Date post: | 21-Dec-2014 |
Category: |
Health & Medicine |
Upload: | inner-ear |
View: | 691 times |
Download: | 1 times |
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
The older Generation is Getting Bigger
1970
1980
1990
2000
2010
2020
2030
2040
2050
0
5
10
15
20
25
30
35
Japan
Germany
France
UK
USA
Percentage
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
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
1960 1975 2000 2025 2050
Norway
UK
Germany
Spain
• 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
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1974
1984
1994
2004
• 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
xHRN-In
terfa
ce
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