Nick Hunn

CTO – WiFore, Vice-Chairman, Mobile Data Association

Mobilising Wireless and Health

The role of wireless in consumer healthcare

What is changing in the healthcare business environment?

• Political– Local purchasing of health services– Personal budgets

• Economic– Reduced economic growth– Tax implications for public spending

• Social– Aging population– Family structure and dispersal– Demands for choice in health and welfare

• Technological– Focus on technology development (e.g. economic driver)– New developments in wireless (e.g. range and power requirements)– Internet and information technology

When so many drivers occur together change can be revolutionary, not evolutionary.

Where are the business opportunities?

• Not in curing patients. It’s too hard.

• In helping patients to live with existing conditions.• In helping people to live independently at home for longer.• In allowing people to continue their normal lifestyle.• In providing support and reassurance for family and carers• In helping businesses maintain a health workforce.

Two key opportunities are Managing Long Term Chronic Conditions Assisted Living

Long Term Chronic Disease in England

• One of the major costs is treating and caring for Long Term Chronic Conditions.

Number of people with at least one LTC in England

• Our current lifestyle means that this cost will increase.

Proportion of people with LTCs by age

• And as we get older, we collect more of them…

Market Drivers – Long Term Condition Management

• It’s not about curing people – it’s about reducing costs and helping people to live healthier lives.

• People with LTCs should be supported to make healthier lifestyle choices • We need to promote the benefits of healthier lifestyle choices and support people to make

those choices. • The greater an individual’s sense of self worth, the more they will want to take care of their

health and the more likely they are to work and become socially included.

Who buys it?• Patients• Companies• Insurers• Drug Suppliers

Assisted Living

• It’s about learning people’s living patterns, to help reinforce confidence and detect changes of pattern that might be associated with illness or deterioration.

• Assisted Living enables people to remain independent longer and reduces unplanned hospital admission.

Mostly simple sensors:• Motion • Fire / Smoke / CO2

• Occupancy (Bed / Chair)• Use (Cooker / Door / Fridge / Oven)• Final Exit / Geotagging (for Alzheimers)• Fall Alarms• Water flow / flood

Assisted Living – Typical Sensor Locations

SAPHEProject

An example of sensor placement – typically many simple passive sensors

The Market

• 30% of homes in Europe and the US could benefit from assisted living monitors.• Each deployment will include between 10 and 30 sensors.

Between 1 and 3 Billion sensors

It is the largest single market for wireless sensors

Market Drivers – Assisted Living

• Increasing Independence• Giving Peace of Mind to the frail, their family and their professional carers• Reduce emergency admissions and readmission to hospital

Who buys it?• Kids (who don’t want their parents to live with them)• Parents (who don’t want to live with their kids)• Local Authorities / Social Services• Retirement Homes

Why Wireless?

• Remote Capture of Data– Patients don’t need to remember anything – it just happens

• Transmission of Data to Server Application– Timely delivery means useful analysis

• Ease of Installation (and removal)– No wiring

• Ease of Expansion– Add additional sensors as they’re needed

“Too many wires.”

“There was a mess with all the wires. It took them a while to sort it out and conceal them.”

JIT Evaluation of the Telecare Development Programme – Final report

• The Continua Health Alliance - www.continuaalliance.org• Continua defines Data Transport - currently Bluetooth BR/EDR for wireless• IEEE 11073 and Bluetooth low energy define Data Formats

Continua member companies help people with chronic conditions live healthier lives by connecting them to their care team through a more efficient exchange of personal health information.

Familycare

givers

Diseasemanagement

service

PersonalHealthRecord

Healthcareprovider

DigitalHome

Cell Phone

PC

Personal Health System

PEDOMETER

BLOOD-PRESSURE

CUFF

MEDICATIONTRACKING

WEIGHTSCALE

FITNESSEQUIPMENT

IMPLANTPULSE

OX

Internet

Standards Help

The Wireless Advantage

• Short range wireless connects personal devices to the Internet, where patient data can be tracked and analysed.

• Most analysis will be about trends which can be used to promote wellness, NOT critical data.• It needs a short range connection (typically Bluetooth), going to a wide area link – mobile or

broadband.

There are two Bluetooth standards that are applicable:

• Health Device Profile for devices that measure waveforms, perform frequent measurements, or connect to clinician systems.

• Low Energy Bluetooth for battery powered sensors and wearable devices

Bluetooth low energy is going to enable a new ecosystem of connected patients.

The Bluetooth low energy approach to internet connected devices

• Connect (“pair”) devices by an intuitive method, e.g. NFC, proximity or simple buttons.• The Phone interrogates the scale and sees that it wants to connect to a gateway

service, which the phone can provide.

Gateway finds list of remote services

• Gateway (phone) reads the list of Health 2.0 services that the scale can be linked to and displays these for the user to select.

• If the gateway is not a phone and has no display, (e.g. a router or STB) then there should be a default choice, otherwise,

• The User makes their choice.

Gateway connects device to middleware

Internet

• Gateway (phone) gets the IP address and any specific access information from scale and uses these to create a connection to the middleware.

• This process automatically registers the device with the Health 2.0 application and informs the user how they can access their data on the website.

Gateway provides transparent bridge

• From this point the Gateway (phone) becomes a transparent bridge.• Middleware can now read data directly from the device and acts as a “virtual master” to perform any

other setup or updates.• In use, the device can interact directly with the middleware whenever it detects the presence of a

gateway, sending real time or stored data.• The user accesses the data directly via the Health 2.0 application.

What’s missing?

The Compelling Application that keeps users involved.• Use Web 2.0 technology / hype to “empower” the patient.• Today applications requires manual data entry or patients need to understand medical data.• The market happens when it becomes as easy and as compelling as Weightwatchers.

Where will it come from / Who will own the health brand?• Consumer Medical Device Vendors?• Mobile Network Operators?• Start-ups?• Healthcare Providers?• Health 2.0 Application Developers• Supermarkets?• Patients and Community Groups?

The Catch 22 of Telecare

• We’re still waiting for large scale trials.• Data fusion remains the missing piece.• We need to be able to automate and scale rapidly to meet the demographics issue.

Open Source development may be the answer to these issues.

In that case, the industry or sponsors should concentrate of providing development tools rather than services.

There’s a growing number of programmers and product developers who are at the age where they have a vested interest in making it work.

We need to engage them with Health 2.0 if we’re going to progress beyond it.

Mass deployment means thinking out of the box

• Mass compliance means we have to hide the sensor.• Think about devices that people use and make them the assisted living sensor.• Design or use new sensor technology that can be hidden.

I’ve got up…I’ve got up… I’m watching the TV…I’m watching the TV… I’m going to bed…I’m going to bed…

The consequences of Health 2.0

Professional Scribes

Medical Profession

“Scribe 2.0”

Health 2.0

?

Major Barriers to be aware of

• The Medical Profession– Who don’t want to lose the status they have built up over the last few centuries. That’s why they

prefer “Consumer directed” to “Patient empowerment”.

• Silo Funding– Working out who pays for it. Total savings are often lost or hidden because of the fragmented

funding routes.

• Data Fusion– The Catch 22 of not enough participants to generate a critical mass of data to feed expert systems.

The nightmare scenario is that when we have sufficient data we cannot dig any useful information out of it.

Essential Reading

• Raising the Profile of Long Term Conditions Care – Dept of Health tinyurl.com/ltcdoc• JIT - Final Evaluation Report on Telecare (Scotland) 2009 tinyurl.com/jitreport• JIT Appendices

tinyurl.com/jitappendix• “Overtreated” – Shannon Brownlee – an analysis of the US healthcare system• “Sicko” – Michael Moore – How bad it can be (before the demographics kick in)

• Creative Connectivity blog – www.nickhunn.com• Mobile Data Association – www.themda.org/ehealth

Thank You

Nick HunnDirector

mob: +44 7768 890 148email: nick@wifore.comweb: www.wifore.com

The older Generation is Getting Bigger

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Source: dti Global Watch

• People are living longer, and not being replaced at the same rate.• It places a growing strain on healthcare support, in terms of costs and carers.

UK Demographics

2014 (predicted) 2008 Actual• over 65s > than under 16s

2050• Four times as many needing care• At four times the current cost• While the numbers available to do

the caring decline.

Fewer Carers & Tax Payers

Ratio of Working to Retired Population

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UK

Germany

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• Most health systems rely on today’s payments to fund today’s care costs.• With fewer to pay, that model will break. We have to take cost out of the healthcare system.

Costs are Rising

Health spend as % of GDP

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• Already, healthcare costs are rising.• Patients demand more, yet live more years of ill health while treatment costs rise.

Well controlled condition

Partly controlled single condition

Multiple / complex conditions

Professional Care

Assisted Living /eHealth

Prevention

Healthy Population

Intensity of Care

• Assisted Living and eHealth can help keep people out of expensive Professional Care.

£1

£10

£1,000

£100

£10,000

Cost of Care / Day

Quality of Life

Home Care

Residential Care

Healthy Independent Living

Community Clinic

Chronic Disease Management

GP’s Surgery

Hospital Care

Assisted Living

Specialty Clinic

Community Hospital

Intensive Care Unit

Skilled Nursing Facilities

0%

100%

Dr M Bainbridge NHS CfH - CIU

Assistive Technogy

Assisted Lifestyle

Assisted Lifestyle

It is vastly cheaper to keep patients at home in good health.

• That makes technology that encourages wellness and independence increasingly important.

Why it’s important to work on prevention

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Topologies for the local wireless connection

Application Hosting Device

PAN Device

Continua modelEHR Compliant

WAN Device

Bluetooth low energy gateway

Bluetooth Health Device Profile

Key Features– Reliable Data Transfer– Streaming Data

(or any combination of the above)– Precise Time Synchronisation ~ 1msec– Efficient Reconnection Management

• Connection Manager• Retained System State

Computation Engine Concept– Mobile Phone– Home Health Centre– Set Top Box– PC

Targeted Devices for Bluetooth HDP and LE

Bluetooth EnabledHealth Devices with BR/EDR

Bluetooth EnabledComputation Engines with BR/EDR

Bluetooth EnabledHealth Devices with LE

Blood PressureMeters

Weight Scales

Pulse Oximeters(Streaming data)

Glucose Monitors

Thermometers

Mobile Phones

PCs

TelehealthDevices

HealthcareAppliances

Personal DigitalAssistants (PDAs)

Heart RateBelts & Monitors

Physical ActivityMonitors

GlucoseMonitors

(coin cell versions)

Thermometers(coin cell versions)

BR/EDR LE