ibm healthcare and life sciences innovation team © copyright ibm corporation 2006 enabling homecare...

IBM Healthcare and Life Sciences Innovation Team

© Copyright IBM Corporation 2006

Enabling Homecare with Remote Monitoring Technology

Kathy SchwedaWW Business Segment LeaderPervasive Healthcare Solutions

12 June 2006



Personalized Health Care

Remote Monitoring

Traditional HCPatient Reported Data

Episodic Treatment Electronic Health Records Information Augmented

Chronic Disease Mgmt

Clinical Trial Data Collection

In-Pt Automated Vitals

Rules Based Clinical Response

Pre-symptomatic Treatment

Lifetime Health Management

Evolutionary Practices

Rev

olu

tio

nar

y T

ech

no

log

y Automated Systems

Non-specific (Treat Symptoms)

Information Correlation

1st Generation Diagnosis

Organized(Error Reduction)

Personalized(Disease Prevention)

Th

rou

gh

pu

t A

nal

ytic

s

Data and Systems Integration

IBM Healthcare Innovation Engine: Evolution to Personalized Healthcare

CDI

Source: Kathy Schweda

Clinical Decision Support



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 ManagementRemote 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 self-management 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 “greatlyenhance 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

Age

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

60 - 64

65 - 69

70 - 74

75 - 79

80+

21%

15%

8%

6%

2%

29%

33%

Today’s seniors

Boomer vanguard

Approaching

50 - 59

Under 50

Digital-ready

Base: US consumers

Digital-Ready Consumer Defined: •Either a broadband connection or a home network,AND•Any two-way, wireless communication device (cell)



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 GaudetInsurers 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 04-200665% of organizations interviewed have invested in Remote

Patient Monitoring71% using RPM have received State/Federal Grants



Why are Organizations Investing in RPM Solutions

Source: Healthcare Without Bounds – Spyglass 4/06Source: 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 physicianhospitalization

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

CostsEscalating

ResourcesLess Available BedsStaff Shortage: Physicians, Nurses, Allied Professionals (RT, PT, LT)

OutcomesUnmonitored patient leads to acute and rescue eventsSelf reported results prone to errors:

No data Bad data Adjusted/Altered data

TechnologyCurrent 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)

Patient

ICU/BedsideICU/BedsideMonitorMonitor

ORORMonitorMonitor

TransportTransportMonitorMonitor

RemoteRemoteMonitorMonitorER MonitorER Monitor

PACUPACUMonitorMonitor

Overview of Flexible Monitoring



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

GlucoseMeter

Pedometer

Blood-pressure

MedicationTracking

Fitnessequipment

WeightScale

Thermometer

PulseOximeter

Spirometer

Cholesterol Monitor

Homesensing &

control

Bed / ChairSensors

ImplantMonitors

BabyMonitors

PERS

CONNECTIVITY

Ethernet

SENSORS AGGREGATIONCOMPUTATION

SERVICES

Diet or FitnessService

DiseaseManagement

Service

PersonalHealth

RecordService

ImplantMonitoring

Service

HealthcareProviderService

PC

PersonalHealthSystem

Cell Phone

Set Top Box

Aggregator

N E

T W

O R

K (P

OT

S, G

SM

, BB

)

ConsumerElectronics



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



Wireless Data Receiver AD9030TPulse Oxi meter

Blood Pressure

Glucose Meter

ECG Monitor

Body Weight & Fat

Vital Sign Monitors Internet connection

TV Phone Heath Monitor Conference

Pedometer

NTT I-see TV Phone

Mitsubishi International CorporationHomeCare Support (2003)

Examples of Available Homecare Solutions

WristClinic™Medic4All Services International



Medication Compliance Examples

Honeywell HomMedMedPartnerTM Medication Reminder

Bang & Olufsen Medicom, Denmark“Helping Hand” Bluetooth

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



Server

Use Case: Chronic Condition Management – Personal Care Connect

Patient Diary

BT

Data

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

Care plan is determined by physician based on medical data analysis

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



Infrastructure and integration details

Client GatewayHosting

middlewareWireless Internet

Portals & ApplicationsNetworks

Internet Server

Device Domain /

“Gateway”Sensor / Client

Ad

ap

ters

Bluetooth

NetworkOperator

InternetProvider

Network

IBMSoftware

Monitoring

and

Data Mining

Applications

IBM /PartnerSoftware

Patient StakeholdersProvider

Payer

Family Caregivers

Database

Sensor Data

GPRS

Personal Wireless Gateway

Bluetooth

Bluetooth

Bluet

oothZi

gBee



Application Portal Examples: Elder Care Provider screen



Medication reminder



Medication taken



Standards Used by Component

Medical DeviceWireless sensor agents : Bluetooth

HubWireless 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 SourceHTTP 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 Partner ObjectivesTargeted Disease(s)

Biomedical Devices Status

Elder care community pilot

Municipality in Europe

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.

congestive heart failureHypertensionPre-diabetic

blood pressure cuffmedical weight scalepatient UI for medication compliance

20 families using the system with positive response to the technology

Renal Study

Academic Medical Center - Europe

Remote monitoring of pediatric patients suffering renal failure.Goals: Reduction in rescue events between dialysis. Improved health through medication management between dialysis.

kidney disease blood pressure cuff – pediatric medical weight scale

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

Juvenile Diabetes Study

Children’s Medical Center-US & Clinical ISV

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

glucose meterfuture: injection registration device

Integration testing of PCC to PHR, Payer collaboration, then kick off 4Q’06

IBM Disease Mgmt

IBM CHQ w/ selected Disease Mgmt firm

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

congestive heart failurediabetes

medical weight scaleGlucose meter

Decision on employee population and pilot definition by 7/20

Asthma Academic Medical Center -USA

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

Asthma Pulse OximeterSpriometerAnalog Peak Flow Meter

Defined pilot with selected patients to start 4Q 2006



Pilot Results: University Hospital of Heidelberg

September 2005 to present



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

Section Pediatric Nephrology of the University Hospital HeidelbergDialysis Center for Children and Adolescents



• 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

Content

• Integration of additional sensors for additional measurements

• Connection to Electronic Medical Patient Record Systems

• Connection to Hospital Information Systems

Expansions

Data-Recordation,

Data-Transmission, Visualisation

• 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

Pilot Project with Heidelberg:Clinical survey at the Pediatric Nephrology



• 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

Medical Results

• Total availability

• Reliable transfer of data

• Easy handling

• Robust against temporary interruption of network infrastructure (GSM/GPRS, Bluetooth)

Technical Results

Results of the Pilot Project



Remote Monitoring in Action



Pilot Results: Denmark Eldertech



.... the ”Interactive Citizen Home” innovation partnership with the University and Municipality of Aarhus in Denmark

PCC Server

BTGPRS

Browser

Leverages PCC solution developed by IBM Research and HCLS Solution Development…

… in unique 3-way innovation partnership with Center for Pervasive Healthcare (academia) City of Arhus, attracting public R&D funding…

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

WPS

… 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 eldercarein a project led by BCS Strategy & Change

and involving IBM Research, Software, Systems and Lenovo.

Pilot

2005 2006

Extended operation

Pilot evaluation

Research Workstream

xDSL



Eldertech in Action



Innovations



One Patient, Many Monitoring Scenarios, One Record

Patient

ICU/BedsideICU/BedsideMonitorMonitor

ORORMonitorMonitor

TransportTransportMonitorMonitor

RemoteRemoteMonitorMonitorER MonitorER Monitor

PACUPACUMonitorMonitor

Flexible Monitoring



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

Medic4all/Telcomed Future: Bluetooth enabled

Medtronic

CardioNet

GE

WristClinic™



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 InitiativeHealthcare 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



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

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



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

[email protected]+01 414-223-6749

ibm healthcare and life sciences innovation team © copyright ibm corporation 2006 enabling homecare...

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