In September 2013 I went for a truly inspirational bike trip across 5 countries, covering over 2100 km from Brussels to Barcelona. Many of my fellow cyclists were Type 1 diabetics and the trip was organized to give insight into how issues of interoperability can be resolved.
‘Why’ a bike trip?
The fundamental problem facing people with diabetes (PWD) is keeping their Blood Glucose (BG) levels within a normal range. To do this PWD use devices to monitor their BG levels. These devices provide a reading that is then used to make therapeutic decisions such as taking insulin or treating a low reading by eating. Diabetes is a data driven disease, PWD need to log, track, interpret and share the data with their healthcare professionals (HCP) and others who can help them turn the data into information. Today, there is no single platform that patients, carers and HCP can use to capture, track and share information to help PWD, indeed there is no current standard for interoperability between the various device manufacturers and platform operators.
People with diabetes like Paul Buchanan of Team Blood Glucose make a compelling case for the need for integration, underlining the issues with the lack of interoperability. Their diabetes management includes; BG monitoring, insulin use, food eaten, exercise, mood, stress, and other daily factors that affect BG control. The hurdle is this transformation of information between the PWD’s monitoring device and the physician’s system including the the accessories used to transmit the data. A bunch of wires, transformers, and tech gadgets truly limit a PWD’s ability to live a productive life.
By examining cyclists with diabetes whose hands were consistently on the handlebars with no opportunity to stop in order to manually enter data, we were able to test our solutions and understand the hurdles interoperability challenges bring.
A world first…
We united GSMA, Orange, ANT+, Dexcom, HMM, McCann Health, and Sony Mobile to develop wireless online monitoring of Continuous Blood Glucose levels, heart rate, weight and cycling statistics.
The ability to see and remotely track blood glucose levels via the web was a world first. Additionally the riders’ weight was tracked using a scale that sent the data wirelessly to the Orange Health Cloud via a smartphone. All the data stored on the Orange cloud was accessible via the web with an easy-to-read dashboard, which could also be viewed by friends and family. The portal also included the ability to geo-locate the rider to see where they were on the tour.
The solution was built in a matter of weeks using sensors that sent data to a Smartphone and an M2M module that the riders carried with them. For the mobile devices, software was developed using the Continua interoperability guidelines. The collection of data required no specific input from the riders, a design requirement that Bastian Hauck wrote about in his insightful post on MedTech Views.
A cyclists’ insight…
I was riding with Type 1 diabetic rider one day. Approximately 100km into the day’s ride, the alarm on the continuous glucose monitor alerted her that her levels were dropping. She decided to stop for the day. She later told me: “without this I would have probably have kept riding until I had a hypo” (note: hypoglycaemia, or low blood sugar).
The impact of having real-time monitoring was brought home to me the following day when we came across another rider who had stopped by the road side. We inquired whether everything was well, he explained that the continuous glucose sensor had stopped working and so he now had to stop every 30 minutes and take a traditional glucose reading, adding a significant burden to his day and reducing the joy of the ride.
When speaking about this later I asked if it affected his impression of the solution. He told me that it did not, as the benefits it provided far outweighed the odd error (in his case the sensor had loosened). The fact that it stopped was not a problem for him, even though it meant he had to check his levels manually, which proved to be a chore.
We had some manual data entry for nutrition during the tour but it was quiet apparent that riders did not want to have to do this, full stop, the request was made clear “get rid of manual entry and make all my data available on the phone and the web.”
As for the technicalities…
The use of standards enabled the seamless connection of devices and the data that was generated directly to the cloud. It is important to point out that at this early stage it is not an all-or-nothing scenario; it is entirely possible to use non-Continua and Continua sensors alongside each other and to have the data standardised in the mobile device. This means data can be shared across platforms in a semantic and syntactical format for many device types, which is critical to enable the scalability of mHealth solutions and to answer patient concerns such as those expressed by the riders above.
Orange benefited greatly from the reduced development time, delivered in weeks rather than months. Thanks to the use of standardised interfaces and data formats. Users are demanding simplicity and data interoperability in order to manage their conditions. The means to do it are available and the benefits of doing so were amply demonstrated during the Tour, even with the limited number of sensors we used.
Still more to go
Unfortunately, in the case of insulin pumps the story is not an ideal one. With standards not ready for the various medical devices, the same principles cannot yet be applied. Earlier this year, T1D patient Anna McCollister-Slipp voiced concerns as an engaged patient, “right now all of my medical devices use different data formats, different data standards [and] they don’t communicate.” However, this paradigm is changing with the availability of standards based interfaces and data formats as defined by Continua.
The next step is adoption by more healthcare systems (Denmark and Norway have already decided to use Continua) and the addition of more device types so that we create an interoperable ecosystem of personal connected health devices, in a similar fashion to how mobile phones are today, allowing people to choose the solution that is right for them without being restricted to a single vendor solution.
– Ian Hay, Orange Healthcare, Head of Emerging Ecosystems