Continua Health Alliance: The Next Generation of Personal Telehealth is Here

1. Continua Health Alliance:The Next Generation of Personal Telehealth is Here A non-profit, open industry alliance of healthcare and technology companies joining together in collaboration to improve the quality of personal connected healthcare.

2. Continua Health Alliance “Our Mission is to establish an eco-system of interoperable personal health systems that empower people & organizations to better manage their health and wellness”

3. The Continuum of Care Elderly LivingIndependently Acute Recovery Amateur Athlete Diet/FitnessFocused WorriedWell Chronic Patient Infant CONTINUUM of LIFE Continua Health Alliance enables a personal health eco-system that empowers individuals & families to better manage their own health and wellness across the continuum of life and care methods. CONTINUUM of CARE GIVERS Fitness Wellness Coach Home Nursing Professional The Family Doctor/NP/Nurse New Parents

4. The Challenge & The Opportunity • Worldwide today: • 1 billion adults overweight • 860 million chronic disease patients • 600 million elders age 60 or older • 75-85% of healthcare spending is on chronic disease management Source: World Health Organization; McKinsey

5. US healthcare spend is projected to roughly double by 2017, ballooning to $4.3 trillion from $2.1 trillion (16% of GDP) spent in 2006 Challenged by increased demand, health systems are seeking sustainability and improved value (outcome/spend) Source: National Health Expenditure. CMS; Bureau of Economic Analysis 4 • US population is aging, driving demand for healthcare products and services • US Census Bureau estimates that 65+ population will grow to 86.7 million (20.7% of total) by 2050 • Growth in the elderly population will further exacerbate the unfunded Medicare liability • The demand for professional healthcare services is eclipsing the supply of professionals providing services • The Association of American Medical Colleges projects a nationwide physician shortage ranging from 124,000 to 159,300 by 2025 • The US Bureau of Labor Statistics predicts more than one million new and replacement nurses will be needed by 2016 • Chronic illness currently claims 75% of total healthcare expenditure and is expected to grow

6. Health care is converging around the patient in three global trends, with increasing connections to health, wellness, and value Low cost, high utility personal health tools, products and services that enable consumers to customize options for their own health needs that provides better value and easier access. Health System Evolution (Regulatory Reform) Revolution in Care Impact of New Science As health moves out of the clinical setting and into the context of people’s everyday lives, Continua play a unique role in connecting products/services and health. By providing new solutions to the consumer for health management, Continua member companies can engage with them to deliver new forms of value. Source: PwC analysis, Institute for the Future 2

7. Current health spending is not sustainable Two to three percentage points greater than economic growth Restructuring the delivery system is the only long-term viable option Organized, integrated networks of care are best suited to optimize quality and minimize costs Payment reform must precede adoption to realign the financial incentives of the providers Reimbursement Reform: Delivering Greater Value for Costs Incurred Alternative Forms of Payment Options Recalibrate FFS Payments Options focuses on creating a competition on value, with it being measured and reported at a level where value is created for the patient. Pay for Performance Bundled Payments for Episodes of Care Global Payments Source: Health Affairs. Payment Reform Options. January 27, 2009

8. Segmenting health Age 0 25 65 60-80% Lifestyle Irreversible Recoverable Wellness Illness Health Zone Unpredictable Health Predictable (Rules-based) Health Death 2008 2009 Continua Health Alliance Brigitte Piniewski, MD 8 8

9. Preventive Health Behavior Age 0 25 65 Irreversible Recoverable Wellness Illness Health Zone Unpredictable Health Predictable (Rules-based) Health Death 2008 2009 Continua Health Alliance Brigitte Piniewski, MD 9

10. 2015 Health Advantage/Group Age 0 25 65 NHS advantage Health Advantage $$$$$$ Irreversible Recoverable Wellness Illness Health Zone General Population trend Death 2008 2009 Continua Health Alliance Brigitte Piniewski, MD 10

11. Wave of poor health Not predicted nor prevented (and may not have peaked). Mismatch between our evolved biology and our modern life — the advantages of fat storage in the past have become disadvantages today. By Michael L. Power and Jay Schulkin. 392 pp., illustrated. Baltimore, Johns Hopkins University Press, 2009. 2009 Continua Health Alliance Brigitte Piniewski, MD 11

12. Health and WellnessOne billion adults overweight world wide • Benefits: • Monitor and motivate • Achieve individuals’ goals • Access personal fitness information anywhere • Enhance trainers’ services • “Worried well” vital sign monitoring: • Weight • Blood pressure • Glucose • Cholesterol • Activity level HealthyFamily Continua member companies help people live healthier, more active lives by connecting them to their health and wellness team through a more efficient exchange of their personal fitness information. Heart Strap Blood-pressure Cuff Digital Home Pedometer Weight Scale Cell Phone Fitness Equipment Weight loss and fitness coaching Personal Health Record Healthcare Professionals Internet MedicationTracking PC

13. Disease Management860 million chronic disease patients world wide • Benefits: • Provide better-coordinated care • Connect to care team • Empower individuals • Encourage early detection • Reduce costs • Vital sign monitoring: • (remote patient monitoring) • Diabetes • COPD • CHF • Hypertension • Chronic disease • Post trauma • Pre-op Continua member companies help people with chronic conditions live healthier lives by connecting them to their care team through a more efficient exchange of personal health information. Pulse Ox Thermometer Blood-pressure Cuff Digital Home Pedometer Cell Phone Weight Scale Internet Personal Health Record FamilyCare Givers Disease Management Service Healthcare Provider PC Fitness Equipment Personal Health System MedicationTracking Glucose Meter

14. Aging Independently600 million elderly individuals world wide • Benefits: • Involve family members • Allow remote analysis & care • Provide integrated view • Encourage early detection • Reduce costs • Basic life monitoring: • Bed pressure (sleep) • Bathroom sensor • Gas / water sensor • Emergency sensor • Independent living • Chronic disease Continua member companies help the elderly age independently, with dignity and security, through the efficient exchange of personal health and safety information that connects them to their family and care team. Pulse Ox Blood-pressure Cuff Digital Home Pedometer Cell Phone Home Automation & Control Internet Disease Management Service, Healthcare Provider FamilyCare Givers ElderlyMonitoringServices Diet andWellnessServices Fitness Equipment Personal Health System MedicationTracking

15. Guidelines  Certification  Recognizable Logo Electronic Media / Software Guidelines Continua member companies will select connectivity standards and publish Guidelines for strict interoperability. Certification and Logo Continua is establishing a test and certification program with a recognizable logo signifying the promise of interoperability with other certified products. Product Packaging Product Applications Product Substrates

16. Working Groups Over 1,900 members participating in the various Working Groups Marketing – Promote Continua (events, PR), provide marketing materials, and grow membership in targeted industry markets. Policy Strategy - Advance Continua's Mission globally by addressing policy barriers, promoting policies that drive adoption, educating Continua's membership on relevant policy, furthering Continua brand recognition with governments, and collaborating with external stakeholders on advocacy activities. Use Case- Identify and prioritize user experiences to be addressed by the Interoperability Guidelines. Technical– Decompose Use Cases into requirements and develop Interoperability Guidelines that specify industry standards and profiles. Wellness Solutions - Establish a clear value proposition for innovative health benefit plans that effectively manage the health, wellness, costs, and productivity of the workforce using personal telehealth technologies. Regulatory – Clarify and describe interoperable device functions in a regulatory environment. Test & Certification - Create and maintain the Test and Certification Program for Continua, including member test tools, plugfests, certified test labs, and certified product listings.

17. Board Of Directors Executive Director VTM Admin Use Case WG Technical WG Test & Certification WG Wellness Solutions WG Marketing WG Regulatory WG Policy Strategy WG Expert Group NHS, AAFP, ATA, AHA… Sub- Committees EU Policy WG Japan Policy WG Latin America Policy WG U.S. Policy WG Australia Policy WG PR & Marketing agency Working Group Structure – Internal Over 2,000 members participating in the various Working Groups Focused on guidelines and certification development Testing and Certification Lab

18. Board Of Directors Executive Director VTM Admin Use Case WG Technical WG Test & Certification WG Wellness Solutions WG Marketing WG Regulatory WG Policy Strategy WG Expert Group NHS, AAFP, ATA, AHA… Sub- Committees EU Policy WG Japan Policy WG Latin America Policy WG U.S. Policy WG Australia Policy WG PR & Marketing agency Working Group Structure - External Over 2,000 members participating in the various Working Groups Focused on external awareness and education Testing and Certification Lab

19. Interfaces & Standards Personal Device Thermometer Health Records Pulse Oximeter Aggregation Manager Telehealth Service Center Pulse /Blood Pressure Weight Scale Glucose Meter Cardio / Strength Independent Living Activity EHR Peak Flow Medication Adherence Health Record Network (HRN) Interface PHR Wide Area Network (WAN) Interface Personal Area Network (PAN) Interface Physical Activity Electrocardiogram Insulin Pump Version 2 (underway)

20. Ecosystem Development Developer Resources Certification • Test and certification tools • Right to use certified logo upon completion of successful certification • Web-based environment (repository, collaboration tools) • Reference source code Market Intelligence Collaboration • Access to market research data • Access to pre-publication drafts of the design guidelines • Internal and external education and training • Plugfests participation • Participation in RFP MatchMaker program • Unlimited participation in Continua quarterly summits, town hall meetings, and education seminars Monday, March 22, 2010

21. End-to-end demo – Vancouver Q2 2009 Device Interface XHR Interface Device Manager Sender Receiver Glucose Meter Pulse Oximeter WAN Based upon proposed protocols for Continua WAN PHR EHR Roche Accu-Chek 360 xHR IP network Web services Wi-fi or 3G Disease management platform LNI Android-based G1 Cell phone 20601 manager

22. Latest Continua Certified™ Products Manager (TBA) Nonin Pulse Oximeter Nonin Wireless Fingertip Pulse Oximeter Omron Blood Pressure Monitor Roche Accu-Chek® Smart Pix Device Reader Omron Pedometer A&D Medical Weight Scale Omron Body Composition Monitor Bluetooth™Stack for Windows® by Toshiba Texas Instruments MSP430 USB Agent Platform A&D Medical Blood Pressure Monitor A&D Blood Pressure Monitor w/ CPX186 Converter Cable A&D Weight Scale w/ CYPAK Converter Cable

23. Continua sponsored public symposiums and member summits Luxembourg April 2008 London January 2007 Tokyo April 2007 Spain March 2009 San Francisco June 2006, 2007, 2008 Ireland January 2008 Boston October 2006, 2007, 2008, 2009 Building Awareness Around the World… Vancouver June 2009 San Diego February 2010 Tokyo February 2009 2009: Tokyo, Barcelona, Vancouver B.C., Boston 2010: San Diego, Belfast, South Korea

24. Opportunities for PCMH It is clear that wide adoption of home healthcare monitoring poses many challenges. The full benefits rely on physician investments in interoperable health information technology (HIT) A 2008 New England Journal of Medicine survey, however, found that only 4 percent of physicians have an extensive, fully functioning electronic medical record (EMR) system in their offices, while another 13 percent use a basic EMR. Monitoring patients at home will result in large volumes of clinical data previously unavailable to physicians. Currently, however, there is little reason for them to analyze and act on this information. Doing so will require incentives, such as global payment models for longitudinal care and pay-for-performance programs.

25. Opportunities for PCMH Physicians will also require intelligent information systems that filter data, look for trends, provide actionable alerts and information to physicians or their proxies, and integrate this information into the EHR. While multiple forces are moving healthcare into the home, the Connected Medical Home cannot be fully realized unless the technologies are there to support it.

26. Thank You Thank you!

27. Promoter Members Open International

28. Contributor Members Over 232 Member Companies! • 7 Layers AG • 24eight, LLC • Advanced Digital Institute • Air Products • Alcatel Lucent • Alere • Alive Inc. • Allion Test Labs, Inc. • All Medicus Co., Ltd. • AmbiCom Holdings Inc. • American Heart Association • Analog Devices • Analogic Corporation • Andago Ingenieria s.l. • Aptar Pharma • Archinoetics, LLC • ASE Consulting Limited • AstraZeneca • AT4 Wireless • AT&T • Attrezzature Medico Sanitarie SRL • Authentidate Holding Corp. • AViTA • Awarepoint • Bayer • BiancaMed • Biocomfort Diagnostics GmbH • BIOSPACE Co., Ltd. • Bluegiga Technologies Oy • Boston Scientific • Broadcom Corporation • Brunel University • Burwood Group, Inc. • BXI Health Systems, LLC • Cambridge Consultants Ltd. • Canada Health Infoway • Cardiff University • CEA - LETI • Centre for Global eHealth Innovation • Cerner Corporation • Chiptech Limited • Christus Health • Chunghwa Telecom Co., Ltd. • ConnectBlue AB • Continuity Health • CSR plc • CYPAK AB • Dell • DELTA • Denso Corporation • Dossia Consortium • Duodecim Medical Publications • Dynastream Innovations Inc. • eflow Inc. • Elbrys Networks • Ember Corporation • Empirica GmbH • Epstein, Becker, & Green P.C. • ETRI • EuroTech, Inc. • FitLinxx • Flextronics Design SRL • France Telecom R&D, LLC • frog design, inc. • Frontline Test Equipment • Fujitsu Limited • GenerationOne, Inc. • GlaxoSmithKline • Google Inc. • H3System Co., Ltd. • Hill-Rom • Hitachi, Ltd. • Holst Centre (IMEC) • Home For Life Solutions • HoMedics • Honeywell HomMed LLC • Hosiden Corporation • Hospira, Inc. • HTC • I2BC – Insitute of Innovation for Human Wellbeing • iFoundry Systems Singapore Pte Ltd • iMetrikus • Industrial Technology Research Institute • Infineon Technologies • INFORSON Co., Ltd. • Innomed Medical Zrt. • Innovation Centre Scotland • Institute for Infocomm Research • Institute of Biomedical • Insung Information Co., Ltd. • InterComponentWare, Inc. • Intramed A/S • ISOFT • Kai Sensors, Inc. • KDDI R&D Labs • Korea Electronics Technology Institute • Korea Electrotechnology Research Institute • Laird Technologies • Lamprey Networks, Inc. • LG Electronics Inc.

29. Contributor Members Continued • TechnoGym • Telbios, SpA • Telecom Italia SpA • Telefonica S.A. • Telehealth Solutions Ltd. • TELUS Health Solutions • TesanSpA • Textronics Inc. • The European Centre for Connected Health • Toshiba Corporation • TSB • TTA • Tynetec Ltd • UnitedHealth Group • University of Applied Sciences Technikum Wien • University of Miami - Miller School of Medicine • Valentia Technologies • Verizon • VigNet Inc. • Vitaphone GmbH • Vocollect Healthcare Systems, Inc. • Vodafone Group Services Ltd. • VTT Technical Research Centre of Finland • Waldo Networks • Welch Allyn • Wind River • Wipro Technologies • Yellow Digital Health Lab • Zarlink Semiconductor • Ziehm Medical LLC • ZyXEL Communications, Inc. • Lifescan • LifeSync Corporation • LifeWatch AG • Logic • Marvell International Ltd. • McLaren Applied Technologies • MedApps, Inc. • Medgate AG • MedHelp International • MedixineOy • Microchip Technology • Microlife Corporation • MindTree Limited • MIR- Medical International Research • MTI Ltd. • MTS Medication Technologies • Murata Manufacturing Co., Ltd. • Mythos Co., Ltd. • NanoEnTek, Inc. • National Technical Systems • NEC Access Technica, Ltd • Nestle • Neusoft Medical Systems • Nippon Telegraph and Telephone Corporation • Nordic Semiconductor ASA • North End Technologies • Novo Nordisk • Numerex Corporation • Nuubo (Smart Solutions Tech) • ON Semiconductor • Oracle • Oregon Medical Labs • Oregon Scientific Inc. • Orthosensor, Inc. • PA Consulting Group • Pfizer • Polymap Wireless • Precor Fitness • Product Development Technologies (PDT) • Proskauer Rose LLP • Proximiti Communications, Inc. • Red Embedded Design • Renesas Technology America • ResMed Corp. • RF Technologies • RMD Networks • RTEmd • Ryoyo Electro Corporation • Sagemcom • Sanofi-Aventis • SHL Telemedicine • Sigma Designs • Silicon and Software Systems • Silicon Laboratories, Inc. • SINTEF • SK Telecom Americas • Sony Electronics Inc. • SterlingTech, Inc. • STMicroelectronics N.V. • Stollmann E+V GmbH • Stonestreet One, LLC • Sumitomo Electric Networks, Inc. • Sybase iAnywhere • T-Mobile USA • TaiDoc Technology Corporation • Taiyo Yuden Co., Ltd. • Tanita Corporation

30. Industry Liaisons