TURN ON BLUETOOTH TO RECEIVE MY VCARD Connected Care: Adding Value to the Electronic Health Record David Doherty Business Development

Connected Care: Adding Value to the EHR > Why a disconnect in care is holding back EHR adoption > The Mobile Phone – the optimal device for Connecting your Health > Why health information and devices will converge to the Mobile > Unique benefits of Mobile for personalized delivery of connected care > Some examples of how the Mobile is Connecting Care > How 3G Doctor is Connecting Care > How a mobile connected care would enhance care services today > Summary

Why is EHR adoption languishing? Financial Security & Privacy Legal Liabilities Consumer owned Mass produced Personal & unshared Always on & connected Biometric authentication Patient Owned & Managed Up-to-the-minute Ubiquitous Mobile Connectivity

How should Patients carry their Health Information?

Convergence to the Mobile Device we have already seen Video Player /Recorder Camera Calculator/ Converter Answer machine Calendar/ Diary Internet Browser NFC/ Barcode Reader GPS/Altimeter/ Navigator Pager Clock/Alarm Music recorder /player Games Console Office Software

The inevitable convergence of personalised Connected Care to the Mobile Weighing Scales Temperature/ Touch Exercise Coach /trainer Sleep Monitors Food Diary Holter Monitor Connected Point of Care Testing Medication Reminders BioSensors Games & Cognitive Monitoring Blood Sugar Blood Pressure Monitors Carer-Ping

Unique benefits of the Mobile Phone for Personalized Delivery of Connected Care > Completely personal device Facilitates highly personal health services Can help to ensure fidelity of patient > Always turned on and carried or within arms reach Facilitates Wireless Body Area Networks Facilitates the gathering of contextual info Ensures it's there in unexpected emergency scenarios Provides assurance that care is at hand Facilitates push services as well as pull > Built in micropayment means Enables lower costs to deliver services Supports low cost pay-as-you-use health services

Early successes in Mobile Healthcare… > In 2004 London Ambulance service began locating callers following EC Directive 2002/22/EC requiring MNOs to provide data to EMS > Today 80% of the 30 million UK Emergency 999 calls are made from a Mobile Phone - up from only 25% in 2004. > 8 million NHS Direct calls - again most were made from Mobile Inevitably a lot of these are happening within the vicinity of a fixed-line phone.

Early successes in Mobile Healthcare… " I n C ase of E mergency" Number programmed into your phone memory under the name “ICE” In case of emergency the 24/7 service will provide Medics with information and inform family and friends Annual subscription based service

Early successes in Mobile Healthcare… Mobile Health Promotion for over 36 NHS Primary Care Trusts (Islington CS) Fully automated appointment reminders and targeted group messaging. Started by using SMS to reduce GP missed appointments the services are now used to support: Smoking cessation Child immunization CVD Breast Screening Obesity Flu-Jab Hypertension

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare… BLOOD BANK

Early successes in Mobile Healthcare… Nokia Wellness Diary Free to download application for Symbian S60 Mobile Phones Enables the collecting, Storage & analysis of Wellness-related data collected from everyday life. Over 150,000 downloads per month from Nokia website

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare… Samsung MiCoach Partnership between Samsung & Addidas Provides an on-the-go real time coaching system comprised of a connected stride sensor & heart rate monitor. By fusing music, sports, fashion & mobile technology the service connects through the website to enable fitness planing, tracking and analysis. Contrast with Apple/Nike+ Mi Coach.com

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare… Medical Intelligence – Columba bracelet Safety Device for those with advanced stages of cognitive impairments & for peace of mind for their families and caregivers. Permanently wrist worn, waterproof, shock resistant and requires a special key to be removed. 24/7 accurate GSM & GPS location & exit detector.

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare… Interactive health management & remote patient monitoring for populations with conditions including asthma, diabetes, COPD, cardiovascular disease, obesity as well as general wellness.

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare… Integrated Technology and Service Ambulatory Cardiac Monitoring with realtime beat-to-beat analysis, automatic arrhythmia detection & wireless ECG transmission. Benefits over 24-48 hour Holter Monitoring or event recorders include the fact that some arrhythmias may occur too infrequently or be asymptomatic presenting difficulties triggering the alarm.

Early successes in Mobile Healthcare… LifeCOMM US Based Mobile Virtual Network Operator (MVNO) set to launch 2008 "Targeting women aged 40-65 because they are influencers when it comes to health" "15 million U.S. women look after 2 sets of parents - an unserved market" "Today we primarily use our phones for communication, information gathering & entertainment, but LifeCOMM wants to transform our phones into 'in-the-hand' tools that can help us maintain our good health or manage a condition we may already have"

Tuvi orbach screenshots Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare…

Early successes in Mobile Healthcare…

How we're Connecting Care at 3G Doctor Ability to Create, Manage and Share your important health information. Questions & Answers handled by remotely Distinct servers and SSL encryption Data stored remotely and not on the Device so no issues with loss/theft. Can be referred to when Video Consulting with 3G Doctor from registered mobile Can be electronically transmitted to official authority with Name, Mobile Number, IMEI, Address, Photo or NHS Number etc.

How we're Connecting Care at 3G Doctor 24hr x 365 day 3G Video access to an informed General Medical Council registered Doctor for non-urgent help and advice. Video Call is made to the patient after the completion of an interactive Medical History Questionnaire and the review of this by the consulting Doctor. Following the Video Consultation the Patient receives a 3G Doctor Consult Report including their Medical History and the Doctors advice. Charged at £35 per consultation inclusive.

3G Doctor Future Developments Medication management program using low cost NFC sensory technologies Connection of Point of Care Testing to Video Education and 1-2-1 Advice Support of secure Mobile Care Communities International multilingual 3G Video Advice Informed Doctor triage of Emergency calls

What can happen when we Connect Care to the EHR through the Mobile… Community Critical Normally managed by friends & family Non urgent Professional Advice Professional Referral eg. Test Results Emergency Emergency Telephone Home Help On scene at emergency Telephone/online advice Dermatology referral

80% of all care is delivered by unqualified friends and family Growth of ever more sophisticated home health technologies will continue to impact on this particularly as 9 in 10 of US 60+ claim that they want to stay in their home & community as they age*. The need for remote access to informed care is increasing and the ability to access anytime anywhere care means that patients aren't discouraged from leading out going lives by fixed systems. And can benefit from physical and social benefits of this additional mobility. * American Association of Retired Persons Home Help

Authenticated Connected Care would: > Enhance the Continuity of Care and reduce repetition > Improve the speed and quality of decision making > Prevent misuse and privacy breaches > Enable the international support of patients. > Increase access to quality care and ensure it is current > Better support new medical technologies and POC tests The NHS itself is leading by example in this area with Healthspace Push instead of pull… eg. Drug recalls and seasonal advice Epidemic awareness: by knowing who is reporting we can make more informed decisions. Eg. Profiling of diseases and patients Strengthening the carer' ability by giving them more information and better tools which will lead to better decisions and less burden. Telephone/online advice

Book appointment & attend Clinic Questions asked by Mobile Device Questions asked by Nurse Images uploaded by patient Images taken by Nurse Patient receives Nurse receives Report report Clinic arranges for patient to attend Patient attends appointment Patient contacted by Nurse receives Query Consultant Patient attends appointment Nurse Queries patient Consultant Review case Nurse receives report Patient attends appoint Mobile Connected Care Current Store & Forward Practice Referral / Treatment A B A B Consultant Reviews Case Dermatology referral

Which service would you like, Police, Ambulance, Fire or Coastgaurd? 3G Video Connected Care would offer the Who, Where, Next of Kin, Doctors Name, Condition(s) and Identity enabling more appropriate and timely referral to staff with appropriate skills Future enabled eg. "I understand you have a device called an ABC that is reporting XYZ". 75% of the 30 million UK annual 999 calls are hoax & more than 17,000 per day originate from inadvertent key pressing. Emergency Telephone

As the device that is always with us, always connected. In the event that it is not data and informed care can be retrieved using any other means of connectivity Identification uses every patients unique mobile phone number but can be extended to IMEI number, SIM Card Number, Name, Address, Biometric Recognition. Ultimately the provision by the patient of important information in a timely and electronic way will let us start to utilise the most underutilised person in todays healthcare system. On scene at emergency

Summary EHR and Connected Care present a classic chicken and egg scenario: because the value of either is dependent on the other. The value in health records cannot be realised until they are connected. The value of remote care cannot be realised until it is connected to information. Advanced consumer Mobile devices and networks are placed uniquely to be the means by which this can be delivered. 3G Mobiles provide additional ubiquity, future proofing, location data, higher speed data transfers (both up and down link) and multimedia abilities. The healthcare industry should build to exploit consumer 3G technologies and Always Best Connected principles