The Challenge
Worldwide today:
– 1 billion adults
overweight
– 860 million individuals
with chronic conditions
– 600 million individuals
age 60 or older
– 75-85% of healthcare
spending is on chronic
condition management
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Source: World Health Organization; McKinsey
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
2
The 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; Scalvini S
et al., 2001; Elsner et al, 2006; Van Ginneken et al 2006)
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3
Continua Domains
To organize its work, Continua segmented the market in
three large Domains
Living Independently
Longer
Wellness
Manage Chronic Conditions
People are at the center of everything we do
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4
Interfaces & Standards
Personal Device
Thermometer
Aggregation
Manager
Pulse Oximeter
Telehealth
Service
Center
Health
Records/
Networks
Pulse /
Blood Pressure
Weight Scale
Glucose Meter
Cardio / Strength
PHR
Independent
Living Activity
EHR
Peak Flow
Medication
Adherence
Physical Activity
Electrocardiogram
Insulin Pump
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Personal
Area
Network
(PAN)
Interface
NHIN
Wide
Area
Network
(WAN)
Interface
Health
Record
Network
(HRN)
Interface
HIE
5
Interfaces & Standards
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WAN Code
The Continua WAN interface is the component of the
Continua end to end architecture that enables measurement
data to flow from an Application Hosting Device (AHD) to a
WAN device with the resources necessary to share this
information with a Personal Health Monitoring Report
(PHMR) enabled system such as an Electronic Medical
Record (EMR).
The CESL WAN interface is a JAVA based code library that
provides the WAN Observation Sender component of the
Continua WAN interface for a AHD. This code library
implements the following interoperability standards:
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WAN Code
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•
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HL7 v2.6 EDI Encoding
IHE PCD-01 transaction of the IHE DEC profile
SOAP 1.2 over HTTP v1.1
Web Services Interoperability Organization Basic Profile
Version 1.1 (WS-I BP)
• Web Services Interoperability Organization Basic
Security Profile 1.0 (WS-I BSP)
• Web Services Interoperability Organization Reliable
Secure Profile (WS-I RSP)
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8
Coming - mCESL
• J2ME version of PAN, Manager and WAN link
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The Problem
• Integration of Patient Care Devices
– Value Proposition:
• Supports on going care at lower cost points by
allowing patient to be at home
– Issues blocking effectiveness
• Many different devices
• Getting useful data to the people who need it
Providing Continua Solutions for a Connected Health World
The Continua Solution
• Continua is an industry trade association that
– Profiles standards that enable devices to
represent and deliver medical observations in a
common way
– Addresses regulatory issues associated with the
use of the information
– Promotes the market adoption of the overall
ecosystem
• Focus – The technical Framework
Providing Continua Solutions for a Connected Health World
Overview
Providing Continua Solutions for a Connected Health World
PAN/LAN Interface
(Personal Area Network/Local Area Network)
Providing Continua Solutions for a Connected Health World
Representing Device Information
• Core Technology is from ISO/IEEE 11073
– 11073 Nomenclature: Maps a medical
understanding of an observation to a number
(systolic blood pressure)
– 20601 Standard: Building blocks for representing
and communicating information
– 104XX Specializations: How to represent a
particular class of device
Providing Continua Solutions for a Connected Health World
Device Classes
• ISO/IEEE 11073-104XX work on going, already
covers many common devices including:
– Pulse oximeter
– Blood Pressure
– Weight Scale
– Glucose meter
– Medication Monitor
– Peak Flow
Providing Continua Solutions for a Connected Health World
One collection point
• 20601 (Optimized Exchange Protocol) specifies
how a common local aggregator collects this
information from different devices
– One hub (PC, cell phone, TV, or home Internet
gateway) can collect data from any device from
any manufacturer
– Bluetooth, USB, ZigBee
Providing Continua Solutions for a Connected Health World
PAN/LAN Interface (1 of 2)
Continua PAN Server (IEEE 20601 Agent)
• Pan Server sits on the medical sensor component or
Personal Health Device (PHD)
– Implements common data representation
– (Can) store data while device is “off line”
– Sends data to PAN Client when communication is possible
Providing Continua Solutions for a Connected Health World
PAN/LAN Interface (2 of 2)
Continua PAN Client (IEEE 20601 Manager)
• Resides on a hub or aggregation point (called an
Application Hosting Device) such as a cell phone or
PC
– Must be in close proximity to the server
component
– Can store data locally or forward data
automatically using other parts of Continua
Ecosystem
Providing Continua Solutions for a Connected Health World
LNI PAN Building Blocks
LNI Provides core PAN/LAN technology
• HealthLink PHD – The PAN Server component for
medical sensors
• HealthLink OXP – The PAN Client for aggregators
– mOXP - Java implementation of PAN Client targeted at
Android platforms
– HealthLink SDK for Android
– OXPLib – Continua Certified PC class solution for Windows
32 and 64 bit systems
Providing Continua Solutions for a Connected Health World
WAN Interface
(Wide Area Network)
Providing Continua Solutions for a Connected Health World
WAN Interface
Purpose – Move the data from the local
environment elsewhere
•WAN Sender
– Collocated on the AHD in the home environment
– Converts IEEE 11073 representation to HL7 2.6 form
– Sends data using IHE PCD-01 transaction
•WAN Receiver
– Sits in the web services of a professional organization
– Collects data from the WAN Sender
– IHE PCD-01 transaction
Providing Continua Solutions for a Connected Health World
HRN Interface
(Health Record Network)
Providing Continua Solutions for a Connected Health World
HRN Interface
Purpose – To move medical documents
between organizations
• HRN Sender - The end point of the Continua
ecosystem
– Can be located on local AHD, or in professional
office
– Data is now represented in a formal HL7 3.0 CDA
•Measurement is in a component call a Personal Health
Monitoring Record
Providing Continua Solutions for a Connected Health World
Key Points
• Continua technology provides a standard
based approach to collecting device data
– Common tools for representing data
– Many devices specializations defined
– Path out of high cost locked proprietary end to
end systems
– Can integrate technology into system in a
evolutionary manner
Providing Continua Solutions for a Connected Health World
Continua Gets it There
Providing Continua Solutions for a Connected Health World