The 4 "-e's" of eHealth: connectivity, conformity, usability, security

December 1, 2010 OpenSystems Media

Editor’s note: As discussed in our recent E-cast (archived at ecast.opensystemsmedia.com), the telehealth industry is exploding, with some estimates projecting an $8 billion connected health care device market in 2012. To gain better understanding about how embedded technologies can improve the broader picture of eHealth systems, we assembled a virtual panel of experts working to connect patients with quality care. Our panelists identify four main areas representing both opportunities and challenges: connectivity with open, high-bandwidth wireless networks; conformity to product standards, appropriate business models, and rigorous certification processes; usability in enabling patients and providers to leverage medical data; and security for protecting that data.

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Figure 1: eHealth panelists

ECD: What’s the biggest challenge right now in enabling connected medical devices and eHealth?

Normandin: Security and privacy, especially in the hospital and health care setting, are certainly the biggest challenges AMD currently faces when enabling our connected medical devices. Because telemedicine applications and encounters exchange multimedia patient information, the security and privacy of this patient data must be ensured by firewalls, encrypted data, and other security measures.

Kvedar: The biggest challenge in enabling connected medical devices is the fragility of the wireless industry as it relates to gathering data from sensors and sending it to the cloud for analysis. The U.S. FDA has not been clear on whether it will regulate mobile phones as medical devices, and thus firms have been skittish about simply linking a sensor to a mobile phone and using the phone as a communicator. Furthermore, there are two competing technological visions emerging. One relies on embedded mobile chips in each sensor, and the other relies on the home hub as a communication point. Finally, no vendor has really achieved ease of use to the point that will facilitate widespread consumer adoption.

Augustinos: The biggest challenge in enabling devices on telehealth networks is a lack of adherence to standards and protocols for device connectivity and data transports. That is the reason why Cisco along with Intel, Medtronic, Partners Healthcare, Samsung, Sharp, and 220-plus companies and organizations have engaged in an open alliance, called the Continua Health Alliance, to develop architectures based on standards, as well as a testing and certification process to advance interoperability for medical devices.

Barthelemy: The availability of open networks to connect with enough bandwidth to carry high-quality motion images along with vital data is a huge challenge. We are looking forward to Long-Term Evolution (LTE) 4G communications.

Brown: The biggest challenge is not the hardware and software, but the policy and practices within health care systems. There are still challenges in finding the right place to use these technologies in health care, challenges in policy and payment for providers who wish to participate, and challenges in making it easy for providers to fully leverage these technologies for their patients. Consumers are way ahead of their providers and health systems in the use of this technology.

ECD: Describe an example of a telehealth device that impresses you.

Augustinos: The Cisco HealthPresence platform (Figure 2) combines high-definition video, audio, and data generated by medical devices and transmitted over the network to create an environment similar to what patients experience when visiting their doctor or health specialist in-person. HealthPresence provides:

·    An immersive clinical encounter, regardless of distance or location, allowing patients to experience care in the same way as if they were in the same location as the caregiver

·    A means to extend primary and specialty care expertise to citizens, thus optimizing clinical capacity and allowing communities, states, and countries to organize around access to clinical expertise anywhere, anytime

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Figure 2: Cisco HealthPresence expands access to quality health services by offering high-definition video, audio, and diagnostic devices in an immersive, coordinated-care environment.

Brown: I am impressed by several of the “telehomecare” packages out there that support patients with serious chronic disease. Several companies have made these packages very simple for consumers (particularly patients who are quite ill or elderly) to use and yet provide comprehensive monitoring for their condition.

Kvedar: As health care providers, we must find strategies that enable care plan adherence. An example of such a system is the Vitality smart pill bottle cap and hub. These products are well-designed and consumer-friendly and make a real impact on medication adherence. At the Center for Connected Health, results from an adherence study showed a 27 percent higher rate of medication adherence in patients using Vitality’s GlowCaps smart pill bottle (Figure 3) compared to controls. Study participants using the Vitality system achieved an adherence rate of 98 percent.

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Figure 3: Vitality’s GlowCaps have been shown to help increase medication adherence in patients using Internet-connected medication packaging and feedback services.

Normandin: AMD’s General Exam Camera (Figure 4) is a popular product in the telemedicine market. It is currently deployed in more than 5,600 sites worldwide and now has the capability to be integrated with our AGNES Medical Gateway.

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Figure 4: The AMD-2500 General Exam Camera can be integrated with the AGNES Medical Gateway to disseminate patient medical information in real time independently from a video conferencing system network.

AGNES is an alternative way to accomplish clinical telemedicine, which typically relies on medical devices being integrated into the videoconferencing codec. AGNES allows the General Exam Camera and other medical devices to be separated from the in-band codec-based model, instead creating an ad hoc, on-demand medical device network of its own. Nurses and doctors gather data directly from the device via Web browsers on their desktop PCs.

Status and availability of the devices are revealed via a Web 2.0 architected Web Services model. All communications between clinician and the device are peer-to-peer. For security, quality, and speed reasons, no relay servers are involved. High-quality imagery and device data are delivered at bandwidths ranging from 64 Kb to 1 Mb.

In the future, I’d love to see designers consider how to embed the AGNES functionality directly into medical devices like the General Exam Camera.

Barthelemy: One example is the home monitoring equipment the Veterans Administration provides to our U.S. military veterans for monitoring chronic conditions like congestive heart failure. Because one U.S. World War II veteran dies every 90 seconds, pervasive care for the greatest generation is a must from the latest generation. We will all benefit from these types of products.

ECD: What technology advances are needed to make future connected medical devices better?

Brown: Smartphones are everywhere now, and these will become the de facto communications platforms for the foreseeable future. We need apps and lower-cost devices that work with them.

Kvedar: Usability and reliable connectivity will be critical in the widespread adoption of connected medical devices. The ability for patients and providers to collect, access, and share data seamlessly, regardless of the product brand or wireless connection, will increase confidence and the application of connected medical devices, thereby helping consumers and providers better manage personal health and wellness.

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ECD in 2D: In his keynote at the 2010 Connected Health Symposium, Dr. Kvedar emphasizes the importance of developing trusting relationships with technology to leverage the network of providers across the demand for services. Use your smartphone, scan this code, watch a video: http://bit.ly/hsrCOA.

Barthelemy: I refer to my first comment: We need open, high-bandwidth, wireless communications that work in rural as well as metropolitan areas.

Normandin: While telemedicine has been around for many years, the buzz surrounding it has increased recently. The telemedicine industry has made more progress in the past 20 months than in the previous 20 years, partly because there is a new generation of doctors who are much more exposed to technology.

As technology continues to progress, telemedicine devices can continue to improve through persistent advances in sustained bandwidth capabilities. The vast improvements and advancements that 3G and 4G cellular technology are experiencing are certainly helping advance the bandwidth capabilities available for telemedicine consults.  Continued advances to make mobile access to high-bandwidth services accessible, efficient, and affordable will only help make telemedicine’s connected devices more accessible in the future.

Augustinos: While many technologies already exist, we still need investments in infrastructure and the adoption of business and reimbursement models that support a distributed health care delivery system enabled by technology. The first step in achieving a connected health care environment is building a robust IP infrastructure that supports the rapid and secure exchange of information within and across facilities and applications, thus enabling collaboration across the continuum of care. This is where cloud technologies can enable not only new capabilities in delivering the services, but also new business models, making it more affordable and, as a result, more broadly available. The network as a platform is critical to support advanced technologies that will meet health care’s most pressing challenges by: 

·    Enabling organizations to empower caregivers and administrators to better meet patient needs

·    Using collaborative technologies to deliver a personalized and interactive patient experience

ECD: What one thing should device designers understand about eHealth to improve their next designs?

Kvedar: Device manufacturers must make the consumer interface with devices “iPod easy.” Connected medical devices need to be simple, intuitive, and able to securely capture and transmit personal health data.

Normandin: Designers should understand the privacy and security issues that are unique to the use of embedded devices in telehealth by making themselves familiar with the HIPAA and FDA guidelines associated with telemedicine.  

Our team spends a great deal of time and energy opening the correct ports to enable our devices and solutions to work with an organization’s firewalls. In the future, a solution that could recognize our telemedicine devices as a trusted and secure device and automatically navigate through firewall issues would be a huge time-saver.

Augustinos: Simplicity, durability, security, and of course cost are the features that are important. One should be able to use the device almost without having to read the manual. Technically, features such as standards-based data, video, and audio capabilities are critical to any care-at-a-distance experience.

Brown: I have three (connected) things:

1.  Consumers want to connect with other people (not just data) – usually their health providers.

2.  Providers need practical and simple technology for it to catch on in a big way.

3.  Everyone needs business models that work.

Barthelemy: We are inundated with mobile apps that have little or no true user input. If they had that, they would be more intuitive, more iPod-like. The old “design a solution looking for a problem” scenario still exists in development.  Our goal is to design and engineer what is needed. We listen to understand the problem and attempt to solve it while continuously collaborating with the intended users and thought leaders in health care. Then, we consider all other aspects or touch points of our product designs. You can never relax on a design because there will always be a better one around the corner – if not from us, then possibly from a competitor.

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ECD in 2D: GlobalMedia is collaborating with the Carondelet Foundation to deliver a telemedicine Van of Hope to the homeless of Tucson, Arizona. Use your smartphone, scan this code, watch a video: http://bit.ly/hTcMRj.

Jennifer Hesse
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