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Slide 1: Enabling a Revolution in 21st Century Healthcare The role of wireless in consumer healthcare Nick Hunn CTO – WiFore, Vice-Chairman, Mobile Data Association presented at “The Future of Wireless 2009” - Cambridge Wireless Network
Slide 2: 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 • • •
Slide 3: The older Generation is Getting Bigger • 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. Percentage 35 Japan 30 Germany France 25 UK USA 20 15 10 5 Source: dti Global Watch 0 1970 1980 1990 2000 2010 2020 2030 2040 2050
Slide 4: 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.
Slide 5: Fewer Carers & Tax Payers • 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. Ratio of Working to Retired Population 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 1960 1975 2000 2025 2050 Norway UK Germany Spain
Slide 6: Costs are Rising • Already, healthcare costs are rising. • Patients demand more, yet live more years of ill health while treatment costs rise. Health spend as % of GDP 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 y nd n ur g um ai n nd al m an pa rtu g la er la Sp lg i om m bo Ic e St a Ja gd te s 1974 1984 1994 2004 G er Be Po Sw itz Ki n d xe Lu ni te U U ni te d
Slide 7: Intensity of Care • Assisted Living and eHealth can help keep people out of expensive Professional Care. Professional Care Multiple / complex conditions Assisted Living / eHealth Partly controlled single condition Well controlled condition Prevention Healthy Population
Slide 8: It is vastly cheaper to keep patients at home in good health. • That makes technology that encourages wellness and independence increasingly important. Assisted Lifestyle 100% Healthy Independent Living Chronic Disease Management Community Clinic GP’s Surgery Assisted Lifestyle Quality of Life Assisted Living Skilled Nursing Facilities Specialty Clinic Community Hospital Assistive Technogy Intensive Care Unit Home Care 0% £1 £10 Residential Care £100 Cost of Care / Day Hospital Care £1,000 £10,000 Dr M Bainbridge NHS CfH - CIU
Slide 9: Why it’s important to work on prevention
Slide 10: 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. Two key opportunities are Managing Long Term Chronic Conditions Assisted Living
Slide 11: Long Term Chronic Disease in England • One of the major costs is treating and caring for Long Term Chronic Conditions.
Slide 12: Number of people with at least one LTC in England • Our current lifestyle means that this cost will increase.
Slide 13: Proportion of people with LTCs by age • And as we get older, we collect more of them…
Slide 14: 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 Insurers Drug Suppliers
Slide 15: 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
Slide 16: Assisted Living – Typical Sensor Locations An example of sensor placement – typically many simple passive sensors SAPHE Project
Slide 17: 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
Slide 18: 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
Slide 19: Why Wireless? • • • • Remote Capture of Data – – – – Patients don’t need to remember anything – it just happens Timely delivery means useful analysis No wiring Add additional sensors as they’re needed Transmission of Data to Server Application Ease of Installation (and removal) Ease of Expansion “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
Slide 20: Standards Help • • • 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 IMPLANT PULSE OX BLOODPRESSURE CUFF Cell Phone 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. PEDOMETER Digital Home PC WEIGHT SCALE FITNESS EQUIPMENT Internet Personal Health System Family care givers Disease management service Healthcare provider Personal Health Record MEDICATION TRACKING
Slide 21: Why Wireless? • • • 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
Slide 22: Topologies for the local wireless connection Continua model EHR Compliant Bluetooth low energy gateway PAN Device Application Hosting Device WAN Device xHRN-Interface
Slide 23: 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
Slide 24: The Bluetooth low energy approach to internet connected devices • • Pair devices by an intuitive method, e.g. NFC, proximity or simple buttons. Phone interrogates the scale and sees that it wants to connect to a gateway service, which the phone can provide.
Slide 25: 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.
Slide 26: 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.
Slide 27: 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.
Slide 28: Targeted Devices for Bluetooth HDP and LE Bluetooth Enabled Health Devices with BR/EDR BR/EDR Bluetooth Enabled Computation Engines with BR/EDR LE Bluetooth Enabled Health Devices with LE Blood Pressure Meters Weight Scales Mobile Phones Heart Rate Belts & Monitors PCs Physical Activity Monitors Pulse Oximeters (Streaming data) Telehealth Devices Healthcare Appliances Glucose Monitors (coin cell versions) Glucose Monitors Thermometers Thermometers Personal Digital Assistants (PDAs) (coin cell versions)
Slide 29: 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? • Healthcare Providers? • Health 2.0 Application Developers • Supermarkets? • Patients and Community Groups?
Slide 30: 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.
Slide 31: 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’m watching the TV… I’m going to bed…
Slide 32: 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.
Slide 33: 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
Slide 34: Thank You Nick Hunn Director mob: +44 7768 890 148 email: nick@wifore.com web: www.wifore.com