On the same wavelength

The Continua Health Alliance turns 3 years old this month.

The not-for-profit consortium, touted at its launch in San Francisco in June 2006 as the “convergence of the healthcare and consumer electronics industries,” set as its primary goal the development of a set of nonmandatory, consensus guidelines for data transmission that all home health medical-device makers could and should adopt.

The aim was to end what was then—and remains largely to this day—an electronic cacophony of output from these devices by encouraging their diverse and often competing manufacturers to submit to voluntary testing and certification. Consumers could then look for the Continua logo and know these devices all sing off the same digital telecommunications hymnal.

After a long slog selecting the appropriate standards, and a bit of a delay releasing them, the alliance has grown from an initial 22 companies and provider organizations into a consortium of more than 180 members.

“It’s taken a good amount of time getting political agreement and getting everybody onboard with this,” says Paul Williamson, the U.K.-based head of the wireless medical development team for Continua member Cambridge Consultants, a subsidiary of the Altran Group, Paris, an international technology consulting firm.

“In the next few months, it could tip over and become something very significant,” Williamson says. “We have a number of licensees who are developing products to market. Once people start seeing devices they can go online” to buy and that carry a Continua badge on them, “it will help move those who have been just sitting back,” he says.

At its founding, Continua boasted some of the world’s highest-profile technology companies and medical-device makers, including Cisco Systems, GE Healthcare, IBM Corp., Intel Corp., Medtronic, Motorola, Panasonic Corp., Royal Philips Electronics, Samsung, Sharp Corp. and Welch Allyn, as well as two prominent U.S. provider organizations, Oakland, Calif.-based Kaiser Permanente and Boston-based Partners HealthCare Systems.

David Whitlinger, director of healthcare device standards and interoperability at chipmaker Intel who served as the first Continua president and board chairman, said in 2006 that the consortium set a goal of having tested and certified products on the market by 2008. It didn’t quite happen.

It wasn’t until January of this year that Continua completed work on what it calls its Continua Version One Design Guidelines, says Rick Cnossen, Continua’s current chairman and president. Those first-round guidelines cover data transmissions from five of the most popular digital home health devices: blood pressure monitors, blood glucose readers, pedometers, pulse oximeters and weight scales.

Also in January, Plymouth, Minn.-based Nonin Medical announced it had become the first medical-device maker to offer an appliance tested and certified by Continua to be in compliance with the consortium’s interoperability guidelines. Nonin manufactures and sells pulse oximeters for a wide range of users—from airplane pilots to mountain climbers to home health patients. The certified product, called the Nonin 2500 PalmSAT, is a hand-held device that uses a USB plug-in connection to transfer data via Continua standards to a computer.

According to the company, a wireless, Bluetooth-enabled model is undergoing Continua testing and certification. Nonin also plans to bring a number of its other devices in compliance with Continua guidelines.

Cnossen, whose day job is with Intel as its director of personal health enabling, says he hopes that at least 10 Continua-certified devices will be on the market by year-end. Cnossen says he thinks that there will be at least one device in each of the five key product lines. A second version of Continua guidelines covering wide-area-network communications could also be ready by year-end, he says.

Unlike the federally supported Certification Commission for Healthcare Information Technology, Continua receives no government funds. CCHIT also charges electronic health-record vendors on a per-product basis for certifying their systems. Continua does not, Cnossen says.

Instead, to cover testing, certification and other operating expenses, Continua relies on membership dues that afford different benefits and voting privileges. It charges $5,000 for its “liaison” and “contributor” classes of membership, $35,000 for a “promoter” class and an amount Cnossen declined to reveal for a “director.”

With an aging U.S. population, sales of home health-monitoring devices are expected to soar. Cnossen said that market research reports estimate the market is about $3 billion in 2009 and is expected to more than double to $7.7 billion in just three years.

Cambridge Consultants, which designs and develops electronic products for manufacturers, showcased at a trade show in Lisbon, Portugal, last month a pilot asthma inhaler coupled with its proprietary Vena wireless platform. Cambridge is adapting that platform to the Continua standards. Company officials could not give a precise date when the device would reach the market, but indicated it would be available soon.

Pamela McNamara, president of U.S. operations for Cambridge Consultants, Boston, says that with the wireless system, “individuals can track themselves. The inhaler device is programmed to give a reminder to the patient to take a puff and records the puff and transmits it via Bluetooth to a portal so it can be tracked.”

On the receiving end of the transmission could be the patient’s own personal health-record system, a caregiver—the parent of a child who is a patient, or, conversely, the adult son or daughter of an elderly parent who is the patient—a physician’s EHR, or a monitoring service.

One other potential use for the technology in addition to patient care is to assist in documenting medication use for clinical trials, McNamara says.

“Are they taking the inhaler puff according to protocols? Where you don’t have the connectivity, compliance to protocol can be down in the 11% to 20% range, but with the connectivity you can get the compliance in the 80% range,” she says.

Williamson says that Cambridge became actively engaged with the development of Continua standards about a year ago.

The inhaler, Williamson says, will be able to connect via the short-range, Bluetooth wireless telecommunications standard either to a cell phone in the user’s pocket or purse, or to a wireless receiver in a patient’s home. For now, Williamson sees home receivers as the likely connecting points for the devices, but “the future of this technology is using the mobile technology as the hub.”

“We’re also coming on to the Version 2 standards coming out this year with a peak-flow meter and a medication monitoring standard that’s emerging for devices such as the asthma inhaler.” The peak-flow meter tells asthma patients how much air they are moving in and out of their lungs.

The digital home health medical device market has a lot of latent demand for products that can communicate with PHRs and remote monitoring services, Williamson says. “What Continua presents a potential for is completely unlocking that. It will enable service providers to connect to any Continua-certified device. It brings an economy of scale to the whole market and reduces the barriers to entry.”

John Halamka, a physician informaticist who is chairman of the federally supported Healthcare Information Technology Standards Panel, which is developing its own sets of data transmission guidelines for EHR systems, says that “the Continua stuff is absolutely aligned with the HITSP stuff,” although some additional development work

is needed.

Halamka, who is also chief information officer at Boston-based CareGroup Healthcare System, says that the hospital network has yet to specify purchasing only Continua-certified products for its own use.

“It’s too early,” Halamka says, “we’ve not implemented a lot of home health activity. But we plan to.”

Halamka says the organization hopes to have home health programs using bathroom scales, blood-pressure cuffs and glucose meters within a year.

While a few hospitals and healthcare delivery systems have toes in the water with electronic devices and home health, in 2003 the Veterans Affairs Department took the plunge, having since then enrolled more than 43,000 patients in its care coordination/home telehealth program, according to a report by Adam Darkins, chief consultant for care coordination at the VA.

Darkins, a neurosurgeon, is the lead author of a report published in the December 2008 issue of the journal Telemedicine and e-Health showing the benefits of the technology. The report is based on a study of more than 17,000 VA patients enrolled in the home health monitoring program.

“We’re showing a 25% reduction in bed days of care” for those patients, Darkins says of the findings. The study also found a 19% reduction in hospital admissions for monitored patients after enrollment and an 86% mean patient-satisfaction score.

“We haven’t put an overall cost to that,” Darkins says, but he adds that the VA spends $1,600 a year for electronic home-health monitoring, while the cost of providing nursing home care on the open market is about $78,000 a year.

“The purpose of this is to help veteran patients to live in their own home,” Darkins says. “They would like to live, as we all would, independently in their own homes.” The VA expects to see the number of veterans age 85 and older—prime candidates for home health—soar to 1.4 million by 2012, up from 510,000 in 2000.

The VA purchases home health devices for its program “off the shelf” from public-sector vendors and interfaces the devices with its own health information technology.

The VA is not currently a member of the Continua coalition, Darkins says, but “we are certainly looking toward how we will relate to Continua” in the future. “We are also looking as we contract how we will use standards. We’re working through those contracts.”