Dr. George Margelis - University of Western Sydney
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Personal Connected Health AllianceEmpowering individuals to better manage their health
Dr George Margelis
Is Personal Connected Health the Answer to Interoperability?
The world is moving to a focus on linking individuals with interoperable, personalized health solutions that meet their lifestyle needs.
Empowering Individuals to Better Manage Their Health
Advantages of Personal Connected Health
Consumers are not just linking health data to the Providers any longer
• Potential to transform human health and healthcare delivery, and to reduce global disparities in healthcare access
• Adds motivation and inspiration to health self-management by taking advantage of support networks in social media and other online forums
• Capable of reducing the impact of chronic disease, which is responsible for the greatest portion of healthcare expenditures
• Ability to shift from treatment focus to preventive care by making health self-management a part of everyday life
• Allows us to enjoy life longer outside of traditional healthcare
Engaging Consumers at Every Stage of Life
Health and Relief Pharma
…and Providing Links to Family, Friends, Social Networks & Providers
• Consumers become engaged in health self-management• Links to social networks become a source of positive
reinforcement• A secure line of communication is established between
providers and caregivers outside the exam room
• Consumer-collected data can enrich healthcare for
individual patients and patient populations
PCH Creates an Information- and Inspiration-Rich Environment for Health Improvement
Better use of resources, reduced cost, improved clinical outcomes…and health management incorporated into everyday life
7
The Goal: Improve Lifestyle Choices, Health
= Non Modifiable Contributors to Disease
= Modifiable Contributors to Disease
Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women. NEJM 2001 Sep 13;345(11):790-7.Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22
• Wearable trackers to monitor calories burned through activity
• Apps for diet/nutrition advice and caloric intake, on smart phone and/or computer
• Social networking for inspiration and competition (i.e., Jenny Craig, Biggest Loser), using online forums such as Facebook
Envisioning A Better Way: Weight Loss
• Wearable trackers to monitor specific activity• New sensors to enable 3d tracking and
movements• Already in use for Rehabilitation and
Diagnostic purposes• Can be utilized to stimulate inactive or
cognitive impaired individuals• Interoperability allows for this data to be
collected by healthcare team
Envisioning A Better Way: Gaming
• Disease-based forums (web, social media) for peer advice on treatment options and experience
• Connectivity to providers via provider portal, for expert advice during diagnosis, treatment and follow-up Apps to find a clinical trial
• PCH-enabled studies that use sensors, trackers and/or remote monitoring for data accuracy and patient convenience
Envisioning A Better Way: Management of Rare & Serious Diseases
• Individual and online gaming for children/teens with chronic diseases
• Apps to support connection to people with communication disorders, such as autism
• Wearable sensors and wireless monitoring for elderly living independently
• Remote monitoring by healthcare providers to augment parental care of a sick child or aging parent
• Social networking for caregivers, i.e., Facebook book, online chat with the ability to share sensor data
Envisioning A Better Way: Care of Special Populations
Envisioning A Better Way: Clinical Trials
• Direct involvement of the individual in the trial
• Evaluate patient populations
• Accelerate patient recruitment
• More efficient and effective management of clinical trails, data collection and reporting
• Better quality, more reliable data
• Get new drugs to market faster
Compliance with global industry standards is proven to decrease time to market and reduce development costs:
• Lower Design Costs: saves US$ 40,000-$80,000 in development costs per device
• Faster to Market: decreases integration time from three months to just three weeks
• Increased Efficiency: quicker, less expensive integration to EMR or HIE platforms
• Forward/backward compatibility: longevity of devices
• Easy to expand or add new programs/products with plug-and-play
Envisioning A Better Way: Interoperability
Envisioning A Better Way: Adoption
UK (NHSWorcestershire)
Japan WG
Denmark
Singapore
SE Asia WG
Australia WG
India WG
Brazil WG
Middle East
= Adopting Continua
= Local Work Group
US Veterans Administration
& US Department of
Defense
US WG
Japan
EU WG
PCH: Why Now?
• Consumer market is exploding– more than 97,000 mobile health apps are currently available;
– each day the top 10 apps generate up to 4 million free and 300,000 paid downloads
• New regulations and incentives transforming healthcare delivery, putting consumers at the center of their care – the Affordable Care Act features comprehensive health insurance reform to improve the
quality and patient access to care in the US
– Meaningful Use Stage 3 to address population health
• Governments around the world demonstrating significant interest in adopting personal connected health (ex: Denmark, UK, Abu Dhabi, Singapore)– the UK’s 3million lives initiative changing care delivery using connected health tools for
citizens with chronic conditions
• Globally, healthcare in crisis and world population aging
PCHA: An Historic CollaborationContinua Health Alliance, mHealth Summit & HIMSS
• Global plug-and-play interoperability Design Guidelines and Product Certification program
• Unmatched industry education, thought leadership and networking
• International leadership in hospital-based health technologies
• Worldwide presence to promote local, regional and national public policy, advocacy and market development
Generating greater awareness, availability and access to plug-and-play, consumer-friendly personal health technologies to
empower individuals to better manage their health and wellness, anywhere at any time.
PCHA Mission
• 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
PCHA Strategic Initiatives
The Time is Now
PCHA will coordinate stakeholders in PCH and maintain a ‘consumer first’ position
• It’s about the individual• The technology is available• Consumers are demanding it• Nations are implementing it• We can’t afford to miss this opportunity
The Market will not grow until we reach interoperable solutions
HealthRecord
Network(HRN)
Interface
Personal Device
Weight Scale
Pulse Oximeter
Independent
Living Activity
Cardio / Strength
Medication
Adherence
Glucose Meter
Pulse /
Blood Pressure
Thermometer
Physical Activity
Peak Flow
Electrocardiogram
Insulin Pump
AggregationManager
PersonalArea
Network(PAN)
Interface
WideArea
Network(WAN)
Interface
TelehealthServiceCenter
HealthRecords/Networks
EHR
PHR
NHIN
HIE
WiFi, 2G, 3G & 4G
Architecture to Enable PCH
Case Examples
Denmark’s National Action Plan for Telemedicine
Scope
• Secure collection, transmission, storage of personal health data from
patients’ homes to healthcare providers across the country
• Sharing of medical documents & images
• Management of health records, medical appointments, etc.
Objectives
• Ensure end-to-end, plug-and-play connectivity of personal health
devices; establish interoperability standards
• Ensure personal health devices & services easy to deploy, secure &
convenient for patients & providers
• Reduce acute care stays
• Enable elderly to live home independently
• Develop chronic disease management programs
• Expand use of telemedicine
Denmark: Centralized Approach to Standards Adoption
• Mandated national compliance with interoperability
standards (Continua)
• Pros:
– National healthcare IT conformity supports large-scale
population health and creation of cost, operational
efficiencies
– Limited systems integration issues during rollout and
subsequent changes in technology
• Cons: limited regional, local influence over standards
development; currently fewer choices in devices
UK Dept of Health: 3millionlives (3ML) Campaign
• Based on evidence from the Whole System Demonstrator
Programme (6,000+ person telehealth/telecare study)
Goals
• Improve lives of 3ML people with long term conditions, social
care needs
• Develop market, remove barriers to delivery (5 yrs)
• Create environment to support uptake
• Public/private cooperation to simplify procurement and
commissioning processes for telehealth, telecare at scale
• Put NHS and UK industry at the forefront of telehealth, telecare
globally
• Promote benefits of telehealth and telecare services to patients
3ML: Regional Approach to Standards Adoption
• All personal health device providers must comply with CEN ISO/IEEE 11073
• Contracting occurs on a local basis
• NHS Worcestershire County and East Shires Purchasing Organization have voluntarily adopted Continua
• Pros: localities maintain maximal control (device selection, cost)
• Cons: healthcare IT infrastructure likely to require significant integration to achieve end-to-end interoperability at a national scale
Catalonia, Spain: Regional Approach
• Catalonia, Spain
– Population covered by universal healthcare with a mix
of public/private providers
– Health Ministry funded ICT organization (TicSalut)
coordinates standards, integrates health and social
welfare systems
– 100% of hospitals use EHRS; 70% have mobile tools
– Device integration primarily based on Hl7 standards
Opportunities & Challenges for Big Data
Opportunities• Adopt common standards for PHRs to enable data
aggregation, tracking from multiple consumer devices– A starting point for big data, especially in decentralized
markets• Agree upon type, definition and format of personal health data
relayed from consumer devices to a medical records system– Ex: Health Records Network
Challenges• Retail and home devices need common standards to enable
consumer plug and play• Clinical workflow impact complicates standards adoption• End-to-end standards adoption