Case-Study: Denmark

Report
Continua ‘Now” Webinar
Oct 30, 2014
Kelvin Lim – Roche Diagnostics, Continua TCWG Chair
Michael Kirwan – PCHA/Continua Technical Operations Director
Raul 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
PCHA - Confidential
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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
New regulations and incentives transforming healthcare
delivery, pushing consumers to the center of their care
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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Areas of Focus
Education
Public Policy:
Global Reach,
Global Presence
Advocacy
IOP Standards
and
Certification
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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 until
we reach interoperable solutions!!!
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Continua Members
http://bit.ly/continua-members
160+ Members
Promoter Members
Industry Liasons
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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
Aggregation
Manager
Personal Device
Thermometer
Telehealth
Service
Center
Cloud Service
Health
Records
Networks
Pulse Oximeter
Pulse /
Blood Pressure
Weight Scale
WiFi, 2G, 3G & 4G
Glucose Meter
Cardio
Strength
EHR
Independent
Living Activity
NHIN
Peak Flow
HIE
Medication
Adherence
Physical
Activity
ECG
Insulin Pump
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PHR
Personal
Area
Network
(PAN)
Interface
Consumer
Wide
Area
Network
(WAN)
Interface
Health
Exchange
Health
Record
Network
(HRN)
Interface
Health
Exchange
Empowering individuals to better manage their health.
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-play
Source: 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 2011
Interoperability 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
Time
Man-weeks
(1 FTE per
company)
Non-Continua
Continua
12 weeks**
incl. 30 days for connectivity
2 weeks*
incl. 3 days for connectivity
Bring down
deployment time
down to 1/6

72**
$166k**
12*
$27k**
60 man-weeks
or $139k saved
Interoperability assured quality because each company could focus on their module in D-CAP
*Figures based on actual experience, **Estimates
Source: Time and Cost Savings of Using Continua’s Design Guidelines – A PwC Survey
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Development Support
Design
Guidelines
CCEs
Resources:
CESL
mCESL
Test Tool
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Webinars
Demo
Optys
Plugfests
Trainings
Certification
Program
Logo
Enforcement
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Certification Program
Guidelines
Select connectivity standards
and publish Guidelines for strict
interoperability.
Certification Goal
Assurance that a device has
been designed to meet the
requirements of the
Continua Design Guidelines.
Certification and Logo
Recognizable logo signifying the
promise of interoperability with
other certified products.
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Scope of Certification Program
Data /
Protocol
(i.e. 11073
PHD)
Testing conformance
to transport
specification and
interoperability at
the transport level.
Transport
Interop
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Testing conformance
to data and
messaging standards.
Testing 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
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Worldwide Continua/PCHA Adoption
Denmark
US Department
of Defense
UK (NHS
Worcestershire)
US Veterans
Administration
US WG
EU WG
Japan
Japan WG
Abu Dhabi
India WG
Brazil WG
SE Asia WG
Taiwan
Singapore
= Adopting Continua
= Local Work Group
Australia WG
= Continua Test Labs and
Certification Experts (CCEs).
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ITU-T - H.810
2012:
–
–
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 ehealth 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:
–
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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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US model through incentives
The US (Medicare/Medicaid) fosters innovation via incentives based on
meaningful achievements. Healthcare providers have objectives they
must achieve to get incentive payments.
http://www.healthit.gov/providers-professionals/how-attain-meaningful-use
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf
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Asia Pacific
1. Progress in many Countries becoming significant
• China
• Taiwan
• Singapore
• India
• Japan
• S. Korea
1. 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 Countries
Denmark 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 studies
Partners HealthCare: Connecting Heart Failure Patients to Providers Through Remote Monitoring of 640 patients with chronic
heart failure and COPD
http://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 Care
http://www.phi.org/uploads/application/files/6599rmk3ryclv4ep8f7sknng65awjfel7znj24kl9vl7tmoezd.pdf
The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally
http://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 program
http://www.wpi.edu/Pubs/E-project/Available/E-project-121813160755/unrestricted/MQP_Telehealth_ROI_and_Overall_Benefit_Analysis_FINAL_VERSION.pdf
Telehealth Navigating the Maze and Turning Challenges into Opportunities
http://www.swedish.org/for-health-professionals/cme/archives-2013-fall-conferences/telehealth-improving-access-tohealthcare/online-syllabus/telehealth-pdfs/0740-cress
Deployment of an mHealth Patient Monitoring Solution for Diabetes
http://www.touchendocrinology.com/articles/deployment-mhealth-patient-monitoring-solution-diabetes-improved-glucosemonitoring-leads-r#.Uv0cgT4piU8.twitter
3millionlives program
http://3millionlives.co.uk/about-telehealth-and-telecare#ccg_potential_savings_featured_at_nhs_innovations_expo
Socio-economic impact of mHealth
http://www.pwc.fr/assets/files/pdf/2013/09/pwc_etude_socio_economic_impac_of_mhealth_the_european_union.pdf
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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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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
http://bit.ly/1zDkaEh
– Downloaded by apx. 50 countries
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Case-Study: Denmark – the uptake
Project name: TeleCare Nord (OpenTele)
•
Apx. 4500 COPD patients
•
Cross sector cooperation
Project name: KIH (Clinical Integrated
Homemonitoring) (OpenTele)
•
Pregnants with complications (160)
•
Diabetes (180)
•
Hospital controlled
Project name: KIH (Clinical Integrated
Homemonitoring) (OpenTele)
•
Pregnants without complications (300)
•
Bowel disceases (250)
•
COPD (280)
•
Hospital controlled
• Continua based
• 2 Tenders for products
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Project name: Next Step Citizen
• Home Monitoring
• COPD
• Video consultation
• Cross sector cooperation
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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
Device type
Number of Continua certified
devices (March 2014)
Glucose monitor
6
Blood pressure monitor
5
Aggregation unit (eg. AHD)
21
Pulse oximeter
5
Weight scale
6
Reference systems
38
CE Mark
6!
• More products needed to create the market for Continua certified devices
– Legislative requirement for tenders
• Survey coming up!
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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
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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
PCHA - Confidential
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Continua Roadmap
Aggregation
Manager
Personal Device
Thermometer
Telehealth
Service
Center
Cloud Service
Health
Records
Networks
Pulse Oximeter
Pulse /
Blood Pressure
Weight Scale
WiFi, 2G, 3G & 4G
Glucose Meter
Cardio
Strength
EHR
Independent
Living Activity
NHIN
Peak Flow
HIE
Medication
Adherence
Physical
Activity
ECG
Insulin Pump
PCHA - Confidential
PHR
Personal
Area
Network
(PAN)
Interface
Consumer
Wide
Area
Network
(WAN)
Interface
Health
Exchange
Health
Record
Network
(HRN)
Interface
Health
Exchange
Empowering individuals to better manage their health.
Continua Roadmap
Genome
IOP release
Iris
Q3 2014
Keratin
Q2 2015
Q2 2016
(+6 mo. till public)
• Weight Scale
(BT Smart)
• SABTE
• Timestamp &
time sync
• WAN updates
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• Insulin Pump
• Remote AHD
control
• bGM revision
• Direct for ONC
• Pulse Ox.
(BT Smart)
•
•
•
•
•
CGM C&C
Sleep Monitor
…
…
…
Empowering individuals to better manage their health.
CESL – Reference Code
Speed the
adoption
Reference
source
code
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Testing
Prototypes
Basis for
Continua
Test Tool
http://bit.ly/download-cesl
Creation of
reference
devices for
IOP
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mCESL – Example AHD
for Android
http://bit.ly/download-mcesl
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
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Continua Test Tool
http://bit.ly/download-testtool
Official
Certification
Test Tool
Helps ensure you can
pass all conformance
tests.
Recommended for
internal pre-testing
before going to test lab.
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Continua Membership Levels
Promoter
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 plugand-play interoperability and create educational materials
incorporating Continua's key technical or business concepts
http://www.continuaalliance.org/about-continua-join/benefits-of-continua-membership
http://www.continuaalliance.org/about-continua-join/how-to-join-continua
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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 Center
National 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:
–
–
–
–
–
–
–
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•
•
•
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-wintersummit
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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
PCHA - Confidential
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Questions and Answers
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References
Personal 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 Recovery
http://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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Kelvin Lim
Michael Kirwan
Raul Gonzalez
Brian Hedegaard
[email protected]
[email protected]
[email protected]
[email protected]
END
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