Geneva, Switzerland, April 2012 Continua Health Alliance Beyond the Four Walls of Traditional Healthcare Charles Parker, Executive Director, Continua Health Alliance Joint ITU-WHO Workshop on e-Health Standards and Interoperability (Geneva, Switzerland, April 2012)

Geneva, Switzerland, April Continua Health Alliance Continua is a not-for-profit (U.S c6) association focused on the development of interoperability standards for personal connected health devices. Continua also works as a trade association to enable adoption and knowledge sharing within providers, policy/regulatory bodies, payers, vendors and consumers. Continua was founded in June 2006 Main location in Portland, OR with offices in Austin, TX, Brussels and Tokyo Currently, Continua has 240 member organizations

Main results to date: Involvement in EC-funded and International projects Smart Personal Health 2010/11: Interoperability recommendations Renewing Health large scale pilot : Telemedicine RCTs in nine EU regions eHealth Governance Initiative : coordinates eHealth in EU starting with common approach to electronic identification Japanese Government – requirement for use in Sendai Earthquake refugee camps US Veterans Program – requested requirement for new vendor procurement Geneva, Switzerland, April 20123

Future activities Momentum thematic network : Developing a blueprint for deploying telemedicine in regular healthcare eHealth Innovation : Developing roadmap for integrated and interoperable eHealth services Advisory roles in other large scale pilots for integrated care and telemedicine (2013-?) Participation in thematic network to provide a technological base for large-scale deployment of innovative services (2013-?) Leadership roles in US led Health Information Exchange Work with GSMA on deploying as a standard for Mobile Operators internationally Geneva, Switzerland, April 20124

Challenges, lessons learned Long lead times for initial development of Guidelines to products Interoperable devices often not available on local markets Price often primary driver of eHealth procurement Legal uncertainty for procurers mandating standards compliance Reimbursement issues with providers Uncertain regulatory models Geneva, Switzerland, April 20125

Contact details for further info Charles Parker, Questions to: Web Address Geneva, Switzerland, April 20126

[Optional] Additional slides Geneva, Switzerland, April 20127

Executive Summary In this new era of changing healthcare models and the potential for governments to further institute reimbursement change, where are the new opportunities? How do we reach new consumers and engage them? An opportunity exists with personal connected health. Continua Health Alliance is a not-for-profit (501c6) association focused on the development of interoperability standards for personal connected health devices. Continua also works as a trade association to enable adoption and knowledge sharing within providers, policy/regulatory bodies, payers, vendors and consumers. The discussion will cover the questions of new business models, workflow changes, consumer engagement models, business partner opportunities and new revenue streams. 8

About Continua Health Alliance: Continua Health Alliance is an international not-for-profit industry organization dedicated to establishing guidelines for combining and applying existing standards to personal connected health products and services. Continua makes a transition from the personal connected health marketplace to a marketplace of interoperable devices that facilitate better care, empower consumers, improve outcomes and lower overall healthcare costs possible. With more than 240 member companies around the world, Continua is comprised of technology, medical device and healthcare industry leaders as well as service providers dedicated to making personal connected health a reality.. 9

Beyond the Four Walls of Traditional Healthcare Today Current rates of adoption are low in the home space – less than 7% Primary use of the technology is limited to Post-acute recovery with some Aging at Home programs Personal use is not integrated with clinical data Only limited trials of data flowing into Medical Records in US (outside of the Veterans Health deployments) Why? Some opportunities 10

11 Cancers, mental disorders and diabetes are projected to grow the fastest, even though they are currently not the highest in prevalence Source: Milken Institute Projected rise In population (19%) Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and is restricted to that use and cannot be copied or shared without prior written consent of PwC.

12 Hypertension has the highest cost to employers, followed closely by cancers Source: Milken Institute The economic cost resulting from employees and their caregivers missing work days (absenteeism) or showing up but not performing well (presenteeism). This economic impact of chronic diseases is estimated at over $1 trillion annually Lost productivity definition: Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and is restricted to that use and cannot be copied or shared without prior written consent of PwC.

13 Although cardiovascular diseases result in the greatest treatment expenditures, stroke has the highest cost on a per-case basis Source: US Department of Health and Human Services 4,1144,6611,9081,6251, ,1694,6805,1133,3031,959 Treatment Expense Per Patient ($) Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and is restricted to that use and cannot be copied or shared without prior written consent of PwC.

14 Cost components vary greatly by disease; the large share of hospitalization costs for cardiovascular diseases offers a great cost reduction opportunity Source: US Department of Health and Human Services Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and is restricted to that use and cannot be copied or shared without prior written consent of PwC.

15 Per-patient medical expenses also indicate that a large portion of stroke expenses are attributed to home health, indicating a potential mHealth area of opportunity Source: US Department of Health and Human Services Confidential – This information was prepared by PwC for the Continua Health Alliance board of directors and is restricted to that use and cannot be copied or shared without prior written consent of PwC.

Beyond the Four Walls: Personal Connected Health 16

17 Our Mission is to establish an ecosystem of personal connected health systems that empower individuals & organizations to better manage their health and wellness

2/22/ Goal: Realize Peak Health Potential Goal Experience peak health potential throughout life for a high quality of life at minimal costs Reality Average individual is experiencing much less of full health potential than expected at a high financial & quality of life cost Cause Adverse health events such as stress, poor nutrition, inactivity… are causing the population to fall away from their peak health potential Adapted from Oregon Medical Labs Age Illness Pre-Illness Wellness Unpredictable Health Predictable (Rules-based) Health Deat h 60-80% Lifestyle Management Modifiable lifestyle Irreversible Disease state Happening earlier in life Higher $$ Costs to All Realize Peak Health Potential

19 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): 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

A Solution: Personal Connected Healthcare There is increasing evidence to support the value of remote monitoring for individuals with chronic conditions, including: 35-56% reduction in mortality; 47% reduction in risk of hospitalization; 6 days reduction in length of hospital admission and 65% reduction in office visits; 40-64% reduction in physician time for checks and 63% reduction in transport costs (Cleland et al 2005; Lee R, Goldberg et al, 2003; Scalvini S et al., 2001; Elsner et al, 2006; Van Ginneken et al 2006) 20

Primary focus areas Health & Wellness Chronic Condition Management Living Independently Longer With a second separation and focus on non-regulated and regulated devices to ensure appropriate adoption

Already Complete: Interfaces & Standards Health Record Network Interface Personal Device Weight Scale Pulse Oximeter Independent Living Activity Cardio / Strength Medication Adherence Glucose Meter Pulse / Blood Pressure Thermometer Physical Activity Peak Flow Aggregation Manager Device Connectivity Wide Area Network (WAN) Interface Telehealth Service Center Health Records EHR PHR HIE NHIN CCD PCD HDP and LE

2/22/ Examples of Solutions implemented: Aging Independently – Garfield Center: (Zigbee enabled living center) Chronic Condition Oxygen level, Heart rate, Weight, Blood pressure Activity Monitors Ensure appropriate levels of activity Gait monitor Ensure proper orientation and early stroke warning Devices are wired for entire center. Individuals can move about the entire facility.

2/22/ Examples of Solutions implemented: Veterans Administration: (45,000+ end users of technology) Fixed system for deployment to chronic population Largest deployment in the world Health conditions Diabetes Heart Failure Hypertension COPD and Asthma Published reports show savings of 53 to 85% over existing practice and treatments.

2/22/ Examples of Solutions implemented: Sub-Saharan Africa (Maternal health): Pulse/Oximeters Heart rate Blood Pressure Pre-eclampsia Hypertension Glucometers Measure for gestational Diabetes ECG Mobile platform Devices are portable and can be shared

2/22/ Examples of Solutions implemented: Japan Earthquake/Tsunami: Personal Health Records Allows data to be shared quickly as residents are transferred/moved Provides an easy way to acquire data in single location Devices Japan has required devices to have standardized interfaces to allow easy implementation Can carry devices from different manufacturers and still acquire data Standardization and Personal Health Record allows transfers of displaced to have records follow them.

2/22/ Examples of Solutions in development: Organized Competition for engagement: Studies repeatedly show that: Competition is highest driver In a group that is non-threatening Group results Self-insured employee activation Can provide optimized results Near real-time Multiple measurements for diversity Can provide a safety measure in sports Sensor technology can be deployed for safety Devices are portable and can be shared in situ

2/22/ Examples of Solutions in development: Diagnostic Gaming: Provide advanced platforms that: Can measure health of individual Recovery of individual Provide rehabilitative assistance Determine early signs of cognitive issues Can measure a whole facility Devices can be fit on individuals and can be re-used. Architecture allows standardized acquisition.

2/22/ Examples of Solutions: Highly Mobile Platforms: (Emergency Response) Personal Health Records Allows data to be shared quickly Provides an easy way to acquire data in single location Portable and unobtrusive Can carry in pocket or stuck on Can carry devices from different manufacturers and still acquire data Wireless setup and portable devices allowed quick dissemination and deployment

Key Points The certified technology provides a standard based approach to collecting device data rather than having to manually input data. Common tools for representing data Many devices specializations defined Can integrate technology into systems in an ad hoc manner Technology can be repurposed quickly Can be integrated into health records or set up for quick single issue management Highly portable

Thank you! For more information or to join Continua Health Alliance… Sign up for our newsletter Visit our website