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Emerald Group Publishing Limited
Copyright © 2009, Emerald Group Publishing Limited
An interview with David Whitlinger, Director
Article Type: Talking Heads From: Leadership in Health Services, Volume 22, Issue 2
An interview with David Whitlinger, Director, Healthcare Device Standards and Interoperability for the Intel Corporation in its Digital Health Group
Interview by: Alistair Craven
David Whitlinger is responsible for Intel’s healthcare device interoperability strategies and the standards development to support those strategies. He is currently leading a large, cross-industry consortium, the Continua Health Alliance, focused on the establishment of an ecosystem of interoperable, personal telehealth systems.
David has been with Intel since 1993 and prior to establishing the Healthcare Device Standards Group he worked on a wide variety of wireless standards. As a result, David and his team are leaders in many standards organizations throughout the World, including: Health Level Seven (HL7); Integrating the Healthcare Enterprise (IHE); IEEE 1073; Bluetooth SIG; WiMedia Alliance; Homeplug Alliance; UPnP Forum; Oasis; WSI; and, the Digital Living Network Alliance (DLNA).
He also served on the Bluetooth SIG Board of Directors for several years. David Whitlinger is the author of five research journal articles, four of which focused on breast cancer DNA analysis.
1 Can you give us an insight into your day-to-day role?
As President and Board Chair of Continua I am responsible for running the organization. Continua Health Alliance now has 170 member companies worldwide and well over 1,500 individual people that are participating in various working groups. I involve myself in the day-to-day efforts of keeping all the working groups on track, the marketing programmes, the technical work, regulatory work, policy work and also a variety of contract resources that contribute to the output of the organization. That’s all the mechanics of running a business.
3 Generally speaking, what would you cite as the main lifestyle, health, and demographic trends contributing to the skyrocketing costs of healthcare in the USA?
There are two. One of them makes it to the newspapers quite frequently at this point. It is best characterized as the diseases associated with obesity, but more and more of the papers are starting to refer to it as “lifestyle disease” or “lifestyle attributed disease”. What that means is poor diet and a sedentary lifestyle is leading to health risk factors such as obesity, diabetes, congestive heart failure and other chronic diseases. Compounding that, of course, is our aging demographic.
5 Continua is an impressive example of cross-industry collaboration, with over 113 corporate partners involved. How difficult is it to manage relationships and such potentially varied pools of opinion?
That’s a great question! It is very interesting, and it has been a very interesting journey over the last three years for that exact reason. As you can see, there is a wide variety of different companies involved, and if I could characterize one of the more significant ways of compartmentalizing, there’s a large number of consumer electronics companies, or companies that are more used to working and operating in a consumer electronic marketplace. Then there’s the health industry. The melding of those two is what has made Continua so unique in addressing consumer or personal telehealth, but that melding has also created interesting conversations about how we work together, because one side comes from a space of high regulation, safety, efficacy and “it’s only proven when it’s clinically proven”. The other side comes from a rapid prototyping, quick design, consumer driven, focus group driven environment. The learning that has crossed between those two different market spheres and sets of organizations has really been fascinating and unique, and what has enabled Continua to be so successful.
7 What is Continua’s vision of a “personal health eco-system?”
One of the principal elements is about patient centricity. An individual is empowered – through devices and services that our member companies can provide – to take charge of his or her own healthcare. We break it down into three large categories.
The first is health and wellness, and in that context somebody has the authority to monitor their daily living through pedometers and cardio vascular equipment, and all of that data connects into Internet services via their PCs and cellphones. They can measure and monitor things that would be contributing to obesity and pre-chronic conditions.
The second is chronic disease management. This is – unfortunately – all about monitoring and managing somebody who already has a chronic disease. Again, we are interested in providing people with devices such as blood pressure tools and glucose meters and weight scales so they can monitor their disease in the comfort of their own home, or if they are a diabetic, perhaps they are doing it on the move. The data flows into internet services for monitoring purposes and the provision of clinical intervention if necessary.
The last category is aging independently, and that’s all about our aging demographic and helping family members and elders age more gracefully in their own homes, and again providing services to help manage that.
9 You recently said “it’s time to stop working on research projects and get the industry moving forward”. Does this suggest you are frustrated with the speed of progress so far?
Well, yes, but it’s a healthy frustration! I think that industries go through evolutions, and the first iteration of course is that everything is concerned with research. Nobody knows they are glueing together devices with bubblegum and bailing wire and putting together ad-hoc Internet services and so forth. That is really where this whole chronic disease management, remote patient monitoring and personal telehealth industry started. That was over ten years ago. Now we are moving to the next evolution where major brand companies and large consumer electronic companies are getting involved, and it is stepping into the mainstream, so to speak. There have now been hundreds of trials over the last five years to prove whether or not remote patient monitoring is effective across the world. Now it is proven as a more cost-effective way of delivering care to patients, it is beyond the time to trial and pilot. To steal the phrase from Nike, it’s time to just do it. That is where many now see the industry. Continua is an example of that. You can imagine as an industry grows up, standards and interoperability become much more important as companies start to partner more.
11 The alliance is working to provide individuals with tools to proactively manage their health, and thereby calling for a paradigm shift in the way people view the healthcare system. Assuming that is a fair assessment, can you shed some light on exactly how big a challenge this is?
That’s absolutely correct. It is a paradigm shift, and if you believe many public health officials and those at Harvard who do public health analysis, to quote Dr. Joseph Kvedar from Harvard, “we’ve already lost the war”. He is referring to the fact that the large, mainframe doctor office, hospital bed healthcare system will not be able to keep up with the demand for healthcare services in the current delivery mechanism. We will not be able to graduate enough doctors and we will not have enough nurses to deal with the demand that will arrive in the coming decades. The healthcare system therefore has to change in order to be able to scale, and scalability brings healthcare home. People will need to be more conscientious about their own health, take more responsibility for their own health and use the existing healthcare system in a much more infrequent, concerted way. That healthcare system will also need to evolve in order to be able to be much more efficient in the delivery of care through the Internet so the resources of doctors and nurses can be more effectively used.
13 You mentioned the term “interoperability”. Can you explain how important that is in your field?
From a healthcare perspective and from a consumer perspective, we need to know that when we purchase something it is going to be part of a larger system, even if some of those players or companies don’t succeed or survive in the marketplace. It’s much easier for a healthcare provider to take a bet and purchase devices that are interoperable and are going to be able to be used with other systems in the event that one of those companies does not survive. To give you a specific example, there are dozens of companies today that produce remote patient monitoring systems. Many of these are small companies that you would never have heard of unless you were working in the industry. For the NHS in the UK or a large healthcare provider in the US, to take a bet on that small company’s hardware and software and services is a tough proposition. If you don’t know whether the company will survive, you don’t know whether your hardware purchase of several hundred thousand or even millions of dollars is going to be a good or bad investment. If the pieces and parts of that system are interoperable, and the ecosystem was built from multiple partnerships so that the risk was spread, the rest of the investment would still be useful – that’s a much safer proposition for a large healthcare provider with scant resources. It also demonstrates to them that the ecosystem and the marketplace has truly arrived, that it’s a robust marketplace and not just a bunch of five guys in a garage with a dog and a tambourine who have put together a system!
15 Indeed! What sort of challenges do you face in encouraging your audience to adopt new technologies?
There are a couple of levels of adoption. Speaking of physicians, there’s a lot of concern there. Many physicians will look at these kinds of systems and wish they had them to get better data when caring for patients instead of the small glimpses acquired when they are visited by a patient. However, on the other side some will say that they don’t know how to get paid for all of that or reimbursed for the time they would spend looking after their patients in a more concerted way. That is an adoption factor that really needs to be addressed and another shift in the paradigm of our healthcare delivery system. Large governments that take care of national healthcare are going to have to get involved in order to help create some of the solutions.
17 In reference to a consumer-driven healthcare system you have said that through technology “we could tighten the feedback loop to contribute to lasting behavioural change.” Can you explain what you mean?
The general thought process here is that to a large degree, those below the age of 45 or so have hidden risk factors building up in their bodies. You don’t know that because there’s no external measure unless you actually go and get a blood test. For example, your glucose level or your cholesterol level throughout the course of 40 years could build up into a cardio-vascular condition or diabetes, but you don’t know that as neither one of those indicators is externally visible. In order to create a bio-feedback loop, if somebody was to get a blood draw and get their cholesterol and glucose numbers on a more regular basis, firstly they may be shocked into changing their diet and lifestyle if their results are high. Secondly, if you can provide that information to them frequently so that when they do change their diet and exercise regime they would see a positive effect on these “invisible indicators”, they can witness improvements until after a year of two of bio-feedback they have reached a lasting lifestyle change.
19 In a recent interview you highlighted initial cost of adoption as a reason why governments may be slow to act in this area. How difficult is it to convince them of long term benefits?
It has to do with who pays and who receives benefit from the payment. The quick way to describe that is quite frequently, those that are in a position of providing remote patient monitoring and spending the money to buy the hardware and deploy the systems and monitor the patients are not necessarily the same organization inside a government or healthcare enterprise that would receive the benefit of lower hospital admissions and lower cost of emergency conditions. So, because of the fact that he who pays for the system may not necessarily be he who financially receives benefit in an overall healthcare system, it is very difficult at times to convince a health organization to take on these kinds of systems. It’s that split in the healthcare system that creates the difficulty. You have to get everybody together and have those who receive the benefits essentially take a leap of faith with those who are going to have to outlay the financial resources to deploy the system.
21 We touched on the fact that methods of managing health will need to shift from traditional institutional settings to peoples’ everyday environments. Can you provide some more examples of what you intend to achieve in this area?
Some of the leading usage examples for chronic disease would be a diabetic using a glucose meter with a cellphone in order to upload their glucose readings. Charts and graphs can be made from the data and a much better view of lifestyle can be gained. Add a pedometer to that and now you have some activity monitoring. You can get a much better view into how many calories an individual is burning and how the insulin is behaving. Jumping over to health and fitness, everything from large employers in the US to a national programme in Japan and programmes in Europe are looking at monitoring activity level, monitoring weight, and trying to start to get a handle on obesity. We can combine that with, as we described, a health risk assessment to look at the invisible indicators on a regular basis such, perhaps quarterly or even every six weeks for those really at risk.
For those that are unfortunately homebound, we are talking about having a home-based monitoring system with a weight scale, a blood pressure machine and perhaps a glucose meter and a pulse meter in order to help manage cardio vascular patients. It’s about monitoring those people not only post-hospitalization, but also – if they are congestive heart failure patients – being able to monitor their fluid retention, adjust their treatment and call them in before they have an emergency condition.
23 A slightly crystal ball question for you now, but where do you see Continua in, say, five years’ time?
Well, we are looking at shipping products next year. We already have five products knocking on the door to be certified. By the end of next year we are looking forward to having 30 or 40 products in the market that are certified and have internet services to support them. We have already started with our “Version 2” guidelines and use cases, and our technical group has started to break those down. There’s a big appetite to take what we have already done and build upon it. Seeing that momentum and excitement, five years from now I would definitely see the Continua brand and logo as being almost consumer aware. That might not be advertisements at the Superbowl level, but certainly along the lines of people knowing that when they buy a cellphone with a Continua logo on it that it will work with their pedometer or weight scale or glucose meter.