Albert 2 oklahoma telemedicine

Oklahoma Telemedicine Conference
2014
David E. Albert, MD
Founder and Chief Medical Officer
AliveCor
The mCardiology Company
1 © 2013 AliveCor, Inc. All Rights Reserved. Proprietary & Confidential.

Disclaimer
Statements, opinions and results of studies contained in
the program are those of the presenters/authors and do
not reflect the policy or position of the Board of Regents
of the University of Oklahoma (“OU”) nor does OU
provide any warranty as to their accuracy or reliability.
Every reasonable effort has been made to faithfully
reproduce the presentations and material as submitted.
However, no responsibility is assumed by OU for any
claims, injury and/or damage to persons or property
from any cause, including negligence or otherwise, or
from any use or operation of any methods, products,
instruments or ideas contained in the material herein.

Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial
interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship Company
• Major Stock Shareholder/Equity
• Ownership/Founder
• Salary & Other Financial Benefit
• AliveCor, Inc.

Objectives
• Describe the current status of healthcare delivery in
the US and OUS
• Describe how mHealth can help address some of the
global issues
• Describe the current status of mHealth in the US and
OUS
• Provide real-world examples of how mHealth is
working
• Describe the potential in the future

US Healthcare Expenditures

Expenditures Continue to Increase

Healthcare Problems Differ For the Developed
vs. the Developing World
• Developed world (especially the US) spends too
much on healthcare and doesn’t get its money’s
worth.
• Developing world spends too little and gets
exactly what it pays for (i.e., almost nothing).
• We must find solutions and technologies which
can address the problems of both… and that’s
not as crazy as it sounds!

Population Growth (in the Developing World) Demands Action
to Improve Healthcare!

Healthcare Globally Must Go from Reactive to
Proactive: Hygiene & Diet & Fitness & Vaccines, Etc.

Inadequate Healthcare Access
Global HC workforce vs. disease burden* The challenge 2013
57
Countries below WHO critical
healthcare coverage threshold
4.3 million
Worldwide shortage of health workers
including doctors, nurses, and midwives
$2 billion
Annual cost just for training of needed
U.S., Canada, and Latin America have 37% of global HC professionals in India alone
healthcare workers and only 10% of global disease
burden
*: Size of circles proportional to healthcare expenditures
Source: World Health Organization
AliveCor Company Confidential Oct-14

Health Data, like All Information, will be
Shared, Connected & Engaged
*: 1 exabyte = 109 gigabytes
Source: Cisco VNI Mobile 2011
92% CAGR

And Exponential Change will bring a
New Paradigm to Healthcare

Smartphones Introduced Apps & As the Late
Steve Jobs said, “That changed everything”!
• > 1 Billion Apple and Android
devices sold to date
worldwide
• Over 70% of US subscribers
have a smartphone
• 100 billion app downloads
from Apple’s iTunes Store &
Android Market
• 5 years from now there will be
no dumb phones but only
smartphones

Smartphones: The Global Technology Growth Engine
mHealth: Bringing Smartphone Dynamics to Medicine
75
38
13
4 2.5
mHealth by 2017
Telephone Radio TV Internet Smartphone
Years to reach 50 Million Users
500M
$26B
Users
Market
size

The Smartphone Will be the World’s Healthcare
Portal

Smartphone ownership by demographic group—
gender, age, race/ethnicity
% within each group who own a smartphone
Own a smartphone
All adults (n=2,252) 56%
Gender
Men (n=1,029) b
a 59
b Women (n=1,223) 53
Age
a 18-24 (n=243) 79
cdef
b 25-34 (n=284) 81
cdef
c 35-44 (n=292) 69
def
d 45-54 (n=377) 55
ef
e 55-64 (n=426) 39
f
f 65+ (n=570) 18
Race/ethnicity
a White, Non-Hispanic (n=1,571) 53
b Black, Non-Hispanic (n=252) 64
a
c Hispanic (n=249) 60
Source: Pew R e s earch Center’s Internet m& A erican Life Projectp, A ril
17-May 19, 2013 Tracking Survey. Interviews were conducted in English
and Spanish and on landline and cell phones. Margin of error is +/-2.3
percentage points based on all adults (n=2,252).
Note: Percentages marked with a superscript letter (e.g., a) indicate a

Smartphone ownership by income/age grouping
% within each age/income grouping who own a smartphone (example: 77% of 18-29
year olds with an annual household income of less than $30,000 are smartphone
owners)
77%
47%
100%
80%
60%
40%
20%
Source: Pew R e s earch Center’s Internet &m A erican Life Project 6April 2 -May 22,
2011, January 20-February 19, 2012, and April 17-May 19, 2013 tracking surveys. For
2013 data, n=2,252 adults and survey includes 1,127 cell phone interviews. All surveys
include Spanish-language interviews.
22%
8%
81%
68%
40%
21%
90%
87%
72%
43%
0%
18-29 30-49 50-64 65+
Less than $30,000 $30,000-$74,999 $75,000 or more

Physicians & Mobile Computing
Devices
Source: QuantiaMD, Tablets Set to Change Medical Practice, 2011

Physicians Support Mobile Monitoring
• Percentage who want to monitor patients at home
65% - Weight
61% - Blood sugar
57% - Vital signs (e.g. blood pressure,
heart rate, respiratory rate)
54% - Exercise/physical activity
36% - Calories/fat content taken in
36% - Pain level
35% - Sleep patterns
28% - Cardiac rhythm
17% - Bladder control
16% - Acid reflux/indigestion
13% - Digestive health
Source: PricewaterhouseCoopers HRI Physician Survey, 2010

Patients Accept Ownership
and Responsibility
Source: IBM Report: The Future of Connected Health
Devices, March 2011
“Among those surveyed, nine out of ten (93 percent) are
satisfied or very satisfied with the basic functionality of their
devices. Although less than 10 percent are paying out-of-pocket
charges for their devices today, more than one-third
expect to do so within two years. Most users are willing to pay
for a device, but will not spend more than US$100 out of
pocket. An increasing number of consumers also
anticipate paying monthly fees in the future; while only 5
percent pay a monthly charge today, 35 percent expect to do so
in two years.”
AliveCor Company Confidential May 2011

Highlights
A Huge Opportunity To Do Good & Do Well!
PwC and GSMA predicts
that global mHealth
revenues will increase to
$23 billion over the next
four years
The market opportunity

Global mHealth Market Relevance
US & Western Europe
 Empower consumers
 Improve effectiveness of existing
systems
 Reduce costs
Developing World
 Create health infrastructure
 Leap-frog bricks and mortar
 Provide accessible health solutions

Outcomes are Improved When We Connect

App-Drug Synergy will Enable Patient
Self-Management
• Diabetes: Sanofi iBGStar
• Hypertension: Withings BP
• Atrial Fibrillation: AliveCor ECG

Smartphone & Cloud Computing Enable Global
Telemedicine

Smartphones & Big Data Will Rely on CLOUD
COMPUTING To Create Connected Innovations!

BIG DATA will allow innovation in everything
from weather to energy to medicine!

H1N1 Virus

1919 Spanish Influenza Epidemic

The New Vectors of Social Virality

Idea Epidemics can Literally Span the Globe in a Day

Ideas Spread At the Speed of Light With No Control

Cardiovascular Disease: A Large Market
Atrial Fibrillation Chronic Heart
Failure
Heart Flutter Coronory Artery
US patient population
Disease
Hypertension
Opportunity
6M
78M
3M
30M
47M
US Cardiovascular Annual Disease Expense $273 Billion

Growth in Heart Disease –
US population 2000 - 2050
Beller GA. Circulation. 2001; 103:2428 – 2435
Foot DK, et.alo. J Am Coll Cardiol. 2000; 35:1067 -1081

Hypertension: The Statistics

Prevalence of Atrial Fibrillation
Summary of studies
investigating the prevalence of
atrial fibrillation in various
populations and age groups1
%
< 40 60 64 74 > 75
10
8
6
4
2
1Cairns J, Connolly J. Nonrheumatic atrial fibrillation: risk of stroke and role of antithrombetic therapy.
Circulation. 1991:84;469.
Age (years)
0

Annual Utilization/Primary Diagnosis
More than $1.3 billion spent annually due to AF primary diagnosis
Unspecified
Conduction Disease
Sick Sinus Syndrome
Premature Beats
Junctional Rhythms
Atrial Flutter
Atrial Fibrillation
Ventricular Tachycardia
Ventricular Fibrillation
Cardiac Arrest
0 200 400 600 800 1000
Thousands of Hospital Days The Lancet, 1993;341:1319.

Primary Healthcare Expenditures
Annual Economic Burden
40
35
30
25
20
15
10
5
0
Billions of $ US
HF AF VT/VF Brady

A Growing Medical Challenge
Heart failure management
Annual
Incidence
Heart Failure
Prevalence
400,000 5.0 million
250,000
6.5 million
Annual
Mortality
U.S.
Europe 580,000 300,000
Congestive heart failure worldwide markets, clinical status and product development opportunities. New Medicine, Inc. 1997:1-40.
Wilkerson Group Survey, 1998.

mHealth Cardiology Solutions are Growing
Rapidly

One Small mHealth Solution:
AliveCor Smartphone ECG

The AliveCor Smartphone System is a Global,
Cloud-Based ECG Monitor
Patient Takes ECG
Via Hands or Chest
ECGs Securely Stored &
Processed In the Cloud
ECGs Stored Locally
ANYWHERE IN
THE WORLD
ECGs Accessed Via
HIPAA-compliant,
Secure Login

In-Flight Arrhythmia Diagnosis CASE
Patient Profile and History
• A male patient in his mid 20’s experiences
shortness of breath, palpitations, and chest
pain during an intercontinental flight. Physician
unable to diagnose rhythm with stethoscope.
Clinical Assessment Using the Heart Monitor:
• An ECG recorded with the Heart Monitor
showed runs of Ventricular Trigeminy
(Premature Ventricular Contractions every
third beat).
• Patient was instructed to see a doctor when
arriving at home and take the ECG to the
appointment
Value of the Heart Monitor:
• The Heart Monitor in this instance was able to assist the doctor in diagnosing PVCs.
• This allowed the plane to continue on its journey without an expensive emergency landing to care
for the patient.
• The patient was given the peace of mind that their symptoms were not life threatening and could
see their primary physician when arriving at home.

AFib Screening & Stroke Risk Identification
Cardiologist A Cardiologist B AliveCor AF Algorithm*
94% 95% 97%
 109 patients evaluated with standard ECG and AliveCor
 70 sinus rhythm, 39 AFIB
 Blind evaluation
Concord Hospital, University of Sydney, Australia (PI, Dr. Ben Freedman, Professor of
Cardiology and Deputy Dean of Medicine)
Presented at the American Heart Association in November 2012
*AliveCor AF Algorithm in testing, not currently available for sale in the US or elsewhere

Database Currently Contains Over a Million
ECGs- Following Them Over Time.
Bradycardia Tachycardia
Heart Rate Distribution From Customer Database

mHealth Transforming Heart Health By
Empowering Self-Care
Traditional ECG AliveCor ECG
 Difficult to access
 Expensive
 Limited to institutions
 Appointment driven
 Data driven
 Instantly available
 Accessible & affordable
 Consumer-centric

Physician-Directed Patient Self-Management of Left Atrial
Pressure in Advanced Chronic Heart Failure
Ritzema J et al. Circulation. 2010;121:1086-1095

Patient Self-Management Case Study
 Patient with atrial fibrillation (AFIB), an erratic heart beat, on the drug
Amiodarone which causes severe side effects
 Patient buys the AliveCor device with subscription, using it on a daily basis for
remote monitoring
 Patient and physician adjust prescription dosage while monitoring ECG real time
from home, eliminating side effects and controlling AFIB
 Expensive hospital and office visits avoided
 Money saved for payors
Ubiquitous ECG monitoring can transform healthcare delivery,
reducing cost while improving outcomes!

Veterinary mHealth Opportunity
• From dogs & cats to horses and
exotic animals, mHealth presents
opportunities to take state-of-the-art
care to the patients.
• Vets have always made house calls
especially for farm animals and
horses- they are true “mobile care
providers”
• Owners can source biometric data
as it’s always easier to “move data”
than to “move patients” , especially if
they are LARGE!
AliveCor Company Confidential Oct-14

Impact of Digital & Mobile Health
Changing the paradigm – creating a new S-curve
 Extends reach of healthcare institutions to home & mobile
 Cellphone-based disease management improves outcomes
 Enabled by consumer electronics cost structures and channels
 Physicians embrace mobile monitoring for their patients
 Patients accept ownership and financial responsibility for
better health and wellness tools
 Mobile health solutions present major business opportunities

What’s Going to Happen to mHealth?
1. Consumerization is early but it’s coming to
cardiovascular and all healthcare.
2. Technologies like Smartphones & Cloud
Computing are enablers but Changing
Economics & Increased Personal
Responsibility are the Drivers!
3. Change creates Opportunity so embrace it!
THANK YOU!

Albert 2 oklahoma telemedicine

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