Wednesday, April 7, 2010

Telemonitoring for the Home

As Accountable Care Organizations and medical homes start thinking about alternative quality contracts that reimburse for keeping patients healthly and not for delivering more care, it's likely that wellness care will include home telemonitoring between clinician visits.

Devices will include electronic scales for measuring fluid retention in CHF patients, blood pressure measurement for refractory hypertension, glucometers for diabetics, and home spirometry for patients with COPD or asthma.

I recently tested a home monitoring product that illustrates the future of consumer healthcare devices, emerging approaches to interoperability, and the need for consistent transport standards.

The Withings Internet Connected Body Scale incorporates several mainstream technologies to achieve a highly functional result. Here's how it works:

After taking the scale out of the box, you connect it to your USB port (only used during setup) and launch the scale configuration website. You specify the wireless access point and security settings to use and link the scale to a web-based account. You set up users in your account and provide basic height/age/preferred method for body mass index calculation. Technologies used - WiFi with WEP or WPA security, HTTPS, and USB.

Once the scale is associated with your account, using it is simple. When you stand on the scale, it wirelessly uses a RESTful protocol to compare your weight with the list of known scale users on your account, probabilistically choosing the right user by matching weights. It retrieves demographic information, calculates body mass index, and % body fat, then sends the data to the user account.

Once posted, there are multiple data options - graphing over time, PDF of measured weights, automated posting to Google Health, automated posting to Microsoft Healthvault, and even posting in realtime to Twitter (I'm not sure who would want to do this). Technologies used include PDF rendering, calling the Google API, and calling the Microsoft Health API.

I had my Withings scale updating my Google Health account (shown above) in real time via WiFi in about 5 minutes after opening the box. No programming or technical knowledge was required. This illustrates the power of standardized APIs.

Here's the technical detail of how the scale's API works.

A few observations on interoperability.

Although Withings did something remarkable by incorporating WiFi, WEP, WPA, HTTPS, REST, Google Health, Microsoft Health, and PDF in one product, it does require that the device posts to the Withings website and that this website manages interoperability with other website APIs.

Per the discussion by the NHIN Direct Implementation Group, imagine a world in which all vendors have agreed on a consistent RESTful or SMTP-based transport protocol using a well defined addressing mechanism, such as described in my Health URL blog. Imagine that the payload adhered to a consistent, vocabulary controlled format such as the work being done by the Continua Alliance. The scale could directly interact with Google, Microsoft or other vendor sites. The only scale configuration needed is to specify the Health URL of each user.

As Beacon Communities focus on advanced interoperability that engages patients and families for disease management, I'm confident that devices such as the Withings scale will be widely deployed in homes.

Over the next few years, I'm hopeful that devices will evolve from interoperability that works by embracing multiple proprietary APIs to a single simple interop that begins with common transport and addressing standards and progresses to demand for rapid adoption of common content standards.

Kudos to the Withings engineering team for great steps on the journey to bring interoperability to the home.


Medical Quack said...

Great review on the Withings Scale. There's one other scale that Blue Cross is now promoting too called Ideal, but I don't have the entire details on their program and exactly where and to who the information goes. Google Health and HealthVault are still my choices for me as a patient.

Also, the Withings Scale connects to RazCode, the encrypted version of Microsoft Tags and I connected my HealthVault account up with a sample code in my post. When you read down you can see RazCode with the Withings scale being supported on the sample image.

I really like the use of Tags too, so simple and have suggested the system to the FDA and medical device companies to tag stents, knees, etc. before it is used. With the way we update phones, there's an endless supply, just connect old ones on WiFi w/o a cell carrier if all you want to do is scan.

Also in time with the Tags, scan that information into your PHR, free program and cell phone, iPhone, Blackberry is all that is needed. All of this technology seems to be working together in some form or another.

I agree on Twitter, not my place of choice to post my weight too:)

Tim Patton said...

This is a nice example of automation done right. Beyond simply automating the data transmission process, the inclusion of the ability to “probabilistically choos[e] the right user by matching weights” is a particularly critical innovation that will foster increased integration of health technology into the home environment.

Using statistical algorithms at this level is only the beginning. Beyond saving effort in collecting data, other statistical process controls could also be used to aid in the interpretation of the already collected data, alerting users and clinicians alike when changes warrant a closer look. Using the example of the Withings Scale, a system might provide an alert only if your weight changes outside of what is determined to be your normal range.

Increasingly, patients, working in tandem with clinicians, have to be more engaged in managing their own health. Designing technology that does not increase the burden on already busy people is key to widespread adoption.

Ted Blizzard said...

Do you know of any automation with Google Health and Blood Pressure monitoring?
Thank you