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 | Source: World Health Organization; McKinsey

The Goal: Improve Lifestyle Choices, Health

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 | –22

= Non Modifiable Contributors to Disease = Modifiable Contributors to Disease

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

) | 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

| 4

Interfaces & Standards

Personal Device Thermometer Pulse Oximeter Pulse / Blood Pressure Weight Scale Glucose Meter Cardio / Strength Independent Living Activity Peak Flow Medication Adherence Physical Activity Electrocardiogram Insulin Pump

|

Personal Area Network (PAN) Interface Aggregation Manager Wide Area Network (WAN) Interface Telehealth Service Center Health Records/ Networks Health Record Network (HRN) Interface

5 PHR EHR NHIN HIE

Interfaces & Standards |

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: | 7

WAN Code

• 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) | 8

Coming - mCESL

• J2ME version of PAN, Manager and WAN link | 9

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