Download - Continua ‘Now” Webinar Oct 30, 2014
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Continua ‘Now” WebinarOct 30, 2014
Kelvin Lim – Roche Diagnostics, Continua TCWG ChairMichael Kirwan – PCHA/Continua Technical Operations DirectorRaul Gonzalez – AT4 wireless, Continua Certification Expert (CCE)Brian Hedegaard – Delta, Sr. Consultant
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Agenda
• Overview: PCHA & Continua• Continua Standards: Benefits• Status of Continua’s International Developments• Case-Study: Denmark• Continua Membership Benefits and Incentives• Questions & Answers / References
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Personal Connected Health Alliance (PCHA)
• PCHA is a first-of-its-kind collaboration between Continua, mHealth Summit and HIMSS, focused on engaging consumers with their health.
• Mission - Making health and wellness a convenient part of daily life through personal connected health technologies.
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PCHA, why now?
Globally, healthcare in crisis and world population aging
Governments around the world demonstrating significant interest in adopting personal connected health: Denmark, UK, Abu Dhabi, Singapore
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Consumer market is exploding: +97k mobile health apps are available, each day the top 10 apps generate up to 4M free and 300k paid downloads
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Education
Advocacy
IOP Standards and
Certification
Public Policy: Global Reach,
Global Presence
Areas of Focus
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PCHA Strategic Initiatives
• Promoting education and awareness through events and outreach to all stakeholders
• Facilitating adoption of global industry standards for user-friendly interoperability between devices; privacy and security– Publishing annual Continua Design Guidelines for end-to-end, plug-and-play
interoperability; certifying products – Ratified by ITU as global standard for PCH technologies
• Defining the path to market by advocating for appropriate regulation and promoting investment
• Supporting governments and health ministries seeking connected health solutions
• Operating in nations around the globe to promote market development
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PCHA Momentum
• PCHA will coordinate stakeholders in Personal Connected Health ecosystem and maintain a “consumer first” position:– It is about the individual– The technology is available– The consumers are demanding it– Nations are deploying and using it– We cannot afford to miss this opportunity
The Market will not grow untilwe reach interoperable solutions!!!
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Industry Liasons
Promoter Members
Continua Members160+ Members
http://bit.ly/continua-members
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Agenda
• Overview: PCHA & Continua
• Continua Standards: Benefits• Status of Continua’s International Developments• Case-Study: Denmark• Continua Membership Benefits and Incentives• Questions & Answers / References
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Continua End-to-End Architecture
HealthRecordNetwork(HRN)
InterfaceHealth
Exchange
PersonalArea
Network(PAN)
InterfaceConsumer
WideArea
Network(WAN)
InterfaceHealth
Exchange
EHR
PHR
NHIN
HIE
WiFi, 2G, 3G & 4G
Personal Device
Weight Scale
Pulse Oximeter
Independent Living
Activity
Cardio Strength
Medication
Adherence
Glucose Meter
Pulse /Blood
Pressure
Thermometer
PhysicalActivity
Peak Flow
ECG
Insulin Pump
AggregationManager
TelehealthServiceCenter
Cloud Service
HealthRecordsNetworks
More
Coming!!
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Architecture Benefits
• Full End-to-End Architecture:– Observed Measurements travel from the Medical Device to Health
Record– Data keeps the accuracy, the semantic and the patient identification
• Flexible Architecture:– It can me adapted to most common Use Cases. From personal
wellness applications to remote patient monitoring.
• Publicly Available Standards:– Continua Design Guidelines are publicly available for free– Underlining Standards and specifications selected by Continua are
open and publicly available– Continua Design Guidelines have been adopted by United Nations
through ITU-T as official global standard (H-810).
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Architecture Benefits
• Enables the Interoperability:– Continua Design Guidelines add constraints to underlying standards to
clarify them and reduce available options in order to enable the interoperability
– Continua Certification Program and Plugfests empowers the interoperability and the Continua Logo recognition by the end user
• Development Costs Reduction:– Open standards without royalties– Reference Stack, Example Applications ant Certification Test Tool
available for free for Continua Members
• Deployment Costs Reduction:– Avoid proprietary and captive solutions– Option to select different vendors. Multiple choices, Lower Prices and
Second Sources.
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Interoperability Benefits
• Lower Design Costs: Save 40k – 80k USD* in development costs per device**
• Faster to Market: Decrease integration time from 3 months to just 3 weeks*
• Increase Efficiency: Quicker, less expensive integration with Heath Records
• More Robust and Reliable Communication: Higher custumer satisfaction
• Forward/Backward compatibility: Longevity of devices• Easy to Expand: Add new products with plug-and-playSource: Personal Connected Health Alliance: Applications to Diabetes Care* Source: Time and Cost Savings of Using Continua’s Design Guidelines – A PwC Survey** Continua Members survey estimates factor 3-5 cost savings potential for certain devices
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Example: Japan Earthquake of 2011
• The Disaster Cardiovascular Prevention Network (D-CAP) was developed to remotely monitor the blood pressure of evacuees in campsites, with a goal to prevent cardiac events in survivors identified as “high risk.”
• 400 people with elevated cardiac risk were enrolled in D-CAP program• D-CAP registrants received electronic identification cards and were encouraged to
measure their own blood pressure at automated stations within the evacuation camp. • The data were sent via wireless communication to a data server and relayed to Jichi
Medical University, about 200 kilometers away. Clinicians monitored the data and alerted on-site physicians by phone of any significant developments.
• The system was deployed in just two weeks
Source: Building the Case: Interoperability in Disaster Recovery
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Example: Japan Earthquake of 2011Interoperability problem
• Continua guidelines allowed for a quick RPM solution during the Great East Japan Earthquake.• Disaster Cardiovascular Prevention Network (D-CAP) was developed to remotely monitor the blood
pressure of evacuees in Campsites without hospital infrastructure.• Interoperability was guaranteed because the six companies involved were Continua members.• Devices: A&D (Automatic blood pressure monitors), Alive Inc. (Gateway firmware), Ryoto Electro
Corp. (data server), Panasonic (PC), Toppan Forms (Patient ID Cards), Intel (Project coordination)
Value of Continua guidelines
*Figures based on actual experience, **Estimates
Source: Time and Cost Savings of Using Continua’s Design Guidelines – A PwC Survey
Time 12 weeks**incl. 30 days for connectivity
Man-weeks(1 FTE per company)
72**
Non-Continua
2 weeks*incl. 3 days for connectivity
12*
Continua
Bring down deployment time
down to 1/6
60 man-weeks or $139k saved
Interoperability assured quality because each company could focus on their module in D-CAP
$166k** $27k**
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Development Support
Design Guidelines
Certification Program
PlugfestsLogo
Enforcement
Resources:CESL
mCESLTest Tool
CCEs
Webinars Trainings
Demo Optys
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Certification GoalAssurance that a device has
been designed to meet the requirements of the Continua Design Guidelines.
Certification Program
GuidelinesSelect connectivity standards
and publish Guidelines for strict interoperability.
Certification and LogoRecognizable logo signifying the
promise of interoperability with other certified products.
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Scope of Certification Program
Data / Protoco
l (i.e.
11073 PHD)
Testing conformance to data and messaging standards.
Transport
Testing conformance to transport specification and interoperability at the transport level.
InteropTesting conformance to Continua Interoperability Guidelines
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Agenda
• Overview: PCHA & Continua• Continua Standards: Benefits
• Continua International Developments• Case-Study: Denmark• Continua Membership Benefits and Incentives• Questions & Answers / References
Empowering individuals to better manage their health.PCHA - Confidential
Worldwide Continua/PCHA Adoption
UK (NHSWorcestershire)
Japan WG
Denmark
Singapore
SE Asia WG
Australia WG
India WG
Brazil WG
Abu Dhabi
= Adopting Continua
= Local Work Group
US Veterans AdministrationUS WG
Japan
EU WGUS Department of Defense
Taiwan
= Continua Test Labs and
Certification Experts (CCEs).
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ITU-T - H.8102012:
– In 2012, the World Telecommunication Standardization Assembly adopted Resolution 78 – “Information and communication technology applications and standards for improved access to e-health.”
– That same week, the Global Standards Symposium expressed the need for ITU to take a leading role in the e-health field by building on its collaboration with the World Health Organization (WHO) to create a global, open environment for the development and promotion of e-health standards.
2013:– In December 2013, the International Telecommunication Union (ITU), the United
Nations’ specialized agency for information and communication technologies (ICTs), announced the adoption of Continua’s Design Guidelines for interoperability under Recommendation ITU-T H.810.
– International standards avoid costly market battles over preferred technologies, and for companies operating in emerging markets, create a level playing field with regard to market access. Through economies of scale, global ICT standards can reduce costs for manufacturers, operators and consumers, and are also an essential aid to developing countries building their infrastructures and promoting economic dev.
2014:– Continua contributes entire test suite to the ITU. Test suites were consented in
July.– H.810 converted in to 6 different languages.
2015:– Continua working toward further contributions with ITU moving forward (DG
2015 and other materials, etc.).Source: Building the Case: Developing the Global Ecosystem for Personal Connected Health
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Americas
1. Food and Drug Administration (FDA)• Continua working closely with the FDA on several fronts
(Regulatory, Specification and Certification Guidance).
2. Veterans Affairs (VA)• Continua working closely with the VA on time-stamping (ensuring
a consistent time-line for remote monitoring).
3. The US Model (Medicare/Medicaid) evolving • Fosters innovation via incentives based on meaningful
achievements. • Launching innovation into the health information exchange
4. New Membership Level• Continua adds a New Adopters Membership, significantly
reducing membership fees and listing fees.• Lowering the barriers of entry to all countries, all organizations.
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http://www.healthit.gov/providers-professionals/how-attain-meaningful-usehttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf
The US (Medicare/Medicaid) fosters innovation via incentives based on meaningful achievements. Healthcare providers have objectives they must achieve to get incentive payments.
US model through incentives
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Asia Pacific
1. Progress in many Countries becoming significant• China • Taiwan• Singapore• India• Japan• S. Korea
2. New Membership Level• Continua adds a New Adopters Membership, significantly
reducing membership fees and listing fees.• Lowering the barriers of entry to all countries, all organizations.
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Europe/Middle-East/Africa
1. ITU-T• Continua and ITU-T contributions continue.
2. Many active and new programs• Continua working closely EU countries ensuring Guidelines
recognition within RFPs and Tenders.
3. Nordic countries engagement • Continua recognized now by many countries.
4. New Membership Level• Continua adds a New Adopters Membership, significantly
reducing membership fees and listing fees.• Lowering the barriers of entry to all countries, all organizations.
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mHealth Grand Tour (for diabetes)• Charity event for diabetes in September, including a showcase for mHealth
and an opportunity to highlight mHealth’s potential to enable active, healthy lifestyles and disease management for people with diabetes.
• 13-day cycling challenge from Brussels to Barcelona (2,300 kilometers). • Participants included 167 cyclists from 24 countries. • Sponsors: GSMA and the International Diabetes Federation European
Region• Technology collaborators designed and deployed a novel, end-to-end
mHealth system for real-time tracking of the cyclists’ blood glucose levels, heart rate and cycling statistics.
• Internet followers were able to track their data, and included a back-end database that accumulated data in real time for analysis by the research team.
• Devices included wearable sensors, bike computers and a web portal to capture rider data.
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EU Nordic CountriesDenmark was the 1st country to adopt Continua and make the Continua framework a fundamental part of the national reference architecture. Reference architecture officially released in June 2013. Downloaded in more than 50 countries.
Norway is working toward mandating Continua compliance by 2018
Sweden recently held a large event involving industry and government. Sweden made the decision to move from pending to actively working toward Continua adoption.
Finland is working on similar top-down approach as Norway with regards to Continua adoption
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Call to Action – Be a part of History
• Membership– Join now and experience
• Certification– Certify your devices
• Contribution– Create: Empower and influence future Guidelines
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Links to a few studiesPartners HealthCare: Connecting Heart Failure Patients to Providers Through Remote Monitoring of 640 patients with chronic heart failure and COPDhttp://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2013/Jan/1656_Broderick_telehealth_adoption_Partners_case_study.pdf
Centura Health at Home: Home Telehealth as the Standard of Carehttp://www.phi.org/uploads/application/files/6599rmk3ryclv4ep8f7sknng65awjfel7znj24kl9vl7tmoezd.pdf
The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationallyhttp://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2013/Jan/1657_Broderick_telehealth_adoption_VHA_case_study.pdf
Return on investment analysis of the VISN1 telehealth programhttp://www.wpi.edu/Pubs/E-project/Available/E-project-121813-160755/unrestricted/MQP_Telehealth_ROI_and_Overall_Benefit_Analysis_FINAL_VERSION.pdf
Telehealth Navigating the Maze and Turning Challenges into Opportunitieshttp://www.swedish.org/for-health-professionals/cme/archives-2013-fall-conferences/telehealth-improving-access-to-healthcare/online-syllabus/telehealth-pdfs/0740-cress
Deployment of an mHealth Patient Monitoring Solution for Diabeteshttp://www.touchendocrinology.com/articles/deployment-mhealth-patient-monitoring-solution-diabetes-improved-glucose-monitoring-leads-r#.Uv0cgT4piU8.twitter
3millionlives programhttp://3millionlives.co.uk/about-telehealth-and-telecare#ccg_potential_savings_featured_at_nhs_innovations_expo
Socio-economic impact of mHealthhttp://www.pwc.fr/assets/files/pdf/2013/09/pwc_etude_socio_economic_impac_of_mhealth_the_european_union.pdf
Empowering individuals to better manage their health.PCHA - Confidential
Agenda
• Overview: PCHA & Continua• Continua Standards: Benefits• Status of Continua’s International Developments
• Case-Study: Denmark• Continua Membership Benefits and Incentives• Questions & Answers / References
Empowering individuals to better manage their health.PCHA - Confidential
Case-Study: Denmark
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Case-Study: Denmark
• Facts in brief– Population 5.5 mio – Single Government– 5 Regions with local government
• Responsible for:– Hospitals– GP’s
– 93 municipalities• Responsible for:
– Nursing homes– Home care
• Tax based healthcare system– Some payment on pharmaceuticals
• Numerous telemedicin projects / pilots– Estimated concurrent projects – 1 pr. 11000 citizens.– Few successes – in production
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Case-Study: Denmark
• Wish to have a fully connected healthcare system– Multiple systems exchanging data
across sectors – standardised interfaces
• Patient empowerment– Self management
• Creating the market– New Super Hospitals– Closing older hospitals
• 20% reduction in hospital beds• Increased distance to rural areas
• TELEMEDICINE SOLUTION REQUIRED
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Case-Study: Denmark – Action plan
• Action plan for dissemination of Telemedicine (2012)
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Case-Study: Denmark – Reference architecture
– Downloaded by apx. 50 countries
http://bit.ly/1zDkaEh
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Case-Study: Denmark – the uptake
• Continua based• 2 Tenders for products
Project name: TeleCare Nord (OpenTele)• Apx. 4500 COPD patients• Cross sector cooperation
Project name: KIH (Clinical Integrated Homemonitoring) (OpenTele)• Pregnants without complications (300)• Bowel disceases (250)• COPD (280)• Hospital controlled
Project name: Next Step Citizen• Home Monitoring
• COPD• Video consultation• Cross sector cooperation
Project name: KIH (Clinical Integrated Homemonitoring) (OpenTele)• Pregnants with complications (160)• Diabetes (180)• Hospital controlled
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Case-Study: Denmark – Status
• Infrastructure implementation in progress– Solutions deployed
• High focus on interoperability– Device – System – systems
• High focus on interoperable device – but lacks products
• More products needed to create the market for Continua certified devices – Legislative requirement for tenders
• Survey coming up!
Device type Number of Continua certified devices (March 2014)
CE Mark
Glucose monitor 6
6 !Blood pressure monitor 5
Aggregation unit (eg. AHD) 21
Pulse oximeter 5
Weight scale 6
Reference systems 38
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Case-Study: Denmark – Activities• Center of Integrated Care
– Permanent Plugfest– Large scale test – ~5000 users
• Mockup, Care home, Hospitals and GPs
– Innovation and test in real world settings - Realitylabs
An easy way in to co-developments• Standard model for developing and testing• Screening and match-making• A model for business partnerships• Pre-testing in lab • Knowledge sharing and facilitation of progress
Reality Labs • Initiatives driven by user needs• Testing directly within daily operations• Documentation and certification• Training, development of competency
and implementation
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Case-Study: Denmark – The market place
• Denmark alone is a small country- 5.5 mio– Technology accustomed population
• Measured by the number of smartphones and tablets pr. Capita – it’s a big country
– High degree of co-evolution (PPP)– Great test market– More tenders (on continua certified products) coming up
– Reimbursement on devices ( Eg. Diabetes treatment)• Free of charge (White list): Glucose monitor, sticks,
insulin pens/pumps, needles• User payment(Limited): Insulin, special devices
• Nordic movement towards Continua– August 2014, Norwegian report recommends Continua certificate to become
mandatory by 2018.
– Sweden and Finland actively moving towards adoption
– Total population of 28 million
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Agenda
• Overview: PCHA & Continua• Continua Standards: Benefits• Status of Continua’s International Developments• Case-Study: Denmark
• Continua Membership Benefits and Incentives
• Questions & Answers / References
Empowering individuals to better manage their health.PCHA - Confidential
Continua Roadmap
HealthRecordNetwork(HRN)
InterfaceHealth
Exchange
PersonalArea
Network(PAN)
InterfaceConsumer
WideArea
Network(WAN)
InterfaceHealth
Exchange
EHR
PHR
NHIN
HIE
WiFi, 2G, 3G & 4G
Personal Device
Weight Scale
Pulse Oximeter
Independent Living
Activity
Cardio Strength
Medication
Adherence
Glucose Meter
Pulse /Blood
Pressure
Thermometer
PhysicalActivity
Peak Flow
ECG
Insulin Pump
AggregationManager
TelehealthServiceCenter
Cloud Service
HealthRecordsNetworks
Already supported
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Continua Roadmap
IrisGenome Keratin
Q3 2014 Q2 2015 Q2 2016IOP release (+6 mo. till public)
• CGM C&C• Sleep Monitor• …• …• …
• Insulin Pump• Remote AHD
control• bGM revision• Direct for ONC• Pulse Ox.
(BT Smart)
• Weight Scale (BT Smart)
• SABTE• Timestamp &
time sync• WAN updates
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CESL – Reference Code
Speed the adoption Reference
source code
Testing Prototypes
Basis for Continua Test Tool
Creation of
reference devices
for IOP
http://bit.ly/download-cesl
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mCESL – Example AHD for Android
Continua Reference Device Code (Mobile)
PAN - Reference Manager Application WAN - developed in C++ and JAVA.
Available as an SDK and Reference Application developed for the Android Nexus platform
http://bit.ly/download-mcesl
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Continua Test Tool
Official Certification Test Tool
Helps ensure you can pass all conformance tests.
Recommended for internal pre-testing before going to test lab.
http://bit.ly/download-testtool
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http://www.continuaalliance.org/about-continua-join/benefits-of-continua-membershiphttp://www.continuaalliance.org/about-continua-join/how-to-join-continua
Continua Membership LevelsPromoter All Contributor Member benefits + eligibility to become a Continua
Council member; responsible for ratifying specifications; the selection of use cases, standards, industry technologies, and other key Working Group decisions
Contributor Includes access to all Continua technical Guidelines, use cases and technical specifications; full participation rights; voice in defining Continua's future direction
Adopter Significant savings on membership and certification; self-certify a device or service within first year of membership
Developing Market
Organizations from emerging economic regions or small companies
University Provide research, review Continua test tools, Guidelines and documents, use Continua tools to demonstrate end-to-end plug-and-play interoperability and create educational materials incorporating Continua's key technical or business concepts
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Certification Incentives
• New members: free certification testing for one device before the end of 2014 AND a free listing (Type A or Type O).
• Developing market: $1,000 for the first year of membership. Increase to $2,500 USD for the second year and full Contributor costs in year three. One free listing fee.
http://www.continuaalliance.org/about-continua-join/new-member-incentives
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Don’t miss! Continua Winter Summit & Plugfest
December 9-12, 2014
Gaylord National Resort & Conference CenterNational Harbor, MD 20745
Held in connection December 7-11
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Learn More About Continua Activities at mHealth Summit
• Visit the Continua booth (#403) or attend one of our sessions:– Value Prop for Standardization Monday, Dec. 8th, 3:45pm– Global Interoperability Update Tuesday, Dec. 9th , 2:30pm– Recent Interoperability Standards & Collaborations Wednesday, Dec. 10th, 12 Noon– Impact of Recent FDA Regulation Wednesday, Dec. 10th, 1pm– IEEE 11073 Training Wednesday, Dec. 10th, 8am– Continua Path to Certification Training Wednesday, Dec. 10th, 1pm– Continua Implementation Guides Training Wednesday, Dec. 10th, 3pm– Time-Stamping and Time Synchronization Wednesday, Dec. 10th, 1pm
• Live Member Demos | MHealth Summit Interoperability Showcase™• Interested in meeting with Continua leadership to discuss more at mHS?
Contact [email protected]• Continua members, agenda details for the Winter Summit are available here:
https://cw.continuaalliance.org/wg/members/home/2014-continua-winter-summit
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Agenda
• Overview: PCHA & Continua• Continua Standards: Benefits• Status of Continua’s International Developments• Case-Study: Denmark• Continua Membership Benefits and Incentives
• Questions & Answers / References
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Questions and Answers
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ReferencesPersonal Connected Health Alliance (PCHA) www.pchalliance.com
Continua Health Alliance www.continuaalliance.org
Personal Connected Health Alliance: Applications to Diabetes Care http://bit.ly/1rqyd5J
Building the Case: Interoperability in Disaster Recoveryhttp://bit.ly/1qjv9sO
Time and Cost Savings of Using Continua’s Design Guidelines – A PwC Survey http://bit.ly/1s9G4sl
Building the Case: Developing the Global Ecosystem for Personal Connected Health http://bit.ly/1o7Ocva
The mHealth Grand Tour for Diabetes – Population mHealth in Action http://bit.ly/1EPMaVb
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ENDKelvin Lim [email protected] Michael Kirwan [email protected] Gonzalez [email protected] Hedegaard [email protected]