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Voices of Innovation - January 2009
Date: 26 January 2009
Voices of Innovation
Robert D. Hughes
Bluetooth Medical Devices Working Group
The increasing prevalence of chronic diseases, combined with an ageing population and other demographic pressures, are forcing healthcare providers to evaluate their structure and the way they manage patients’ care. The problems facing healthcare providers are acutely evident now and are set to worsen, and so change is necessary. Telehealth has been heralded as a potential saviour for over-burdened healthcare providers looking to maximise their resources. Wireless technologies will undoubtedly play an essential role in accelerating the uptake of telehealth products and services.
What do you see as the current state of the market for telehealth?
Telehealth is entering an exciting era. As part of a large and dedicated team that has been working to define and develop sorely needed personal health standards for the last 3 years, we are just now beginning to see the fruits of our labour. The momentum is clearly shifting from proprietary transports and data standards to those based on some of the health standards recently approved by the Bluetooth SIG, USB IF and the ISO/IEEE 11073. This transition to standards for personal healthcare devices will reduce development costs, speed time to market, enable new and exciting use cases, and fuel market growth. At a time when any investments are greatly scrutinized, governments and large healthcare providers realize that continued investment in healthcare can ultimately reduce the overall costs by increasing efficiency and have a positive impact on healthcare consumers. I believe telehealth is at the start of a period of tremendous growth.
What demographic do you believe will drive the market for telehealth – chronic disease sufferers, the elderly or health conscious young people?
Statistics from the World Health Organisation indicate that chronic conditions are on the rise and consume the majority of the world’s healthcare dollars so I expect the bulk of the initial investment to be in the area of chronic condition management. Helping to keep people healthy and enabling the elderly to maintain an independent lifestyle are also quite important, but the strain put on healthcare budgets due to chronic conditions will limit what payers can do in other areas.
Do you see any regional differences in the acceptance of telehealth?
Yes. Generally, parts of the world which have more consolidated healthcare systems, such as the UK and Japan, can make more rapid progress by integrating the use of new telehealth approaches into their more established systems. The US has perhaps the most fragmented healthcare system in the world, and while the US spends the most, it arguably gets the least for that money. There is tremendous interest in the US for the expansion of telehealth, but this will take more time and effort to establish across the country since a more cohesive system needs to be put in place to take maximum advantage of it.
What do you believe are the main barriers preventing the widespread use of telehealth? When will these barriers be overcome?
A couple of years ago, I might have said that the main barrier was the lack of standards for personal healthcare devices. Without these in place, it would be like trying to move a large system of trains that all have different track sizes and fuel types across a country quickly and efficiently. Great progress has been made in our ability to create standards-based data capture devices, but there is much more to do to put these to use in markets around the world. While some countries have more mature healthcare systems and are well positioned to take quick advantage of these standards, others such as the US, are working hard on a variety of fronts to establish a firm foundation and will lag in adoption. While some countries and payers are moving quickly to invest in modern systems based upon these new standards, others are continuing to study to better understand the return on investment and benefit to healthcare consumers.
There are many stakeholders in the telehealth market, from device manufacturers, to service providers to insurance companies. What is the weakest link in the telehealth ecosystem?This varies by country, but to me the weak link is really the ability to get the various systems working in harmony together, much like one big efficient engine. There is such inter-dependence between the device market and service providers, and between healthcare providers and payers and consumers, that it is quite challenging to get the engine started. In many countries, systems are now getting in place for a successful start.
In my group, a team of highly dedicated individuals have done a lot to address weak links by taking a bottom-up approach and focusing on removing barriers starting at the device level. There is good indication that the world’s leading healthcare device manufacturers are in the process of migrating from proprietary connectivity and data formats to standards-based methods. With standard data formats starting to take hold, this allows applications and services that handle this data to be built on top of these and for standards further up the stack to be developed. Once digital data capture and services become more prolific, payers are expected to see a clearer financial benefit to telehealth,as well as a positive impact on healthcare consumers,and increase their investments in this area. As each ofthese systems matures, we get closer to the firing point. That’s where I think that large industry organizations such as the Continua Health Alliance, come into play. To a large extent, I see Continua acting as a starter for this engine. Continua is making great progress kick-starting the marketby getting industry alignment on which specific standards to use and by also working to reduce regulatory and reimbursement barriers.
How important is it that home-use telehealth devices have wireless connectivity? Will this lead to higher patient compliance?
From a healthcare device perspective (perhaps influenced by my three years as Bluetooth Medical Devices Working Group chair) I feel very strongly about the benefits of wireless technology and the freedom and flexibility it affords in data capture devices. I expect these factors, along with creative applications, to increase patients’ desire to use them in their daily lives, thus leading to improved compliance.
In June 2008, The Bluetooth Special Interest Group (SIG) approved version 1.0 of the Health Device Profile (HDP). What is the current status of the HDP and how many manufacturers of medical devices have implemented it?
I am aware of HDP implementations at various stages of development by over 20 companies at this time. This does not include health device companies that will leverage these ingredients in their next generation of products, nor the fact that some of these companies have multiple implementations. Of those 20, I would classify 10 as quite mature as of today, with progress being made each week. The first of these HDP devices are just now going through the qualification process in the SIG and it is interesting to start seeing press releases. Manufacturers that make-up the majority of the world health device market are involved. One important driving factor is that HDP is a required element of all Continua-compliant Bluetooth devices. With over 170 leading health and technology companies members of Continua, there is significant momentum building and 2009 will be an exciting year. In the Bluetooth Medical Devices Working Group, we are also starting work to extend device standards for use with the upcoming Bluetooth Low Energy specification. Our goal is to enable a new category of very low power health and fitness sensors using this technology.
How do you envisage that classic Bluetooth and Bluetooth Low Energy will be used in telehealth systems?
In general, I view that Bluetooth Low Energy is a nice complement to classic Bluetooth, rather than the two technologies competing. For the majority of telehealth device applications, HDP with classic Bluetooth does a great job. Most of these devices only turn the Bluetooth radio on when they have data to send and quickly turn it off for power consumption, so battery life for these types of devices can last a year or longer. Bluetooth Low Energy will enable devices not optimal or not previously possible with classic Bluetooth by employing several power saving techniques. Bluetooth classic was not designed to support devices powered by coin cell batteries for example and Bluetooth Low Energy will fit well in this part of the market.
What is currently “state-of-the-art” for telehealth technology?
Bluetooth HDP devices being used at home, in the gym and on the road send data to be shared with an authorized caregiver, family member or fitness coach without consumer interaction. Consumers of these devices can monitor the progress to their goals on their PC or mobile phone and optionally choose to share this with others. The devices are low power and are designed to fit well with busy lifestyles, thus compliance improves, goals are attained, outcomes improve, efficiency increases and costs are reduced.
What do you believe will be the future trends for telehealth technology?
I expect the first major trend is the adoption of recent personal health standards by data capture devices as well as devices which can read and interpret such data, such as telehealth consoles, mobile phones and PCs. These standards include the Bluetooth Health Device Profile and USB Personal Healthcare Device Class and both of these use the same ISO/IEEE 11073 Personal Health Device specifications as a common format. This common format means that USB data and Bluetooth data for a given device will appear exactly the same to a receiving device and is no longer specific to the manufacturer or type of physical transport. The use of a common international data standard is powerful and will be the basis for numerous applications and services between the device and caregiver. As these devices become more common and costs decrease, they will start to become available in a wide variety of retail stores.
Bluetooth Low Energy devices will then start to enter the market for lower power and smaller form factor applications and fill a much needed void. Both Bluetooth Low Energy and Bluetooth classic will be integrated onto the same silicon enabling dual mode operation to be common in all gateway devices where Bluetooth classic is common today. With over 1 billion Bluetooth classic devices shipped annually and rapid adoption of Bluetooth Low Energy into these same devices, Bluetooth Low Energy isexpected to become an incredibly fast growing wirelesstechnology and will change the low power wireless landscape.
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