Getting personal - patients manage health via remote

Healthcare costs are soaring and this trend is set to continue, driven largely by a rise in chronic conditions, an ageing population and busy lifestyles that leave little time for fitness and weight management. Indeed, 75% of US healthcare spending goes on treating chronic illnesses while more than 95% of Medicare and Medicaid's spending is devoted to chronic disease.

In 2005, for example, Medicare spent $91 billion on patients diagnosed with Alzheimer's disease and this is expected to rise to $189 billion in 2015 and over $1 trillion by 2050. Personal connected healthcare technologies have the potential to eliminate many of the unnecessary costs associated with these diseases from the healthcare system as well as encourage patients to be more proactive in managing their health. For example, rather than visiting the hospital or clinic several times a week, patients with long-term conditions could transmit vital signs from their home to their health professional via a wireless-enabled medical device. However, the only way this model can truly work is if interoperability exists between these devices and other information sources such as electronic health and medical records (EHRs/EMRs).

This is something medical device manufacturers need to start taking into account and is the reason why Continua Health Alliance was established in June 2006. Comprised of technology, medical device and healthcare industry leaders, the Alliance is a non-profit organisation that aims to establish a system of interoperable personal connected health solutions. "The original intent was to focus the industry on creating a set of standards," says Chuck Parker, executive director of Continua Health Alliance.

"This was an area of the industry in which there had been no standards at all applied to using a device in the home or in remote settings. It's really about how we focus the attention on the architecture for the devices, but then also carry that information from the devices through secure means and into EHRs."

The interoperability system is defined by a set of international standards that begin with the devices themselves, based on an IEEE specification. The devices then transmit information over standardised transports, such as USB, Bluetooth or Wi-Fi, and the data is captured by 'hubs' or 'managers'. The hubs encapsulate the data - with the suitable security protocols in place - and transmit it over a standard IT network using standardised Health Level 7 (HL7) messaging streams that can plug into the health records network interface using the Integrating the Healthcare Enterprise (IHE) patient care device descriptions.

For Paul Coebergh van den Braak, senior director of standardisation at Philips Intellectual Property and Standards, and a board member of Continua Health Alliance, the development of the organisation has been timed to perfection.

"Whenever you see a field emerging where there are a lot of interested vendors but there is a need for integrated solutions, something needs to happen to ensure that it's not going to be a fragmented market," he notes. "A small number of companies have taken the initiative; they had a vision that there was a lot to be gained from fostering interoperability and true standards well before the market had a chance to evolve."

Five years later, there are 35 devices or services that have been Continua Certified (see Figure 1 for more information on the certification process, and 'Certified devices and services' deloy, for three examples of Continua-certified devices). The organisation certifies devices, managers/hubs, the LAN itself and the health records networks or interfaces.

The advantages of certification for medical device manufacturers are clear. "It's not just a label, it's the fact that the devices can interact with many different services, hubs and phones, so they can be included in many different requests for proposals (RFPs)," says Clint McClellan, senior director of market development at Qualcomm, and also president of the Continua board. "Continua has essentially taken two disparate industries, wireless and health, and got together all the necessary specifications, future-proofing the roadmap for device manufacturers to follow."

Continua also offers advice and guidance to vendors that wish to standardise their device software. "The Continua guidelines give all the details on how to implement the different communication protocols as well as giving guidance on how to combine and parameterise them," says Coebergh van den Braak. "Moreover, just by being a member of the Continua community, people have a lot of resources available such as the Continua reference code."

"We have just launched the Continua Certified Experts Programme," says Parker. "This consists of experts in the industry that vendors can go to for help Moreover, we offer plugfests - safe testing environments for companies to come together and test their equipment with each other pre-market. This allows them to ensure that their devices can actually work well together."

When a new standard is launched, stakeholders are faced with the inevitable 'chicken and egg' scenario. "What we've tried to do is establish an ecosystem of interoperable devices, which will hopefully result in complete solutions," says Coebergh van den Braak. "This is important because there are only a few vendors willing and able to offer the entire solution as an integrated set of products. But who comes first?"

While the technical help offered by Continua is useful, Coebergh van den Braak feels that the main challenge faced by manufacturers is finding the right partners. "If they have the normal skills needed to develop products, they can get through the certification," he says. "The challenge is to find the right partners in the marketplace, both on the complementary product side and the services side, to bring the meaningful total solution to market. If you just bring one element to the market and wait for others to bring the other elements to market, that is not necessarily the right way to build a business."

While an alliance such as Continua must remain, for the most part, in the pre-competitive part of the collaboration process, it also acts as a valuable platform where people can meet, greet and network. "We also have a new workgroup called the Market Adoption Workgroup, where we want to bring in the parties that will offer these services," says McClellan. "For five years, Continua has been building specifications and guidelines and now is the time to bring in the parties that will sell these services.

"We can collect and transmit this great biometric data, but what do you do with it? There has to be an emotional component in it; you have to make people care about their health. We're working on personalised health services and our new goal is to bring in the parties who will actually start developing these services, demonstrating to them that these interoperable devices that 'plug and play' now exist and that they can begin to offer services from this platform."

It will be a faster process than many. "2011 is the year where we're seeing many of the technologies available and ready," McClellan declares. "2012 will be the year that you start seeing many of these services being offered. Sensors that are able to measure activity and help with weight management are beginning to be released this year and our goal is to be able to connect these sensors in a standardised way."

Continua's goals

The objectives of the non-profit body include:

- Developing design guidelines to enable vendors to build interoperable sensors, home - networks, telehealth platforms, and health and wellness services.

- Establishing a product certification programme with a consumer-recognisable logo signifying the promise of interoperability across certified products.

- Collaborating with government regulatory agencies, such as the Global System Mobile Association and the Global Certification Forum, to provide methods for safe and effective management of diverse vendor solutions.
- Working with leaders in the healthcare industries to develop new ways to address the costs of providing personal telehealth systems.

Joint enterprise

Continua Health Alliance is made up of leaders in the technology, healthcare and medical device industries, all of which have brought their unique expertise to the table. IBM is an interesting example. In collaboration with Google and Continua Health Alliance, IBM has created software that enables personal medical devices used for patient monitoring, screening and routine evaluation to automatically stream data results into a patient's Google Health Account or other personal health record (PHR).

Google Health, which was launched in May 2008, allows users to store, manage and share their medical records and personal health information securely online. The IBM software therefore enables patients to exchange vital health information with their doctors and other healthcare professionals in real-time, and vice versa. It was developed based on guidelines from Continua Health Alliance and, as well as enabling device manufacturers and hospitals to easily upload recorded data into PHR platforms such as Google Health, it is able to:

- support a wide variety of cases, including chronic disease management, health and wellness and elderly care

- leverage the power of services-orientated architectures (SOA) so that the partners can quickly build increasing volumes of flexible solutions for healthcare consumers and services providers based on modular components

- support the rapid growth of open standards via Continua Health Alliance.

Certified devices and services

NTT DOCOMO mobile phone
The NTT DOCOMO device, which has a Fujitsu HDP manager platform, is a high-spec 3G mobile phone that features a super-quick response touchscreen and a 13-megapixel high-resolution camera. With the installation of the Fujitsu HDP Manager Platform, the device enables users to connect any Continua Certified blood pressure monitor and weighing scale via Bluetooth to transmit data to electronic health applications.

Intel Evaluation Kit
The Intel Evaluation Kit with IEEE 11073 Continua Certified Software Stack for Medical Applications is the company's first Continua-approved medical evaluation kit that can be used to build Continua Application Hosting Devices (AHD) as well as allowing customers to develop, debug and showcase their future products on an embedded platform.

Omron Pedometer
Along with its Bluetooth docking station, the Omron Pedometer provides market-proven accuracy thanks to its ability to easily transmit data to electronic health and fitness applications. The docking station is Continua Certified and allows a family to each have a pedometer and transmit their data through a single device.