integrating the Healthcare Enterprise – US Initiative

Healthcare industry organization promoting coordinated use of established standards to improve healthcare IT system integration





IHE is NOT a standards development organization



IHE profiles clarify the use of existing standards such as HL7 and DICOM

IHE produces healthcare integration profiles which:





Address a given healthcare integration scenario

Build upon one or more existing, established standards





Define constraints which limit the options available when using underlying standards

To reduce the effort and cost to integrate systems spanning a diverse set of healthcare IT vendors



IHE Patient Care Device (PCD) Activity in 2006

New domain for IHE; working on first set of profiles in

2006







Enterprise Communication of PCD Data (ECPCDD)



Consistent, reliable communication of PCD data to clinical data repositories, clinical decision support systems and EMRs

Filter PCD Data (FPCDD)





Filter PCD data by (type, instance, rate, etc) flowing to healthcare IT systems



Builds upon ECPCDD

Patient Device-ID Association (PIDA)

Addresses how to bind enterprise patient id to PCD data



HHS contract to build a Patient Centric Network prototype for information exchange: Monitored data will feed the repository

Contract background

 Duration 1 year

 HHS defined use cases

Prototype Objectives:

• Start-up money to seed the market

• Establish up to 4 “utilities” that can contract with communities for future support

• Create market momentum

• Pressure/incent the consortias to invest in building a full fledged community based healthcare information exchange

• Accelerate eHR adoption


Summary


•Healthcare environment drives the need for Remote Patient

Monitoring

•Technology exists to enable it

•Investment is growing as benefits are validated

•Existing standards and emerging ones help drive down solution costs

•Innovation in sensor technology and wireless communications builds the device portfolio



Thank You!

Information Based Medicine

IBM Healthcare and Life Sciences

Kathy Schweda

World Wide Business Segment Leader

Pervasive Healthcare Solutions kschweda@us.ibm.com

+01 414-223-6749


Remote Patient Monitoring

Kathy Schweda

Forrester Research: Who Pays For Healthcare Unbound

The $34 Billion Market For Personal Medical Monitoring

Spyplgass Consulting: Healthcare Without Bounds 04-2006

Reduction in costs for chronic condition management:

Reduction in costs for care of elderly:

Improved Clinical Outcomes

Improved Health & Wellness

Demographics

Costs

Resources

Outcomes

Technology

Three Precepts Predict Technology Penetration

To succeed, technology’s benefits must be:

Commensurate with costs

Obvious extensions of an existing behavior

More visible than the technology

Interoperable Vision for Home Healthcare

Any Medical Device

Any Communications Hub

Any Place

Any Time

Open Standards Will Harmonize the Ecosystem

Literature and experience support improvements in patient care and reduced costs

Traditional telemedicine relies on existing wireline and broadband infrastructure

Limits ability to monitor patients outside of the home

Infrastructure and integration details

Medical Device

Hub

Server

The Fastest Time to market and Highest Value impact

The Easiest to maintain and most Responsive to changes

The Highest ROI in terms of technology, hardware and personnel

Extremely Scalable and Reliable solutions adaptable to existing IT infrastructures

Minimizes the Complexity of the ecosystem

Customers Benefit:

General Population

Study Population:

•

children with chronic renal insufficency

•

children and adolescents in dialysis treatment

•

children and adolescents after kidney transplantation

Healthcare industry organization promoting coordinated use of established standards to improve healthcare IT system integration

New domain for IHE; working on first set of profiles in

2006

Thank You!

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