HS24 Project Presentation

HealthService24
Continous Mobile Services for Healthcare
eTEN-C517352
PROJECT
PRESENTATION
Project Facts and Figures
Our vision, goals & time plan

Vision of HealthService24
HealthService24 aims at launching

innovative, integrated mobile healthcare
services, supporting patient and health
professional mobility, as well as enhancing
quality-of-care whilst decreasing health
expenditures
© HS24 Consortium 3 Project Presentation HealthService24

Goals of HealthService24
• Offer a viable mobile healthcare service permitting health
professionals to remotely assess, diagnose and treat patients
whilst the patients are free to continue with daily life activities and
stay fully mobile
• Test the feasibility of the deployment of the existing prototype on

the European market via pilot runs (prototype is based on the
solution that was developed in the MobiHealth project, IST-2001-
36006)
• Demonstrate and validate the precise conditions to be fulfilled for

subsequent commercial deployment
• Make the service applicable to many areas, ranging from patient

management to sports, with post hospitalisation, public healthcare
and home care
The project shall result in obtaining a fully marketable solution

HealthService24 – Project Consortium
Medisch Spectrum ▲Twente

HealthService24 – eTEN-517352
HS24 project duration: February 2005 – September 2006
Project type: Market validation, eTEN
Project objectives: Validation of existing prototype

Acceptance by hospital staff and patients
Integration into existing systems & processes
Health economics potential
Focus of the pilots: COPD patients (Hospital Clínic, Barcelona)

Cardiac Patients (LITO Polyclinic, Cyprus)
High risk pregnancies (MST, Enschede)
Total project costs: 2.24 mil € (EC contribution: 1.2 mil €)
More info: www.healthservice24.com

The HealthService24
Mobile Monitoring System
The technology behind

HS24 – Functional System Description
• A user is equipped with sensors interconnected under a Body Area

Network (BAN) managed by a PDA or a mobile telephone
• The collected data is constantly and wirelessly transmitted via UMTS

or GPRS to a medical service centre or directly to medical
professionals
• Included content management functionality allows for immediate

analysis of individual body data and personalized patient feed-back
in real-time (e.g. alarms or reminders)
• Healthcare professionals can remotely assess, diagnose and treat

patients whilst the patients stay mobile. In case of rapidly deteriorating
medical conditions, the data centre can also send an SMS-alarm or
provide the patient with a first level medical support

A mobile communication platform
for healthcare
Analysis &
Content
Management
Medical Call
GPRS / Center / Service
UMTS
Mobile
Networks
Measuring
body
values
(BAN) Doctor
Patient Feedback Loop in Real-Time

Overall system architecture
Applications Applications
Sensor /
Actuator M-health service layer
Services
Intra BAN1) Extra BAN

communication provider communication provider
Sensors Mobile Base Unit (gateway + host) Computing infrastructure

(on the body) (on the body) (Healthcare provider)
1) BAN=Body Area Network

The HealthService24 end-user device

Patient Management System Integration
• Software for patient management,

including
– Patient demographics
– Past history (including previous
hospital admissions)
• Selected episodes (e.g. previous

ECGs and other tests)
– Medication
– Alerts
– Statistics, audits, management
reports
The HS24 BAN system was successfully integrated into DITIS – the Patient
Management System used at one of the trial sites to further enhance efficieny.

Vital signs HS24 2.0.1R
The following vital signs can be measured with the HS24 2.0 system
• ECG (4 channels, 24bits)

• EMG (4 channels, 24bits)
• Plethysmogram (wave form, 8bits)
• SpO2 (0-100%)
• Pulserate (0-255)
• Respiration (wave form, 24bits)
• Skin temperature (25-40C)
• Activity - step-counter (optional)
Note: TMSi Mobi4/5 up to 256Hz sample freq. over GPRS (Vodafone NL)

Market Considerations
Show me the money!

Current challenges in the healthcare
We are getting older, Costs, budget deficits

What keeps healthcare chronic diseases are rise and can’t be
managers awake? on the increase controlled
New, stringent budget- Research for new

models like “Diagnose drugs becomes very
Related Groups” (DRG’s) expensive
Patient Outdated and not-

empowerment integrated ITC
systems
m-health services are suitable to contribute to

solving the challenges of the healthcare sector

The future of m-health
Different resources come up with different market figures and prognosis

due to different definition of mobile healthcare …
Although numbers are dynamic, a clear trend is registered:
⇒ Personal healthcare, prevention, fitness and wellness is one of

the most dynamically expanding markets concerning consumption
of media and information systems – including mobile solutions 1)
⇒ Mobile Healthcare will be one of the most rapidly growing segments

in the area of mobile enterprise solutions 2)
1) Durlacher
2) Gartner Group

m-health market projections
Forecast for total e- and m-health market potentials in EU countries –

examplified calculation for the German market
• Health industry 2010: 271 Billion Euros (figure for Germany)
• eHealth industry 2010: 5 % of health budgets will be invested

in eHealth systems and services:
for Germany: 13.55 Billion Euros
• mHealth industry share: 10-15% of eHealth budgets
for Germany: 1.356 - 2.03 Billion Euros
Source: European Union

Target groups and value proposition
Hospitals: Home & mobile Care:

Mobile patient monitoring of Patient monitoring of elderly
people in order to reduce costs by
early discharged patients in
ged
complete safety to reduce costs ar tion improved patient security und
H de r
h
om l y
El
c improvement of internal processes
and comply with cost cutting is olu
ec C a
D S (e.g. documentation)
a r re
ile ts
e
ob en
/
M ati
P
Mobile Health
Solution
c
ni on
M
M ket
ar
ob in
o i
hr t
C olu
ile g S
ile e S
Tr olu
Pharmaceutical industry:
Public Healthcare / doctors:
ia ti
b
o as
l & on
Mobile clinical trials (fast, high- M se

i Mobile disease management (e.g.
quality clinical data for shorter D less disease related costs and
time-to-market and safer
better quality-of-life for chronic
medicine), direct-to-patient
disease patients)
communication

Savings through disease management
- Asthma (I)
The Asthma case: potential yearly net savings/patient in
Germany amount to € 600 - € 1800 (10-30%)
Cost Basis for

Insurers 100
Savings in
Treatment 30 - 40
Costs
New claims 5 -10

Due to PM
Costs of PM 5 -10
Programm
Total Costs 70 - 90
Net Savings for 10 - 30

Insurers
Source: McKinsey

Savings through disease management
Asthma (II)
The Asthma case: potential yearly net savings of € 24-72 mil for
the German healthcare system (based on 1% acceptance)
Acceptance*
Potential savings:
Disease Prevalence (Germany) 3% 1%
€ 24 – 72 mil
Diabetes 5.000.000 150.000 50.000
Stroke 1.500.000 45.000 15.000
Asthma 4.000.000 120.000 40.000
Hypertension 17.600.000 528.000 176.000
CAD 1.500.000 45.000 15.000
Total potential users 888.000 296.000
* Estimated acceptance rates for mobile patient management programs

Example: cost savings in public health
through patient management (UK)
Mobile patient management can yield significant cost savings
for health providers
Yearly costs for a
person undergoing
conventional treatment
Yearly costs for a

person taking part in a
SEDS1) programme
GBP 28,000
GBP 10,300
Source: Wireless Healthcare 2004 1) SEDS – Supervised Exercise, Diet and Stress management programme

Example: cost savings in public health
through early hospital discharge (UK)
Discharging patients earlier from hospitals to their homes can result

in savings of 85% in weekly care costs
Average cost of Average cost of Average cost of

care per week care per week care per week
and person in a and person in a and person in
hospital: nursing home: own home:
GBP 805 GBP 337 GBP 120
Source: Wireless Healthcare 2004

Mobile applications help hospitals to
lower care costs
Hospitals in Germany can save up to €1.5 bn per year through early
discharge of patients made possible by mobile monitoring services
Early discharged Average costs Average number Total yearly cost

hospital for one of hospital savings
patients using hospital day: days saved through early
mobile services through early discharge:
(20% of total): discharge:
3.3 m € 150* 3 days € 1.5 bn
* Excl. administrative costs that are also applicable if using a mobile monitoring system
Source: GesundheitScout 24 GmbH

Bayerisches Rotes Kreuz

Benefits for pharma companies:
shortening of clinical trial time
The pharma industry loses on average $ 1 mil for each day a new
pharmaceutical product is not yet on the market
CRF Logist.
Selection Data
Study Study Cap-
Protocol, Center Obser- ture Data
CRF & Training vation Com- Ana-
Design Doctors Recruiting Time plete lysis
Traditional
study 31
(weeks)
4 1 6 8 4 8
Difference:
8 weeks
Mobile
Internet =
study 23
(weeks)
4 0 6 8 4 1
Source: BMZ (CRO), Munich

Model for a service and supply chain
Doctor / Hospital / Pharma Company

(patient enrolment and management)
2nd line
technical support Medical Service Medical and 1st line technical support
Provider
(Helpdesk & Training)
Diagnosis
Doctor
Mobile System Order Solution Provider / Supplies Specifications
Hardware Deparment Patient
System Integrator Nurse
Integrator Order
Installation/Config.
System Integration Training, Registration
Mobile Network Rates

Operator Network Services

The HealthService24
Validation pilots
What we did & results

HS24 target groups
Day surgery
Mobile discharged patient solution Early discharged
Home hospital
Geriatrics
Homecare / Elderly care
Social programs
Mobile Chronic Disease Solution COPD, CHF, Diabetes
Pharma industry
Mobile Trial & Marketing solution
Wellness

HS24 validation pilots
• Follow-up / prevention program in frail chronic patients (cardio-

respiratory diseases)
• HS24 supports professional mobility (+ Patient self-monitoring)
25 patients were trialled
• Earlier discharge and follow-up of cardiac patients admitted for

an acute episode
• Follow-up of cardiac patients with suspicion of a condition not
fully diagnosed
• 20 patients were trialled
• Distant monitoring of pregnant women (detection of uterine

activity that could forecast delivery within 48 hours)
M edisch Spectrum Tw ente
• 18 patients were trialled

Evaluation
Technical In-lab
issues
Control environment
Controlled field tests
Patients uncontrolled
Clinical
Organisational
Real pilot Economic issues

End-user social evaluation
• High satisfaction
• Convenience of use, high acceptance
• Not disruptive with current work practices
• Easy to apply / extend to other areas
• Patients felt more reassured that they were given a higher level of
care. E.g. patient could pin point the time that he felt any symptoms
using the system, lead to the comprehension that the patient could
play a more vital role in his health care supervision
• Professionals satisfaction related to access to patient condition (from
anywhere, anytime, any location)

Clinical outcomes (I)
Self-management skills (%) Readmissions (%)

100 100
80 80
60 60
40 40
20 20
0 0
Control HS24 Control HS24
Introducing mobile health monitoring services had a positve clinical outcome.

Patients claimed to better understand their disease and thus improved their self-
management skills of their condition.
This led to less re-admissions in comparison to the control group.

Clinical outcomes (II)
Hospital admission (%) Emergency room (%)

30 30
20 20
10 10
0 0
Control HS24 Control HS24
The number of hospital admissions declined because the HS24 patients felt more
reassured about their condition. Also a lower rate in unexpected patient admissions
was obsereved.
The emergency room admisisons declined dramatically, which represent a big part
of the costs.
Health economics
• Reduction in unnecessary admissions, associated savings in scarce resources
• Higher rate of early discharge observed because patients using the system felt
more reassured that they were ok
• Reduction in the use of emergency room care
• Savings in total examination time by experts (by remotely assessing the

patient)
• Reduction in travelling costs for patient and relatives
• Less home visits by nurse
• Exact charging scheme for home care still under discussion
Up to 38% of direct costs could be saved by applying the HS24 concept

in comparison to conventional treatment

Concluding Remarks
Deployment plans of
HS24 consortium members
Barriers of entry
• Reluctance of the healthcare players to embrace new

technologies, work methods and business processes
• Healthcare is a highly regulated area and difficult to access
• Lack of health-political support
• Potential health hazards from wireless communication
technology
• Medical data security hurdles, ethical and legal requirements
• Technology is not enough – management of complex value
chains and processes is necessary

Factors of success – technology
is not enough
• Adequate market entry-strategy,
taking into account all value chain
players and providing respective
business models and benefits
• Integration of e- and m-health
• Complete system offer, providing

end-to-end services and solutions
• Straight-forward, easy to handle and

robust solutions
• Availability of good medical and

health-economic validation data and
proof of concept on customer site

Where are the HS24 consortium partners
heading now ?
• ERICSSON has a CE-certified product on the

market– Ericsson Mobile Health – available for
commercial rollout worldwide. Ericsson will
continue development of further functionalities
• YUCAT offers a MBU software platform that can

be used in different mobile measurements
settings
• Twente Medical Systems International offers

different models of the BAN-research system
and has developed a telemedicine device for
monitoring pace-maker patients

heading now ?
• University of Twente
– has created an eHealth laboratory for knowledge
valorization purposes
– Main target is to provide a mHealth services
platform for niche markets that does not compete
with full commercial services
– Proof the generic mHealth services platform in
hospital and research institutes
• Medisch Spectrum of Twente

– Study conditions that can predict labour and
develop algorithms that can be embedded
– Obtain a patent Medisch Spectrum ▲Twente
– Commercial development and deployment

heading now ?
• University of Cyprus / LITO Polyclinic
– Reorganization of current clinical practices related
to the cardiac patients’ service provision in order
to integrate the HS24 mobile solution into the clinic
processes as the regular equipment for home care
(main target until 2008). If successful, expansion
to other conditions likely.
• Hospital Clínic Provincial de Barcelona

– Integration of HS24 mobile monitoring solution as
the regular equipment for monitoring patients
within the institutional integrated care program
– HCPB plans to combine the mobile monitoring
service with an already existing patient
management system in the area of lunge
diseases, especially COPD

HealthService24 contacts
Overall Project Coordination Scientific Coordination
Jennie Weingartner, M.A, MBA Prof. Dr. Ing. Dimitri Konstantas

Ericsson GmbH Universities of Twente and Geneva
Fritz-Vomfelde-Str. 26 Rue du General-Dufour 24
D-40547 Düsseldorf, Germany CH-1211 Geneva 4, Switzerland
Tel: +49 211 534 2234 Tel: +41 22 379 76 59
Mail: jennie.weingartner@ericsson.com Mail: dimitri.konstantas@cui.unige.ch
Technical Coordination
Ing. Richard Bults

University of Twente
Application Protocol Systems Group Project Website:
Drienerlolaan 5
NL-7500 AE Enschede, The Netherlands www.healthservice24.com
Tel: +31 53 489 3743
Mail: bults@ctit.utwente.nl

HealthService24
Continuous Mobile Services for Healthcare
eTEN-C517352
THANK YOU

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HealthService24

Continous Mobile Services for Healthcare

Our vision, goals & time plan

HealthService24 aims at launching

© HS24 Consortium 3 Project Presentation HealthService24

• Test the feasibility of the deployment of the existing prototype on

• Demonstrate and validate the precise conditions to be fulfilled for

• Make the service applicable to many areas, ranging from patient

The project shall result in obtaining a fully marketable solution

© HS24 Consortium 4 Project Presentation HealthService24

Medisch Spectrum ▲Twente

© HS24 Consortium 5 Project Presentation HealthService24

HS24 project duration: February 2005 – September 2006

Project type: Market validation, eTEN

Project objectives: Validation of existing prototype

Focus of the pilots: COPD patients (Hospital Clínic, Barcelona)

Total project costs: 2.24 mil € (EC contribution: 1.2 mil €)

More info: www.healthservice24.com

The technology behind

• A user is equipped with sensors interconnected under a Body Area

• The collected data is constantly and wirelessly transmitted via UMTS

• Included content management functionality allows for immediate

• Healthcare professionals can remotely assess, diagnose and treat

© HS24 Consortium 8 Project Presentation HealthService24

© HS24 Consortium 9 Project Presentation HealthService24

Intra BAN1) Extra BAN

Sensors Mobile Base Unit (gateway + host) Computing infrastructure

1) BAN=Body Area Network

© HS24 Consortium 10 Project Presentation HealthService24

© HS24 Consortium 11 Project Presentation HealthService24

• Software for patient management,

• Selected episodes (e.g. previous

© HS24 Consortium 12 Project Presentation HealthService24

• ECG (4 channels, 24bits)

© HS24 Consortium 13 Project Presentation HealthService24

Show me the money!

We are getting older, Costs, budget deficits

New, stringent budget- Research for new

Patient Outdated and not-

m-health services are suitable to contribute to

© HS24 Consortium 15 Project Presentation HealthService24

Different resources come up with different market figures and prognosis

⇒ Personal healthcare, prevention, fitness and wellness is one of

⇒ Mobile Healthcare will be one of the most rapidly growing segments

© HS24 Consortium 16 Project Presentation HealthService24

Forecast for total e- and m-health market potentials in EU countries –

• Health industry 2010: 271 Billion Euros (figure for Germany)

• eHealth industry 2010: 5 % of health budgets will be invested

for Germany: 13.55 Billion Euros

• mHealth industry share: 10-15% of eHealth budgets

for Germany: 1.356 - 2.03 Billion Euros

Source: European Union

© HS24 Consortium 17 Project Presentation HealthService24

Hospitals: Home & mobile Care:

Mobile clinical trials (fast, high- M se

© HS24 Consortium 18 Project Presentation HealthService24

Cost Basis for

New claims 5 -10

Net Savings for 10 - 30

© HS24 Consortium 19 Project Presentation HealthService24

Stroke 1.500.000 45.000 15.000

Asthma 4.000.000 120.000 40.000

Hypertension 17.600.000 528.000 176.000

CAD 1.500.000 45.000 15.000