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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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Market Intelligence:Disease ManagementRemote Patient Monitoring
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
(2) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15167389
(3) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15360065
(4) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14512778
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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).
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Growth in Employer Disease Management Activity
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Health Plans Investment in Disease Management
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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)
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
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Why are Organizations Investing in RPM Solutions
Source: Healthcare Without Bounds – Spyglass 4/06Source: Healthcare Without Bounds – Spyglass 4/06
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
One Patient, One System (Future)
Patient
ICU/BedsideICU/BedsideMonitorMonitor
ORORMonitorMonitor
TransportTransportMonitorMonitor
RemoteRemoteMonitorMonitorER MonitorER Monitor
PACUPACUMonitorMonitor
Overview of Flexible Monitoring
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Interoperable Vision for Home Healthcare
Any Medical Device
Any Communications Hub
Any Place
Any Time
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Telemedicine:Examples in the Market
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Medication Compliance Examples
Honeywell HomMedMedPartnerTM Medication Reminder
Bang & Olufsen Medicom, Denmark“Helping Hand” Bluetooth
RFID Technology
SWEDEN
IPP: Intelligent Pharmacuetical Packaging
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
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Application Portal Examples: Elder Care Provider screen
IBM Healthcare and Life Sciences Innovation Team
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Medication reminder
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Medication taken
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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 Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
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Pilot Results: University Hospital of Heidelberg
September 2005 to present
IBM Healthcare and Life Sciences Innovation Team
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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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
• 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
IBM Healthcare and Life Sciences Innovation Team
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• 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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Remote Monitoring in Action
IBM Healthcare and Life Sciences Innovation Team
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Pilot Results: Denmark Eldertech
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
.... 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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Eldertech in Action
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
Innovations
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
One Patient, Many Monitoring Scenarios, One Record
Patient
ICU/BedsideICU/BedsideMonitorMonitor
ORORMonitorMonitor
TransportTransportMonitorMonitor
RemoteRemoteMonitorMonitorER MonitorER Monitor
PACUPACUMonitorMonitor
Flexible Monitoring
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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.
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
High Quality Remote Cardiac Monitoring
Telzuit: BioPatch Wireless Holter Monitor
Medic4all/Telcomed Future: Bluetooth enabled
Medtronic
CardioNet
GE
WristClinic™
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
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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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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
IBM Healthcare and Life Sciences Innovation Team
© Copyright IBM Corporation 2006
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