Wireless Medical Revolution Endless Possibilities!

SUNIL HATTANGADYPresident, Emblaze Consulting LLC

June, 2009

ABSTRACT

Wireless technologies are bringing about dramatic improvements in the quality of healthcare by allowing patients unprecedented mobility while providing healthcare professionals with easy and real-time access to patient data. Awareness of telehealth and wireless medical applications is increasing with more high profile companies (GE, Google, HP, IBM, Intel, Microsoft, Philips, Qualcomm, Siemens, TI, Wal-Mart, etc,) entering the space, along with prominent media coverage and a rise in the number of conferences highlighting the technology. A recent national study by Philips showed compelling and tangible benefits with telehealth. Private and public payers are beginning to buy into the advantages of telehealth. Medicare now reimburses for telehealth under particular circumstances and some private payers in certain geographies are also paying providers to use telehealth.

This whitepaper provides a review of the state-of-the-art in tele-medicine and wireless medical devices including the key drivers, important developments in end-to-end health & wellness solutions, the opportunity ahead of us, and key challenges for wireless medical device deployment

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Wireless Medical Revolution: Endless Possibilities Jun, 2009

INTRODUCTIONThe wireless revolution has had a tremendous impact on society and people worldwide. The technologies and networks that connect us to people, data, and devices wirelessly are rapidly transforming our everyday lifestyle and productivity in ways never imagined before. This technological trend is quietly and swiftly permeating the medical sector as well, where wireless technologies are bringing about dramatic improvements in the quality of healthcare by allowing patients unprecedented mobility while providing healthcare professionals with easy and real-time access to patient data.

DRIVERS FOR WIRELESS MEDICAL APPLICATIONS

• Aging Demographic

The aging demographic trend in the society will mean more patients would want to stay at home, yearn to be longer independently, and call for improved quality of health care. With a few simple yet critical measurements at home or on-the-go, care providers can better manage chronically ill patients to improve their overall quality of health and life.

• Chronic care is the predominant health care issue around the world

In 2006 the cost for healthcare in the United States rose to $2.1 trillion or 16 percent of the gross domestic product (GDP)1. The US Department of Health and Human Services2 reports on chronic conditions (disease that is long-lasting or recurrent) that

o 60% (over 100M) of American adults have at least 1 chronic condition (disease that is long-lasting or recurrent)

o 77% of Americans over 65 have 2 or more chronic conditions

o 90% of all health care spending is towards treating chronic conditions

o 65% of total health care spending is on care for the approximately 25% of Americans with multiple chronic conditions3

By 2020 at least 160 million Americans will be monitored and treated remotely for at least one chronic condition4.

Chronic conditions consume a disproportionate amount of health resources thus leaving little for people with acute or routine medical needs. Chronic diseases are estimated to account for 70%-80% of health care expenses in Denmark and comprise eight of the top eleven causes of hospital admissions in the U.K5. Likewise, total cost of chronic diseases (including treatment cost and lost productivity cost) has reached C$80 billion annually6.

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Fig. 1: Chronic diseases and aging populations are escalating health care costs7

Fig.2: (a) Number of people with chronic conditions in the US16; (b) Ratio of Average Spending relative to an individual 50-64 years8

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• Government regulation and initiatives to control escalating health care costs

The US government perceives a crisis in the cost and quality of health care. Over $2 trillion annual spending today is projected to grow to over $4 trillion by 2016.

The new Home Health Compare initiatives9 and Medicare PPS (Prospective Payment System) regulations10 will force agencies to put more emphasis on comparative quality and efficiency.

Other initiatives are specifically directed at home health monitoring. FCC provides $400M funding for building telehealth and telemedicine infrastructure11. S631 legislation (Remote Monitoring Access Act of 2007, frozen)12 is targeted at providing coverage of remote patient management services for specific chronic health care conditions for reimbursement under the Medicare Program. Likewise, S.321 (Fostering Independence through Technology Act 2007, also frozen)13 proposes to establish a pilot project under Medicare to incentivize home health agencies to use home monitoring and communications technologies.

Recently, the FCC published a rule proposing additional spectrum, or more radio frequencies, to allow healthcare organizations to support a broader range of wireless devices14. The agency is proposing to allow use of "wireless micro-power networks," which include networked and implanted stimulation devices. The devices in question activate and monitor nerves and muscles by sending electric currents, and are used for those with varied neuro-musculoskeletal disorders, ranging from migraines to Parkinson's disease and, according to some research, possibly even clinical depression at some point in the future. Under the proposed rule, published in the Federal Register15, the FCC will seek comment on the suitability of four segments within the 413-547 MHz band (currently used by federal agencies for land mobile radio and radar applications) to be made available for wireless micro-powered networks or similar networks.

• Migration of health care model – From institution to proactive home care

The traditional care delivery model is unsustainable over the long-run and leads to escalating healthcare costs. Healthcare services are generally facility-bound, i.e. patients have to go to doctor’s clinic or the hospital to receive care. Diseases are treated only when they are acute and diagnosed, increasing the need for hospital stays and emergency room visits. Also, patient information is hardly available in historical context and real time to aid proactive diagnosis & treatment via lifestyle-

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changing and wellness programs as a preventative measure to reduce the onset or risk of chronic diseases.

With aging demographic, more and more people are keen on proactive health care to assure long-term independence. In a recent survey, over 75% of the home health care agencies surveyed reported that telehealth services led to patients improving self care by proactive disease management.

• Disruptive forces come together – The Internet and Wireless Technology

The timing is fortuitous. Just when the US administration has recognized and announced significant initiatives for an overhaul of the health care system to improve quality, reduce costs, and make health care affordable to one and all. The combination of the Internet and Wireless, two disruptive technology forces, is poised to bring about a profound and compelling transformation in modern health care bringing together cognitive behavior research and e-therapy to remote patient monitoring and treatment.

The new generation of wireless and internet connected devices will enable physicians the opportunity to continuously monitor patients anytime and everywhere by receiving and processing critical health information in real time, and will herald an explosive growth in the consumer medical market. When treating chronic diseases such as heart disease and diabetes, health monitoring is a critical component of patient care.

The internet also offers the potential for efficient storage and retrieval of health records. Often patients undergo redundant testing for the same ailment at different clinics, resulting in significant wastage due to lack of portability of patient records. Several companies such as Microsoft and Google have announced key initiatives to offer a way to store health information from many sources in one location, so that it’s always organized and available to the patient online.

“e-Health”, an acronym popularly used, is this delivery of such health care to consumers using a combination of modern broadband communications infrastructure such as the internet and wireless, with databases and software for critical decision analysis and support.

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• New Revenue Opportunities for Operators, Health Care Device Manufacturers, and Health Care Service Providers

Wireless medical applications open up new revenue streams particularly for wireless operators and MVNOs, health care device manufacturers, and home health care service providers.

For wireless operators, the contracts are typically longer term and would not be expected to churn as compared to traditional cellular subscribers. Additionally, eHealth initiatives promise a boost to service providers whose expertise in service provisioning, bandwidth management, and technical support would serve them well in expanding their customer base into hospitals, integrated health systems, and large physician groups as they upgrade their telecommunication infrastructure, revamp clinical information systems, and digitize their medical records.

For home health care providers, telehealth can lower costs leading to improved efficiency and return on investment. In a recent survey16, over 42% of the polled agencies reported that telehealth programs led to a reduction in costs.

END-TO-END HEALTH & WELLNESS – Getting ready for prime time

Many recent industry developments are signaling the keen interest and trend by companies to invest in developing end-to-end wireless health & wellness solutions. While it is difficult to document all, some noteworthy initiatives and developments are:

• Wireless Health Device & Remote Patient Monitoringo CardioNet, a mobile cardiac telemetry technology, is a prime example16. It

used to be very difficult to detect infrequent and dangerous heart rhythms during a patient’s brief clinic visit or by using a 24-hour Holter monitor. Using 3G technology, CardioNet continuously monitors and sends patient health information directly to a clinician allowing physicians to continuously monitor the patient while the patient goes about his/her daily activities.

o Qualcomm is enabling companies to offer end-to-end wireless health & wellness services17 to companies like CardioNet.

o Philips has announced several initiatives to offer wireless handheld medical care services18 including in-home wireless monitoring devices19 to help patients take a more active role in their health and stay connected to their healthcare providers.

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Fig. 3: Wireless Medical Solution Value-Chain and Eco-system

o Bosch offers a Telehealth Platform to Support Remote Health Monitoring and Management Programs via subsidiary Health Hero20

o Medtronic CareLink® Network with Conexus™ Wireless Telemetry for cardiac disease management21

o GE introduced Quiet Care™, a remote monitoring system for seniors, alerting caregivers to changes that may signal potential health issues or emergency situations such as a fall or emerging health problem22.

o Intel and GE announced a health care alliance and Invest $250M in Medical Devices for telehealth and home health monitoring23

o MedApps launched their mobile wireless remote health monitoring system24

o Enfora, a leading global supplier of intelligent wireless networking solutions, demonstrated several advanced wireless patient monitoring solutions25

o St. Jude Medical introduced HouseCallPlus™, its remote Patient Monitoring System26

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o Biotronik introduced a remote patient monitoring service and the Cardiomessenger27, an external device resembling a cell phone that receives data from an implanted device (trend, event, or patient-initiated) and forwards them to BIOTRONIK's Service Center via the cellular phone network

o Tunstall28 received FDA approval to market Wireless Telehealth Monitoro Alere developed Allegro29, a web-based Integrated Health Management

Solution to monitor heart failure, coronary artery disease, diabetes and respiratory diseases that interface with biometric devices using wireless technology

• E-Health Records Initiativeso Microsoft launched HealthVault30 that offers a way to store health information

from many sources in one location, so that it’s always organized and available to the patient online.

o Google announced its own Personal Health Records (PHR) initiative31

o Likewise, Wal-Mart and Intel announced a joint eHealth records initiative32

• Wireless Health Forumso Continua Health Alliance33 is a non-profit, open industry coalition of healthcare

and technology companies joining together in collaboration to improve the quality of personal healthcare. With more than 180 member companies around the world, Continua is dedicated to establishing a system of interoperable personal health solutions that empowers individuals and provides the opportunity for truly personalized health and wellness management

o Wireless-Life Sciences Alliance34 is an organization founded to create and promote an ongoing and expanding dialogue around the many opportunities to use wireless technologies to advance the delivery of healthcare.

o Another indicator of telehealth's growing presence is the number of industry conferences that are now related to the technology. For instance, not only has American Telemedicine Association's (ATA) membership and conference attendance increased dramatically, but ATA has also added a mid-year conference to delve into specific aspects of telehealth. HP's Health and Life Science Symposium is now devoting a number of sessions specifically to telehealth.

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• Tangible perception of benefits – Finally!

In a comprehensive Philips national study35 involving a survey of home health care agencies using telehealth, tangible benefits were recognized:

o 89% of agencies report that telehealth led to an increase in quality outcomes 76.6% cited reduction in unplanned hospitalizations 77.2% cited reduction in ER visits

o 76% of agencies reported that telehealth services led to patients improving self care by proactive disease management

o 70.8% of agencies using telehealth report an increase in patient satisfaction scores

THE OPPORTUNITY

An independent market study predicts36 that the market for telehealth and home health monitoring for US and EU combined will grow from $3 billion in 2009 to an estimated $7.7 billion by 2012. Another study pegs the US market to grow from about $800M (2009) to $2.5B (2012)37.

By 2020 at least 160 million Americans will have at least one chronic condition and likely be monitored and treated remotely. The market for such remote monitoring of patients was $3.6 billion in 2007; it is estimated to have grown to $3.8 billion in 2008 and is forecast to reach $5.1 billion by 2013 at a CAGR of 6.5%38.

From a demographic perspective there are three major categories:

• Aging Independently (Seniors with aging and chronic conditions)

o ~20% population over age 65 by 203016

o ~77% of Americans over 65 have 2 or more chronic conditions39

o Over two-thirds of Medicare population has at least two chronic condition16

• General Health & Wellness (Individuals below 65 with chronic conditions)

o ~60% of American adults have at least 1 chronic condition16o 76% of the home health care agencies surveyed reported that telehealth

services led to patients improving self care by proactive disease management16

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• Fitness and Stay Well Category (Individuals who are fitness conscious)

o Over 43M Americans are members of a health/fitness club with over 54% above 33 years of age16

Major chronic diseases where opportunities for telehealth can be perceived are:o Congestive heart failure (CHF)o Chronic obstructive pulmonary disease (COPD)o Diabeteso Hypertension, ando Asthma

Major opportunity areas for wireless health & wellness include:o Remote diagnostics & monitoring systems o Vital sign monitoring devices tracking weight, blood pressure, blood

glucose, cholesterol, pulse oximeter, lung function, heart rate, ECG, etc.o Home health hubs / medical gatewayso Fitness management devices & applications ((calorie burn, heart rate,

weight watch etc.)o Implanted medical therapy managemento Remote monitoring for elder care including emergency event detection,

accidental fall detection, sleep quality etc.o Medication complianceo Drug delivery systems & sensors

KEY CHALLENGES FOR WIRELESS MEDICAL DEVICE DEPLOYMENT

• Feasible Business Model The wireless medical model presents an opportunity to re-align interests between the key players in the value chain, namely consumers, health care providers, and insurance companies. A successful business model is one that is aligned with the interests of all three entities. Despite the benefits of telehealth, the hesitation for reimbursement for telehealth by insurance providers continues to be the most pressing challenge to widespread adoption. While there is a growing interest among private insurers, they would like to see a compelling ROI via reduced costs and improved efficiency, and a

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genuine improvement in health care quality over current practices. Telehealth thus needs to move into the forefront of healthcare agendas and become an integral part of the daily practice of medicine.

• Risk Management:Use of any medical device comes with some degree of risk. Use of wireless may seem straightforward, but no technology is perfect. There are many technologies that would bring significant improvement to patient health care. But these are resisted partly due to an aversion to the perceived risk. With the emphasis on healthcare technology in the US stimulus plan, even the most technophobic US providers are however recognizing that they will have to start using technology whether they want to or not. Nevertheless, the goal is to understand, mitigate and manage the risk. While operational risk is generally associated with existing products in the field, the innovation risk model has many unknowns. The challenge is to develop a solid risk model and then realize innovation objectives in tandem with safety objectives.

• Compelling Use-cases The application of wireless must offer compelling benefits. When the first internet shopping malls began to compete with the brick-and-mortar stores, the benefits were obvious. But the same internet shopping model never became successful when applied to food and grocery stores, primarily because food was core to health and people wanted more control and visibility over the items. Likewise, the use of wireless technology with medical devices must offer compelling benefits and outweigh associated risks.

Further, telehealth solutions need to be better tailored to their end users. The market is not one-size-fits-all. The mismatch between available technologies and the day-to-day realities and preferences of end users needs to be addressed. Accuracy, mobility, and ease of use are a few of the criteria that end users will use to judge which solutions they will purchase.

• Design – Optimized for performance, cost and power Key design considerations are

o Efficient and high performance medical sensors (including wearable sensors for motion analysis) for accurate and reliable measurements

o Integration of these sensors and devices with wireless networks

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o Hardware architectures for ultra-low-power sensing, computation, and communication for overall extended battery life

o Understanding and satisfying radio protocols and requirements for optimized low-power and low-cost design comprehending such considerations as selection of an appropriate frequency band, data rates, interference and noise, environmental conditions, and a tradeoff between open standards and proprietary protocols.

o A fast response time to alert patient and doctors on patient status

o Inter-operation with hospital information systems comprehending privacy and reliability issues

o Scalable software and hardware infrastructure for wireless medical devices across a wide range of network densities, ranging from sparse clinic and hospital deployments to very dense, ad hoc deployments

• Coexistence and InteroperabilitySafe and reliable operation, coexistence and interoperability, and stable solutions are key goals for a wireless device implementation. Many isolated and proprietary solutions exist today. Even if some devices use the same transport mechanism, such as Bluetooth, Wi-Fi, USB, etc., each of them uses a different way of transmitting the data over that transport mechanism. It is soon evident that getting all these different devices from different vendors to work together in concert is a daunting task for a telehealth system vendor.

Coexistence between different networked medical device systems, or the approach of enabling plug-and-play interoperability and connectivity within the context of wireless personal telehealth, is thus quintessential for the success of future telehealth systems. While this remains a formidable challenge, the Continua Alliance40 and HL7 (Health Level Seven)41 are facilitating the establishment of standards and certification processes to ensure interoperability and co-existence.

Continua, for example, is working towards the development of design guidelines to enable interoperability. Figure 3 below shows the Continua Reference Architecture42 that contains the type of components of a personal telehealth system and how they are connected. The first version of the design guidelines focuses on the Personal Area Network (PAN) interface and the Electronic/Personal Health Record Network (xHRN) interface. This first selection was made to demonstrate workable results in a limited amount of

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time and to focus the effort of the organization on the highest priority interfaces first.

Figure 4: The Continua reference end-to-end architecture

The IEEE has also begun work on 10 telehealth device standards43 for controlling information exchange among the devices and cell phones, personal computers, personal health appliances and other compute engines. These standards, a part of the ISO/IEEE 11073 family of health informatic standards, will provide clear definitions of what is needed to implement common communication features for personal telehealth devices.

Standard design guidelines will enable new entrants to play in this market and focus them in their own specific areas of core competency. This reduction in the entry barrier and the healthy increase in competition will ultimately lead to better devices and improved quality of health care at lower costs.

• FDA Device Regulation & CertificationFDA's Center for Devices and Radiological Health (CDRH) is responsible for regulating firms who manufacture, repackage, relabel, and/or import medical devices sold in the United States. As with any equipment, medical devices are prone to failure. Problems that can arise with use of medical devices include

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mechanical failure, faulty design, poor manufacturing quality, adverse effects of materials implanted in the body, improper maintenance and/or specifications, user error, compromised sterility/shelf life and electro-magnetic interference among devices. The resulting impact of these problems on patient health can vary and in some instances lead to improper diagnosis or even patient death. The FDA regulation and certification processes are geared towards protecting public health with respect to medical devices.

Not all wireless medical devices may need FDA certification. But those that address critical disease management areas such as congestive heart failure will certainly do. This is often a long and arduous process requiring significant investment in time and effort from the device manufacturer.

Medical devices are generally classified into Class I, II, and III with regulatory requirements and control increasing as we move to Class III. Most Class I devices are exempt from Premarket Notification 510(k); most Class II devices require Premarket Notification 510(k); and most Class III devices require Premarket Approval. Device classification depends on several factors, with primary considerations including (i) the intended use of the device, (ii) the indications for use, and (iii) the risk the device poses to the patient and/or the user. Overview and details on FDA device regulation and classification can be found at the FDA website44.

• Best PracticesSince the field is relatively new, medical device vendors launching their first wireless products know little about what they’re getting themselves into. IT departments also lack the background and experience to understand the requirements for effectively deploying and managing wireless medical devices. The development and proliferation of best practices, adopted by both vendors and end users, is essential for successful deployment of wireless medical device strategy. A big challenge is the transition of medical device systems deployed on pilot vendor controlled networks to their deployment on hospital controlled enterprise networks. Over 75% of home health agencies surveyed cited importance of integration with EMR (electronic medical records) system as a pre-requisite for purchase of telehealth solutions16.

This transition, often assumed to be straight-forward and simple, is riddled with many inefficiencies and hidden costs for vendors and providers alike. For example, medical device systems may not be configured on the network infrastructure in the same way they were configured on the device vendor’s

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network. Another situation is when network infrastructure upgrades or new products installed on the network have not been fully tested and verified by the medical device vendor.

SUMMARYWireless technologies are bringing about dramatic improvements in the quality of healthcare by allowing patients unprecedented mobility while providing healthcare professionals with easy and real-time access to patient data. Awareness of telehealth and wireless medical applications is increasing with more high profile companies (GE, Google, HP, IBM, Intel, Microsoft, Philips, Qualcomm, Siemens, TI, Wal-Mart, etc,) entering the space, along with prominent media coverage and a rise in the number of conferences highlighting the technology. A recent national study by Philips showed compelling and tangible benefits with telehealth. Private and public payers are beginning to buy into the advantages of telehealth. Medicare now reimburses for telehealth under particular circumstances and some private payers in certain geographies are also paying providers to use telehealth.

Wireless is surely and swiftly bringing about a new revolution in health care.

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1 Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, 2006, National Health Care Expenditures Data, January 2008.2 US Department of Health & Human Resources Report on Chronic Conditions (2008) 3 US Department of Health & Human Resources - HHS Initiative on Multiple Chronic Conditions 4 Johns Hopkins University - Chronic Conditions Study (2004) 5 Largely Preventable Chronic Diseases Cause 86% Of Deaths In Europe (2006) 6 Home Telehealth in Canada (2007) 7 Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.8 The National Center for Policy Analysis: Health Care Spending - What the future will look like 9 Home Health Quality Initiatives, Centers for Medicare & Medicaid Services (2008) 10 Medicare Hospital Outpatient Payment System 11 FCC announces broadband telehealth $400M grant (2007) 12 S631 – Remote monitoring access act (2007) 13 S321 Fostering Independence through Technology Act (2007) 14 FCC may expand medical spectrum (2009) 15 Federal Register 16 CardioNet (2009) 17 Qualcomm Wireless Health Initiatives (2009)18 Philips joins Intel to develop wireless services (2009) 19 Philips wireless healthcare devices 20 Bosch and Health Hero (2009) 21 Medtronic Carelink (2009)22 GE Quietcare (2009) 23 GE and Intel to Form Healthcare Alliance (2009) 24 MedApps wireless health monitoring system (2009) 25 Enfora demonstrates wirelss patient monitoring solutions (2009) 26 St. Jude Housecall Plus 27 Biotronik Cardiomessenger 28 Tunstall receives FDA approval for wireless telehealth monitor (2009) 29 Alere Medcal’s Allegro 30 Microsoft HealthVault (2008)31 Google PHR initiative (2008) 32 Walmart and Intel eHealth initiative (2008) 33 Continua Healthcare Alliance 34 Wireless-Life Sciences Alliance 35 Philips National Study on telehealth and home health monitoring, Fazzi Associates ( 2008) 36 Combined data for United States and Europe. Data Monitor report - Telehealth spending North America and Telehealth spending 2007–2012 (2007)37 Parks Associates – Technology Meets Medicine (2008) 38 BCC Patient Monitoring Report (2008) 39 The Business of Healthcare, By Kenneth H. Cohn, Douglas E. Hough (2008) 40 Towards plug-and-play interoperability for wireless telehealth systems (2009) 41 HL7 (Health Level 7) 42 Randy Carroll, Rick Cnossen, Mark Schnell, David Simons, "Continua: An Interoperable Personal Healthcare Ecosystem," IEEE Pervasive Computing, vol. 6, no. 4, pp. 90-94, Oct-Dec, 200743 IEEE Telehealth Standards (2007)44 US FDA Overview of Medical Device Regulation and Guidance

For more insight on how you can penetrate the wireless medical market, please contact:EMBLAZE CONSULTING LLCinfo@emblazeworld.comTel: +1 469 236 1388

ABOUT THE AUTHOR

Sunil Hattangady is the President of Emblaze Consulting LLC, a company dedicated to helping technology businesses define and implement strategies for business competitiveness, new market penetration & customer acquisition, product innovation, creative marketing & communications, and strategic alliances & acquisitions.

Sunil is a marketing and business leader with multi-disciplinary achievements, international experience, and a track record in achieving revenue generation via market analysis and competitive product positioning, driving new product & business initiatives, building business-enhancing eco-systems, and managing effective & persuasive communications.

In his 14 years at Texas Instruments, Sunil has had a track record of innovation and product delivery in diverse roles such as Strategic Marketing Manager for TI’s 2.5G/3G/4G Wireless Products, OMAP Software Product Line Manager, OMAP Wireless Security Program Manager, and Technology Development Leader.

His major accomplishments include driving product management and competitive strategy for TI’s 2.5G/3G/4G smartphone, featurephone, and MID (Mobile Internet Device) products; managing TI’s OMAP Wireles Security Applications program from concept to first implementation; driving strategic alliances with smartphone OS partners that led to revenue-generating joint products; leading a miniaturization initiative that culminated in the smallest ‘phone-in-a-chip’ GSM module; and pioneering an advanced semiconductor technology now an industry standard and adopted worldwide.

Sunil is currently working on strategic opportunities and business development for growing companies with a focus on next-generation communication technologies (4G), smartphone development including applications & services, consumer devices (e.g. e-book readers), wireless M2M (machine-to-machine) communication devices and systems, energy conservation (smart-metering), and medical devices.

Sunil has an MBA from University of Texas at Austin, and a Ph.D. in Engineering from North Carolina State University, and holds over 20 US patents.

For more insight on how you can penetrate the wireless medical market, please contact:EMBLAZE CONSULTING LLCinfo@emblazeworld.comTel: +1 469 236 1388http://www.emblazeworld.com