IBM Healthcare and Life Sciences Innovation Team Enabling Homecare with Remote Monitoring Technology Kathy Schweda WW Business Segment Leader Pervasive Healthcare Solutions 12 June 2006 © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Personalized Health Care Automated Systems CDI Information Correlation 1 st Generation Diagnosis Lifetime Health Management Throughput Analytics Revolutionary Technology IBM Healthcare Innovation Engine: Evolution to Personalized Healthcare Pre-symptomatic Treatment Rules Based Clinical Response Remote Monitoring Clinical Decision Support In-Pt Automated Vitals Clinical Trial Data Collection Chronic Disease Mgmt Traditional HC Patient Reported Data Episodic Treatment Electronic Health Records Information Augmented Data and Systems Integration Non-specific (Treat Symptoms) Source: Kathy Schweda Organized (Error Reduction) Personalized (Disease Prevention) Evolutionary Practices © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Definitions Telehealthcare – Broad spectrum of remote services delivered outside of the traditional healthcare institutions using telecommunications such as phone, broadband or wireless technology. Telemedicine – Form of telehealth that describes the direct provision of clinical care for diagnosing, treating or follow up with a remote patient Remote Patient Monitoring (RPM) – Form of telehealth that uses sensing technology and telecommunications to deliver monitored data to clinical professionals from remote patients © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Market Intelligence: Disease Management Remote Patient Monitoring © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Scientific Literature Search identifies Savings: Cardiac, Diabetes, Obesity, Asthma… Clinical trial of an Internet-based case management system for secondary prevention of heart disease: results indicate that fewer cardiovascular events occurred …. resulting in a gross cost savings of $1418 US dollars per patient. With a projected program cost of $453 USD per patient, the return on investment is estimated at 213%. For diabetics healthcare costs per individual are estimated to be $950 less per year for well managed vs. unmanaged patients (1) $450 lower healthcare costs person per year in lower healthcare costs for active vs. obese/sedentary individuals (3) For high-risk and high-cost asthma patients, …analysis revealed that the most cost-effective alternative for reducing ER visits was a peak flow-based selfmanagement plan. The peak flow-based self-management program had an incremental cost-effectiveness (C/E) ratio of $ 60. 57 per ER visit averted compared to usual care/NAP…The PFB-AP was also the most cost-effective in reducing asthma hospitalization costs with an incremental C/E ratio of $300 per hospitalization prevented, compared with usual care (4) (1) (2) (3) (4) http: //www. ncbi. nlm. nih. gov/entrez/query. fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11176811 http: //www. ncbi. nlm. nih. gov/entrez/query. fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15167389 http: //www. ncbi. nlm. nih. gov/entrez/query. fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15360065 http: //www. ncbi. nlm. nih. gov/entrez/query. fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14512778 © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team MI Sources Advisory Board 3/16/06: Telemedicine takes hold as means to reduce costs, ED visits ü president of the American Medical Association says the technology can “greatly enhance the patient-physician relationship” by providing patients with around-the-clock access to medical advice ü A study by Kaiser Permanente compared two groups of 100 patients and ü found that patients who used telemedicine technology reduced hospitalizations by 200 days between May 1996 and November 1997. ü Similarly, a telemedicine program run by the Eddy Visiting Nurses Association reduced ED visits by 29% and overall hospitalizations by 37%. ü Meanwhile, the number of companies manufacturing telemedicine equipment has tripled to 15 over the last three years, ü and according to the American Telemedicine Association, the U. S. Department of Veterans Affairs hopes to double the number of patients using telemedicine at home to 20, 000 by next year. ü The AP notes that several states, especially those with vast rural areas, are moving to reimburse providers for telecare provided to Medicaid beneficiaries (Choi, AP/Long Island Newsday, 3/12). © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team MI Sources Cont’d Forrester 1 -19 -06 Integrated Health Management Will Dismantle Disease Management’s Information Barriers by Jennifer Gaudet with Eric G. Brown, Will Mc. Enroe ü By 2007, two-thirds of all employers plan to offer benefits that include DM — a big leap from the 45% that do so today (see Figure 1). 1 ü Forrester surveyed 18 health plans about their investments in DM-related technologies and found that 13 of them will grow their budgets for DM technology in 2006 (see Figure 2). ü The Medicare Health Support programs — the Center for Medicare & Medicaid Services (CMS)initiated projects that intend to demonstrate the value of DM — have further focused national attention on the topic Frost & Sullivan 9/27/05 Growth in Flexible Patient Monitoring Solutions Nathan H. Cohen ü $100 M Market by end of 2006 for Remote Patient Monitoring ü Reduce volume of acute patient visits ü Maximize medical treatment at low cost by © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Growth in Employer Disease Management Activity © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Health Plans Investment in Disease Management © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Digital-ready consumers are more prevalent than you might think Digital-Ready Consumer Defined: • Either a broadband connection or a home network, AND • Any two-way, wireless communication device (cell) 33% 50 - 59 29% 21% 15% 70 - 74 8% 75 - 79 6% 80+ Today’s seniors Under 50 65 - 69 Boomer vanguard Digitalready 60 - 64 Approaching Age 2% Base: US consumers Source: Forrester’s Consumer Technographics® 2005 North American Benchmark Study © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Who Pays? Forrester Research: Who Pays For Healthcare Unbound The $34 Billion Market For Personal Medical Monitoring by Elizabeth W. Boehm with Bradford J. Holmes, Eric G. Brown, Lynne “Sam” Bishop, Sara E. Mc. Aulay, and Jennifer Gaudet ü Insurers Aren’t Eager To Pick Up The Tab For Healthcare Unbound A recent survey sponsored jointly by the American Telemedicine Association and AMD Telemedicine identified only 34 telemedicine programs receiving funding from health insurers. ü To date, only five states — California, Kentucky, Louisiana, Oklahoma, and Texas have passed legislation mandating reimbursement of telemedical consults that would be covered if treatment occurred in the traditional face-to-face mode. Spyplgass Consulting: Healthcare Without Bounds 04 -2006 ü 65% of organizations interviewed have invested in Remote Patient Monitoring ü 71% using RPM have received State/Federal Grants © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Why are Organizations Investing in RPM Solutions Source: Healthcare Without Bounds – Spyglass 4/06 © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Business Value Reduction in costs for chronic condition management: ü chronic condition acute care ü long term chronic care by primary physician ü hospitalization Reduction in costs for care of elderly: ü Rehab, nursing and long term care Improved Clinical Outcomes Improved Health & Wellness © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Mobile Monitoring – business driver summary: Demographics ü Aging Population ü Chronic Conditions Increasing Costs ü Escalating Resources ü Less Available Beds ü Staff Shortage: Physicians, Nurses, Allied Professionals (RT, PT, LT) Outcomes ü Unmonitored patient leads to acute and ü Self reported results prone to errors: } } } rescue events No data Bad data Adjusted/Altered data Technology ü Current Devices and Communications Support Remote Monitoring © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Three Precepts Predict Technology Penetration To succeed, technology’s benefits must be: 1. Commensurate with costs 2. Obvious extensions of an existing behavior 3. More visible than the technology Source: Forrester HC Unbound 8/05 Boehm © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team One Patient, One System (Future) Overview of Flexible Monitoring Remote Monitor ER Monitor Patient PACU Monitor Transport Monitor ICU/Bedside Monitor OR Monitor © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Forrester Forecast for Total Healthcare Unbound Market: Money to be saved; Money to be made; Reimbursement Models to change CURRENT SPEND ON CHRONIC CARE-$1 T = 75% of 1. 4 T annual US HC Spend © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Interoperable Vision for Home Healthcare üAny Medical Device üAny Communications Hub üAny Place üAny Time © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Telemedicine: Examples in the Market © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team The Home Healthcare Ecosystem is Complex SENSORS Cholesterol Monitor Home sensing & control CONNECTIVITY Weight Scale Bloodpressure N Personal Health System E T Thermometer O R Pulse Oximeter K (POTS, GSM, BB) Cell Phone Baby Monitors Disease Management Service W Implant Monitors Healthcare Provider Service PC Glucose Meter Bed / Chair Sensors SERVICES AGGREGATION COMPUTATION Spirometer Medication Tracking Ethernet PERS Pedometer Set Top Box Consumer Electronics Fitness equipment Diet or Fitness Service Personal Health Record Service Implant Monitoring Service Aggregator © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Open Standards Will Harmonize the Ecosystem • Device communications standards (IEEE, ISO) ü Wired/wireless • Data transaction standards for interoperability (HL 7, ANSI; IHE Pt Care Device activity ) ü BP transaction = x ü Glucose transaction = y ü Weight transaction = w ü Alerts and messaging • Device Application Standards (Java, Java. Soft) ü Applications to manage communications/device adapters • Branding/ Certification of Devices (Consortium-like Wi. Fi – Med. Fi? ) ü Certification of interoperability ü May support and populate the standards bodies • Security and Privacy Standards (HIPAA) ü Encryption ü Authentication • Regulatory Compliance (FDA, FCC) ü Level playing field for device manufacturers © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Telemedicine Solutions- Proprietary Architectures Honeywell Hom. Med Lifeline Mc. Kesson Telehealth Advisor RPM (Remote Body. Media Patient Monitoring) Philips Motiva ADT Cyber. Net Carematrix Partners Telemedicine: Tele-dermatology Vitaphone Xanboo i. Metrikus Body. Kom by Telia. Sonera Health Hero Ayaa Medic 4 all / Telco. Med Cardio. Net © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Examples of Available Homecare Solutions Mitsubishi International Corporation Home. Care Support (2003) Vital Sign Monitors Internet connection Pulse Oxi meter Wireless Data Receiver AD 9030 T Blood Pressure Glucose Meter Medic 4 All Services International TV Phone Heath Monitor Conference Wrist. Clinic™ Body Weight & Fat ECG Monitor NTT I-see TV Phone Pedometer © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Medication Compliance Examples Bang & Olufsen Medicom, Denmark “Helping Hand” Bluetooth Honeywell Hom. Med. Partner. TM Medication Reminder RFID Technology SWEDEN IPP: Intelligent Pharmacuetical Packaging © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Tele-healthcare Summary Literature and experience support improvements in patient care and reduced costs Traditional telemedicine relies on existing wireline and broadband infrastructure Limits ability to monitor patients outside of the home © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Use Case: Chronic Condition Management – Personal Care Connect BT Data Server Patient Diary § Monitoring device collects patient data § Data is sent to mobile hub via Bluetooth pairing § Data is automatically sent to server but can also be inspected on hub § Data is processed on server and inspected by physician § Custom Features can be built such as entering data into a patient diary on the hub § Care plan is determined by physician based on medical data analysis © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Infrastructure and integration details Client Wireless Gateway Internet Device Domain /Network Operator “Gateway” Sensor / Client Hosting middleware Networks IBM Software Internet Provider Portals & Applications IBM /Partner Software Database Blu eto oth Internet Network Monitoring and Server Data Mining Applications Sensor Data Stakeholders ee et Zi g. B Bl u Patient oo th eto Blu Adapters Bluetooth GPRS Personal Wireless Gateway ØProvider ØPayer ØFamily Caregivers © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Application Portal Examples: Elder Care Provider screen © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Medication reminder © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Medication taken © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Standards Used by Component Medical Device ü Wireless sensor agents : Bluetooth Hub ü Wireless sensor agents : Bluetooth ü Web. Sphere client for VPN secure data transfer between hub and server. APACHE Open Source ü J 2 ME/CLDC 1. 0 or 1. 1/MIDP 2/JSR 82 (OSGI - stationary hub) Server Web. Sphere server components to accept and persist secure data. APACHE Open Source ü HTTP 6. 0 ü © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team IBM benefits from standards-based approach: The Fastest Time to market and Highest Value impact ü The Easiest to maintain and most Responsive to changes ü The Highest ROI in terms of technology, hardware and personnel ü Extremely Scalable and Reliable solutions adaptable to existing IT infrastructures ü Minimizes the Complexity of the ecosystem ü Customers Benefit: • LOWEST COST OF OVERALL OWNERSHIP • LOWEST-RISK INTEGRATION APPROACH • GREATEST OPPORTUNITY FOR SUCCESS © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Summary of Pilot Engagements: Personal Care Connect Project Elder care community pilot Partner Objectives Targeted Disease(s) Biomedical Devices Status Municipality in Europe Remote monitoring to improve care of the elderly in a community setting including medication compliance. Goals: Decrease costs through Reduction of doctor visits, nursing home/hospital admissions. Improved resource management – focus home visits on those patients with acute need. congestive heart failure Hypertension Pre-diabetic blood pressure cuff medical weight scale patient UI for medication compliance 20 families using the system with positive response to the technology Renal Study Academic Medical Center Europe Remote monitoring of pediatric patients suffering renal failure. Goals: Reduction in rescue events between dialysis. Improved health through medication management between dialysis. kidney disease blood pressure cuff – pediatric medical weight scale Phase 1 completed with excellent adoption – next phase in home dialysis patients Juvenile Diabetes Study Children’s Medical Center-US & Clinical ISV Demonstrate real-time, objective delivery of children’s glucose data into the PHR Goals: Reduce ED and admissions for children with diabetes. Reduce risks of associated illness through better glucose management. juvenile diabetes glucose meter future: injection registration device Integration testing of PCC to PHR, Payer collaboration, then kick off 4 Q’ 06 IBM Disease Mgmt IBM CHQ w/ selected Disease Mgmt firm Demonstrate incremental improvements in health of employees with chronic conditions through remote monitoring. Goals: Further reduction in claims cost for selected employee populations – $36 M saved in 2004 on 15 K employees -$2400/em congestive heart failure diabetes medical weight scale Glucose meter Decision on employee population and pilot definition by 7/20 Asthma Academic Medical Center -USA Proof of concept to successfully monitor and control Chronic Asthma with available monitoring technology and a patient diary Asthma Pulse Oximeter Spriometer Analog Peak Flow Meter Defined pilot with selected patients to start 4 Q 2006 © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Pilot Results: University Hospital of Heidelberg September 2005 to present © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Section Pediatric Nephrology of the University Hospital Heidelberg Dialysis Center for Children and Adolescents General Population 8 million Study Population: • 50 children with chronic renal insufficency • 30 children and adolescents in dialysis treatment • 90 children and adolescents after kidney transplantation © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Pilot Project with Heidelberg: Clinical survey at the Pediatric Nephrology • Expansions Duration: 20 weeks survey + 4 weeks technical and organisational preparation Measurements: blood pressure, weight, 1 x a day • Recordation of the blood pressure and weight measurements via Bluetooth and transmission to the mobile phone • Mobile Health Server receives data and archives it into an internal database • Visualisation of the patients data of different periods via Web. Interface • Data. Recordation, Data. Transmission, Visualisation • • Content Test persons: 80 patient weeks with teenage dialysis patients Integration of additional sensors for additional measurements • Connection to Electronic Medical Patient Record Systems • Connection to Hospital Information Systems © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Results of the Pilot Project • Patients and Parents: • Very high acceptance • Easy handling • Consistent use Medical Results • Major relief from responsibility for therapy management • Medical Practitioners: • Helpful tool for ambulant therapy - Documentation of hypo-/hypertensive crises - Taking corrective action with fluid balance • Technical Results Total availability • Reliable transfer of data • Easy handling • Robust against temporary interruption of network infrastructure (GSM/GPRS, Bluetooth) © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Remote Monitoring in Action © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Pilot Results: Denmark Eldertech © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team . . the ”Interactive Citizen Home” innovation partnership with the University and Municipality of Aarhus in Denmark Leverages PCC solution developed by IBM Research and HCLS Solution Development… … in unique 3 -way innovation partnership with Center for Pervasive Healthcare (academia) City of Arhus, attracting public R&D funding… WPS BT GPRS x. DSL … to enhance quality of life for elderly citizens through assisted living and communication… Browser PCC Server … and enable unified service delivery for a large care provider. . … automate data monitoring and alerts. . . while extending the strong position of IBM/Acure in healthcare to the wider area of eldercare in a project led by BCS Strategy & Change and involving IBM Research, Software, Systems and Lenovo. Pilot Extended operation Pilot evaluation Research Workstream 2005 2006 © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Eldertech in Action © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Innovations © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team One Patient, Many Monitoring Scenarios, One Record Flexible Monitoring Remote Monitor ER Monitor Patient PACU Monitor Transport Monitor ICU/Bedside Monitor OR Monitor © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Pulmonary Gas Exchange Monitors J Clin Monit Comput. 2002 Apr-May; 17(3 -4): 241 -7. Related Articles, Links ü Monitoring pulmonary function with superimposed pulmonary gas exchange curves from standard analyzers. Zar HA, Noe FE, Szalados JE, Goodrich MD, Busby MG. Department of Anesthesiology, University of North Carolina at Chapel Hill, 27599 -5136, USA. OBJECTIVE: A repetitive graphic display of the single breath pulmonary function can indicate changes in cardiac and pulmonary physiology brought on by clinical events. Parallel advances in computer technology and monitoring make real-time, single breath pulmonary function clinically practicable. © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team High Quality Remote Cardiac Monitoring Telzuit: Bio. Patch Wireless Holter Monitor Wrist. Clinic™ Medic 4 all/Telcomed ü Future: Bluetooth enabled Medtronic Cardio. Net GE © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Implanted Glucose Meter – link to RPM in the future C – Glucose Sensor D – Wireless transmitter to Insulin Pump (and RPM communications hub in the future) A – Insulin Pump B – Insulin Delivery Canula © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team IHE – Integrating the Healthcare Enterprise – US Initiative Healthcare industry organization promoting coordinated use of established standards to improve healthcare IT system integration IHE is NOT a standards development organization } IHE profiles clarify the use of existing standards such as HL 7 and DICOM ü IHE produces healthcare integration profiles which: } Address a given healthcare integration scenario } Build upon one or more existing, established standards } Define constraints which limit the options available when using underlying standards } To reduce the effort and cost to integrate systems spanning a diverse set of healthcare IT vendors ü © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team IHE Patient Care Device (PCD) Activity in 2006 New domain for IHE; working on first set of profiles in 2006 Enterprise Communication of PCD Data (ECPCDD) } Consistent, reliable communication of PCD data to clinical data repositories, clinical decision support systems and EMRs ü Filter PCD Data (FPCDD) } Filter PCD data by (type, instance, rate, etc) flowing to healthcare IT systems } Builds upon ECPCDD ü Patient Device-ID Association (PIDA) } Addresses how to bind enterprise patient id to PCD data ü © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team HHS contract to build a Patient Centric Network prototype for information exchange: Monitored data will feed the repository Contract background § Duration 1 year § HHS defined use cases Prototype Objectives: • Start-up money to seed the market • Establish up to 4 “utilities” that can contract with communities for future support • Create market momentum • Pressure/incent the consortias to invest in building a full fledged community based healthcare information exchange • Accelerate e. HR adoption © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Summary • Healthcare environment drives the need for Remote Patient Monitoring • Technology exists to enable it • Investment is growing as benefits are validated • Existing standards and emerging ones help drive down solution costs • Innovation in sensor technology and wireless communications builds the device portfolio © Copyright IBM Corporation 2006
IBM Healthcare and Life Sciences Innovation Team Thank You! Information Based Medicine IBM Healthcare and Life Sciences Kathy Schweda World Wide Business Segment Leader Pervasive Healthcare Solutions kschweda@us. ibm. com +01 414 -223 -6749 © Copyright IBM Corporation 2006
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