Joint ITU-WHO Workshop on
e-Health Standards and Interoperability
(Geneva, Switzerland, 26-27 April 2012)
Continua Health Alliance
Beyond the Four Walls of Traditional
Healthcare
Charles Parker, Executive Director,
Continua Health Alliance
Chuck.parker@continuaalliance.org
Geneva, Switzerland, 26-27 April 2012
Continua Health Alliance
Continua is a not-for-profit (U.S. - 501c6) association
focused on the development of interoperability standards
for personal connected health devices.
Continua also works as a trade association to enable
adoption and knowledge sharing within providers,
policy/regulatory bodies, payers, vendors and consumers.
Continua was founded in June 2006
Main location in Portland, OR with offices in
Austin, TX , Brussels and Tokyo
Currently, Continua has 240 member
organizations
Geneva, Switzerland, 26-27 April 2012
2
Main results to date:
Involvement in EC-funded and International
projects
Smart Personal Health 2010/11:
Interoperability recommendations
Renewing Health large scale pilot 2010-13:
Telemedicine RCTs in nine EU regions
eHealth Governance Initiative 2011-14:
coordinates eHealth in EU starting with
common approach to electronic identification
Japanese Government – requirement for use
in Sendai Earthquake refugee camps
US Veterans Program – requested
requirement for new vendor procurement
Geneva, Switzerland, 26-27 April 2012
3
Future activities
Momentum thematic network 2012-14:
Developing a blueprint for deploying telemedicine in
regular healthcare
eHealth Innovation 2011-1014:
Developing roadmap for integrated and interoperable
eHealth services
Advisory roles in other large scale pilots for integrated
care and telemedicine (2013-?)
Participation in thematic network to provide a
technological base for large-scale deployment of
innovative services (2013-?)
Leadership roles in US led Health Information
Exchange
Work with GSMA on deploying as a standard for
Mobile Operators internationally
Geneva, Switzerland, 26-27 April 2012
4
Challenges, lessons learned
Long lead times for initial development of
Guidelines to products
Interoperable devices often not available
on local markets
Price often primary driver of eHealth
procurement
Legal uncertainty for procurers mandating
standards compliance
Reimbursement issues with providers
Uncertain regulatory models
Geneva, Switzerland, 26-27 April 2012
5
Contact details for further info
Charles Parker,
chuck.parker@continuaalliance.org
Questions to:
admin@continuaalliance.org
Web Address
www.continuaalliance.org
Geneva, Switzerland, 26-27 April 2012
6
[Optional]
Additional slides
Geneva, Switzerland, 26-27 April 2012
7
Executive Summary
In this new era of changing healthcare models and the
potential for governments to further institute
reimbursement change, where are the new opportunities?
How do we reach new consumers and engage them?
An opportunity exists with personal connected health.
Continua Health Alliance is a not-for-profit (501c6)
association focused on the development of
interoperability standards for personal connected health
devices. Continua also works as a trade association to
enable adoption and knowledge sharing within providers,
policy/regulatory bodies, payers, vendors and consumers.
The discussion will cover the questions of new business
models, workflow changes, consumer engagement
models, business partner opportunities and new revenue
streams.
8
About Continua Health Alliance:
Continua Health Alliance is an international not-for-profit industry
organization dedicated to establishing guidelines for combining
and applying existing standards to personal connected health
products and services.
Continua makes a transition from the personal connected health
marketplace to a marketplace of interoperable devices that
facilitate better care, empower consumers, improve outcomes
and lower overall healthcare costs possible. With more than 240
member companies around the world, Continua is comprised of
technology, medical device and healthcare industry leaders as
well as service providers dedicated to making personal connected
health a reality. .
9
Beyond the Four Walls of Traditional
Healthcare
Today
Current rates of adoption are low in the home space – less
than 7%
Primary use of the technology is limited to Post-acute
recovery with some Aging at Home programs
Personal use is not integrated with clinical data
Only limited trials of data flowing into Medical Records in
US (outside of the Veteran’s Health deployments)
Why?
Some opportunities
10
Cancers, mental disorders and diabetes are projected
to grow the fastest, even though they are currently
not the highest in prevalence
Projected Rise in Cases by 2023, by Chronic Disease
70%
62%
60%
54%
53%
50%
41%
40%
39%
31%
29%
Pulmonary Conditions
Stroke
30%
20%
10%
0%
Cancers
Mental Disorders
Diabetes
Heart Disease
Hypertension
Source: Milken Institute
Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and
is restricted
11 to that use and cannot be copied or shared without prior written consent of PwC.
Projected
rise In
population
(19%)
Hypertension has the highest cost to employers,
followed closely by cancers
Lost Productivity, by Chronic Disease (US$B)
300
$280
$271
250
200
$171
150
$105
$105
100
$94
50
$22
Hypertension
Lost
productivity
definition:
Cancers
Mental Disorders
Diabetes
Heart Disease
Pulmonary Conditions
Stroke
The economic cost resulting from employees and their caregivers missing work days
(“absenteeism”) or showing up but not performing well (“presenteeism”). This
economic impact of chronic diseases is estimated at over $1 trillion annually
Source: Milken Institute
Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and
is restricted
12 to that use and cannot be copied or shared without prior written consent of PwC.
Although cardiovascular diseases result in the
greatest treatment expenditures, stroke has the
highest cost on a per-case basis
Total US Treatment Expenses ($B) and Number of Patients (millions)
100
60
90
50
80
70
60
50
30
40
20
30
20
10
10
-
Cardiovascular
diseases
Treatment
Expense
Per Patient
($)
Cancers
Mental disorders Osteoarticular
diseases
COPD and
asthma
Hypertension
Total Expense ($B)
4,114
4,661
1,908
1,625
1,155
Diabetes
Kidney Disease
Stroke
Epilepsy
Maternal-Fetal
Health
5,113
3,303
1,959
# of patients (millions)
858
2,169
4,680
Source: US Department of Health and Human Services
Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and
is restricted
13 to that use and cannot be copied or shared without prior written consent of PwC.
# of Patients (millions)
Total Expense (US$B)
40
Cost components vary greatly by disease; the large
share of hospitalization costs for cardiovascular
diseases offers a great cost reduction opportunity
US Total Medical Expenses -- by Disease by Type of Service (US$B)
100
95.6
90
80
72.2
72.1
70
60
57.0
Home Health
53.7
Prescribed Medication
50
47.4
45.9
Emergency Room
40
Inpatient
Outpatient or Office Visit
30
19.9
20
18.8
8.2
10
2.7
0
Cardiovascular
diseases
Cancers
Mental
disorders
Osteoarticular
diseases
COPD and
asthma
Hypertension
Diabetes
Kidney Disease
Stroke
Epilepsy
Source: US Department of Health and Human Services
Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and
is restricted
14 to that use and cannot be copied or shared without prior written consent of PwC.
Maternal-Fetal
Health
Per-patient medical expenses also indicate that a
large portion of stroke expenses are attributed to
home health, indicating a potential mHealth area of
opportunity
US Average Medical Expenses Per Patient -- by Disease by Type of Service (US$000s)
6
5.1
5
4.7
4.7
4.1
4
Home Health
3.3
Prescribed Medication
3
Emergency Room
2.2
2.0
1.9
2
Outpatient or Office Visit
1.6
1.2
0.9
1
Cardiovascular
diseases
Cancers
Mental
disorders
Osteoarticular
diseases
Inpatient
COPD and
asthma
Hypertension
Diabetes
Kidney Disease
Stroke
Epilepsy
Source: US Department of Health and Human Services
Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and
is restricted
15 to that use and cannot be copied or shared without prior written consent of PwC.
Maternal-Fetal
Health
Beyond the Four Walls:
Personal Connected Health
www.continuaalliance.org
16
“Our Mission is to establish an
ecosystem of personal connected
health systems that empower
individuals & organizations to better
manage their health and wellness”
17
Goal:
Realize
Peak
Health
Potential
Realize Peak Health Potential
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
Pre-Illness
Illness
Wellness
25
Modifiable
lifestyle
Irreversible
Disease state
Higher $$ Costs to All
Age
0
65
60-80% Lifestyle
Management
Happening earlier in
life
Unpredictable Health
Deat
h
Predictable (Rules-based)
Health
Adapted from Oregon Medical Labs
5/30/2016
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The Goal: Improve Lifestyle Choices,
Health
= Non Modifiable
Contributors to
Disease
= Modifiable
Contributors to
Disease
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
19
A Solution: Personal Connected
Healthcare
There is increasing evidence to support the value of
remote monitoring for individuals with chronic
conditions, 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;
20
Primary focus areas
Health &
Wellness
Chronic
Condition
Management
Living
Independently
Longer
With a second separation and
focus on non-regulated and
regulated devices to ensure
Already Complete: Interfaces & Standards
Personal Device
Aggregation
Manager
Telehealth
Service
Center
Health
Records
Thermometer
Pulse Oximeter
CCD
Pulse /
Blood Pressure
PCD 01
Weight Scale
Glucose Meter
HDP and LE
Cardio / Strength
EHR
Independent
Living Activity
HIE
PHR
Peak Flow
Medication
Adherence
Physical Activity
Device
Connectivity
Wide
Area
Network
(WAN)
Interface
Health
Record
Network
Interface
22
NHIN
Examples of Solutions implemented:
Aging Independently – Garfield Center:
(Zigbee enabled living center)
Chronic Condition
Oxygen level, Heart rate, Weight, Blood pressure
Activity Monitors
Ensure appropriate levels of activity
Gait monitor
Ensure proper orientation and early stroke warning
Devices are wired for entire center. Individuals can
move about the entire facility.
5/30/2016
23
Examples of Solutions implemented:
Veterans Administration: (45,000+ end users of
technology)
Fixed system for deployment to chronic population
Largest deployment in the world
Health conditions
Diabetes
Heart Failure
Hypertension
COPD and Asthma
Published reports show savings of 53 to 85% over
existing practice and treatments.
5/30/2016
24
Examples of Solutions implemented:
Sub-Saharan Africa (Maternal health):
Pulse/Oximeters
Heart rate
Blood Pressure
Pre-eclampsia
Hypertension
Glucometers
Measure for gestational Diabetes
ECG
Mobile platform
Devices are portable and can be shared
5/30/2016
25
Examples of Solutions implemented:
Japan Earthquake/Tsunami:
Personal Health Records
Allows data to be shared quickly as residents are
transferred/moved
Provides an easy way to acquire data in single location
Devices
Japan has required devices to have standardized interfaces
to allow easy implementation
Can carry devices from different manufacturers and still
acquire data
Standardization and Personal Health Record allows
transfers of displaced to have records follow them.
5/30/2016
26
Examples of Solutions in development:
Organized Competition for engagement:
Studies repeatedly show that:
Competition is highest driver
In a group that is non-threatening
Group results
Self-insured employee activation
Can provide optimized results
Near real-time
Multiple measurements for diversity
Can provide a safety measure in sports
Sensor technology can be deployed for safety
Devices are portable and can be shared in situ
5/30/2016
27
Examples of Solutions in development:
Diagnostic Gaming:
Provide advanced platforms that:
Can measure health of individual
Recovery of individual
Provide rehabilitative assistance
Determine early signs of cognitive issues
Can measure a whole facility
Devices can be fit on individuals and can be re-used.
Architecture allows standardized acquisition.
5/30/2016
28
Examples of Solutions:
Highly Mobile Platforms:
(Emergency Response)
Personal Health Records
Allows data to be shared quickly
Provides an easy way to acquire data in single location
Portable and unobtrusive
Can carry in pocket or “stuck on”
Can carry devices from different manufacturers and still
acquire data
Wireless setup and portable devices allowed quick
dissemination and deployment
5/30/2016
29
Key Points
The certified technology provides a
standard based approach to collecting
device data rather than having to
manually input data.
Common tools for representing data
Many devices specializations defined
Can integrate technology into systems in an ad
hoc manner
Technology can be repurposed quickly
Can be integrated into health records or set up
for quick single issue management
Highly portable
Thank you!
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