1. Agenda & Objective Stepstone Connected Health project update ( BOCA ) Connected Health Architecture hi – level overview –Vision –Mapping to projects ( existing & potential ) –Scenario example

2. Stepstone/Continua Project (a Connected Health Reference Implementation) 2Q2009 Content. Added Deleted & Changed Milestones Packaging Editions Dependencies Pressures SODA (DeviceKit) Impl of ASN-1 protocol Statistics 1 new contributor 284 revisions Intercept requirements from OHT Projects CUI IHE Profiles Terminology Service Understand relationship with OHT Platform Project Understand relationship with OHT Architecture Project Continua Dev Kit Continua V2 SODA components to move from Eclipse OHF to Eclipse Runtime Set up Continua projects with namespace org.openhealthtools.stepstone.phd Restructure and create OHT Build based on Eclipse RT pre-req Add device support Glucose, Med Monitor, Weight “Cookbook” documentation for creating generic and Continua builds - Dec 08 Provisioned OHT sub project - May release (0.4.0) 0.4.0 to match IHE Profiles project and indicate pre-alpha status

3. Stepstone/Continua 2Q09 4Q09 3Q09 1Q10 2Q10 First Iteration on Continua V2: WAN/API (WS-I Basic) Initial OHT Release with Continua Support. Additional device support Stepstone Dev-Kit Refactoring OHT Security Integration, Continua Dev-Kit

4. Connected Health Architecture - 30k feet Medical Devices Devices to provide personal health data Collect device data Telehealth / care management applications, aggregate data, event processing, format/route to health systems, services EMRs, PHRs, clinical trials, analytics, etc. Device Interfaces Server Interfaces Application EDGE Interfaces System Interfaces Application Device manager (EDGE) Remote Monitoring Server System Interfaces Application Health Systems Controller

5. Connected Health – Stepstone today Medical Devices Devices to provide personal health data Platform to support multiple device interfaces Supports Continua (IEEE,USB,Bluetooth) No user application Platforms Supporting Continua (v2 EDGE is WIP, IHE/HL7 CDA) Liteweight, generic user application Uses IHE Profiles project EMRs, PHRs, clinical trials, analytics, etc. Device Interfaces Server Interfaces Application EDGE Interfaces System Interfaces Application Device manager (EDGE) Remote Monitoring Server System Interfaces Application Health Systems SODA Eclipse project Controller

6. Implement Scenarios Using OHT Projects, Refactor Project TaskUSES. 1. Medical Device Integration (Stepstone) –Consumer connected health devices –Non medical devices (e.g. RFID, motion, tracking, ID readers, alarms, climate control) –Standard and propriety –Extend to Clinical? 2. Applications (CUI, Security) –Information rendering on access devices including tablets, smart phones, soft AHD's, etc –Guidelines –Open alternatives to Silverlight implementation –Consumer Control Dashboard –Context-driven UI (e,g, Gadget/Widget composition) 3. Edge Controllers (Stepstone) –dedicated "hard" AHD –soft/mobile AHD 4. Data Sharing and Access (IHE, Security, Tooling) –IHE profiles –EHR/EMR sharing and access –Consumer record access/sharing, and PHRs (Google, Healthvault) –Privacy, Access, Security Services, ID 5. Remote Monitoring Server (IHE, Stepstone) –Event Processing and Monitoring –Security and sharing (end-to-end for key scenarios) –Dynamic and Distributed Business Rules and Processes –Healthcare Analytics Apps 6. Eventing and associated Business Processes (new?) –standard event structure –the easy tie to pre-defined workflow and business processes

7. Scenario example – Chronic Disease Mgmt Chronic disease accounts for ~75% of healthcare costs ( USA ) Setting: 52 year old male with adult-onset diabetes mellitus (type II diabetes) on two oral medications for diabetes: –Metformin, which reduces glucose production by the liver. Dose: 850 mg tablet taken orally once a day. –Repaglinide (Prandin®), which stimulates insulin secretion by the pancreas. Dose: 1 mg tablet taken orally before each meal. –Patient is overweight to obese and was put on a diet 2 weeks ago by his physician. –Daily monitoring of weight was recommended by the physician. –Patient provided with the following devices Glucometer Weight scale Medication pack 1.In morning patient reminded to take meds, readings (weight & glucose ). 2.Devices upload data to device manager which transmits to remote monitoring server 3.Patient views own data via Portal application, PHR, diabetes care management application to better manage their disease. 4.Care provider ( e.g. Patient centered medical home model, telehealth nurse ) has immediate access to patient data and can act. 1.E.g. no readings from this patient, not taking meds, glucose readings irregular  contact patient / arrange doctor visit 5.Provider / Payer manages care program across a set of chronic disease patients 6.Device data packaged and made available in physician’s system prior to next scheduled appointment for this patient.

8. Scenario Messaging / Value Chronic diseases typically require monitoring of multiple parameters. Knowing that relevant information related to his health condition is reliably captured for review is very valuable. The electronic record is far superior to the paper diary he used before. The information is more complete and accurate. Concentrating all this information in one health management software provides a nice overview and keeps track of his progress all in one place. Therapy decisions require contextual information, i.e., putting data in context. Example: Weight reduction brings the additional benefits of lower average glucose levels as well as lower blood pressures. Accurate information takes out the guesswork for the physician. Together, patient and physician can make informed therapy decisions and lifestyle adjustments. Good data makes discussions with the physician much more effective and productive. This shortens consultations. Patient feels involved and empowered because he more clearly understands the interactions of food, activity, medication, etc. The system enables synchronization with a personal health record as well as an electronic health record for a complete end-to-end solution connecting the patient to the physician, as well as his support network, improving the quality of data, and ultimately the quality of care. Outreach to patient / intervention prior to acute care episode benefits patient and less costly to the system

9. Takeaways Stepstone architecture open, SOA based Refactor into subprojects: –Easily combine components into solutions –Enable more robust application projects –Platform for support for multiple interface requirements Using IHE Profiles project code today Looking ahead: –CDA modeling project tooling –Security –CUI –…