1. Continua Health Alliance:
Advancing Information Technology in
the Personal Health Solutions
Ecosystem
By Chuck Parker, Executive Director, Continua Health Alliance
Conflict of Interest Disclosure
Chuck Parker, Executive Director,
Continua Health Alliance
Has no real or apparent
conflicts of interest to report.

2. Technology Out Paces Biology
Our evolutionary ability to store fat cannot support our current sedentary high-calorie
activities
Private and Confidential, Oregon Medical Laboratories
3
Remote Patient Monitoring
Objectives:
• What is Continua?
• Market influence and implementation
• Use case driven
• Interoperability
– Approach
– Constraining
– Protocol
• Market and political drive
2/24/2010 4

3. The Continua Health Alliance Mission
2/24/2010 5
Connected Healthcare Monitoring Market
• The challenge:
– In England 15.4 million people, including 60 percent of those over age 60, suffer from
a long-term condition. LTCs account for 72 percent of all inpatient bed days, 65
percent of all outpatient appointments and 52 percent of all GP appointments. LTCs
consume 69 percent of England’s primary and acute care budget (NHS England)
– Almost half of all Americans – 133 million people in 2005 – have at least one chronic
condition, and the medical care costs of people with chronic diseases consumes more
than 75 percent of US medical care costs (CDC)
– Up to 60% of all medication prescribed is taken incorrectly, or not at all (National
Council on Patient Information & Education)
Source: Employee Benefit Research
Institute estimates from Centers for
Medicare and Medicaid Services and U.S.
Department of Commerce.
Last Updated: January 6, 2008
6

4. Need for Transformation
• Area of connected health/home health monitoring is predicted to grow
from a $3B market in 2009 in North America and Europe to an estimated
$7.7B in 2012 (Data Monitor, 2007)
• Number of connected health subscribers worldwide will increase to 55.5
million by 2016, representing a forecast CAGR of almost 72%, (InMedica,
2008)
• There is increasing evidence to support the value of remote monitoring
for patients with chronic diseases, 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)
2/24/2010 7
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
Time Peak Health Potential Line
Min
Max
Unpredictable Health
Event/Accident Expectations
Health
Costs
Poor nutrition, Actual Health
inactivity, Experience
Stress…
Non-modifiable & Unpredictable Health
Max
Min
Modifiable & Predictable Health
Adapted from Oregon Medical Labs
Death
8

5. Address 60-80% modifiable Adverse Health
91% Diabetes 83% Heart Disease
• Many diseases can be broken
down into non-modifiable and
modifiable contributors
69% Cancer
• Non-modifiable contributors
– Age, gender and genes
• Modifiable contributors
– Lifestyle choices Actual Goal
• Today, poor lifestyle choices
increasingly are the largest
Non-modifiable Contributors to Disease
contributors to common
Modifiable Contributors to Disease
adverse health outcomes Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women. NEJM 2001
Sep 13;345(11):790-7.
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 9
Remote Patient Monitoring: enablers &
drivers
2/24/2010 10

6. Remote Patient Monitoring
Objectives:
• What is Continua?
• Market influence and implementation
• Use case driven
• Interoperability
– Approach
– Constraining
– Protocol
• Market and political drive
2/24/2010 11
Remote Patient Monitoring: Standards
• Continua founded to organize and push market in one
direction
• Structure (Working groups) is to model real-world Use
Cases from industry and healthcare
• Process then deconstructs requirements and selects best
industry standards
• Then vet processes and fill holes either with direct work
within SDO’s or add definitions and refinements
• Ballot and then publish program and guidelines
• Strongest Value of Continua though is the Certification
program for interoperability of devices
2/24/2010 12

7. Guidelines → Certification → Recognizable Logo
2/24/2010 13
Ecosystem Development
Developer Resources Certification
Web-based environment Test and certification tools
(repository, collaboration tools) Right to use certified logo upon
Reference source code completion of successful
PlugFests certification
Market Intelligence Safe Environment
Access to market research data Industry competitors could discuss
without Anti-trust
Access to pre-publication drafts of
the design guidelines Unified Political drive to encourage
adoption
Internal and external education
Single voice for industry
and training
Wednesday, February 24, 2010

8. Remote Patient Monitoring
Objectives:
• What is Continua?
• Market influence and implementation
• Use case driven
• Interoperability
– Approach
– Constraining
– Protocol
• Market and political drive
2/24/2010 15
Continua Domains
• Continua segmented the market in three large
Domains:
Aging Independently
• An adult child helping their elderly parents
age gracefully in their own home.
• Basic life monitoring as appropriate (ADL)
Health & Wellness Disease Management
• Weight loss • Vital sign monitoring
• Fitness (RPM)
• Email / chat / video • Medication reminders and
• Appt scheduling compliance
• Personal Health Records • Trend analysis and alerts
• Connect with family care
givers
2/24/2010 16

9. Domain 1: Continua Use Cases
• Disease management market:
– evolve the current models of care; chronic and post-acute
– connect patients, families and healthcare providers to the right information at
the right time
– more informed decision-making
– empowering people to take a more active role in their own care
– e.g.: Northern Ireland, West Lothian (UK); AOK Cardio Integral (DE)
– mostly led by public healthcare administrations; statutory health insurers
2/24/2010 17
Domain 2: Continua Use Cases
• Health and wellness market:
– health conscious and worried well
– fitness and lifestyle trackers, PHRs
– employer programs and occupational health (HRA)
– national public health programs, screening
– e.g.: Diabetes Prevention DEHKO (FI); metabolic syndrome – mandatory
HRA (JP); 10K Steps a Day; Nike Plus; Google Health; MS HealthVault;
Dossia
– mostly privately driven; a few national programs
2/24/2010 18

10. Domain 3: Continua Use Cases
• Ageing independently market:
– residential care, independent living facilities, individual homes
– support ADL, fall detectors, bed occupancy, medical reminders, …
– personal emergency response services
– e.g.: Tunstall, Philips Lifeline, GE Quiet Care
– driven by a mix of social care providers, group housing, individual
subscribers
2/24/2010 19
V 1 Interoperability Standards - Protocol
Pulse
Oximeter
• 11073-10404 = Pulse Oximeter PC
• 11073-10406 = Pulse / Heart Rate
Pulse /
• 11073-10407 = Blood Pressure
Blood Pressure • 11073-10408 = Thermometer
• 11073-10415 = Weighing Scale Personal
Weight • 11073-10417 = Glucose Health System
• 11073-10441 = Cardiovascular Fitness Monitor
Scale • 11073-10442 = Strength Fitness Equipment
• 11073-10471 = Independent Living Activity
Glucose • 11073-10472 = Medication Monitor
Cell Phone
Meter
Cardiovascular
and Strength
Fitness Monitor Bluetooth Medical
Device Profile Specification
Independent Set Top Box
Living Activity
Medication
Monitor USB Personal Healthcare Aggregator
Device Class Specification
2/24/2010 20

11. V 1 Data Standards - Syntactical
Healthcare Provider
CDA/CCD-based
Disease
Personal Health Monitor (PHM) Labs
Management
Specification
Service
Home-based Remote
Patient Monitoring
(RPM) System Electronic
Health Record
System
XDR Transport Specification
Patient
Vital Sign EHR / PHR
Devices
Use Case Development
M1: Decompose UC M2: Select Standards M3: Identify gaps between
into requirements standards and requirements
2010)
inter
2010) V2 (W N
pring g for HR ring
V1.5 (S nitor l Codin Monito
ti on Mo Clinica ation
Medica ice • nd Respir
vanced ng Dev WAN ECG a ice
• Exit Ad
Monito
ri n the Exit • ExitMonitoring Dev
Pea k Flow ation o Device ity
• He lt h Inform ce Successful TWG a l Activ
TWG, oUCWG Area
Successfulareview rfa
Upload Inte Physic we r B
dy
• t xHR e
• ow-Popresentation
(E2E eaker-NeTWG, or Devic
Sn Arch, p Monit Ballot, BOD • Ultra-L
rk
• Pum approval Netwo AN
UCWG)lin m V 1
Insu o we r L HR
• fro Low-P g for x city
Errata dio • l Codin thenti
• wer Ra Clinica ent Au
Low Po • and Pati Sharin
g
• D evice ation sers
• d Inform iple U
M5: Create Test Co ntrolle e nt Mult
• a nagem
M4: Develop Procedures and complete • Disease M
Guidelines review M6: Update
Test Tool
Exit Exit
TWG review Successful Exit
and ballot TCWG review Pass
Tool 22
Test

12. V2 Use Cases Underway
PAN Device Health
Electric Health Record (XHR) Interface
Application WAN Device Record
Physical Activity Monitor
Hosting Device
Device (PAN)
Device
Interface
Medication Monitor
Service (WAN) Interface
Electrocardiogram (ECG)
Insulin Pump
LAN Device Low Power Radio
Network (LAN)
Interface
Portable XHR
Media Extension
V1 Extensions (e.g., Multiple
device users, enhanced device Final link in end-end connectivity
authentication)
23
Remote Patient Monitoring
Objectives:
• What is Continua?
• Market influence and implementation
• Use case driven
• Interoperability
– Approach
– Constraining
– Protocol
• Market and political drive
2/24/2010 24

13. Working Group Structure - Internal
Board
Of
Directors More than 2,000 members
Participating in the various
Working Groups
Executive
Director
VTM
Admin
Test & Wellness Policy
Use Case Technical Marketing Regulatory
Certification Solutions Strategy
WG WG WG WG
WG WG WG
Expert Testing Latin
PR & EU Japan U.S. Australia
Group Sub- and America
Marketing Policy Policy Policy Policy
NHS, AAFP, Committees Certification Policy
agency WG WG WG WG
ATA, AHA… Lab WG
2/24/2010 25
V1 Interoperability - Semantic
• Use of HL7 and SNOMED CT for
semantic understanding
• V 2 will have further implementation and
conditional understanding
2/24/2010 26

14. Interoperability in Three-tier Approach
• Continua constrains the outputs at the
device level. (PAN interface)
– Reduces device overhead and intelligence
requirements
– Reduces power requirements
– Reduces development time
– Reduces connection complexity
• Intelligence is at the Hub / Manager
– Understands what it is communicating with
– What data to expect
– May issue commands to send certain data
2/24/2010 27
Continua Reference Device Classes
Application
Hosting Device
PAN “Adapter” Device:
to represent a device as a
PAN PAN Device in the
Device Continua ecosystem
LAN “Sharing” Device:
to represent a device as a
LAN LAN Device in the
Device Continua Ecosystem
WAN Health Record
Device Device
28

15. V1 Certification Process
SDO Transport Continua Continua
Certificate Compliance Certification
Testing & Logo
Test Test
Plans Report
Members
TCWG Test Lab
Test Test Admin
Suites
Logo
Remote Patient Monitoring
Objectives:
• What is Continua?
• Market influence and implementation
• Use case driven
• Interoperability
– Approach
– Constraining
– Protocol
• Market and political drive
2/24/2010 30

16. Working Group Structure - External
Board
Of
Directors
More than 2,000 members
Participating in the various
Working Groups
Executive
Director
VTM
Admin
Test & Wellness Policy
Use Case Technical Marketing Regulatory
Certification Solutions Strategy
WG WG WG WG
WG WG WG
Expert Testing Latin
PR & EU Japan U.S. Australia
Group Sub- and America
Marketing Policy Policy Policy Policy
NHS, AAFP, Committees Certification Policy
agency WG WG WG WG
ATA, AHA… Lab WG
2/24/2010 31
RPM market in the future
• Personal Connected Health
• The individual / home as the hub
• Convergence consumer / healthcare
• Mobile health / Personal Health Records
fitness - sometimes with public incentives
• Rewards for keeping people healthy
• Greater integration among wellness, health
and social care
• Best-of-breed plug and play
• Increased connectivity, evolutionary,
scalable, service driven offerings
2/24/2010 32

17. Health App Growth iTunes
Parks Associates- All Rights
Reserved
End-to-end demo – Vancouver Q2 2009
Device Interface XHR Interface
Device Manager WAN Sender Receiver
Based upon
proposed PHR
protocols for
Continua WAN EHR
Glucose Meter
Roche Accu-Chek 360
xHR
IP network
Web
services
Wi-fi or 3G Disease
management
Pulse Oximeter platform
LNI Android-based G1 Cell
phone 20601 manager

18. RPM market now: Current Participants
• Continua membership shows across the
board interest both from supply and
demand sides:
– Medical devices
– Governmental Agencies
– Fitness
– Pharma
– Health care providers
– Health insurers
– Telecommunications
– IT
– Integrators
– Applications (PHR, EHR, desktop)
2/24/2010 35
Promoter Members
Open
International

19. Contributor Members
7 Layers AG Centre for Global eHealth GenerationOne, Inc.
24eight, LLC
Advanced Digital Institute
Innovation
Cerner Corporation
GlaxoSmithKline
Google Inc.
More Than
Air Products Chiptech Limited Hill-Rom
Hitachi, Ltd.
228 Member
Alcatel Lucent
Alere
Christus Health
Chunghwa Telecom Co., Ltd. Holst Centre (IMEC) Companies!
Allion Test Labs, Inc. ConnectBlue AB Home For Life Solutions
All Medicus Co., Ltd. Continuity Health HoMedics
American Heart Association Convergence Wireless, Inc. Honeywell HomMed LLC
Analog Devices CSR plc Hosiden Corporation
Analogic Corporation CYPAK AB Hospira, Inc.
Andago Ingenieria s.l. Dell HTC
AppsHub, Inc. DELTA I2BC – Insitute of Innovation for Human
ASE Consulting Limited Denso Corporation Wellbeing
AstraZeneca Dossia Consortium iFoundry Systems Singapore Pte Ltd
AT4 Wireless Duodecim Medical Publications iMetrikus
AT&T Mobility Dynastream Innovations Inc. Industrial Technology Research
Institute
Attrezzature Medico Sanitarie SRL eflow Inc.
Infineon Technologies
Authentidate Holding Corp. Elbrys Networks
INFORSON Co., Ltd.
AViTA Ember Corporation
Innomed Medical Zrt.
Awarepoint Empirica GmbH
Innovation Centre Scotland
BiancaMed Ericsson Nikola Tesla d.d.
Institute for Infocomm Research
Biocomfort Diagnostics GmbH ETRI
Institute of Biomedical
BIOSPACE Co., Ltd. EuroTech, Inc.
Insung Information Co., Ltd.
Bluegiga Technologies Oy Fairbanks Scales
InterComponentWare, Inc.
Boston Scientific FitLinxx
Intramed A/S
Broadcom Corporation Flextronics Design SRL
Kai Sensors, Inc.
Brunel University France Telecom R&D, LLC
KDDI
BXI Health Systems, LLC Freescale Semiconductor
Korea Electronics Technology Institute
Cambridge Consultants Ltd. frog design, inc.
Laird Technologies
Canada Health Infoway Frontline Test Equipment
Lamprey Networks, Inc.
Cardiff University Fujitsu Limited
LAXTHA Inc.
CEA - LETI
Contributor Members Continued
LG Electronics Inc. • Product Development Tekoa Technologies Inc.
Lifescan Technologies (PDT) Telbios, SpA
LifeWatch AG • Proskauer Rose LLP Telecom Italia SpA
Logic • Proximiti Communications, Inc. Telefonica S.A.
Marvell International Ltd. • Red Embedded Design Telehealth Solutions Ltd.
McLaren Applied Technologies • Renesas Technology America TELUS Health Solutions
MedApps, Inc. • ResMed Corp. Textronics Inc.
Medgate AG • RF Technologies Toshiba Home Appliances Corporation
MedHelp International • RMD Networks Toumaz Technology Limited
Medixine Oy • RTEmd TSB
Microlife Corporation • Ryoyo Electro Corporation TTA
MindTree Limited • Sagemcom Tyco Electronics
Motorola • Sensor Technology & Devices Ltd Tynetec Ltd
MIR- Medical International Research • Shimmer Research UnitedHealth Group
MTI Ltd. • SHL Telemedicine University of Applied Sciences
MTS Medication Technologies • Shorewood Packaging Technikum Wien
Murata Manufacturing Co., Ltd. • Sigma Designs University of Miami - Miller School of
• Silicon and Software Systems Medicine
NEC Access Technica, Ltd
• Silicon Laboratories, Inc. Valentia Technologies
Nestle
• SK Telecom Americas Verizon
Neusoft Medical Systems
• Smartlife Technology Ltd VigNet Inc.
Nippon Telegraph and Telephone
Corporation • Sony Electronics Inc. Vitaphone GmbH
Nordic Semiconductor ASA • SterlingTech, Inc. VivoMetrics, Inc.
North End Technologies • Stollmann E+V GmbH Vocollect Healthcare Systems, Inc.
Novo Nordisk • STMicroelectronics N.V. Vodafone Group Services Ltd.
Nuubo (Smart Solutions Tech) • Sumitomo Electric Networks, Inc. VTT Technical Research Centre of
Finland
ON Semiconductor • Sybase iAnywhere
Waldo Networks
Oregon Medical Labs • T-Mobile USA
Welch Allyn
Oregon Scientific Inc. • TaiDoc Technology Corporation
Wind River
Orthosensor, Inc. • Taiyo Yuden Co., Ltd.
Wipro Technologies
PA Consulting Group • Tanita Corporation
Yellow Digital Health Lab
Pfizer • TechnoGym
Zarlink Semiconductor
Polymap Wireless
ZeroG Wireless, Inc.
Precor Fitness
Ziehm Medical LLC
ZyXEL Communications, Inc.
38

20. Industry Liaisons
39
Thank you!
ThankChuck Parker
You
Executive Director
admin@continuaalliance.org
www.continuaalliance.org
40

21. Remote Patient Monitoring
• Additional Content
2/24/2010 41
RPM Market: the Market Segments
Multiple providers / service oriented
Wellness Biometrics
Management/Support Device / Testing
Systems
Systems / Sensors Glucose
Meter
Weight
Scale
Bio-metric/
Weight
Behavioral Cholesterol Spirometer
Blood-Presser Responses HDL/LDL HRA/Health
Administrative
Cuff Triglycerides
Blood- Assistant
Fitness, Pressure
nutrition, stress Blood
management… Sugar
Person Fitness
Lung Air
Pulse
Centered Volume
Equipment
Healthcare
provider Oximeter
Wellness
Resting Body Fat Center
Disease Heart Rate %
Gait
management
Pedometer analysis Body Fat
service
Information Analyzer
Systems
Medication
Activity
Tracking
Hub
PHR/PHA
Family Classes
Elderly care
monitoring givers
services
2/24/2010 42

22. Remote Patient Monitoring
• Additional Technical Content
2/24/2010 43
Continua E2E Reference Topology
Embedded Apps Could subsume PAN interface and expose WAN interface
Health
PAN Device Application WAN Device Record
PAN-Interface
Hosting Device Device
xHRN-Interface
WAN-Interface
LAN Device
LAN-Interface

23. PAN Interface IEEE PHD State Machine
Disconnected
• Agent states Transport disconnect indication
Transport connect indication
shown, Manager is
similar Connected
Disassociating Associated
assocRelReq
+entry / TxAssocRelReq Operating
• Configuration state TxAssocAbort RxAssocRelReq/
TxAssocRelRsp
RxAssocAbort
transmits all static RxAssocRelRsp
Unassociated TxAssocAbort
data one time for RxAssocAbort
Configuring RxConfigEventReportRsp
efficiency RxAssocRelReq/
TxAssocRelRsp
(accepted-config)
Waiting Approval
assocReq
• Operating state is RxAssocAbort
RxAssocRsp
Or RxConfigEventReportRsp
where TxAssocAbort
TxAssocRsp
(accepted)
(unsupported-config)
measurements are Associating
(rejected)
TxConfigEventReportReq
transmitted + entry / TxAssocReq RxAssocRsp Sending Config
(accepted-unknown-config)
WAN Interface Goals
• Minimal Payload Translation
– Keep the device readings consistent with
PAN (e.g., same nomenclature)
• Minimal Payload Transformation
– Manager should not be forced to deal with the
complexity of transformations from one
payload model to another
• Support for all 3 Continua Domains
– Health and Fitness, Aging Independently, and
Disease Management
• Extensibility
• Minimize divergence of standards

24. WAN Recommendations
• HL7 v2.6 messages using IHE PCD-01
– Initially constrained to IEEE 11073-20601 and 104xx
nomenclature for personal health devices
– Can be extended to support IEEE 11073–10101
terminologies and core components of the
-10201 information model for clinical devices
• Web Services transport based on WS-I Basic Profile
– Work with HL7, WS-I, and IHE ITI on further
Web Service Profiles
– TLS for Security
• Define placeholder for alarm, alert, control, and
command messages but defer message contents for
later versions
WAN Proposed Protocol Stack
Device Intermediary Remote Monitoring Management
System
48

25. Personal Connected Health
IMPLANT
PULSE
OX
Health & Wellness
BLOOD-
• Weight loss
PRESSURE
CUFF • Fitness
Cell Phone
• Email / chat / video
PEDOMETER Digital • Appt scheduling
Home • Personal Health Records
Healthy
HOME AUTOMATION
family & CONTROL PC
Disease Management
FITNESS
EQUIPMENT
• Vital sign monitoring (RPM)
• Medication reminders and
MEDICATION Personal Health System compliance
TRACKING
• Trend analysis and alerts
• Connect with family care
Elderly
givers
Internet
Aging Independently
• An adult child helping their
Personal elderly parents age gracefully
Health
Weight loss Records Disease
in their own home.
and fitness Healthcare management • Basic life monitoring as
coaching Professionals service
appropriate (ADL)
Family
care givers
2/24/2010 49
Example Application
Parks Associates- All Rights
Reserved

26. Example Application
Parks Associates- All Rights Reserved
Mobility Topics
• Interoperability standards (Continua)
• Clinician acceptance (workflow, data
overload)
• Policy (reimbursement, regulatory)
• Liability (indemnity)
• Privacy (identifiers)
• Security (encryption)
• Consistency of cell coverage
• Cost
• Business models

27. A Perspective on the Ecosystem
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Reserved