Real-time Patient Health Monitoring with Connected Health Solutions

White Paper

Life Sciences

Ashok Khanna

Global Head, Presales and Solutions, Engineering Industrial Services, Life Sciences

Ashok Khanna has over 19 years of industry experience in the field of healthcare, hi tech and telecom. As a business leader his expertise spans across multiple medical and pharmaceutical domain areas including new product development, product lifecycle management, manufacturing operations management, R&D and quality, regulatory and product sustenance.

Diwakar Punith

Consultant, Presales and Solutions, Engineering Industrial Services, Life Sciences

Diwakar Punith has more than 17 years of experience working in the healthcare (medical devices) and automotive domains with expertise in product development, project management and business development. Diwakar is an accomplished professional with success in business planning, end-to-end product development of embedded medical devices. He has worked for over six years on new product design and development of medical devices including ECG transmitters and charging stations, infusion pumps, patient monitors and Endoscope CAE analysis with various DFX methodologies.

Chandrakant Aknurwar

Solution Architect, Engineering Industrial Services

Chandrakant Aknurwar has more than nine years of experience working in the field of mobility and healthcare with experience in product design and development. He has three years of experience in the disease management software product design and development domains. He has executed complete product development cycles from requirements to product design and global integration.

About the Authors

An increase in the aging population, incidence of chronic lifestyle diseases and huge costs incurred to provide healthcare to citizens, are driving healthcare stakeholders worldwide to pursue remote monitoring and personal health management seriously.

A connected healthcare environment enables access to critical medical parameters across the healthcare ecosystem, thereby facilitating remote health monitoring. This means that health service providers can access the patient health data remotely and prescribe medicines or diagnosis tests without the patient being personally available in the hospital, thus reducing the overall healthcare expenses.

Connected health solutions offer a home care environment wherein patients are monitored for their vital health parameters using medical devices that can capture these health parameters and send it to the aggregator over wired or wireless communication. The data in the aggregator is further securely processed as per the standardized medical data format and stored in commercially available Health Vaults, which the health care service professionals can retrieve for an accurate diagnosis, prognosis and to prescribe the right medicines to the patient.

This paper presents our thoughts on the suggested framework for connected health solutions using Bluetooth low energy that will establish wired or wireless communication between the personal medical health devices like blood pressure monitors (BPM), weighing scales, pulse oximeters, digital thermometers and glucometers among others. It can have an application layer that could take care of data aggregation, compilation and finally converting it into a HL7 format before it is uploaded to a Health Vault.

Contents

Introduction 6

Challenges With Connected Healthcare 6

Suggested Connected Health Solution Framework 7

Who Will Benefit From This Framework 8

Conclusion 9

GDP Gross Domestic Product

PHR Personal Health Record

EMR Electronic Medical Record

EHR Electronic Health Record

COPD Chronic obstructive pulmonary disease

CHF Congestive heart failure

CHD Coronary heart disease

PTSD Posttraumatic stress disorder

IEEE Institute of Electrical and Electronics Engineers

Hl7 Health level 7

PHI Patient Health Index

OEM Original Equipment Manufacturer

USB Universal Serial Bus

IP Intellectual Property

HDP Health Device Profile

List of Abbreviations

IntroductionIncrease in aging population, lifestyle diseases and healthcare costs are driving global healthcare providers towards adopting tele-health technologies, also referred to as connected health solutions, which makes personal health monitoring and management cost-effective.

More than one billion people across the globe are overweight, and at least 300 million of those are clinically 1 2obese . Without action, more than 1.5 billion people are expected to be overweight by 2015 .

Over 600 million people worldwide have chronic diseases, and the spending on chronic diseases is expected to 3increase . For example, in the US alone, spending is expected to increase from $500 billion a year to $685 billion by

42020 .Globally, the number of persons 60 and older was 600 million in 2000. It is expected to double to 1.2 billion 4by 2025 .

These high costs are forcing healthcare payers to reduce hospital stay and drive them to move from clinical care to home care, so individuals can manage their health expenses efficiently. This will lead to the development of intelligent medical devices that remotely monitor the patient's health parameters and enable the health service providers to take an informed decision on diagnosis, prognosis and medicine prescriptions to the ailing patient.

Connected Health solutions enables people with critical illness to transmit vital health signs to the health care professionals and receive real-time feedback thus empowering them to better manage their own health and wellness. This paper presents our thoughts on current challenges and a suggested framework for Connected Health Solutions using Bluetooth low energy that would establish wired/wireless communication between the personal medical health devices.

Continua, an alliance formed by the group of medical device manufacturers, formalizes the industry standards in harmonizing the data communication between various medical devices that will be used in the remote

5monitoring of patient health parameters.

Challenges with Connected HealthcareContinua Health Alliance specifies that the medical devices should have wired as well as wireless connectivity, so that data from these devices can be collected and aggregated on a handheld device such as a mobile or a tablet, which is called an Aggregator device. Subsequently, this data can be converted into medical industry standard format and uploaded to a PHR or EMR of the patient. Family members, caregivers as well as health service providers can subsequently use this data for diagnosis, analysis, path of treatment decision making, and insurance purposes.

Hospitals and patients tend to use a variety of medical devices, and the manufacturers of such medical devices face many challenges in managing and transmitting the acquired medical data. Most medical devices do not collate data in the standard format specified by the Continua Health Alliance.

6

[1] World Health Organization, Obesity and Overweight: Dr. P. Puska, Dr. C. Nishida, Mr D. Porter, 2013

[2] World Health Organization,Ten Facts About Chronic Disease,2005, Retrieved May 19, 2006, from http://www.who.int/features/factfiles/chp/07_en.html.

[3] The Pfizer Journal®, Global Edition Volume 1I, Number 2,4-9, Scaling Mount Proteome to Bring Down Chronic Disease. , 2001

[4] World Health Organization,The world is fast ageing - have we noticed?, 2006, Retrieved May 19, 2006, from http://www.who.int/ageing/en/.

[5] Continua Health Alliance, Retrieved Feb 4, 2014 from http://www.continuaalliance.org/

Once the data is collected from different medical devices, aggregating it and presenting it as a medical report with clear indicators such as Green, Yellow and Red (Personal Health Indicator) becomes an uphill task for different segments.

Currently, most medical device designers do not have an integrated framework, which can work seamlessly before, during and after the hospitalization period. Additionally, cost effective multimode connectivity with wireless and wired options for multiple PHR and EHR are currently not available in the market.

High power consumption by these medical devices makes it challenging for the patient to move around impacting their mobility and quality of life.

Suggested Connected Health Solution FrameworkConsidering the challenges described in section 2 and in order to contribute to the enhancement of global healthcare landscape, we suggest a connected health connectivity and interoperability framework.

Suggested Framework Description

Personal medical health devices should connect to handheld devices such as phones, tablets or personal computers, via wireless (For e.g. Bluetooth, Bluetooth low energy) communication technologies. The suggested framework should offer a standardized software interface for easy plug-and-play integration of Continua compliant personal medical health devices, data aggregation, data upload or download and data display. The overall mobile health setup supported by the suggested Connected Health solution framework is depicted in Figure 1.

7

Figure 1: Suggested Connected Health Solution Framework

Sensor

Blood Pressure

Weighing Scale

Glucose Monior

Health Thermometer

Heart Sensor

Other Devices

Medical HealthRecord

4.Data Server

Medical DataAnalytic

Wiredor

Wireless

Wiredor

Wireless

Aggregator

PersonalHealth

Indicator

HospitalDoctor

Care giver

User

8

An ideal communication framework should work with personal medical devices using a proprietary or standardized protocol on top of an interface such as Bluetooth or Bluetooth low energy.

The suggested application should include components which provide basic services and functionalities, allowing for maximum software re-use and unified access to common mechanisms.

n User Interface Services

n Report generation (text, pdf )

n Threshold monitoring

n Database connectivity (User Data Management)

n Data upload or download services for MS Health Vaultand Electronic Health Record Portal

n XML and HL7 Processing

The suggested Connected Health solution framework should leverage Bluetooth Low Energy. This offers low power (90% power savings), low cost, higher speed, and higher range – up to 100m.

Who will benefit from this framework?With the unique ecosystem for connected health, one can achieve connectivity and interoperability of medical devices to ensure consistent medical data is available to patients, OEMs, and care providers.

Patients: Patients will benefit from better outcome by aggregated data from multiple medical devices and sensors available at a lower cost. Experts may not be required at all times, and family members or a caregiver can be trained to interpret the PHI, thus reducing the cost of care.

OEMs: OEM devices can interface with standard framework for faster time to market, low cost and proven system. As the list of devices grows, OEMs could integrate their products with such systems and develop standard for the respective product lines for medical devices that are not part of Continua. This will help OEMs increase their market share while reducing the cost of integrating output of its devices with devices from other OEMs and achieve industry harmonization.

Care Providers:. Having a device that can offer a PHI would make it easy for caregivers to know when the patient is healthy (Green), needs some attention (Yellow) or needs immediate intervention (Red) from a physician. With aging population in developed countries and economically challenged developing countries, such a solution will improve patient care and may lead to wide adoption of such systems.

Figure 2: Connected Health BluetoothLow Energy Stack

Applications

Generic Access Profile

Generic Attribute Profile

Attribute Protocol Security Manager

Logical Link Control & Adaptation Protocol

Host Controller Interface

Controller

TCS Developed

Changes on top of BlueZStack for profile Dev

Provided by BlueZ Stack

Provided by H/W

HOST

9

ConclusionThe Connected Health Solution can be one of the means to reduce the healthcare liability on patients as well as on the governments providing public health systems. By enabling remote monitoring and aggregating vitals, there will be a significant cost reduction and improved quality of life for these patients.

A Connected Health Framework integrated with Bluetooth low energy devices benefit patients, caregivers and health service providers by offering:

n Seamless and instant data connectivity.

n Data security and confidentiality using secured network protocols and auto-synchronizationeven when the health data is uploaded to medical industry-specific cloud servers.

n Communication through standardized protocols with wider support and security

n Innovative, cost-effective features like PHI, real-time graphical data display, data archivingand feedback.

All content / information present here is the exclusive property of Tata Consultancy Services Limited (TCS). The content / information contained here is correct at the time of publishing. No material from here may be copied, modified, reproduced, republished, uploaded, transmitted, posted or distributed in any form without prior written permission from TCS. Unauthorized use of the content / information appearing here may violate copyright, trademark and other applicable laws, and could result in criminal or civil penalties. Copyright © 2014 Tata Consultancy Services Limited

IT ServicesBusiness SolutionsConsulting

Subscribe to TCS White PapersTCS.com RSS: http://www.tcs.com/rss_feeds/Pages/feed.aspx?f=wFeedburner: http://feeds2.feedburner.com/tcswhitepapers

ContactFor more information, contact lshcip.pmo@tcs.com

About Tata Consultancy Services (TCS)Tata Consultancy Services is an IT services, consulting and business solutions organization that delivers real results to global business, ensuring a level of certainty no other firm can match.TCS offers a consulting-led, integrated portfolio of IT and IT-enabled infrastructure, engineering and

TMassurance services. This is delivered through its unique Global Network Delivery Model , recognized as the benchmark of excellence in software development. A part of the Tata Group, India’s largest industrial conglomerate, TCS has a global footprint and is listed on the National Stock Exchange and Bombay Stock Exchange in India.

For more information, visit us at www.tcs.com

TCS

Des

ign

Serv

ices

I M

I 02

I 14

About TCS Life Sciences

Top Global Life Sciences organizations derive value from TCS' full services play in IT, Consulting, KPO, Infrastructure and Engineering Services as well as new age business solutions including Mobility and Big Data. TCS' rich industry experience, domain expertise and global footprint ensures that it partners with its Life Sciences customers to help them advance clinical trial efficiencies, accelerate drug discovery, maximize manufacturing productivity and improve sales and marketing effectiveness.In addition, TCS has a dedicated Life Sciences Innovation Lab which ensures that its customers have the tools and innovative solutions they need to solve complex business challenges.