A global health alliance: an interview with David Whitlinger
Interview by: Alistair Craven
David Whitlinger serves as the director of Healthcare Device Standards and Interoperability for the Intel Corporation in its Digital Health Group.
Mr. 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.
Mr. Whitlinger 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, Mr. Whitlinger 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. Mr. Whitlinger is the author of five research journal articles, four of which focused on breast cancer DNA analysis.
AC: 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.
AC: 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.
AC: 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 gluing 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.
AC: 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.
“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.”
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!
AC: 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.
AC: 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.
AC: 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.
This is a shortened version of an interview with David Whitlinger. The full version will be available in a forthcoming issue of Leadership in Health Services.
A global health alliance: an interview with David Whitlinger