Continua Health Alliance Executive Director Talks Low-Power Wireless and What’s Next in Connected Health

As executive director of the Continua Health Alliance, Chuck Parker is tasked with helping the nonprofit industry organization achieve its goal of end-to-end plug-and-play connectivity for personal health devices. MED caught up with him to get his thoughts on everything from what progress Continua is making in accomplishing that mission to what wireless technologies are coming to the fore in medical.

Parker

MED: What have been Continua Health Alliance’s most significant accomplishments in 2012?

Parker: This year I think the most significant accomplishment has been getting recognition of countries. The nation of Denmark actually rolled out a formal announcement that they will be requiring the use of Continua and the Continua framework for implementations in the personal connected health space. When they connect devices in the field and remotely, they’ll be using the Continua framework. I think now we’re getting to the point where we have government adoption. We’ve had some of that as well in Japan, and there are other countries that are now looking toward that. I think we’re now getting to the point where we’re seeing the implementations starting to take effect and take hold with governments using it as a requirement.

I think that we now are seeing a significant number of new devices. We now have inside the Continua framework device and architecture services in every category. From an end-to-end perspective, you can put together a set of services in any sort of specification Continua now covers. We now have devices and services in every component architecture.

MED: What are the biggest challenges you face in terms of achieving your goal of interoperable personal connected health solutions?

Parker: I think the long-term aspect of it is keeping people interested in using standards. I think that the market always continues to change around you. When we started, six years ago, we didn’t have the use of cell phones at the level that we do today. With the advent of smartphone technology, focusing on how do we move the architecture and ensure that it has the flexibility to encompass these new devices and new types of communication architectures as they move forward? Making sure that we remain flexible with the architecture and making sure we can incorporate new technologies as they come onto the market space.

MED: There’s a lot of interest in low-power wireless technologies [8] right now. Is any one emerging as the favorite among medical device developers?

Parker: Our research has shown and all the information is indicating that Bluetooth low energy [9] is the predominant one that is coming out to the market space now. The reason for it is that most people had great success with Bluetooth in the past. Using the Bluetooth low energy [10] components adds a new level of functionality that enhances their power-saving capability. That’s one in the market that we’re seeing right now as probably leading the way.

With that said, I think that there’s some architectural components within Zigbee that also allow us to use some of its low-power capabilities, as well, in fixed locations. We’ve looked at both of those technologies and incorporated them into the architecture of Continua.

I think that [the fact that Bluetooth low energy [11] is deploying in most new smartphones today] is one of the main reasons why we see it taking off. When you have in the neighborhood of billions of devices that can connect to it already, that becomes a major market mover.

Beyond Bluetooth low energy, we also, like I just mentioned, are using Zigbee. Zigbee is another protocol that is used typically in a fixed location, like if you were going to wire a house or let’s say a long-term care facility so that you could monitor the individuals within that facility. Zigbee offers us some capabilities in meshing networks that allows us to follow an individual through a home or through a relatively large-square-foot setting. Bluetooth simply can’t accomplish that. It’s got a 33-foot limit, whereas with Zigbee, with its meshing points, we can basically monitor the entire facility, whether it’s on a single floor or multiple floors.

MED: FCC recently set allotted spectrum for medical body area networks (MBANs). Some people cheered that decision, while others criticized it as unnecessary. What are your thoughts on that debate?

Parker: I think that it will do the industry good in the long-term to have a dedicated band. I think it’s going to be a while before we see the standards applied to that, so you’re going to see proprietary solutions for a while in that spectrum. So from our perspective, it’s not going to be something that we can incorporate relatively quickly because we base all of our solutions, all of the guidelines, on standards in the industry. It will take a little while before we can actually get to that point of creating an international standard or at least a U.S.-based standard around that network.

We don’t see it taking off other than in the proprietary networks and use in those areas where you have companies that can develop and will develop in that very specific spectrum. Predominantly, it’s seen as an in-hospital solution. We don’t really see it moving rapidly to the personal connected space, meaning into the home or into the workspace, just simply because we just don’t see a spectrum need. There’s not a spectrum issue. Inside the facility, inside the hospital, yes, there is. It’s quite a bit of noise that’s generated now by all those mobile technologies that are being initiated within healthcare facilities, so I see that it is something that is a little bit more necessary inside the acute care facility, and that’s not a space where Continua really focuses its standardization efforts.

I think that you have spectrum like Bluetooth low energy, we can certainly use Zigbee as well as Wifi in the home already, and we’re just not seeing that there’s a critical issue with those spectrums inside the home because typically your home is not crammed with a lot of electrical gear that causes that type of interference.

Secondarily, the level of criticality is also not as high as you would see inside the acute care space. You don’t have the level of acuity that you have that you do inside of the hospital, [where there is a] need to have a guaranteed connection all the time.

MED: Some are worried about the lack of rules for interoperability in the spectrum allotted for MBANs [12]. Is Continua doing anything to help fix that?

Parker: We, as Continua, are not directly yet. We would have to be working with another standards body that would actually pick up the radio frequency spectrum and then do something with it. It’s a few years off before Continua would be looking at incorporating it. It could be as soon as three, more likely in the five-year time horizon. Because a standards body needs to take it up and create a standard for the use of that spectrum.

It’s like the early days of Wifi, when you had two or three different connection mechanisms that didn’t get standardized for a while in the 802.11 space. It took a little while before you could create standards because it takes companies a while for companies to get together to create the IEEE specification behind how that device is going to connect and initiate connections and what type of communication model you’re going to use in that spectrum, as well. Until we can get that created, there is really no way to start to adopt and then begin to implement a standardized way to approach that.

MED: The IEEE 802.15.6 standard was approved and published this past March. Are you looking at that?

Parker: Yes, we will be. It will certainly be something we’ll be taking a look at. The second factor about this whole thing is that we don’t see here again that whole critical nature of using an MBAN in the home. We think that the equipment is might be a little bit more costly in the short term, and therefore because of the noncritical nature, you can use existing spectrum technologies today that have a much broader appeal and a much broader distribution already.

MED: What products or companies do you see as doing it right with regard to interoperability in medical?

Parker: In our space, I think that we’re starting to see some of the telcos come to the market space now on an international basis with this sort of an aspect. There’re starting to look at how do we institute standards-based approaches. Orange Telecom, out of France, is leading the way; so is NTT, with several of their projects that are taking place inside of Japan. Here in the U.S. you’re seeing companies like Qualcomm who are instituting device architectures based on standards, as well. Those are some of the companies that I can point to today that have physical product in the market space already.

MED: This year Continua began publicly releasing its guidelines for free. What has been the result?

Parker: From our perspective, it wasn’t really a revenue generator, but I think it really helps open up the market space. It helps new organizations who are developing and also for the small developer and student developer for universities who are developing and are working in a particular type of a challenge. That allows them to start to incorporate and use these sort of standards-based approaches and with those standards-based approaches come lot of all of activities which are in essence done for them. It’s what makes it much easier to package and create solutions in the market space. We’re seeing more use of the capabilities of what Continua references in its architecture now beginning to be developed and implemented in technologies. So it has broadened the approach to the marketplace.

MED: How should medical electronics designers be interacting with Continua Health Alliance?

Parker: I think that obviously we make the guidelines available for any organization to download for free. I’d certainly do that as an opportunity. We certainly encourage new members to join as members. There are many things that we can provide to them that are opportunities for them not only in the sense of tools such as reference code that’s already been developed as well as free and downloadable testing tools for members but also it’s a strong networking opportunity as well. It’s a way for developers to get linked to major companies relatively easy as well as find other developers who are in that area to help potentially to solve problems that they may have as well. The alliance itself provides a great opportunity for them to participate and learn about the industry as well as get to know other individuals and other companies within that space.

MED: As consumer and medical products continue to converge, what will be Continua's role?

Parker: I think that anything we take a look at outside of the four walls of the acute care space is something that we’re going to monitor and continue to incorporate in new technologies. The architecture is flexible enough to continue to include new device types. Some of the things that we’re now looking at are infusion pumps that are going home, things such as respiration monitoring that’s going home, as well, from the hospital and acute care setting. So these devices that typically have existed only in acute care settings now are coming into the home, and any time that those do leave we’re going to start look at how we can incorporate those into the Continua architecture.

I think that’s one of the things that we’re going to continue to improve upon. We currently define 12 device classes today inside the Continua architecture, and we probably have five to seven more that are coming within the next two years. These are new architecture types like sleep monitoring, sleep measurement, ECG-type of equipment, continuous glucose monitoring—these are new things that are coming to the market space.

From my perspective, I think that Continua represents and provides some solutions in the market space that now create new and unique opportunities for really rapidly deploying measurement sets. What that leads to are things like mobile clinics. Now I could rapidly create a mobile clinic and monitor an individual or a set of individuals or a whole population as needed with these types of tools, and it allows us to crate some emergency solutions that you wouldn’t have been able to in the past on the fly.

I think with the advent of the cell phone now and what we see in the near future will be the move to perhaps enable the device itself with, for example, a GSM chip, so that you can now just directly connect into the cell cloud. We’re starting to see that as a new type of architecture, so the device itself is enabled inside with a cellular network.

Longer term, what we’re going to see is more and more technologies move into a platform that allows for sort of a plug-and-play capability. The FDA is now driving toward that with something called the medical device interoperability initiatives. These are some strong things that we’re looking for in the market space.

—Jamie Hartford [13] is the managing editor of MED. Follow her on Twitter @readMED [14].

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