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“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

José María FernándezPhilips Home Healthcare Solutions

CSR/VNI domiciliaria y telemedicina. Incidencia, presente y futuro

Confidential Philips Home Healthcare Solutions


Overview

• CSR/VNI at home

• Encorepro Anywhere: starting point

• Challenges for the healthcare system

• Technology examples : Decentralized approaches

• Philips present & future in telemedicine

2



CSR/VNI at home

2



• CHF

• Home care

• Ventilation

2



Obstructive Sleep Apnea

Complex Breathing Pattern

Complex Sleep Apnea

Central Sleep Apnea

Cheyne Stokes Respiration

Periodic Breathing

Complicated Breathing Pattern

Mixed Sleep Apnea

SBAS Classification



Cheyne-Stokes-Respiration (CSR):

• Regulation of respiratory effort by the CO2 concentration in

the blood is affected.

• Reduced cardiac output and hypersensitivity of CO2

receptors.

• Flow limitations and obstructions can worsen the situation.

• Hypoventilation and Hyerventilation.



1. Hanly PJ, Zuberi-Khokhar NS., Am J Respir Crit Care Med 1996.

2. Lanfranchi PA, et al., Circulation 1999.



SDB and Cardiology

Two major groups

• Hypertension

• Chronic Heart Failure

- App. 2% of the population are related to Heart Failure

- Classification NYHA I -IV



Heart Failure

SDB

No-SDB

All Patients with Heart Failure



Types of SDB in HFAll Heart Failure

SDB

No-SDB

OSACSR

OSA+CSR



With 203 CHF-Patients71% had an AHI >10, 43% of all CHF-Patients had OSA,28% of the CHF-Patients had CSR.Schulz, Blau, Duchna, et al. Eur Respir J 2007; 29: 1–5

SDB in 70 % of 450 Patients with CHF (mean LVEF = 27.3 ± 15.6%)33% central sleep apnoea/CSR, 37% obstructive sleep apnoea, 30% normal. Sin, et. al, AM J Respir Crit Care Med. 1999

SDB and CHF

CHF Patients

Obstructive Apnoea

Central Apnoea / CSR

New!



• SPAIN population : > 45.000.000

• CHF = 2% population : 900.000

• SDB = 70% : 630.000

• CSR = 30 % : 190.000

Some calculations …



CSR!CSR!??



5 Min.5 Min.



10 Min.10 Min.



Successful Therapy withSuccessful Therapy withBiPAP autoSV.BiPAP autoSV.



Encore Pro 1.8i

Encore Pro 1.8i



Publications Automatic Servo-Ventilation (ASV)

Kasai et al. First Experience of Using New Adaptive Servo-Ventilation Device for Cheyne-Stokes Respiration With Central Sleep Apnea Among Japanese Patients With Congestive Heart Failure. Circ J 2006; 70: 1148–1154:

Conclusions „ASV markedly improved CSR-CSA in patients with CHF. In addition, the sleep quality improved significantly on ASV, including

– arousal index (62.0±10.5 to 18.7±6.2 /h, p=0.012),

– percentage of slow-wave sleep(2.6±2.6 to 19.4±4.8 %, p=0.042).“



Zhang XL, et al. Efficacy of adaptive pressure support servo-ventilation in patients with congestive heart failure and Cheyne-Stokes respiration. Zhonghua Yi Xue Za Zhi. 2006 Jun 20;86(23):1620-3.

14 Patients, controll group, compared with O2-Therapy and ASV• ASV always more effective than O2-Therapy• AHI • Arousals • LVEF • Six minute walk distance

„CONCLUSION: APSSV, more effective than oxygen therapy, is of great clinical significance in improvement of CHF and its prognosis by a better sleep and breathing.“

Publications Automatic Servo-Ventilation (ASV)



Reduction of AHI and mortality

CANPAP-Study:

• Support of CPAP pressure for HF was investigated.

• With HF patients CPAP could improve

– Nocturnal oxygen desaturation,

– Ejection fraction of the heart (LVEF),

– Physical capability (six minute walk).

• But: with 50% of the patients the AHI could not be reduced.

• Mortality over all was not improved (worsened in the beginning, better in the long term).

Bradley TD, et al. Continuous positive airway pressure for central sleep apnea and heart

failure. N Engl J Med. 2005;353:2025–2033.




Post-Hoc analysis of CANPAP-Study:• Mortality was improved, whenever CPAP therapy could

reduce AHI below 15/h.

Michael Arzt, et al. A Post Hoc Analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP) Circulation. 2007;115:3173-3180.

New!




Michael Arzt, et al. A Post Hoc Analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP) Circulation. 2007;115:3173-3180.

New!



ASV (BiPAP® autoSV™) lowers AHI more effectively than CPAP

Michael Arzt et al. Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men with Heart Failure. Chest 2007 Oct 20; Epub ahead of print.

New!



… Are treated at home

… and can save costs by avoiding entering into the health system

… can be followed up at home

… telemedicine can help

These patients …



Encorepro Anywhere: starting point

2



• Access to patient data for timely intervention

• Too little time, so many patients

• Communication and collaboration with “care team”

Solution: The EncoreAnywhere “My Day” page automatically identifies patient specific issues enabling fast and easy prioritization of patient intervention.

Data can be automatically downloaded on daily basis via a wired modem.

Challenges for Achieving Patient Compliance



• Access to patient data for timely intervention

• Too little time, so many patients

• Communication and collaboration with “care team”

• Reimbursement

Solution: Through EncoreAnywhere, the

entire care team has access to the same information and can communicate via notification messages.

Challenges for Achieving Patient Compliance



System Overview

StandardWeb

Browser

Internet

PhysicianSmart card

Wired Modem

Data Center

Homecare Provider

Sleep Lab



EncoreAnywhere Features

• The Best of Encore Pro features with a Different “Look and Feel”

– Patient record with demographics

– Compliance downloads via SmartCard

– Compliance reports

– Device, mask, and accessory prescriptions

• New features in EncoreAnywhere

– Compliance data downloads via wired modem

– Physician and Sleep Lab access and communication

– Management by exception



Access – Anytime, Anywhere



Your first stop - The “My Day” Page



Patient Record



Prescriptions

Send prescription via modem or smartcard.



Therapy Data



Contacts and Questionnaires



Notes



History



The “My Patients” Page



(press and hold for 2 sec)

M Series Wired Modem

• Fits into smartcard accessory slot

• No interference with patient phone use

• Toll free outbound connections

• Modem stores patient data and automatically downloads to Encore Anywhere

• Automatic prescription changes



Challenges for the healthcare system

2



Why ageing calls for healthcare reforms

50%of healthcare costs is spent on people of 65 years and older 40%

of people in EU will be 65+ by 2050

75%of healthcare costs is spent on chronic diseases

25%of the population would need to work in healthcare by 2040 to provide current levels of care

30%of doctors in former East Germany will retire by 2010, most without succession in place34%

Of German hospitals is loss making



Challenges for the healthcare system:

Major Trends

• Aging population

• Resistance to pathogens

• Patients as informed consumers

• Growing importance of quality of life

• Decentralization within the healthcare system

• Convergence of diagnosis and therapy

• Performance-based payment

3




Support from the Electrical Engineering Industry

• The electrical industry has a major influence on product design, productivity progress and growth in various sectors

• The electrical industry can provide extensive support with regard to improvements in the healthcare system

– Link hospitals, doctors, therapists and patients

– Wider use of sensor technology, remote monitoring

– Improved diagnostics (imaging and analysis)




Example - IT in the healthcare system

• Wider use of IT can help to significantly reduce costs while improving quality

• This can be achieved by

– Simplifying and reducing processes

– Increasing efficiency

– Avoiding duplicate examinations

5



Demographic development:

People Are Living Longer – Everywhere

0 10 20 30 40

EU

Japan

China

US

World 2030

2000

Proportion of the population aged over 65

Proportion in percent



Alter 10 20 30 40 50 60 70 80 90

Men

Source: PKV-Kopfschadenstatistik (Private health association per-head damage statistics) (2004); in-house calculation

Demographic development:

Health Costs Increase with Age

Age

Annual expenditures in thousands of Euros, Germany

Women

10

5

0



Chronic Diseases;

Cost Drivers in the German Healthcare System

• Cardiac insufficiency (CHF)– 800,000 diagnosed patients, second-highest mortality rate

– €2.4 billion in annual costs for the over-65s, 2/3 of which incurred by hospitals

– 40 percent of cases require re-hospitalization in 3 – 6 months, half of which are avoidable

• Diabetes– 5,700,000 diagnosed patients

– Estimated diabetes-associated direct costs: €15 billion per year

• Chronic respiratory illnesses (COPD)– 700,000 diagnosed patients in Germany

– 50 percent re-hospitalization rate within 6 months



Chronic Diseases:

Making it Easier to Live with a Chronic Diseases

• Develop decentralized solutions to increase quality of treatment and to reduce costs

• Avoid hospitalizations or re -hospitalization

10



Decentralized healthcare:

Decentralized Approaches Gain Acceptance

• Telecommunications and broadband applications are gaining ground when it comes to supporting old and chronically ill people. Costs and availability are no longer an obstacle.

• Telemedical solutions enable an increase in standard of life and a reduction in mortality rates:

– Patients know their current state of health and learn how to live with their disease

• Increasing acceptance of decentralized solutions:

– In the UK and Sweden around 10 percent of seniors use such solutions whereas in other countries this figure is less than three percent



Technology examples : Decentralized approaches

2



52


Decentralized Treatment. Example – Cardiac Insufficiency

Monitoring Center

Data transfer • Real-time information about state of health

• Analysis and feedback

Diagnosis and feedback to patient

DoctorPatient




Benefits of Telemonitoring Support

Telemonitoring model

Collecting health status dataCollecting health status data

DoctorDoctor

DoctorDoctor

DoctorDoctor

DoctorDoctor

Care Care ManagerManager

TimeTime

Sta

te o

f he

alt h

Care Care ManagerManager

Conventional model

DoctorDoctor

DoctorDoctor

DoctorDoctor

DoctorDoctor

Emergency Emergency doctordoctor

Emergency Emergency doctordoctor ClinicClinic

TimeTime

Sta

te o

f he

alt h

13




Continued Monitoring of Vital Body Signs




Stroke Rehabilitation at Home

Patient Therapist




New Diagnostic Options

Central laboratory Ward Hospital bed At home

Hours - days Immediately - in minutes

Decentralizing examinations

++++

Blood sugar/fat values

Heart failure/heart attack

Chronic kidney failure

Cancer - chemotherapy

Asthma

Sepsis

Osteoporosis

++++++

Now

In future +



Philips Home Health Hub

Analysis data

Behaviorinfo

Doctor’s diagnosis

Response


Home Treatment

• Easy to use – the patient can conduct tests on his/her own at any time (as with diabetes)

• Send analysis data to doctor for analysis

• Traffic light response to patient: go see the doctor, call the doctor, all is well



Philips present & future in telemedicine

2

Confidential Philips Home Healthcare Solutions 59


Philips Home Healthcare Solutions – Portfolio of Services

TeleCare TeleHealth / RPM

Social Alarms (PERS) Telemonitoring Patient Empowerment

Philips Telemonitoring Services (PTS)

EventMonitoring

Challenges of independent living for at-risk elderly and chronically ill people

• Loneliness, uncertainty and social isolation • Delayed responses to emergencies• Inability of self health management (medication compliance, lifestyle, self monitoring)• Inability to perform Activities of Daily Living (dressing, bathing, nutrition)



Philips Lifeline

• Lifeline improves well-being and feelings of safety for patients and their caregivers

• It is a trusted and affordable service, embedded in the communities it serves

• 90% of subscriptions are paid out of pocket—half of those subscriptions are paid by the children

• 96% of Lifeline calls are not related to emergency response, but related to reassurance and social support

• Lifeline subscribers are 10 times less likely to be institutionalized in a long-term care facility

• Lifeline subscribers had a 26% decrease in hospital admissions and a 23% decrease in length of stay.



How Philips Lifeline Works

1 Subscriber Summons HelpPersonal Help Button / Lifeline Home Unit

2 Professional Intervention

3 Caring Lifeline Response

4 Follow up byLifeline Professional



Personal Medication System MD2



Philips Telemonitoring System (PTS)



Philips interactive telemonitoring healthcare platform

• Providing an interactive care bridge between patients and their healthcare providers

– Better patient health

– Tailor-made care

– Patient satisfaction



Tools to enable Patient Self-management

Knowledge

Timely Reminders and

Goal Setting

Motivation

Inform Nurse with Daily Health

Surveys

Feedback on Goals



Portfolio of Raytel



Basic care delivery at home

67

Outlook and Conclusion

Imaging – early and accurate diagnosis

Clinical IT – correct information at the right time

Today TomorrowImage-based intervention and molecular diagnostics

Comprehensive healthcare provisioning,telemonitoring, decentralized diagnostics

Clinical decision-makingand support through increased use of IT



(the future) Philips Home Monitoring Platform

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Education

health care

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publications

general information

heart failure

achieving

philips respironics

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