Continua Health Alliance aims to cure top telehealth industry challenges

1Striving to cure telehealth challenges - including connected health equipment ease-of-deployment, integration of telehealth data into care providers' normal workflow, and meeting changing patient needs - is all in a day's work for the nonprofit Continua Health Alliance. A primary technical focal point for the organization is to enable personal connected health devices' interoperability/plug-and-play connectivity. And, as the Affordable Care Act (aka "Obamacare") takes hold, the need for personal connected health device connectivity will only increase, as mentioned by Alliance members Ian Hay (Orange), Barry Reinhold (Lamprey Networks), and Frank Wartena (Philips Research Europe) in the following interview.

ECD: Briefly describe the Continua Health Alliance – when formed and by whom, how many members, technology focus.

CONTINUA: Continua Health Alliance, established in 2006, is an international not-for-profit industry organization enabling end-to-end, plug-and-play connectivity of personal health devices and services. Continua convenes industry standards that enable personal connected health technologies, to move health and wellness into the day-to-day lives of consumers and improve health management, quality of life, and clinical outcomes, while reducing costs.

The Alliance’s activities include publication of interoperability Design Guidelines, a certification and brand support program, events, and collaborations to support technology and clinical innovation, as well as promotion of the end-to-end ecosystem. Continua is working with a number of countries and national health ministries around the world to support the development and implementation of groundbreaking national connected health initiatives.

The Alliance is the industry voice with employers, payers, regulatory bodies, government agencies, and care providers, and its policy initiatives influence advocacy and legislative and regulatory agencies on the state, regional, and national government levels. With approximately 220 member organizations reaching across the globe, Continua comprises technology, medical device, and health-care industry leaders and service providers dedicated to making personal connected health a reality.

ECD: What is the Alliance’s mission, and how does it aim to achieve it? Also briefly describe a couple of the design guidelines/specifications the Alliance has passed, and when.

CONTINUA: As mentioned, Continua’s mission is to convene global technology standards as the basis for its interoperability Design Guidelines that promote end-to-end, plug-and-play connectivity for devices, systems, and services in personal connected health. Continua also works to foster independence and empower people and organizations to better manage health and wellness. Continua implements partnerships with international standards bodies – with a total of 13 now represented within the guidelines, including IEEE, IHE, HL7, and W3C – to establish Continua as the global framework for connected health systems.

Continua Design Guidelines make the collection and sharing of personal health data convenient and secure for consumers and health-care providers, and are proven to decrease time to market and reduce development costs. For example, in Japan, Continua-certified devices used in a disaster relief effort for cardiac patients following the 2011 tsunami decreased time to market from three months to just three weeks, and reduced development costs by as much as $80,000 per device. Continua’s 2012 Guidelines, which are now publicly available, include products that incorporate Bluetooth Smart, the low-energy technology at the heart of the Bluetooth v4.0 specification. Continua first issued Design Guidelines in 2009, and provides updated versions of its guidelines each year to further provide enhancements and new technologies.

Certifying a device with Continua guarantees that mandatory and optional functions implemented in a device will work with any other peer device that passed the Continua certification program. It also means guaranteed access to tools and resources throughout the process, including the Continua Enabling Software Library (CESL), test tools, Continua certification experts, premarket interoperability testing, technical operations leads, and brand support for certified products.

ECD: What are the top 3 biggest technical challenges faced by the medical/telehealth community? How will/should those challenges be mitigated?

CONTINUA: The top three are:

1. Integrating data from personal connected health devices or systems into the normal workflow of care providers: Currently, personal connected health tools are separate from the regular EHR [Electronic Health Record) and IT tools that care providers are using for their normal work. There will often be dedicated staff that reviews the data transmitted from devices in patients’ homes and takes action based on that data. However, in many cases, that data never makes it into the normal health record of the patient. To make connected health part of normal clinical practice, the relevant data from these systems needs to be integrated into EHRs. Continua has developed an interface for this data, in close collaboration with HL7 and IHE, which we call the Health Reporting Network interface. We believe that EHR vendors should implement this interface such that they could receive relevant information from personal connected health devices and systems. Meaningful Use stage 3 would be an excellent mechanism to drive the adoption of this interface in EHRs.

2. Achieving easy deployment of connected health equipment: The ease of setup and teardown of devices in patients’ homes is a critical factor to a cost-effective deployment of this equipment. Today, this might require putting an Internet subscription in place in case the patient doesn’t have that yet, sending an installer to the patient’s home to connect the devices to the local Internet gateway, and sometimes pairing the sensors to the connected health hub. Cellular technology is an excellent way to simplify the deployment of personal connected health devices, as no extra steps are needed to hook the devices to the Internet and, in many cases, sending an installer is not required. The duration of the deployment of the equipment in the patient’s home determines if it is cost-effective to spend money on a cellular connection and to remove the need for sending an installer.

3. Accommodating the changing needs and preferences of patients: Patients with a chronic condition often develop additional chronic conditions over time. When such patients are using personal connected health technologies, monitoring systems would need to accommodate those changes in the patient’s health status by adding extra measurement devices and providing additional services. Also, a patient might already be using some measurement devices (for example, a glucose meter or a weight scale) when they enroll in a connected health program. Ideally patients would be able to use existing measurement devices, and add additional measurement devices as needed, within the limitations of the regulatory framework.

Enabling such plug-and-play of measurement devices requires the implementation of solid interoperability standards, which Continua facilitates through its Design Guidelines and certification program. Wider adoption of these standards by medical device and connected health hub manufacturers will enable more flexibility in the setup of personal connected health devices and systems and cater to the needs of patients and providers. In parallel, more discussion with the U.S. Food and Drug Administration (FDA) is required to ensure the safety and efficacy of such flexible personal connected health solutions.

ECD: Which historical or nascent technologies have revolutionized telehealth/medical technology the most? Why/how?

CONTINUA: Mobility represents, arguably, the biggest revolution in personal connected health. More specifically, mobile broadband technology enabled by WiFi and cellular has enabled connected health to gain mobility by removing reliance on POTS [Plain Old Telephone System] in a fixed location to provide service. Broadband provides a step in the right direction, but still requires some level of setup in the home. Even using WiFi to allow sensors and devices to move within the home can raise issues resulting from interference and pairing/security of devices to the home access point. Mobile broadband removes the setup issues but can also suffer from coverage issues depending on the location, so it is not always the most suitable choice.

However, the benefits of enabling mobility both within and outside the home have allowed for a new range of services to be created. An example of this is geofencing, which uses mobile technology to define boundaries that the device must stay within or it will immediately set off an alert to care providers. Using location-based services, the patient can be located and aided. This type of monitoring can be especially beneficial for Alzheimer’s or elderly patients. Being able to free the provision of care from a specific location by using certified devices with interoperable interfaces is enabling the creation of a new range of services.

ECD: What is the best path to achieving the connectivity so vital in telehealth/home health technology today? Where do Android- and iOS-based devices fit in – now and in the future?

CONTINUA: As mentioned earlier, cellular connectivity provides a great way to simplify the deployment of personal connected health equipment in patients’ homes. In addition, off-the-shelf mobile devices such as smartphones and tablets will play an increasingly important role in connected health setups. Managing chronic conditions, which often requires FDA approval, will likely continue to require “locked down” devices. Over time, dedicated versions of off-the-shelf smartphones and tablets will replace the current proprietary connected health hubs; a number of examples exist in the market where specific versions of Android phones and tablets are used as a hub. In the fitness and wellness domain, people will be able to use their own mobile devices with health-related apps and connected health sensors. The app stores of Google and Apple are full of health-related apps and measurement devices such as weight scales and blood pressure cuffs, which can increasingly be connected to phones and tablets. The Continua interoperability guidelines play a key role in leveling the playing field and creating a healthy ecosystem where apps, phones, and medical devices can easily be combined.

ECD: Which technologies are needed most in the telehealth/medical realm but not yet available?

CONTINUA: Actually, the technologies needed most for personal connected health are broadly available today. There are many connectivity options across a variety of technology types, each with specific benefits depending on the need, whether it is out-of-the-box connectivity via Machine to Machine (M2M) cellular connectivity, a smartphone, or a home gateway connected to a consumer’s broadband connection. There are also many medical devices that can connect to a wide range of devices over a number of short-range radio technologies that are required to enable remotely provided care.

ECD: How is the telehealth/medical technology industry landscape changing now, in light of “Obamacare,” and how will it change in the next 5 to 10 years?

CONTINUA: The health-care industry is facing a number of challenges, including payment reform and accountable care, at a time when we have fewer health-care providers available to care for a growing number of patients. That creates demand for personal connected health. Providers are going to have to care for the current patient base, plus the millions of new patients who will be seeking care under the new access reform policies. As a result, providers will have to expand their tool set beyond the office or emergency room visit. Personal connected health devices and systems that are easy for consumers and health-care providers to use are becoming vital in the new health-care delivery paradigm. End-to-end, plug-and-play connectivity for personal connected health devices will enable remote monitoring of chronic conditions such as hypertension and diabetes, and will empower patients to better self-manage their health and wellness.

With new models of care delivery, and as the Affordable Care Act takes effect, we are seeing the need to manage care at the individual level more closely. This allows us to keep individuals out of the expensive modes of care – emergency rooms and hospital beds – and enables patients to stay healthy at home. Also, the need to provide a pathway for those already in hospitals to return home sooner will require follow-up and monitoring, which can be provided through personal connected health. Using this technology, we have already seen a drop in six days for in-hospital stays, thereby allowing more critical needs to be addressed while reducing costs. This is the future of health-care delivery.

Ian Hay is Head of Emerging Ecosystems at Orange and has more than 23 years of experience in telecommunications. He was unanimously elected as the Chair of the Technical Working Group at Continua in 2012, managing the expert group to deliver the Design Guidelines.

Barry Reinhold is the President and Chief Technology Officer of Lamprey Networks. He founded LNI in 1999 and has more than 20 years of leadership experience developing Internet technologies with different standards organizations. He chairs the Service Task Force for the Continua Health Alliance.

Frank Wartena, M.Sc. is Senior Scientist, Care Management Solutions, at Philips Research Europe, and has fulfilled Secretary of the Use Case Working Group and Vice Chair of the Technical Working Group roles in the Continua Health Alliance. He has been recognized for his contributions with two Continua Key Contributor Awards in 2007 and 2010.

Continua Health Alliance admin@continuaalliance.org www.continuaalliance.org

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