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WIRELESS HEALTH:
STATE OF THE INDUSTRY
2009 Year End Report
December 16, 2009
TABLE OF CONTENTS



Publisher’s Note and Editor’s Letter                    1


Industry Metrics: Wireless Health by the Numbers        2


Carriers Take the Lead on Wireless Health               7


Care Providers Push Pilots, Look for Results           11


Alliances and Institutes Accelerate Time to Market     14


Reimbursement Rises and Falls                          18


Consumer Health: The Answer to “Who Pays?”             20


2009 Wireless Health Venture Capital                   23


2009 Wireless Health Deals                             25


A Step-By-Step How-to for Wireless Health Regulation   32


The Year in Conclusion                                 35
Publisher’s Note
Dear reader,

As 2009, the first year of publishing for MobiHealthNews draws to a close, our team has been
busy revisiting the top stories, deals, interviews and event coverage from the past 12 months.
After writing more than 700 posts on the MobiHealthNews site, publishing 45 newsletters,
attending and covering countless industry events and reading well over 2000 comments from our
readers, we would like to present the MobiHealthNews' Wireless Health State of the Industry Year
End Report. We would like to thank our site's premier sponsors: MedApps, West Wireless Health
Institute and AllOne Health for supporting our efforts. We would also like to thank our publica-
tion's many outside contributors whose perspective has added experience and depth to our
industry coverage. While this report pulls from some of their work, I would like to point out that
any errors, misconceptions or wayward commentary rest squarely on the shoulders of our editor,
Brian Dolan.

Thank you for being an active member of the MobiHealthNews community. We look forward to
serving you in the New Year.

Sincerely,
Joe Maillie
Publisher, Co-Founder
MobiHealthNews


                                              Letter from the Editor
Dear Reader,

As the break out year for wireless health comes to a close, so too does MobiHealthNews' first
year of publishing. Please accept this report as our holiday gift to you. Feel free to re-gift it to
colleagues, friends and family. For those scrappy wireless health startups reading, this may be an
opportunity to approach that wealthy uncle or aunt you had hoped would come on as an Angel
investor—N.B. this report contains nearly all of the wireless health market metrics publicly
released this past year as well as a round-up of other startups that received funding in '09. The
quarter-by-quarter deals charts also read like an industry timeline that chronicles much of the
higher-level activity that took place throughout 2009.

We hope that the recaps and summaries contained herein provide a snapshot of much of the
activities that accelerated the wireless health industry these past 12 months. By the looks of it,
2010 should see even more action for wireless health. We look forward to serving you in the New
Year.

Many thanks,
Brian Dolan
Editor & Co-Founder
MobiHealthNews



                                                                     State of the Industry   Page 1
Industry Metrics: Wireless Health By the Numbers
Numbers can be helpful. While industry metrics alone cannot propel an emerging market
forward, they can serve as inspiration to make a change. Many of the numbers pegged in this
section point to opportunity. Here is the summation and aggregation of a year's worth of indus-
try metrics that have shaped and prodded wireless health strategy in 2009.

Sizing up wireless health's market opportunity

The current wireless home health market is $304 million, according to CTIA, the Wireless Asso-
ciation. Citing Parks Associates research, CTIA stated that the market is expected to grow to $4.4
billion in 2013, with estimated annual growth rates of 96 percent in 2010, 126 percent in 2011,
95 percent in 2012, and 68 percent in 2013.

ABI Research estimates that the market for wearable wireless sensors is set to grow to more than
400 million devices by 2014. Of course health and fitness sensors aren't the only use case for
wearable sensors but they will likely dominate that market. ON World's research views the wire-
less sensor market through a different lens: While it does not estimate the market for “wearable”
wireless sensors, it believes wireless sensors in general will reach a global market value of $6
billion by 2012. That estimate would include wireless sensors installed at home or in managed
care facilities: Certainly a key technology group for home health.

ABI Research also estimates that revenue from worldwide sales of WiFi-enabled healthcare
products, a specific sub category of wireless health that probably includes medical devices inside
care facilities, will reach nearly $5 billion in 2014.

Forgetting the specific technologies for a minute: What about a market size for home health
monitoring of chronic diseases overall? Berg Insight pegs that figure at $11 billion last year for
the US and Europe. That market is growing at 10 percent per year, the firm claims, and some 300
million people in Europe and the US have at least one chronic disease that may benefit from
home health monitoring. Berg believes that about 25 percent of that population would benefit
from existing home monitoring solutions currently available, while some 50 percent would
benefit from integrating or connecting existing medical devices with their mobile phones.

No matter how you slice it, the market for wireless health is ripe and growing.

Consumer demand

Some 78 percent of the US is interested in mobile health solutions, according to a survey
conducted by CTIA and Harris Interactive. About 15 percent of the US is extremely or very inter-
ested in learning more about mobile health solutions, according to the survey. Interestingly, 19
percent of respondents said they would upgrade their current mobile phone plan to get access
to wireless health services, while about 11 percent said they would even switch carriers to get
access. Why were they so eager? About 40 percent said mobile health would supplement the
medical care they receive from their doctor; 23 percent believe mobile health services could
                                                                   State of the Industry   Page 2
Industry Metrics: Wireless Health By the Numbers
replace doctor visits altogether. More than half of respondents said mobile health would benefit
rural populations the most; just under half of respondents believed people with chronic condi-
tions would benefit the most; 41 percent said that retired and or Medicare patients would
benefit the most from mobile health. Finally, 38 percent said caregivers would gain the most
from mobile health services.

PricewaterhouseCoopers conducted a similar survey that found 73 percent of consumers would
use biometric electronic remote monitoring services to track their chronic condition or vital
signs. The figure closely mirrors the near three-quarters of the US population interested in
mobile health.

Saying and doing are two separate things: According to a survey conducted by the National Coun-
cil on Aging: One in four people with chronic conditions are delaying care. The percentage is
much higher for Baby Boomer women (39 percent) and Latinos (43 percent.) Perhaps easier-to-
use and more productive tools like some mobile health solutions could help encourage those
with chronic conditions to take control of their own health sooner.

Expected consumer demand is driving wireless health uptake in managed care facilities: A survey
conducted by the Mathers LifeWays Institute on Aging found that senior living community
administrators expect that smart home and wireless health offerings will attract residents to
their communities. As a result smart home technologies are expected to increase their penetra-
tion from 8 percent of senior communities today to 39 percent come 2013.

Overburdened healthcare system

While the aggregate influx of connected health devices and monitoring services could potentially
inject a fire hose of new data into an already overtaxed healthcare system, many wireless health
tools can help care providers do their job more efficiently and stretch their reach more comfort-
ably beyond their current workload. The numbers indicate that care providers as a group are
shrinking while the number of sick and elderly Americans is increasing. Wireless health can play
a role to mitigate these alarming trends.

At the beginning of 2009 during the height of the economic downturn, 71 percent of hospitals
said that budget allocations for IT were expected to be smaller in 2009 than in 2008, according
to a study commissioned by NCR. Because of the economic downturn some 36 percent of hospi-
tals said they were being more cautious about IT spending, while 19 percent said they had
already delayed spending on certain IT purchases. A full 16 percent delayed all non-essential IT
project funding as of February.

As IT budgets shrank, the specter of a physician and nurse shortage loomed: The number of US
medical school students who choose primary care has dropped almost 52 percent since 1997,
according to the American Academy of Family Physicians (AAFP). The group predicts a shortage
of 40,000 family physicians by 2020. The US currently has about 100,000 family physicians, but it
                                                                  State of the Industry   Page 3
Industry Metrics: Wireless Health By the Numbers
will need about 140,000 in ten years. Only half the number of physicians needed are entering the
field today.

The shortage of nurses is already taking a toll on those in wards today: Nurses report the short-
age impacts their day-to-day job, according to a study conducted by Epocrates. About 46 percent
of nurses say the shortage decreases the amount of time they can spend with their patients.
About 42 percent say it increases their responsibilities and about 37 percent say it increases their
patient load.

To compound the problem, Americans as a group are getting older. Today, about 12 percent of
the US is 65 years old or older, but by 2030 about 20 percent of the US population will be 65 or
older. In 2005 the 78 million Americans 65 years old or older accounted for $2 trillion in total
health expenditures. The 78 million Baby Boomers, who were born between 1946 and 1964, will
begin turning 65 in 2011. The other group that could add to the strain on the system is the 47
million uninsured Americans.

Aging aside, the US population as a whole is not fit. The CDC said that the average American is
about 23 pounds overweight and consumers eat about 250 more calories a day than the average
American did two or three decades ago.

According to the West Wireless Health Institute 5 million Americans are affected by Alzheimers;
20 million are affected by asthma; 3 million are affected by breast cancer; 10 million are affected
by COPD; 19 million are affected by depression; 21 million are affected by diabetes; 5 million are
affected by heart failure; 74 million are affected by hypertension; 80 million are affected by
obesity; 15 million are affected by sleep disorders.

Our overburdened healthcare system cannot help them all through the old methods, but wire-
less remote monitoring tools could help prevent and/or manage these conditions and others.
There are many factors that lead to disease, but up to 40 percent of all chronic conditions are
attributable to our behavior. Wireless health solutions can monitor, analyze, encourage and
ultimately change behavior.

The tools are at hand

For many access to wireless health solutions is a given: Close to 90 percent of the US population,
about 276 million Americans, already has a mobile phone. During the first half of the year more
than 740 billion text messages were transmitted in the US. Text messaging is one of the simplest
channels to deliver public health messages like the White House plans to do with its Text4Baby
program for low income, expectant mothers.

The Center for Connected Health estimates that there is about 20 or 30 percent of the popula-
tion where text message reminders will be very powerful.

                                                                    State of the Industry   Page 4
Industry Metrics: Wireless Health By the Numbers
Beyond text messaging, close to 19 percent of Americans now have smartphones. By one
estimate there are about 5,000 health and medical applications currently available in the market
for smartphone users.

Smartphone users may include a number of Medicaid patients: According to one “unofficial”
study referenced at a wireless health industry event this year, five out of seven Medicaid patients
in New York and New Jersey use smartphones.

Of course, healthcare providers are also adopting mobile phones: Manhattan Research found
that 64 percent of physicians use a smartphone today. That's 20 percent more physicians than in
2008. By 2013, 81 percent of physicians will use smartphones, the firm predicts.

Healthcare providers have found that not all their patients are mobile phone or technologically
savvy, however: About 33 percent of the people the Center for Connected Health works with in
their wireless health pilots need a phone call to have someone walk them through how to use
wireless devices.

The tools are largely available and in the market. The key is to let the public know that these
services are available, and then, of course, be sure to support the offerings with adequate
customer service.

Estimates for cost savings

Verizon Wireless recently estimated that mobile broadband solutions improved U.S. health care
productivity at a savings of almost $6.9 billion. That figure is expected to increase to $27.2 billion
by 2016. And it's not just the carriers predicting big numbers: According to one survey conducted
by Cambridge Consultants, 75 percent of healthcare providers, patients, payers and technology
enablers believe that connected health preventative services could cut healthcare expenses by
40 percent.

The Center for Connected Health sees two key drivers for connected health: Employers want to
keep their health insurance costs low by keeping employees healthy; Insurers want to keep their
costs low by ensuring care providers manage costs.

As employers explore ways to help keep their employees in shape and manage their chronic
conditions, wireless health service providers need to be there with solutions that have demon-
strated efficacy.

Insurers are beginning to increase capitation in order to put pressure on care providers to keep
costs low. The Center for Connected Health noted that its parents company, Partners Healthcare
has Blue Cross Blue Shield of Massachusetts breathing down its neck to make sure they are man-
aging costs. Capitation is where the insurance provider pays care providers a flat rate for a year
to care for patients and the care provider then has to do its best to control costs within that
                                                                     State of the Industry   Page 5
Industry Metrics: Wireless Health By the Numbers
context. Partners expects that in the next three years close to 50 percent of its revenue will be
capitated. That's motivation to keep patients healthy and prevent readmissions by equipping
patients with the tools that help them to better manage their own health.

At least 125 million Americans are living with one or more chronic diseases. An individual living
with one chronic disease costs the US healthcare system $6,032 a year on average, according to
Johns Hopkins School of Public Health. The total costs of chronic diseases in the US healthcare
system today top $1.4 trillion.

If a wireless health solution can help take a bite out of these figures, there is a business case for
it.




                                                                    State of the Industry   Page 6
Carriers Take the Lead on Wireless Health
“We took a run at this five years ago and it fizzled out pretty quickly,” explained Rob Mesirow,
Vice President of CTIA, the international association for the wireless industry. “Quite frankly, it
just wasn’t the time, the stars weren’t aligned, wireless data networks weren’t robust enough
and medical data wasn’t there. Now, the next generation of doctors, who are more comfortable
with health IT technology, along with stronger mandates from the federal level and robust carrier
networks are coming together,” Mesirow told MobiHealthNews during an interview this past
spring. “Everyone agrees that the healthcare industry is inefficient — and that’s putting it
lightly.... When I specifically asked the carriers which verticals should we be focusing on, carriers
have unanimously said that healthcare is one we should go for.”

Carrier involvement starts with M2M

One way that U.S. carriers will enable the wireless health market is via machine-to-machine busi-
ness units and joint ventures, which aim to support connectivity for devices other than tradi-
tional mobile phones. Earlier this year Verizon Wireless announced a machine-to-machine
(M2M) joint venture with Qualcomm, called nPhase, which among other devices—will support
wireless remote monitoring company, CardioNet's connectivity. Similarly, AT&T opened a device
certification lab that aims to accelerate the entry of “netbooks, eReaders, portable navigation
devices, utility products, and healthcare-related tracking devices” into the market. Shortly after
the nPhase and AT&T lab announcements, Sprint inked a multi-year agreement with M2M com-
pany DataSmart to help embedded device makers bring their products to market sooner. Sprint
cited the demand for sophisticated M2M applications, including "the rapid growth in M2M
healthcare."

Amazon's eBook reader, the Kindle has long been referenced as a model that the wireless health
industry should emulate in terms of working with wireless carriers: “Maybe it’s a little overused
at this point, but the Kindle represents a different model. It’s not carrier-based. It’s not
subscription-based. It’s one example of the kind of creative business models that are coming out
of the wireless industry,” Mesirow said. Because of devices like the Kindle and the opportunity
for wireless health devices, Harbor Research predicted this past year that M2M device shipments
might top 430 million units by 2013.

Verizon CEO Ivan Seidenberg believes that M2M device uptake is set to explode in the U.S. While
we are approaching a 90 percent penetration rate in the U.S. for the number of Americans using
mobile phones, the opportunity to reach 500 percent penetration is possible thanks to embed-
ded devices and machine-to-machine (M2M) services. Seidenberg specifically pointed to
connected medical devices like a wireless-enabled glucose monitor as an example of an embed-
ded device that could push the industry to 500 percent penetration.

Does wireless health need a LifeComm anymore?

“MVNOs seem to pop up for anything these days,” Mesirow told MobiHealthNews. “So a health-
care MVNO? Sure, why not? But I think all of the carriers are interested in offering wireless health
                                                                    State of the Industry   Page 7
Carriers Take the Lead on Wireless Health
services over their networks.”

Back in 2005 Qualcomm began to publicly discuss plans to launch LifeComm, a mobile phone
service with wireless health applications and devices at its core, but back then specialized mobile
phones services, also called mobile virtual network operators (MVNOs) were all the rage: ESPN
Mobile, Disney Mobile and AMP'd Mobile were among the MVNOs that eventually made it to
market. These sports and entertainment focused services quickly lost steam and mostly
disbanded within a year. LifeComm never launched officially, but Qualcomm worked on the
initiative for years until deciding in 2009 that the existing wireless carriers, especially Verizon
Wireless, AT&T, Jitterbug and Sprint were willing to offer wireless health services themselves.

Early in 2009, just before MobiHealthNews broke the news that LifeComm was shutting down,
Qualcomm presented some of the devices and services that LifeComm was planning to support:
A mobile phone with an embedded glucometer for diabetics and a mobile personal emergency
response system (MPERS) medallion for seniors. For the MPERS device think "Lifeline on
steroids," a Qualcomm representative said, a medallion small enough for users to wear around
their neck, but it still contains the "guts" of a mobile phone and an accelerometer to detect activ-
ity.

“Qualcomm is reviewing its options with LifeComm in light of current capital market conditions
that have prevented LifeComm from raising the third-party capital necessary to fully develop its
initial launch product,” a Qualcomm spokesperson told MobiHealthNews in July. The devices and
services that were set to launch through LifeComm ended up forming into their own start-ups
and companies, Qualcomm said at an event in early December. In a lot of ways, the shuttering of
LifeComm was a good news story for the emerging wireless health industry, Qualcomm's Clint
McClellan noted. It meant that wireless carriers were willing to support these devices and
services. Not needing LifeComm should be seen as a bright spot.

Carriers establish their own health focused business units

While most of the major U.S. carriers ramped up their M2M businesses in 2009 — business units
or joint ventures that clearly have a stake in wireless health—a few carriers around the world
actually launched healthcare dedicated business units, too.

Both Vodafone Group and Verizon, the two owners of Verizon Wireless (45 percent and 55
percent, respectively), launched healthcare focused business units during the fourth quarter of
the year.

“I personally believe that the mobile phone has a very significant role to play in the provision of
healthcare,” Vodafone Group CEO Vittorio Colao told attendees at the Mobile Healthcare Indus-
try Summit in London this December. Colao explained that key use cases for mobile in healthcare
include: the simplification of clinical work flows, statistical analysis of record keeping, supporting
the chronically ill at home as well as reaching under-resourced and geographically dispersed
                                                                    State of the Industry   Page 8
Carriers Take the Lead on Wireless Health
communities.

In the short term, Colao said that many mobile health services can be created without having to
develop new technology. More often than not we think about mobile health as very complex
systems, which may be right for developed markets, but in general technology is not the prob-
lem. For developing markets especially, many pilots have shown the power of mobile healthcare,
Colao said, but unfortunately there has been little success in scaling these projects. Vodafone
Group recently established a new mobile healthcare unit that aims to work with medical organi-
zations, governments and pharmaceutical companies to fully understand what the needs are.

“We want to start listening to governments and listening to pharmaceuticals to understand what
the needs are. It is clear that there is a pressing need for a reevaluation for how we deliver health
services in the coming year,” Colao said. “It is also clear to us that mobile technology has a role
to play in how we … provide better service and improve healthcare for those in mature — and
more importantly — in developing markets.”

Verizon launched its healthcare focused business unit in November: Verizon Connected Health
Care. On the wireless front, the group is working with a hospital in New Jersey to build a collabo-
ration service that allows specialists to conduct video consultations via mobile devices:

“Also coming are even more mobile capabilities, including taking video collaboration down to the
mobile device. For instance, Verizon is already working with a hospital in New Jersey, [Verizon's
managing principle for healthcare, Nancy] Green said, that is building a collaboration service
with mobile endpoints, allowing specialists to do consultations from almost anywhere.”

Verizon offers video consultations for applications like “tele-stroke” which allows physicians to
review patients’ cases via live video to determine whether they should wait for a doctor to visit
or be rush to emergency care. Green believes these services will become much more effective
once remote patient monitoring of vitals and video collaboration applications come into the mix,
too.

Jitterbug ramps up wireless health services

By any measure GreatCall's Jitterbug mobile phone service for seniors has led the pack of carriers
offering or developing wireless health services for their users. In the past year Jitterbug has
become profitable; added Internet capabilities to their phones; switched their network from
Sprint to Verizon Wireless; acquired a mobile personal emergency response service start-up
called MobiWatch; conducted pilots with various wireless health vendors like Meridian and Well-
Doc; and launched a Services Store stocked with wireless health services.

AT&T develops personal health devices; enables remote medical services

While AT&T is the exclusive US carrier for the Apple iPhone, which has spurred much of the
                                                                     State of the Industry   Page 9
Carriers Take the Lead on Wireless Health
direct-to-consumer wireless health market this past year, the carrier itself has also made moves
to offer wireless health services directly to its users. For the past year AT&T has worked with
Texas Instruments and start-up 24Eight on a “smart innersole” technology that uses wireless
sensors to monitor the user's balance and gait. At the end of the year AT&T unveiled a prototype
it called “smart slippers,” which target the senior care market. One analyst estimated the smart
slippers and their service package could run about $100 per month.

AT&T also announced it was providing cellular connectivity to Vitality's GlowCaps device, which
is a pill box cap that fits most standard pill boxes and glows when the user fails to take their medi-
cations.

AT&T is also working with Hollywood-based Wound Technology Network to support the physi-
cians' group's remote wound care management service. WTN is now using HTC smartphones
running on AT&T's data network to access patient records and view images of wounds. WTN
previously inked a deal with Verizon Wireless to support laptop data cards for its physicians. Lab
workers at AT&T’s quality testing lab in San Antonio, Texas also recently let it slip that the carrier
is testing a number of wireless devices and services, including mobile medical tracking systems.

Sprint’s varied wireless health approach

Along with Johnson & Johnson company Lifescan, Sprint funded a mobile phone-based diabetes
management system pilot conducted by WellDoc. WellDoc found that the pilot led to a 2 percent
A1c drop among many of its pilot users.

As noted above, Sprint announced this year that it would work with M2M company DataSmart
to help embedded device makers to bring their products to market sooner.

Sprint teamed up with GE Healthcare update San Antonio, TX-based Methodist Healthcare’s six
hospitals with a converged wireless network platform. The care provider said that since the
system could more easily centrally manage the group's communications, the number of IT
employees might decrease, which opens up an opportunity to hire more care workers.

Sprint partner mVisum announced this year that it was working with the Veteran Affairs to test a
system that aims to get critical medical information to a physician while they are on their way to
a patient’s bedside.

Conclusion: Carriers are out in front

More so than any other potential wireless health service provider, wireless carriers are currently
leading the way for managed wireless health services. Carriers have an engaged user base and
the tools are already at their disposal to offer wireless health services to consumers. It looks like
in the year ahead that carriers will continue to dominate as the service providers of choice. In a
few years carriers will begin to work more closely with care providers not just to offer services to
the care facilities themselves but also to offer them to the care providers' patients.
                                                                      State of the Industry   Page 10
Care Providers Push Pilots, Look for Results
Kaiser Permanente leads the pack on wireless health

While a number of care providers have researched and developed a number of wireless health
services, the clear leader of the pack in 2009 has been Kaiser Permanente. At the very beginning
of the year, Kaiser announced that it had just completed a pilot for text message appointment
reminders with SMS vendor Mobilestorm. The pilot resulted in 0.73 percent fewer “no shows”
across one of its care facility's population, which prompted the care provider to work toward a
national rollout of the service.

Kaiser Permanente's Director of Enterprise Engineering Carlos Matos told MobiHealthNews
during an interview at the HIMSS conference that text messaging reminders are just the begin-
ning:

“On the SMS side we have had some good success with [text message] integration where we
send notifications directly to member [mobile phones] for a variety of reasons,” Matos said. “Our
plan is to stimulate more immediacy for our members and also make these communications
more feature rich by integrating Kaiser Permanente’s carepoint solutions. We want to be able to
provide outreach methods that traditionally took the form of mailings and convert those com-
munications to kp.org or SMS.”

Matos also noted that text messaging could help with the care provider’s population care man-
agement. For example, a diabetic who has not had an A1c exam in a certain amount of time may
be notified based on several different elements pulled from his EMR that it’s time to come in for
an appointment. (Similarly, Mount Sinai recently announced a pilot it was conducting with Care-
Speak to send adherence reminders via text messages to a teenager who had undergone a liver
transplant recently. The pilot demonstrated a decrease in the incident of rejection episodes for
the teens.)

Kaiser Permanente is also “white boarding” a number of other innovation projects. One of the
next services Matos said to expect coming out of Kaiser’s innovation team may be support for
connected biomedical devices. These would be simple ones like wireless-enabled or USB
connected blood pressure monitors that KP can equip its patients with for at-home use. These
really improve clinical outcomes, Matos said, and they let providers capture very granular infor-
mation that they can then use to make decisions based on that data analysis. Another example
may be a connected weight scale that helps providers track a congestive heart failure patient’s
weight over time.

Kaiser's Medical Director of Health Informatics & Web Services Ted Eytan told MobiHealthNews
in an interview this year that the value of mobile "comes back to getting that information in a
useful way -- right when you need it. What Kaiser Permanente is very good at is taking really large
systems and making them very accessible and flexible, which is something a lot of Health 2.0
companies can't do as well. We watch some of the mobile [health] demos going on and try to
take what we can learn from them and apply it to our own system, but our goal, of course, is
                                                                    State of the Industry   Page 11
Care Providers Push Pilots, Look for Results
always to improve the interaction between patient and doctor in order to improve medical care."

At Kaiser the focus is clearly not on the technology or wireless in particular, but regardless, the
group is pushing ahead with more wireless health offerings than most care providers in the US.

The US Army and the Department of Veteran Affairs (VA)

One of the first wireless health deals inked in 2009 was between AllOne Health and the Army for
a mobile phone based communication system that allowed the Army's care givers and physicians
to check-in and remotely monitor “wounded warriors” who had recently returned from the war
with traumatic brain injuries. The Army licensed AllOne Mobile for 10,000 soldiers and is rolling
it out on an incremental basis.

A key wireless health partner of Sprint and BlackBerry's, mVisum, has also worked with the VA
this year on wireless health solutions. mVisum is equipping physicians with a mobile phone appli-
cation that allows them to access patient health information while they are on their way to the
patient's bedside.

Intel also announced that a regional division of VA was now a customer: The division of the VA
had purchased a number of the company's remote patient monitoring, home health touchscreen
devices: Intel Health Guides. Intel also inked deals with Memorial Hospital & Health System and
a number of other Indiana-based home health agencies.

Apple's iPhone: A game changer for care providers?

A number of hospitals began to take a look at how they could better integrate Apple's iPhone into
their overall clinical workflow once it became clear that a majority of physicians (64 percent) now
use smartphones (and a growing number of them favor iPhones.) One of the first hospitals to
announce its infatuation with the iPhone was Pennsylvania-based Doylestown Hospital, which
was the first to be profiled on Apple's corporate site for equipping its care workers with iPhones.
The hospital connected the iPhones to its Meditech EMR system. Houston-based Memorial
Hermann care facilities followed as a second hospital profiled on Apple's site. Then, news broke
that Apple was working directly with EMR vendor Epic Systems to integrate iPhones into Epic's
EMR solution for a hospital at Stanford University. Rumor has it that the iPhone-EMR solution will
roll out early next year and big care providers like Kaiser Permanente are already taking a look.

One start-up that has begun to capitalize on the iPhone's growing popularity among care provid-
ers is Voalte, a Florida-based startup the offers an iPhone-enabled voice, alarm, text service for
nurses. The company piloted its application for nurses at Sarasota Memorial Hospital.

Care providers begin to court wireless remote monitoring

A number of care providers are beginning to develop and launch wireless remote monitoring
                                                                    State of the Industry   Page 12
Care Providers Push Pilots, Look for Results
services for various chronic conditions: Partners Healthcare in Boston even spun out a start-up,
named Connected Health, that is initially focused on a service for wireless remote monitoring of
blood pressure through a connected cuff. The start-up just completed a pilot with Boston-area
employer EMC.

A number of care providers are also taking a look at wireless sensors: London-based St. Mary's
Hospital plans to trial Toumaz Holding's wireless sensor for vital sign monitoring. The bandaid-
like sensor monitors skin temperature, heart rate and respiration. Wireless sensor-enabled
home-based monitoring startup WellAware inked deals with two senior care facilities: Evangeli-
cal Lutheran Good Samaritan Society and Hastin. WellAware will equip the outpatient centers
with wireless sensors for senior care. WellAware inked the deals this fall – only a few weeks after
the startup launched. Mayo Clinic and STMicroelectronics are collaborating on a wireless cardiac
monitoring service that will monitor heart rate, breathing rate, and physical activity. St. Francis
Hospital is testing out St. Jude Medical's wireless-enabled, remote monitoring pace maker, which
transmits data to the server at least once a day. Finally, Ohio Health has been testing out iShoe's
smart innersole technology for fall prevention. iShoe is expected to launch in 2010 with a $100
pricepoint, according to one estimate.

Health insurers offer wireless health services

Health insurers have also begun to take an active role in offering wireless health solutions to their
members:

Significa Insurance Group (Significa) and Erin Group Administrators both inked deals with AllOne
Health to allow their members to view, manage and exchange their health information with their
physicians. AllOne Mobile works on a wide variety of mobile phones so the offering is easier for
an insurance company to provide. When wireless health offerings are tied to a specific device, it
makes more sense for the wireless carrier that supports that mobile phone to offer the service.

Harvard Pilgrim made headlines this fall when it announced plans to pilot MedMinder's
wireless-enabled PillBox for chronic kidney disease (CKD) patients. CKD affects about 26 million
people according to the companies and it has no cure. By adhering to the right medication
regimen, however, the disease can be managed. Harvard Pilgrim is piloting the system to deter-
mine its efficacy.

Blue Cross Blue Shield's venture arm has been particularly active in investing in wireless health
startups this year: The firm made two big investments, one in Myca and another in Phreesia.
Phreesia offers a touchscreen device that enables physicians' offices to more easily check-in
patients and determine their insurance coverage immediately. Myca powers a physician collabo-
ration platform that integrates everything from billing to EMRs to other administrative tasks and
allows physicians to interact with patients via email or even text message.


                                                                    State of the Industry   Page 13
Alliances and Institutes Accelerate Time to Market
While wireless carriers and care providers are perhaps two of the most important players in wire-
less health after the patient, of course, this past year saw a growing role for industry organiza-
tions, academic institutions and non-profit institutes. The groups evangelized the industry
through events and educational seminars and pushed regulators and lawmakers to ripen the
market for innovation. Their guidance has shepherded start-ups closer to launch and accelerated
the overall progress of the industry in the past year. Here are the players worth keeping an eye
on:

West Wireless Health Institute

In March the West Wireless Health Institute founded thanks to a $45 million gift from the Gary
and Mary West Foundation and support from Qualcomm and Scripps Health. The San Diego-
based Institute has since worked to take wireless medicine out of the lab and into the market-
place. Don Jones, Qualcomm’s Vice President of Health and Life Sciences serves as the Institute’s
Founding Board Member while Scripps Health’s Chief Academic Officer Eric Topol is the
Institute’s Chief Medical Officer. Gary West is the Institute's chairman and Mehran Mehregany
recently joined the team as the Institute's executive vice president of engineering and chief of
engineering research. The organization is currently recruiting for other leadership positions.

At the time of the Institute's founding, Topol noted that part of the Institute's mandate is to help
validate the hundreds of wireless health devices that may already have FDA approval but are
looking for clinical validation to make it to the market.

By mid-year the WWHI announced that the first start-up it would help bring to market was wire-
less sensor-enabled remote monitoring start-up Corventis, which specializes in detecting heart
fluid status for patients with heart disease. The company uses a peel-and-stick, bandaid-like
wireless sensor that can interface with a wireless device to track and monitor patients’ vital signs.
The WWHI is currently facilitating clinical trials for the company.

The WWHI has also been particularly effective at educating the industry and others about the
wireless health opportunity by evangelizing key conditions that wireless health solutions could
better manage and assembling data about the opportunities to lower costs in the overburdened
US healthcare system through the use of wireless remote monitoring technologies.

UCLA Wireless Health Institute

The Wireless Health Institute (WHI) was established last year as a community of UCLA experts
from engineering, medicine, nursing, pharmacology, public health and other disciplines that
aims to improve “the timeliness and reach of health care through the development and applica-
tion of wireless, network-enabled technologies integrated with current and next-generation
medical enterprise computing.” In 2009 UCLA appointed Dr. Patrick Soon-Shiong as executive
director of the university's Wireless Health Institute.

                                                                     State of the Industry   Page 14
Alliances and Institutes Accelerate Time to Market
Soon-Shiong told MobiHealthNews in an interview that the Institute’s mandate is to not only
enable the development of these technologies but also to foster wireless health start-ups and
test the wireless health technologies to prove their efficacy: “I believe the only way we can truly
transform healthcare is if we enable both patients and providers to have access to data that is
truly ‘outcomes actionable,’” Soon-Shiong said. “Evidence-based, outcomes-driven data at the
point-of-care is the goal. Those few words have a deep meaning to them — evidence-based
outcomes based point-of-care. That is the holy grail for healthcare transformation.”

Soon-Shiong noted that medication adherence is a key problem that wireless health can work to
solve. He also pointed to a few other wireless health technologies he thinks encapsulates the
potential of the technology: wireless biometric devices; sensors that can help detect developing
foot ulcers before diabetics realize they are getting them; “smart” canes that use accelerometers
to notify caregivers a patient may soon fall; and a wireless lens-less microscope that can use a
phone’s camera for diagnostics.

Continua Health Alliance

The Continua Health Alliance, a consortium of more than 220 wireless and medical companies,
which aim to create an interoperable ecosystem of medical devices and systems, has been busy
this year. After announcing its first two Continua-certified products, the Alliance also announced
two new wireless technologies for its Version 2 guidelines: ZigBee and Bluetooth Low Energy.
Since then Continua has announced additional devices have been certified as Continua-approved
and interoperable.

The Continua Health Alliance has also been recognized as one of the key evangelists for remote
patient monitoring on Capitol Hill. Continua's lobbying efforts helped convinced lawmakers to
include remote monitoring in the US healthcare bill.

Apart from ensuring interoperability among devices and lobbying the legislature, Continua's
representatives have been at most of the wireless health focused industry events in the past
year. Chuck Parker, Continua's executive director gave a stirring speech at an event in Seattle this
past spring. Parker said that remote patient monitoring doesn’t need to do any more trials or
pilots. He said that the Department of Veterans Affairs (VA) has done remote patient monitoring
pilots with about 30,000 patients over the past four years. That’s enough pilots, Parker said, we
don’t need to do any more pilots for remote patient monitoring; we need to move to deploy-
ments, and look to the VA for their pilots’ findings.

CTIA, The Wireless Association

CTIA is an industry association for the wireless industry that hosts a number of events through-
out the year and also serves as the wireless industry's liaison with Congress and various regula-
tory bodies. CTIA quickly became a champion of wireless health in 2009 as it made the emerging
industry a focus at its November event in San Diego. Apart from bringing in more than two-dozen
                                                                    State of the Industry   Page 15
Alliances and Institutes Accelerate Time to Market
wireless health start-ups to show off their wares, the association also successfully courted the
AARP to participate in the wireless health discussion.

During the summer CTIA organized a wireless health event at the U.S. Senate, which brought the
chairman of Intel and other wireless industry luminaries to discuss the opportunity that wireless
presents to the healthcare industry. CTIA also lobbied the FCC not to enact net neutrality legisla-
tion for wireless data networks, because, the CTIA argued, regulating the carriers' ability to
manage wireless data traffic could stymie innovation particularly in the emerging wireless health
industry. Requiring carriers to treat all data traffic the same would make it difficult for carriers to
ensure critical medical information reaches its destination on time or in tact, the association
argued. CTIA also suggested that the FCC make available more wireless spectrum for carriers
citing the growing interest in wireless health services.

American Telemedicine Association

The American Telemedicine Association (ATA) was created in 1993 by a group of doctors who
were using video conferencing links between larger health centers and rural clinics. The ATA now
describes itself as part trade association and part professional association, because its members
include clinicians, physicians, nurses as well as hospitals, institutions, government organizations,
corporations, providers. The ATA offers educational work, including its annual conference, advo-
cacy in Washington and elsewhere. The ATA also has special interest groups, about 15 different
member groups in various areas that provide networking, and it is beginning to create practice
guidelines related to healthcare.

Why is the ATA interested in wireless healthcare? Pike & Fischer recently predicted that the
market for telemedicine devices and services will climb to $3.6 billion in annual revenue over the
next five years largely thanks to a push from wireless technologies, data compression and smart-
phones. Telemedicine will be dominated by wireless technologies during that time period: More
than 70 percent of telemedicine will be wireless healthcare, according to the firm.

m-Health Innovation Centre

This winter the GSM Association announced a partnership with the University of Manchester in
the UK to establish an m-Health Innovation Centre in the city of Manchester. The groups said that
the center will have a UK focus to start and aims to promote healthier lifestyles and early inter-
vention through the use of wireless technology, which it believes can improve health outcomes.

The Manchester m-Health Innovation Centre plans to conduct multidisciplinary research, bring-
ing together researchers, healthcare organisations and industrial partners to conceive, develop
and evaluate mobile health innovations. A major focus will be on citizen-led health and wellbe-
ing, using mobile technology to enable people to play a more active role in determining their
own health, providing a more personalized and responsive interface to public services. The new
center hopes to provide a forum for sharing ideas, in-depth analysis of the market for wireless
                                                                    State of the Industry   Page 16
Alliances and Institutes Accelerate Time to Market
health, facilitation of pilot trials as well as mHealth education and training.

mHealth Alliance

Early in 2009, the Vodafone Foundation, UN Foundation and the Rockefeller Foundation officially
launched a new joint venture called the mHealth Alliance. By mid-year it appointed wireless
industry vet David Aylward to helm the international organization as its executive director.

The mHealth Alliance has a decidedly global health focus with a particular interest in bringing the
wireless health stakeholders to developing markets. Aylward told MobiHealthNews in an inter-
view that no group has managed to scale mHealth services—not in developed or developing
markets. There haven't even been large trials yet. Most of what is out there are small, non-
sustainable proofs of concept. The mHealth Alliance aims to support and facilitate the integra-
tion of services so that rather than having a series of point services these services will become
integrated and part of the healthcare system already in existence in that market.

Integrating those services is just one mission of the Alliance. Integrating those kinds of services
into underlying healthcare systems, e-health to use the short language, is a second. Getting
sustainable economics under both of those is a third. Researching and showing the health and
economic effect of doing that is a fourth. Underneath those there are more procedural activities,
support activities like communications and connecting people together to technology initiatives.

The mHealth Alliance recently announced a partnership with the Vodafone Americas Foundation
to create an mHealth Alliance Award for the developer of an innovative wireless technology with
the most potential to address critical health challenges, especially in developing regions. The
prize for the award includes cash and benefits totaling $50,000 and guidance from the Alliance
about developing the application.




                                                                     State of the Industry   Page 17
Reimbursement Rises and Falls
“You are not going to get paid for cool ideas,” IntelliDOT CEO and founder of CardioNet James
Sweeney told a group of wireless health entrepreneurs at the Wireless Life Sciences Alliance
event this past spring. “You are not going to get paid for saving lives. You are not going to get paid
for anything unless you can prove that you can save them money.... In the world we’re moving
into, more than ever, if you can’t justify the cost benefits, then you will fail,” Sweeney said. “In my
view, getting the FDA’s approval is not nearly as hard as getting the CPTs and insurance reim-
bursement approvals.”

CardioNet, the wireless remote patient monitoring company that Sweeney founded is perhaps
the poster child for the first generation of wireless health companies. The company has the
distinction of being the only pure-play wireless health company to have offered an initial public
offering and one of the few to acquire reimbursement from the Centers for Medicaid & Medicare
Services (CMS). At the very end of 2008, CardioNet secured a CPT that enabled it to collect
$1,123.07 for its Mobile Cardiovascular Telemetry Service.

After months of rumors that Highmark CMS planned to reduce its reimbursement rate for Cari-
doNet and other MCOT services, the payer did. In July CardioNet announced that Highmark
Medicare Services planned to slash its reimbursement rate for MCOT services to $754 per
service, effective September 1, 2009. Highmark CMS gave no explanation for the cut other than
that it believed it was the true value of the service.

CardioNet's reimbursement dip sent the company's stock tumbling and forced it to announce
plans to cut back on operational costs to sustain its business.

Analyst firm Frost & Sullivan sees a bright future for remote patient monitoring, but the key for
the industry is reimbursement: The market for remote patient monitoring is set to achieve
double digit growth in North America, according to the firm, so long as successful payment strat-
egies are implemented. Last year the remote patient monitoring market made more than $98.2
million, but the market could top $428.6 million by 2015. Frost points to direct reimbursement
as one type of payment strategy that needs to mature for the market to grow at this rate:

“At present, it seems very unlikely that any significant progress will be made toward direct reim-
bursement in the next two to five years,” Zachary Bujnoch, industry analyst, Frost & Sullivan
stated in the firm’s release. “As a result, market participants are forced to seek alternative
payment strategies, and while some of these have proved successful, the huge billion dollar
market potential this space possesses is unlikely to be reached without some form of direct reim-
bursement.”

Two to five years before significant progress is made toward direct reimbursement? If Frost is
correct, then more wireless health start-ups will pursue a direct-to-consumer model or an
indirect to consumer model through their employers, who are financially motivated to keep their
employees healthy and working.

                                                                      State of the Industry   Page 18
Reimbursement Rises and Falls
Some online health services began to see some progress on the reimbursement front this past
year: New York-based MPV Health Care plans to reimburse for more than 22,0000 physicians
who use McKesson subsidiary RelayHealth’s webVisit consultations with their patients.

Mobile health companies, however, remain frustrated by CMS. Chronic disease management
service provider BeWell Mobile's Vice President and General Manager Greg Seiler believes that
CMS should help wireless health companies better understand the reimbursement eligibility
process:

“It’d help to have clear support and guidance coming from Washington for how to enter the CMS
system and get reimbursed for technologies that work,” Seiler told attendees of the Wireless in
Healthcare IT event held at a Senate office building this past March. “What are the metrics for
demonstrating the technology works? How can we get them reimbursed? [Answers to these
questions could help mHealth move forward] and help to mitigate some of the risks that we
would otherwise enjoy taking on.”

Even devices that are much cheaper than the ones CMS reimburses for currently have trouble
getting an audience with the payer. The New York Times published a feature entitled Insurers
Shun Multitasking Speech Devices, this past September, that focused on a patient with A.L.S.
Since the muscles around her mouth and throat no longer allowed her to speak, she used an
$8,000 computer that Medicare approved with software that turns typed words into speech. In
this patient's case, however, a much cheaper ($190) iPhone app called Proloquo2Go served her
needs better as a person living a mobile life. Payers do not seem to be interested in taking advan-
tage of consumer devices' cheaper price points, which could, ultimately help curb healthcare
expenditures.

CMS, however, has yet to answer Seiler, Proloquo2Go and the rest of the industry's calls for a
seat at the table. It's a conversation that is not taking place, and if Frost & Sullivan is right, it may
not for a few more years. Until then, wireless health companies need to keep pounding on CMS'
door, while proving their products efficacy and perhaps eyeing a different go to market strategy
in the meantime.




                                                                        State of the Industry   Page 19
Consumer Health: The Answer to "Who Pays?"

There are currently 1.2 million people who use mobile fitness products to track their vital signs
while working out. It starts with fitness, but use cases for health and medical wireless health
services are set to become increasingly popular. A recent ABI report found that 90 percent of the
current wearable wireless sensor market is dominated by the fitness industry. By 2014, the
market will swell to 400 million units, thanks in large part to growing use of sensors for health-
care and medical uses.

With resistance from payers and uncertainty about the stability of a business model dependent
on their steady support, a number of wireless health service providers and device makers have
turned to direct to consumer as the best go-to-market strategy. Others never planned to become
a part of the healthcare system and focused on creating personal health devices with an eye on
the consumer market from the outset.

During the course of the year a number of breakthroughs occurred for the wireless health
consumer play: Best Buy invited wireless health startups to pitch it for shelf space and then
launched fitness sections in 40 of its stores across the US; App developers created thousands of
health, fitness and medical iPhone applications available for download directly from the App-
Store; A myriad of personal health devices began selling their services direct to consumer via
online stores like Amazon.

Best Buy begins selling personal health devices

One of the largest big box electronics stores took an interest in personal wireless health devices
this past year: At the Microsoft Connected Health Conference in June, Best Buy teamed up with
Microsoft’s HealthVault team to invite device makers to pitch the electronics store’s executives in
a private meeting at the event: “If you believe that your product or solution can wow health-
conscious shoppers at the largest consumer electronics retailer in the United States, this is your
chance to make it happen,” stated the Microsoft-Best Buy invitation. The invitation also
explained that “outstanding solutions providers” would have the opportunity to discuss collabo-
ration opportunities with Best Buy during a special dinner later this summer.

A few months later Best Buy announced that 40 of its stores in the U.S. had begun offering
personal health solutions devices like pedometers, Bluetooth-enabled weight scales and blood
pressure monitors.

“New technologies are emerging daily to help people plan, monitor, and enhance their health
and fitness activities,” Best Buy stated in its press release. “Yet finding the ways and the time to
stay fit and motivated can seem more complicated than ever before. Starting today, Best Buy
customers in select markets from Washington, DC to Denver can turn to the nation’s largest
consumer electronics retailer for help in satisfying their health and fitness equipment and man-
agement needs.”

                                                                    State of the Industry   Page 20
Consumer Health: The Answer to "Who Pays?"
iPhone demonstrates consumer demand for mobile health

”Now here’s a class [of services] that we think will be really interesting: medical devices,” Apple
SVP of iPhone Software Scott Forstall announced at the sneak peek event for iPhone 3.0. during
the summer. Forstall then explained that the new iPhone OS will allow application developers to
sync medical devices like blood pressure monitors or blood glucose monitors via both Bluetooth
and USB. “So imagine the possibilities,” Forstall continued. “We think this is profound.” Forstall
then invited a representative from Johnson & Johnson subsidiary Lifescan who demonstrated a
concept iPhone app that interfaced with a connected blood glucose meter device.

Since the iPhone 3.0 event in June, medical device makers and chronic disease management
service providers have all been forging mobile strategies.

iTMP is one startup that was early to market with a peripheral device for the iPhone: SM Heart
Link, is a “wireless bridge” that can collect data from wireless sensors like heart rate chest straps
or cycling sensors on bikes and send them to an iPhone for display and tracking. Wireless remote
monitoring company MedApps looks to be integrating its system with smartphones, including
the iPhone perhaps as soon as next year. Most wireless sensor startups, including Corventis,
Sotera Wireless and Proteus Biomedical have all indicated that their sensors would interface with
an application on the iPhone. Those startups are not pursuing a consumer health market strategy
initially, but many expect them to create cheaper, consumer versions of their sensors in the
future.

Of course, the market for peripheral medical devices that interface with the iPhone could be a
big market opportunity, however, the real success story for the wireless health services via
mobile phones in the past year has been the rise of health, fitness and medical applications
themselves. No other smartphone app store comes close to iPhone's thousands of health-
related apps. From symptom navigators to chronic disease management tools; from medical
reference guides to remote monitoring applications; from medication adherence apps to sooth-
ing relaxation applications. Chances are if you have thought of a potential health-related applica-
tion, there's a version of it already in the iPhone App Store.

BlackBerry has also begun ramping up its health-related applications in its App World store and
they include a wide variety of applications – many of them also offered for iPhone. BlackBerry,
however, only offers a few hundred health apps compared to the thousands available for
iPhones.

Examples of other wireless personal health devices in the market

Zeo Personal Sleep Coach - The Zeo headband uses the startup's patent-pending SoftWave
sensor technology to accurately and safely measure the user's unique sleep patterns through the
electrical signals produced by the brain. Zeo records those signals and can track which level of
sleep the user is in and for how long based on the data. That data is then transmitted to the Zeo
                                                                     State of the Industry   Page 21
Consumer Health: The Answer to "Who Pays?"
alarm clock, which acts as a gateway to send the data to Zeo's server where users can log-in and
review their sleep habits. Zeo is available via Amazon.com or directly from the company's web-
site.

GlowCap – Vitality's GlowCap is a smart pillbox cap that can fit the average pillbox. GlowCap
glows different colors when users forget to take their medication – it uses an accelerometer to
determine when the pillbox is opened and makes a time stamp. The GlowCap can also alert care-
givers when a person forgets to take their medication and can even call the pharmacy to get a
refill. GlowCap is currently available via Amazon.com but the company does not believe direct to
consumer will be its most successful distribution channel. Vitality hopes to get pharmaceutical
companies or others to subsidize GlowCap for patients' use. AT&T recently announced that it
would provide cellular connectivity for the product.

Fitbit – This personal fitness device is currently sold out and on backorder, according to the com-
pany. Fitbit tracks calories burned, steps taken, distance traveled and sleep quality by using an
accelerometer. Fitbit tracks its users' motion in three dimensions and converts this data into
usable information about daily into useful information about your daily activities. Fitbit uses a
wireless base station that is positioned in the home – whenever a user walks near the basesta-
tion the data is uploaded to Fitbit.com where users can analyze their personal health data. Fitbit
is sold through the company's website but it is currently out of stock and not filling new orders
until January 31, 2010.

Philips DirectLife – Philips activity monitor DirectLife measures body acceleration in three differ-
ent directions and combines that information with the user's age, gender, height and weight. The
measurements are then converted to energy use, or calories burned. DirectLife's online program
helps users establish goals and encourages and motivates users to increase their goals to exercise
more in successive weeks. The device itself is tiny, smaller than a matchbox, and has no display
screen. Instead it has a half dozen green LED lights that indicate to the user how close they are to
meeting their exercise goal for the day. The service is currently available from the DirectLife web-
site.




                                                                    State of the Industry   Page 22
Venture
                                      Capital                 2009
Wireless Health Venture Capital in 2009

There were 15 venture capital investments announced during 2009 and 11 of them were for
wireless remote patient monitoring start-ups. The remainder included a start-up working on a
converged platform for physician-patient communications, a smartphone app developer focused
on fitness games, a call-in physician consultation service, and a tablet-based patient check-in
device for physician offices. While there were few, this year's investments cover a variety of wire-
less health business models and offerings.

In September MedMarket Diligence noted that investments and other financings in the medical
device sector topped $400 million in July and August. The $22 million round that wireless health
start-up CardioMEMS secured, led the pack. MedMarket predicted another $400 million in
investments in medtech for the month of September alone.

By October venture capitalists focused on healthcare were hedging their bets based on the direc-
tion US healthcare reform was heading: VCs like Psilos and Chrysalis looked to fund companies
that help people stay healthier and manage chronic diseases, figuring this is one way the govern-
ment will ultimately move to take costs out of healthcare.

In November following the CTIA Wireless IT & Entertainment event in San Diego, where more
than two dozen wireless health start-ups demonstrated their solutions, wireless industry veteran
analyst Chetan Sharma predicted a “lot of investment” would flow into the sector in the coming
days.

One venture capital firm, Mohr Davidow Ventures (MDV), which invested in wireless sensor
start-up Corventis in the past, told MobiHealthNews that it was actively pursuing start-ups like
Corventis that collect clinically-actionable data for point-of-care. MDV was chiefly interested in
companies at the 510K level of FDA regulation. Products that require long, multi-year clinical
trials before getting an FDA regulatory decision were not of interest. For the most part, the list of
venture capital deals in the chart on the next page follow that trend.




                                                                     State of the Industry   Page 23
Venture
                                                            Capital                            2009
                                                         Date
Company            Amount          Location              Announced Investors                         Company Description
                                                                    Arcapita Ventures, Boston        Developer of implantable wireless sensors that
                                                                    Millennium, Foundation           track cardiac output, blood pressure and heart
CardioMEMS         $22.1 million   Atlanta, GA           08/26/09   Medical                          rate (more)
                                                                    Lead Investor: InterWest
                                                                    Partners; Also: Kleiner Perkins
Autonomic                                                           Cau eld & Byers, The            Developer of implantable devices that aim to
Technologies       $20 million     Menlo Park, CA        05/08/09   Cleveland Clinic                soothe severe headaches (more)
                                                                    Lead Investor: BlueCross
                                                                    BlueShield Venture Partners;
                                                                    Also: Polaris Venture Partners, Developer of an automatic patient check-in
                                                                    HLM Venture Partners and        device and service that aims to improve patient-
Phreesia           $11.6 million   New York, NY          02/20/09   Long River Ventures             provider relationship (more)
                                                                    Lead Investor: Seventure
                                                                    Partners; Also: ePlanet,         Developer of wireless monitoring devices,
                                                                    Enterprise Ireland, and          including a motion sensor that detects heart rate
BiancaMed          $9.8 million    Belfast, Ireland      07/20/09   ResMed                           and respiration (more)
                                                                    Lead Investor: HLM Venture       National network of primary care physicians that
TelaDoc                                                             Partners; Also: Cardinal         diagnose illness, recommend treatment, and
Medical Services   $9 million      Dallas, TX            12/04/09   Partners, Trident Capital        prescribe medication over the phone (more)
                                                                                                     Developer of wireless remote monitoring systems
                                                                    Valhalla Partners, .406          that track the daily activities of cared for
WellAware          $7.5 million    Charlottesville, VA   12/08/09   Ventures.                        individuals in the home (more)
                                                                                                  MycaHub combines an EMR, a comprehensive
                                                                                                  admin system, and the ability for doctors to
                                                                    BlueCross BlueShield Venture communicate with their patients via a variety of
Myca Health        $5 million      San Francisco, CA     10/06/09   Partners, Sandbox Industries. channels. (more)
                                                                    Investors include Cotswold       Echo is developing a wireless blood glucose
Echo Therapeutics $3.6 million     Franklin, MA          12/04/09   Foundation                       monitor for diabetics.
                                                                                                     BL's platform, TVx, gathers info from Bluetooth-
                                                                                                     based wireless medical devices at home and
BL Healthcare      $3 million      Foxborough, MA        08/06/09   undisclosed                      displays it on the TV.
                                                                    Lead Investor: PUK Ventures;
                                                                    Also: Catapult Venture           Developer of wireless technology for monitoring
                                                                    Managers, University of          the health of expectant mothers and babies
Monica Healthcare $1.6 million     Nottingham, UK        04/27/09   Nottingham                       (more)
                                                                    Carilion Biomedical Institute,   Developer of medical applications for wireless
Wireless Medcare   $535K           Roanoke, VA           12/11/09   Optimum Sensor Holdings          and web-enabled devices (more)
                                                                                                   Developer of motion-detecting iPhone tness
                                                                                                   apps that include peer challenges to keep users
GymFu              $160K           Hampshire, UK         12/01/09   Lead Investor: Channel 4's 4iP motivated
eCardio                                                                                              Service provider of remote cardiac monitoring for
Diagnostics        undisclosed     The Woodlands, TX     07/01/09   Sequoia Capital                  arrhythmia diagnosis (more)
                                                                                                     Developer of a personalized online tness
                                                                    New Venture Partners,            coaching system and wireless monitoring device
MiLife             undisclosed     Bedford, UK           01/16/09   Unilever Ventures                (more)
                                                                                                     Developer of real-time physiological and
                                                                                                     biomechanical monitoring technology for
                                                                                                     defense, rst responder, training and research
Zephyr Technology undisclosed      Annapolis, MD         06/18/09   Motorola Ventures                markets (more)




Page 24
2009
                                    Wirelss
                                     Health
                                      Deals

Wireless Health Industry Deals in 2009

During the course of 2009, MobiHealthNews chronicled 73 business deals between two or more
companies or organizations active in the emerging industry. We defined a deal as an acquisition,
pilot, program, joint venture, or product or service launch in conjunction with another company.

“For many global firms, the fastest path to market leadership will be through acquisition,” Invest-
ment firm TripleTree's research director Chris Hoffmann told MobiHealthNews. “This consolida-
tion may not come in the same flurry as we’ve seen in enterprise software, but some thoughtful
strategic deals will begin to occur. Because many of the questions surrounding mHealth and
Wireless Health solutions center on ‘who pays for them’, early M&A activity may be focused on
those solutions demonstrating recurring revenue growth or meaningful end user (or patient)
retention.”

The 73 deals summarized here could serve as a timeline for wireless health activity in the past
year. The deals are ordered chronologically, beginning with AllOne Health's massive pilot with
the U.S. Army, which licensed AllOne Mobile for more than 10,000 wounded warriors managing
traumatic brain injuries. The charts on the following pages are testament to the work accom-
plished this year by wireless health companies, and it points to many more deals in 2010.




Page 25
Q1
                                                                                              Wirelss
                                                                                               Health
                                                                                                Deals

                                                                                               Date
Company A                  Company B, etc.           What was the deal?                        Announced Other details?
                                                     Army to pilot AllOne Mobile to stay in               Army licensed the technology for 10,000
                                                     touch with “wounded warriors”                        soldiers, speci cally those with traumatic
U.S. Army                  AllOne Health, Diversinet through their mobiles. (more)          01/14/09      brain injuries.
                                                                                                          The Mobile Viewer allows users to view but
                                                                                                          not edit pro le information as well as
                                                     Anvita developed a mobile viewer of                  current prescriptions, existing health
Google                     Anvita Mobile             Google Health for Android. (more)   02/05/09         conditions, known allergies and more.
                                                                                                          KP worked with Mobilestorm for the pilot,
                                                     Completed a pilot for text message                   which showed 0.73 fewer “no shows.”
Kaiser Permanente          Mobilestorm               appointment reminders. (more)             02/05/09   National rollout to follow.
                                                                                                          As part of the announcement, IBM said it
                                                     IBM and Continua to create                           had integrated its Information
                                                     guidelines for wireless medical                      Management, Business Intelligence and
                           Continua Health Alliance, devices to connect to Google Health.                 WebSphere Premises Server sensor event
IBM                        Google                    (more)                               02/12/09        platform into Google Health already.
                                                     Companies formed, ng Connect, a
                                                     group for vendors looking to create                  The group will focus on ve key areas, one
                           Motorola, HP, Samsung,    next-gen wireless devices with Alca-                 being: enterprise collaboration and e-
Alcatel-Lucent             others                    Lu. (more)                                02/16/09   health.
                                                     The Foundations teamed up with the                   The mHealth Alliance aims to bring
                                                     Rockefeller Foundation to create the                 together the major mHealth stakeholders
Vodafone Foundation        UN Foundation             mHealth Alliance. (more)             02/17/09        for the developing world.
                                                     MobilizeMRS taps FrontlineSMS
                                                     platform for its work in global health.              MobilizeMRS rebranded to
MobilizeMRS                FrontlineSMS              (more)                                  02/24/09     FrontlineSMS:Medic following the deal.
                                                     Ohio Health pilots the smart                         Ohio Health expects iShoe to hit the
Ohio Health                iShoe                     innersole for fall prevention. (more)     02/26/09   market in 2010 with a pricepoint of $100.

                                                     Edge Health to embed Allscript's EMR                 Allscripts launched its own iPhone app a
Allscripts                 Edge Health               into its iPhone app, EdgeRPM. (more) 03/04/09        few weeks later.
                                                     Clickatell enables text messaging for                AllOne Health's users in the Army look to
AllOne Health              Clickatell                AllOne Mobile. (more)                     03/11/09   be the rst to bene t.

                           Signi ca Insurance Group The health plans' members can view,
                           and Erin Group           manage and exchange their health                      The deals made AllOne Mobile available to
AllOne Health              Administrators           info with their providers. (more)   03/16/09          more than 400,000 people total.
                                                     Rady Children's pilots GI's Pillcam, a               Joshua Devine, a high school sophomore,
                                                     tiny wireless camera inside a pill.                  swallowed the Pillcam at Grady's – one of
Rady Children's Hospital   Given Imaging             (more)                                    03/17/09   the rst patients to do so.
                                                     Telstra Foundation funded a two year
                           Murdoch Children's        mobile project for mental health                     The grant was for $285,000 Australian
Telstra Foundation         Research Institute        services. (more)                     03/25/09        dollars.
                                                     Microsoft to allow personal health
                                                     devices to connect to HealthVault via                ANT+ is an alternative short range wireless
Microsoft                  ANT Wireless              ANT+. (more)                          03/25/09       technology to ZigBee or Bluetooth.
                                                                                                          Qualcomm's Don Jones and Scripps' Dr.
Gary and Mary West         Qualcomm, Scripps         GMWF donated $45M to create the                      Eric Topol join as part of the Institute's
Foundation                 Health                    West Wireless Health Institute. (more) 03/30/09      founding board.


Page 26
Q2
                                                                                        Wirelss
                                                                                         Health
                                                                                          Deals
                                                                                              Date
Company A                  Company B, etc.            What was the deal?                      Announced Other details?
                                                      Verizon Wireless launches 4G
                                                      innovation center with Alcatel-Lucent              The center will focus on three key verticals:
Verizon Wireless           Alcatel-Lucent, Ericsson   and Ericsson. (more)                  04/01/09     healthcare, utility and security.
                                                      Intel and GE announce partnership
                                                      for home health monitoring and                     GE will market Intel's Health Guide as part
                                                      contribute $250 million to R&D.                    of the deal, which also focuses on wireless
Intel                      General Electric (GE)      (more)                                  04/02/09   sensors for the senior care market.
                                                      CardioNet agrees to buy Biotel and
CardioNet                  Biotel                     enter clinical research. (more)         04/02/09   The deal eventually falls through.
                                                    Jitterbug pilots a medication
                                                    adherence service from Meridian and                  The services could become part of
                                                    a diabetes management service from                   Jitterbug's Service Store – its version of an
GreatCall / Jitterbug      Meridian Health, WellDoc WellDoc. (more)                     04/03/09         App Store.
                                                      RPM company MedApps connects                       MedApps currently uses a dedicated
                                                      devices' data streams to Microsoft's               wireless device to route data from
MedApps                    Microsoft                  HealthVault. (more)                     04/12/09   connected medical devices.
                                                  Proteus announces two drug
                                                  companies will trial its “intelligent                  Later in the year, Novartis announces a trial
                           Two undisclosed pharma medicine” technology and sensor.                       with Proteus – unclear if it's a separate
Proteus Biomedical         companies              (more)                                      04/14/09   deal.
                                                      A.D.A.M. announces Medzio, a                       Medzio continues to add a few new
                                                      collaborative mobile app suite from                partners throughout the year, but the
                           HelloHealth, Norton,       the newly formed Mobile Health                     app's sum does not appear to be more
A.D.A.M.                   LiveStrong, others         Network. (more)                         04/21/09   popular than its parts.
                                                      Doylestown Hospital becomes rst
                                                      hospital pro led on Apple's site for
                                                      equipping its care workers with                    The hospital connected the iPhones to
                                                      iPhones throughout its facility.                   their Meditech EMR system and also
Doylestown Hospital        Apple                      (more)                                  04/30/09   noticed doctors favor Epocrates.
                                                      The three companies teamed up to                   The collaboration results in AT&T's “smart
                           Texas Instruments,         work on smart innersoles for fall                  slippers” for fall prevention, unveiled in
AT&T                       24Eight                    prevention. (more)                      05/26/09   December.
                                                      Senior phone service provider
                                                      Jitterbug worked with phone maker
                                                      Samsung on its new Jitterbug J
                                                      phone and Qualcomm to create a
                                                      more “seamless” data connectivity for              Jitterbug added 1xCDMA data to its
                                                      users. The phone and data                          phones but it didn't want the users to
                                                      connectivity enable the company's                  know they had Internet-enabled phones –
Jitterbug                  Samsung, Qualcomm          Services Store. (more)                06/02/09     perhaps too daunting.
                                                      Remote cardiac monitoring company
                                                      LifeWatch signed an exclusive
                                                      agreement with Verizon to use its
                                                      network to carry its wireless health
Verizon Wireless           LifeWatch                  services. (more)                     06/04/09      LifeWatch is a big competitor to CardioNet.
                                                      The White House is working with a
                                                      number of industry partners to
                                                      launch a free text messaging service,              Text4Baby originally aimed to launch in
                           Voxiva, CDC, J&J, CTIA,    called Text4Baby, for low-income                   September but has since been delayed
White House                more                       expectant mothers. (more)             06/05/09     until next year.
                                                      Interoperability consortium Continua
                                                      certi ed Nonin's Bluetooth-enabled                 This marks the rst wireless health device
Continua Health Alliance   Nonin                      pulse oximeter. (more)               06/09/09      with Continua certi cation.
                                                      Partners Healthcare in Boston spun
                                                      out a start-up, named Connected
                                                      Health for now, with an initial service            Connected Health just completed a pilot
                                                      around a wireless blood pressure cu .              with EMC, which used the cu for
Partners Healthcare        Connected Health           (more)                                  06/16/09   corporate wellness programs.
                                                      The Institute announced plans to
                                                      conduct clinical trials for Corventis              Dr. Eric Topol and other Institute directors
West Wireless Health                                  and shepherd the sensor to market.                 demo Corventis' monitoring sensor at
Institute                  Corventis                  (more)                                  06/23/09   events all year long.


Page 27
Q3
                                                                                   Wirelss
                                                                                    Health
                                                                                     Deals


                                                                                           Date
Company A                Company B, etc.           What was the deal?                      Announced Other details?
                                                   Roche inked a deal with diabetes app
                                                   developer MYLEstone Health to
                                                   include some of Roche's diabetes                   MYLEstone saw the deal as a baby step for
                                                   management software into the                       the industry and was fed up with hype
                                                   company's Glucose Buddy                            around meter integration into
Roche Diagnostics        MYLEstone Health          application. (more)                     07/01/09   smartphones.
                         Evangelical Lutheran      WellAware to out t the outpatient
                         Good Samaritan Society,   centers with wireless sensors for                  WellAware only launched a few weeks
WellAware                Hastin                    senior care. (more)                     07/01/09   before the announcement.
                                                   Centura Health signed on as the rst
                                                   sponsored listing in Healthagen's
                                                   iTriage smartphone application.                    Healthagen's iTriage helps users determine
Healthagen / iTriage     Centura Health            (more)                                  07/08/09   wait times at hospitals.
                                                   Highmark CMS slashed CardioNet's
                                                   reimbursement rate by one third.                   The move followed months of rumors and
Highmark CMS             CardioNet                 (more)                                  07/13/09   sent the company's stock plummeting.
                                                   Modavox bought Augme Mobile, a                     Augme Mobile Health is the start-up's
                                                   mobile marketing company for an                    wireless health focused marketing arm.
Modavox                  Augme Mobile              undisclosed sum. (more)                 07/15/09   Quickly becomes a focus at Modavox.
                                                   Bayer created “Didget” a blood
                                                   glucose meter that plugs into
                                                   Nintendo DS portable game system.                  The peripheral could spark a healthy
Bayer Healthcare         Nintendo                  (more)                                  07/16/09   games movement.
                                                   CallMD joins A.D.A.M.'s Medzio                     CallMD will license A.D.A.M. Symptom
CallMD                   A.D.A.M.                  Mobile Health Network. (more)           07/17/09   navigator content, too.
                                                   The pilot involves getting physicians              The pilot became public after the VA
Department of Veterans                             access to patient data while they are              announced it would tighten the belt on
A airs                   mVisum                    on their way to the bedside. (more)     07/21/09   pilot spending.
                                                   Digital sales and health marketing
                                                   company Physicians Interactive (PI)
                                                   acquired mobile medical content                    Skyscape has long created mobile
                                                   publisher Skyscape for an                          applications for healthcare workers dating
Skyscape                 Physicians Interactive    undisclosed sum. (more)                 07/27/09   back to PDAs.
                                                   Verizon Wireless and Qualcomm form
                                                   a joint venture called nPhase to
                                                   manage machine-to-machine
                                                   services, including many wireless                  nPhase also took over managing
Verizon Wireless         Qualcomm                  health o erings.                        07/28/09   CardioNet's service as part of the deal.
                                                   Patient at the hospital is rst to
                                                   receive wireless-enabled, remote                   The pacemaker connects to the server at
St. Francis Hospital     St. Jude Medical          monitoring pace maker. (more)           08/10/09   least once a day to make reports.




Page 28
Q3
                                                                                   Wirelss
                                                                                    Health
                                                                                     Deals
                                                                                                                   Continued


                                                                                            Date
Company A                Company B, etc.         What was the deal?                         Announced Other details?
                                                 The store chain teamed up with
                                                 Microsoft to invite wireless health                   Best Buy launched tness sections at its
                                                 device makers to pitch it to carry their              stores with some connected health
Best Buy                 Microsoft               products. (more)                           08/20/09   products a few months later.
                                                 Verizon Wireless certi ed Panasonic's                 The H1 was speci cally designed for
                                                 Toughbook H1 to run on its network.                   clinicians and based on extensive research
Verizon Wireless         Panasonic               (more)                                     08/27/09   conducted by Intel and Panasonic.
                                                 Jitterbug switched over to Verizon                    Jitterbug also announced it was now
Verizon Wireless         GreatCall / Jitterbug   Wireless' network from Sprint. (more)      08/27/09   pro table.
                                                 Harvard Pilgrim will pilot                            Chronic kidney disease a ects about 26
Harvard Pilgrim Health                           MedMinder's wireless-enabled PillBox                  million people and has no cure, but it can
Care                     MedMinder               for CKD patients. (more)                   08/31/09   be managed.
                                                 The carrier is working with the M2M
                                                 company to accelerate time to
                                                 market for healthcare services and                    According to one estimate: 430 million
Sprint                   DataSmart               connected devices. (more)                  09/03/09   M2M devices will ship in 2013
                                                 Halo's myHalo wireless monitoring                     myHalo wirelessly transmits secure vital
                                                 o ering now synchs to Microsoft                       signs, activities of daily living, and critical
Halo Monitoring          Microsoft               HealthVault. (more)                        09/09/09   event info.
                                                 Novartis has tapped Proteus for a
                                                 small, 20 patient study to track
                                                 compliance with a blood pressure                      Novartis told reporters (inexplicably) that
Novartis                 Proteus Biomedical      drug regimen. (more)                       09/22/09   the deal could become exclusive.
                                                 GE and Sprint installed a converged
                                                 wireless network at the company's six                 Methodist may hire more nurses thanks to
Methodist Healthcare     GE, Sprint              hospitals. (more)                          09/23/09   the savings from the network, reportedly.
                                                 AirStrip inked a purchasing
                         Premier Healthcare      agreement with the alliance, which                    AirStrip had more than 100 customers at
AirStrip                 Alliance                has 2,200 hospital members. (more)         09/29/09   the time.
                         EosHealth, StratREF,    DeviceAnywhere tests the wireless                     DA noted an uptick in wireless health
DeviceAnywhere           Sensei                  health service's for QoS. (more)           09/30/09   services looking to test QoS in 2009.




Page 29
2009 stateoftheindustry
2009 stateoftheindustry
2009 stateoftheindustry
2009 stateoftheindustry
2009 stateoftheindustry
2009 stateoftheindustry

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2009 stateoftheindustry

  • 1. WIRELESS HEALTH: STATE OF THE INDUSTRY 2009 Year End Report December 16, 2009
  • 2. TABLE OF CONTENTS Publisher’s Note and Editor’s Letter 1 Industry Metrics: Wireless Health by the Numbers 2 Carriers Take the Lead on Wireless Health 7 Care Providers Push Pilots, Look for Results 11 Alliances and Institutes Accelerate Time to Market 14 Reimbursement Rises and Falls 18 Consumer Health: The Answer to “Who Pays?” 20 2009 Wireless Health Venture Capital 23 2009 Wireless Health Deals 25 A Step-By-Step How-to for Wireless Health Regulation 32 The Year in Conclusion 35
  • 3. Publisher’s Note Dear reader, As 2009, the first year of publishing for MobiHealthNews draws to a close, our team has been busy revisiting the top stories, deals, interviews and event coverage from the past 12 months. After writing more than 700 posts on the MobiHealthNews site, publishing 45 newsletters, attending and covering countless industry events and reading well over 2000 comments from our readers, we would like to present the MobiHealthNews' Wireless Health State of the Industry Year End Report. We would like to thank our site's premier sponsors: MedApps, West Wireless Health Institute and AllOne Health for supporting our efforts. We would also like to thank our publica- tion's many outside contributors whose perspective has added experience and depth to our industry coverage. While this report pulls from some of their work, I would like to point out that any errors, misconceptions or wayward commentary rest squarely on the shoulders of our editor, Brian Dolan. Thank you for being an active member of the MobiHealthNews community. We look forward to serving you in the New Year. Sincerely, Joe Maillie Publisher, Co-Founder MobiHealthNews Letter from the Editor Dear Reader, As the break out year for wireless health comes to a close, so too does MobiHealthNews' first year of publishing. Please accept this report as our holiday gift to you. Feel free to re-gift it to colleagues, friends and family. For those scrappy wireless health startups reading, this may be an opportunity to approach that wealthy uncle or aunt you had hoped would come on as an Angel investor—N.B. this report contains nearly all of the wireless health market metrics publicly released this past year as well as a round-up of other startups that received funding in '09. The quarter-by-quarter deals charts also read like an industry timeline that chronicles much of the higher-level activity that took place throughout 2009. We hope that the recaps and summaries contained herein provide a snapshot of much of the activities that accelerated the wireless health industry these past 12 months. By the looks of it, 2010 should see even more action for wireless health. We look forward to serving you in the New Year. Many thanks, Brian Dolan Editor & Co-Founder MobiHealthNews State of the Industry Page 1
  • 4. Industry Metrics: Wireless Health By the Numbers Numbers can be helpful. While industry metrics alone cannot propel an emerging market forward, they can serve as inspiration to make a change. Many of the numbers pegged in this section point to opportunity. Here is the summation and aggregation of a year's worth of indus- try metrics that have shaped and prodded wireless health strategy in 2009. Sizing up wireless health's market opportunity The current wireless home health market is $304 million, according to CTIA, the Wireless Asso- ciation. Citing Parks Associates research, CTIA stated that the market is expected to grow to $4.4 billion in 2013, with estimated annual growth rates of 96 percent in 2010, 126 percent in 2011, 95 percent in 2012, and 68 percent in 2013. ABI Research estimates that the market for wearable wireless sensors is set to grow to more than 400 million devices by 2014. Of course health and fitness sensors aren't the only use case for wearable sensors but they will likely dominate that market. ON World's research views the wire- less sensor market through a different lens: While it does not estimate the market for “wearable” wireless sensors, it believes wireless sensors in general will reach a global market value of $6 billion by 2012. That estimate would include wireless sensors installed at home or in managed care facilities: Certainly a key technology group for home health. ABI Research also estimates that revenue from worldwide sales of WiFi-enabled healthcare products, a specific sub category of wireless health that probably includes medical devices inside care facilities, will reach nearly $5 billion in 2014. Forgetting the specific technologies for a minute: What about a market size for home health monitoring of chronic diseases overall? Berg Insight pegs that figure at $11 billion last year for the US and Europe. That market is growing at 10 percent per year, the firm claims, and some 300 million people in Europe and the US have at least one chronic disease that may benefit from home health monitoring. Berg believes that about 25 percent of that population would benefit from existing home monitoring solutions currently available, while some 50 percent would benefit from integrating or connecting existing medical devices with their mobile phones. No matter how you slice it, the market for wireless health is ripe and growing. Consumer demand Some 78 percent of the US is interested in mobile health solutions, according to a survey conducted by CTIA and Harris Interactive. About 15 percent of the US is extremely or very inter- ested in learning more about mobile health solutions, according to the survey. Interestingly, 19 percent of respondents said they would upgrade their current mobile phone plan to get access to wireless health services, while about 11 percent said they would even switch carriers to get access. Why were they so eager? About 40 percent said mobile health would supplement the medical care they receive from their doctor; 23 percent believe mobile health services could State of the Industry Page 2
  • 5. Industry Metrics: Wireless Health By the Numbers replace doctor visits altogether. More than half of respondents said mobile health would benefit rural populations the most; just under half of respondents believed people with chronic condi- tions would benefit the most; 41 percent said that retired and or Medicare patients would benefit the most from mobile health. Finally, 38 percent said caregivers would gain the most from mobile health services. PricewaterhouseCoopers conducted a similar survey that found 73 percent of consumers would use biometric electronic remote monitoring services to track their chronic condition or vital signs. The figure closely mirrors the near three-quarters of the US population interested in mobile health. Saying and doing are two separate things: According to a survey conducted by the National Coun- cil on Aging: One in four people with chronic conditions are delaying care. The percentage is much higher for Baby Boomer women (39 percent) and Latinos (43 percent.) Perhaps easier-to- use and more productive tools like some mobile health solutions could help encourage those with chronic conditions to take control of their own health sooner. Expected consumer demand is driving wireless health uptake in managed care facilities: A survey conducted by the Mathers LifeWays Institute on Aging found that senior living community administrators expect that smart home and wireless health offerings will attract residents to their communities. As a result smart home technologies are expected to increase their penetra- tion from 8 percent of senior communities today to 39 percent come 2013. Overburdened healthcare system While the aggregate influx of connected health devices and monitoring services could potentially inject a fire hose of new data into an already overtaxed healthcare system, many wireless health tools can help care providers do their job more efficiently and stretch their reach more comfort- ably beyond their current workload. The numbers indicate that care providers as a group are shrinking while the number of sick and elderly Americans is increasing. Wireless health can play a role to mitigate these alarming trends. At the beginning of 2009 during the height of the economic downturn, 71 percent of hospitals said that budget allocations for IT were expected to be smaller in 2009 than in 2008, according to a study commissioned by NCR. Because of the economic downturn some 36 percent of hospi- tals said they were being more cautious about IT spending, while 19 percent said they had already delayed spending on certain IT purchases. A full 16 percent delayed all non-essential IT project funding as of February. As IT budgets shrank, the specter of a physician and nurse shortage loomed: The number of US medical school students who choose primary care has dropped almost 52 percent since 1997, according to the American Academy of Family Physicians (AAFP). The group predicts a shortage of 40,000 family physicians by 2020. The US currently has about 100,000 family physicians, but it State of the Industry Page 3
  • 6. Industry Metrics: Wireless Health By the Numbers will need about 140,000 in ten years. Only half the number of physicians needed are entering the field today. The shortage of nurses is already taking a toll on those in wards today: Nurses report the short- age impacts their day-to-day job, according to a study conducted by Epocrates. About 46 percent of nurses say the shortage decreases the amount of time they can spend with their patients. About 42 percent say it increases their responsibilities and about 37 percent say it increases their patient load. To compound the problem, Americans as a group are getting older. Today, about 12 percent of the US is 65 years old or older, but by 2030 about 20 percent of the US population will be 65 or older. In 2005 the 78 million Americans 65 years old or older accounted for $2 trillion in total health expenditures. The 78 million Baby Boomers, who were born between 1946 and 1964, will begin turning 65 in 2011. The other group that could add to the strain on the system is the 47 million uninsured Americans. Aging aside, the US population as a whole is not fit. The CDC said that the average American is about 23 pounds overweight and consumers eat about 250 more calories a day than the average American did two or three decades ago. According to the West Wireless Health Institute 5 million Americans are affected by Alzheimers; 20 million are affected by asthma; 3 million are affected by breast cancer; 10 million are affected by COPD; 19 million are affected by depression; 21 million are affected by diabetes; 5 million are affected by heart failure; 74 million are affected by hypertension; 80 million are affected by obesity; 15 million are affected by sleep disorders. Our overburdened healthcare system cannot help them all through the old methods, but wire- less remote monitoring tools could help prevent and/or manage these conditions and others. There are many factors that lead to disease, but up to 40 percent of all chronic conditions are attributable to our behavior. Wireless health solutions can monitor, analyze, encourage and ultimately change behavior. The tools are at hand For many access to wireless health solutions is a given: Close to 90 percent of the US population, about 276 million Americans, already has a mobile phone. During the first half of the year more than 740 billion text messages were transmitted in the US. Text messaging is one of the simplest channels to deliver public health messages like the White House plans to do with its Text4Baby program for low income, expectant mothers. The Center for Connected Health estimates that there is about 20 or 30 percent of the popula- tion where text message reminders will be very powerful. State of the Industry Page 4
  • 7. Industry Metrics: Wireless Health By the Numbers Beyond text messaging, close to 19 percent of Americans now have smartphones. By one estimate there are about 5,000 health and medical applications currently available in the market for smartphone users. Smartphone users may include a number of Medicaid patients: According to one “unofficial” study referenced at a wireless health industry event this year, five out of seven Medicaid patients in New York and New Jersey use smartphones. Of course, healthcare providers are also adopting mobile phones: Manhattan Research found that 64 percent of physicians use a smartphone today. That's 20 percent more physicians than in 2008. By 2013, 81 percent of physicians will use smartphones, the firm predicts. Healthcare providers have found that not all their patients are mobile phone or technologically savvy, however: About 33 percent of the people the Center for Connected Health works with in their wireless health pilots need a phone call to have someone walk them through how to use wireless devices. The tools are largely available and in the market. The key is to let the public know that these services are available, and then, of course, be sure to support the offerings with adequate customer service. Estimates for cost savings Verizon Wireless recently estimated that mobile broadband solutions improved U.S. health care productivity at a savings of almost $6.9 billion. That figure is expected to increase to $27.2 billion by 2016. And it's not just the carriers predicting big numbers: According to one survey conducted by Cambridge Consultants, 75 percent of healthcare providers, patients, payers and technology enablers believe that connected health preventative services could cut healthcare expenses by 40 percent. The Center for Connected Health sees two key drivers for connected health: Employers want to keep their health insurance costs low by keeping employees healthy; Insurers want to keep their costs low by ensuring care providers manage costs. As employers explore ways to help keep their employees in shape and manage their chronic conditions, wireless health service providers need to be there with solutions that have demon- strated efficacy. Insurers are beginning to increase capitation in order to put pressure on care providers to keep costs low. The Center for Connected Health noted that its parents company, Partners Healthcare has Blue Cross Blue Shield of Massachusetts breathing down its neck to make sure they are man- aging costs. Capitation is where the insurance provider pays care providers a flat rate for a year to care for patients and the care provider then has to do its best to control costs within that State of the Industry Page 5
  • 8. Industry Metrics: Wireless Health By the Numbers context. Partners expects that in the next three years close to 50 percent of its revenue will be capitated. That's motivation to keep patients healthy and prevent readmissions by equipping patients with the tools that help them to better manage their own health. At least 125 million Americans are living with one or more chronic diseases. An individual living with one chronic disease costs the US healthcare system $6,032 a year on average, according to Johns Hopkins School of Public Health. The total costs of chronic diseases in the US healthcare system today top $1.4 trillion. If a wireless health solution can help take a bite out of these figures, there is a business case for it. State of the Industry Page 6
  • 9. Carriers Take the Lead on Wireless Health “We took a run at this five years ago and it fizzled out pretty quickly,” explained Rob Mesirow, Vice President of CTIA, the international association for the wireless industry. “Quite frankly, it just wasn’t the time, the stars weren’t aligned, wireless data networks weren’t robust enough and medical data wasn’t there. Now, the next generation of doctors, who are more comfortable with health IT technology, along with stronger mandates from the federal level and robust carrier networks are coming together,” Mesirow told MobiHealthNews during an interview this past spring. “Everyone agrees that the healthcare industry is inefficient — and that’s putting it lightly.... When I specifically asked the carriers which verticals should we be focusing on, carriers have unanimously said that healthcare is one we should go for.” Carrier involvement starts with M2M One way that U.S. carriers will enable the wireless health market is via machine-to-machine busi- ness units and joint ventures, which aim to support connectivity for devices other than tradi- tional mobile phones. Earlier this year Verizon Wireless announced a machine-to-machine (M2M) joint venture with Qualcomm, called nPhase, which among other devices—will support wireless remote monitoring company, CardioNet's connectivity. Similarly, AT&T opened a device certification lab that aims to accelerate the entry of “netbooks, eReaders, portable navigation devices, utility products, and healthcare-related tracking devices” into the market. Shortly after the nPhase and AT&T lab announcements, Sprint inked a multi-year agreement with M2M com- pany DataSmart to help embedded device makers bring their products to market sooner. Sprint cited the demand for sophisticated M2M applications, including "the rapid growth in M2M healthcare." Amazon's eBook reader, the Kindle has long been referenced as a model that the wireless health industry should emulate in terms of working with wireless carriers: “Maybe it’s a little overused at this point, but the Kindle represents a different model. It’s not carrier-based. It’s not subscription-based. It’s one example of the kind of creative business models that are coming out of the wireless industry,” Mesirow said. Because of devices like the Kindle and the opportunity for wireless health devices, Harbor Research predicted this past year that M2M device shipments might top 430 million units by 2013. Verizon CEO Ivan Seidenberg believes that M2M device uptake is set to explode in the U.S. While we are approaching a 90 percent penetration rate in the U.S. for the number of Americans using mobile phones, the opportunity to reach 500 percent penetration is possible thanks to embed- ded devices and machine-to-machine (M2M) services. Seidenberg specifically pointed to connected medical devices like a wireless-enabled glucose monitor as an example of an embed- ded device that could push the industry to 500 percent penetration. Does wireless health need a LifeComm anymore? “MVNOs seem to pop up for anything these days,” Mesirow told MobiHealthNews. “So a health- care MVNO? Sure, why not? But I think all of the carriers are interested in offering wireless health State of the Industry Page 7
  • 10. Carriers Take the Lead on Wireless Health services over their networks.” Back in 2005 Qualcomm began to publicly discuss plans to launch LifeComm, a mobile phone service with wireless health applications and devices at its core, but back then specialized mobile phones services, also called mobile virtual network operators (MVNOs) were all the rage: ESPN Mobile, Disney Mobile and AMP'd Mobile were among the MVNOs that eventually made it to market. These sports and entertainment focused services quickly lost steam and mostly disbanded within a year. LifeComm never launched officially, but Qualcomm worked on the initiative for years until deciding in 2009 that the existing wireless carriers, especially Verizon Wireless, AT&T, Jitterbug and Sprint were willing to offer wireless health services themselves. Early in 2009, just before MobiHealthNews broke the news that LifeComm was shutting down, Qualcomm presented some of the devices and services that LifeComm was planning to support: A mobile phone with an embedded glucometer for diabetics and a mobile personal emergency response system (MPERS) medallion for seniors. For the MPERS device think "Lifeline on steroids," a Qualcomm representative said, a medallion small enough for users to wear around their neck, but it still contains the "guts" of a mobile phone and an accelerometer to detect activ- ity. “Qualcomm is reviewing its options with LifeComm in light of current capital market conditions that have prevented LifeComm from raising the third-party capital necessary to fully develop its initial launch product,” a Qualcomm spokesperson told MobiHealthNews in July. The devices and services that were set to launch through LifeComm ended up forming into their own start-ups and companies, Qualcomm said at an event in early December. In a lot of ways, the shuttering of LifeComm was a good news story for the emerging wireless health industry, Qualcomm's Clint McClellan noted. It meant that wireless carriers were willing to support these devices and services. Not needing LifeComm should be seen as a bright spot. Carriers establish their own health focused business units While most of the major U.S. carriers ramped up their M2M businesses in 2009 — business units or joint ventures that clearly have a stake in wireless health—a few carriers around the world actually launched healthcare dedicated business units, too. Both Vodafone Group and Verizon, the two owners of Verizon Wireless (45 percent and 55 percent, respectively), launched healthcare focused business units during the fourth quarter of the year. “I personally believe that the mobile phone has a very significant role to play in the provision of healthcare,” Vodafone Group CEO Vittorio Colao told attendees at the Mobile Healthcare Indus- try Summit in London this December. Colao explained that key use cases for mobile in healthcare include: the simplification of clinical work flows, statistical analysis of record keeping, supporting the chronically ill at home as well as reaching under-resourced and geographically dispersed State of the Industry Page 8
  • 11. Carriers Take the Lead on Wireless Health communities. In the short term, Colao said that many mobile health services can be created without having to develop new technology. More often than not we think about mobile health as very complex systems, which may be right for developed markets, but in general technology is not the prob- lem. For developing markets especially, many pilots have shown the power of mobile healthcare, Colao said, but unfortunately there has been little success in scaling these projects. Vodafone Group recently established a new mobile healthcare unit that aims to work with medical organi- zations, governments and pharmaceutical companies to fully understand what the needs are. “We want to start listening to governments and listening to pharmaceuticals to understand what the needs are. It is clear that there is a pressing need for a reevaluation for how we deliver health services in the coming year,” Colao said. “It is also clear to us that mobile technology has a role to play in how we … provide better service and improve healthcare for those in mature — and more importantly — in developing markets.” Verizon launched its healthcare focused business unit in November: Verizon Connected Health Care. On the wireless front, the group is working with a hospital in New Jersey to build a collabo- ration service that allows specialists to conduct video consultations via mobile devices: “Also coming are even more mobile capabilities, including taking video collaboration down to the mobile device. For instance, Verizon is already working with a hospital in New Jersey, [Verizon's managing principle for healthcare, Nancy] Green said, that is building a collaboration service with mobile endpoints, allowing specialists to do consultations from almost anywhere.” Verizon offers video consultations for applications like “tele-stroke” which allows physicians to review patients’ cases via live video to determine whether they should wait for a doctor to visit or be rush to emergency care. Green believes these services will become much more effective once remote patient monitoring of vitals and video collaboration applications come into the mix, too. Jitterbug ramps up wireless health services By any measure GreatCall's Jitterbug mobile phone service for seniors has led the pack of carriers offering or developing wireless health services for their users. In the past year Jitterbug has become profitable; added Internet capabilities to their phones; switched their network from Sprint to Verizon Wireless; acquired a mobile personal emergency response service start-up called MobiWatch; conducted pilots with various wireless health vendors like Meridian and Well- Doc; and launched a Services Store stocked with wireless health services. AT&T develops personal health devices; enables remote medical services While AT&T is the exclusive US carrier for the Apple iPhone, which has spurred much of the State of the Industry Page 9
  • 12. Carriers Take the Lead on Wireless Health direct-to-consumer wireless health market this past year, the carrier itself has also made moves to offer wireless health services directly to its users. For the past year AT&T has worked with Texas Instruments and start-up 24Eight on a “smart innersole” technology that uses wireless sensors to monitor the user's balance and gait. At the end of the year AT&T unveiled a prototype it called “smart slippers,” which target the senior care market. One analyst estimated the smart slippers and their service package could run about $100 per month. AT&T also announced it was providing cellular connectivity to Vitality's GlowCaps device, which is a pill box cap that fits most standard pill boxes and glows when the user fails to take their medi- cations. AT&T is also working with Hollywood-based Wound Technology Network to support the physi- cians' group's remote wound care management service. WTN is now using HTC smartphones running on AT&T's data network to access patient records and view images of wounds. WTN previously inked a deal with Verizon Wireless to support laptop data cards for its physicians. Lab workers at AT&T’s quality testing lab in San Antonio, Texas also recently let it slip that the carrier is testing a number of wireless devices and services, including mobile medical tracking systems. Sprint’s varied wireless health approach Along with Johnson & Johnson company Lifescan, Sprint funded a mobile phone-based diabetes management system pilot conducted by WellDoc. WellDoc found that the pilot led to a 2 percent A1c drop among many of its pilot users. As noted above, Sprint announced this year that it would work with M2M company DataSmart to help embedded device makers to bring their products to market sooner. Sprint teamed up with GE Healthcare update San Antonio, TX-based Methodist Healthcare’s six hospitals with a converged wireless network platform. The care provider said that since the system could more easily centrally manage the group's communications, the number of IT employees might decrease, which opens up an opportunity to hire more care workers. Sprint partner mVisum announced this year that it was working with the Veteran Affairs to test a system that aims to get critical medical information to a physician while they are on their way to a patient’s bedside. Conclusion: Carriers are out in front More so than any other potential wireless health service provider, wireless carriers are currently leading the way for managed wireless health services. Carriers have an engaged user base and the tools are already at their disposal to offer wireless health services to consumers. It looks like in the year ahead that carriers will continue to dominate as the service providers of choice. In a few years carriers will begin to work more closely with care providers not just to offer services to the care facilities themselves but also to offer them to the care providers' patients. State of the Industry Page 10
  • 13. Care Providers Push Pilots, Look for Results Kaiser Permanente leads the pack on wireless health While a number of care providers have researched and developed a number of wireless health services, the clear leader of the pack in 2009 has been Kaiser Permanente. At the very beginning of the year, Kaiser announced that it had just completed a pilot for text message appointment reminders with SMS vendor Mobilestorm. The pilot resulted in 0.73 percent fewer “no shows” across one of its care facility's population, which prompted the care provider to work toward a national rollout of the service. Kaiser Permanente's Director of Enterprise Engineering Carlos Matos told MobiHealthNews during an interview at the HIMSS conference that text messaging reminders are just the begin- ning: “On the SMS side we have had some good success with [text message] integration where we send notifications directly to member [mobile phones] for a variety of reasons,” Matos said. “Our plan is to stimulate more immediacy for our members and also make these communications more feature rich by integrating Kaiser Permanente’s carepoint solutions. We want to be able to provide outreach methods that traditionally took the form of mailings and convert those com- munications to kp.org or SMS.” Matos also noted that text messaging could help with the care provider’s population care man- agement. For example, a diabetic who has not had an A1c exam in a certain amount of time may be notified based on several different elements pulled from his EMR that it’s time to come in for an appointment. (Similarly, Mount Sinai recently announced a pilot it was conducting with Care- Speak to send adherence reminders via text messages to a teenager who had undergone a liver transplant recently. The pilot demonstrated a decrease in the incident of rejection episodes for the teens.) Kaiser Permanente is also “white boarding” a number of other innovation projects. One of the next services Matos said to expect coming out of Kaiser’s innovation team may be support for connected biomedical devices. These would be simple ones like wireless-enabled or USB connected blood pressure monitors that KP can equip its patients with for at-home use. These really improve clinical outcomes, Matos said, and they let providers capture very granular infor- mation that they can then use to make decisions based on that data analysis. Another example may be a connected weight scale that helps providers track a congestive heart failure patient’s weight over time. Kaiser's Medical Director of Health Informatics & Web Services Ted Eytan told MobiHealthNews in an interview this year that the value of mobile "comes back to getting that information in a useful way -- right when you need it. What Kaiser Permanente is very good at is taking really large systems and making them very accessible and flexible, which is something a lot of Health 2.0 companies can't do as well. We watch some of the mobile [health] demos going on and try to take what we can learn from them and apply it to our own system, but our goal, of course, is State of the Industry Page 11
  • 14. Care Providers Push Pilots, Look for Results always to improve the interaction between patient and doctor in order to improve medical care." At Kaiser the focus is clearly not on the technology or wireless in particular, but regardless, the group is pushing ahead with more wireless health offerings than most care providers in the US. The US Army and the Department of Veteran Affairs (VA) One of the first wireless health deals inked in 2009 was between AllOne Health and the Army for a mobile phone based communication system that allowed the Army's care givers and physicians to check-in and remotely monitor “wounded warriors” who had recently returned from the war with traumatic brain injuries. The Army licensed AllOne Mobile for 10,000 soldiers and is rolling it out on an incremental basis. A key wireless health partner of Sprint and BlackBerry's, mVisum, has also worked with the VA this year on wireless health solutions. mVisum is equipping physicians with a mobile phone appli- cation that allows them to access patient health information while they are on their way to the patient's bedside. Intel also announced that a regional division of VA was now a customer: The division of the VA had purchased a number of the company's remote patient monitoring, home health touchscreen devices: Intel Health Guides. Intel also inked deals with Memorial Hospital & Health System and a number of other Indiana-based home health agencies. Apple's iPhone: A game changer for care providers? A number of hospitals began to take a look at how they could better integrate Apple's iPhone into their overall clinical workflow once it became clear that a majority of physicians (64 percent) now use smartphones (and a growing number of them favor iPhones.) One of the first hospitals to announce its infatuation with the iPhone was Pennsylvania-based Doylestown Hospital, which was the first to be profiled on Apple's corporate site for equipping its care workers with iPhones. The hospital connected the iPhones to its Meditech EMR system. Houston-based Memorial Hermann care facilities followed as a second hospital profiled on Apple's site. Then, news broke that Apple was working directly with EMR vendor Epic Systems to integrate iPhones into Epic's EMR solution for a hospital at Stanford University. Rumor has it that the iPhone-EMR solution will roll out early next year and big care providers like Kaiser Permanente are already taking a look. One start-up that has begun to capitalize on the iPhone's growing popularity among care provid- ers is Voalte, a Florida-based startup the offers an iPhone-enabled voice, alarm, text service for nurses. The company piloted its application for nurses at Sarasota Memorial Hospital. Care providers begin to court wireless remote monitoring A number of care providers are beginning to develop and launch wireless remote monitoring State of the Industry Page 12
  • 15. Care Providers Push Pilots, Look for Results services for various chronic conditions: Partners Healthcare in Boston even spun out a start-up, named Connected Health, that is initially focused on a service for wireless remote monitoring of blood pressure through a connected cuff. The start-up just completed a pilot with Boston-area employer EMC. A number of care providers are also taking a look at wireless sensors: London-based St. Mary's Hospital plans to trial Toumaz Holding's wireless sensor for vital sign monitoring. The bandaid- like sensor monitors skin temperature, heart rate and respiration. Wireless sensor-enabled home-based monitoring startup WellAware inked deals with two senior care facilities: Evangeli- cal Lutheran Good Samaritan Society and Hastin. WellAware will equip the outpatient centers with wireless sensors for senior care. WellAware inked the deals this fall – only a few weeks after the startup launched. Mayo Clinic and STMicroelectronics are collaborating on a wireless cardiac monitoring service that will monitor heart rate, breathing rate, and physical activity. St. Francis Hospital is testing out St. Jude Medical's wireless-enabled, remote monitoring pace maker, which transmits data to the server at least once a day. Finally, Ohio Health has been testing out iShoe's smart innersole technology for fall prevention. iShoe is expected to launch in 2010 with a $100 pricepoint, according to one estimate. Health insurers offer wireless health services Health insurers have also begun to take an active role in offering wireless health solutions to their members: Significa Insurance Group (Significa) and Erin Group Administrators both inked deals with AllOne Health to allow their members to view, manage and exchange their health information with their physicians. AllOne Mobile works on a wide variety of mobile phones so the offering is easier for an insurance company to provide. When wireless health offerings are tied to a specific device, it makes more sense for the wireless carrier that supports that mobile phone to offer the service. Harvard Pilgrim made headlines this fall when it announced plans to pilot MedMinder's wireless-enabled PillBox for chronic kidney disease (CKD) patients. CKD affects about 26 million people according to the companies and it has no cure. By adhering to the right medication regimen, however, the disease can be managed. Harvard Pilgrim is piloting the system to deter- mine its efficacy. Blue Cross Blue Shield's venture arm has been particularly active in investing in wireless health startups this year: The firm made two big investments, one in Myca and another in Phreesia. Phreesia offers a touchscreen device that enables physicians' offices to more easily check-in patients and determine their insurance coverage immediately. Myca powers a physician collabo- ration platform that integrates everything from billing to EMRs to other administrative tasks and allows physicians to interact with patients via email or even text message. State of the Industry Page 13
  • 16. Alliances and Institutes Accelerate Time to Market While wireless carriers and care providers are perhaps two of the most important players in wire- less health after the patient, of course, this past year saw a growing role for industry organiza- tions, academic institutions and non-profit institutes. The groups evangelized the industry through events and educational seminars and pushed regulators and lawmakers to ripen the market for innovation. Their guidance has shepherded start-ups closer to launch and accelerated the overall progress of the industry in the past year. Here are the players worth keeping an eye on: West Wireless Health Institute In March the West Wireless Health Institute founded thanks to a $45 million gift from the Gary and Mary West Foundation and support from Qualcomm and Scripps Health. The San Diego- based Institute has since worked to take wireless medicine out of the lab and into the market- place. Don Jones, Qualcomm’s Vice President of Health and Life Sciences serves as the Institute’s Founding Board Member while Scripps Health’s Chief Academic Officer Eric Topol is the Institute’s Chief Medical Officer. Gary West is the Institute's chairman and Mehran Mehregany recently joined the team as the Institute's executive vice president of engineering and chief of engineering research. The organization is currently recruiting for other leadership positions. At the time of the Institute's founding, Topol noted that part of the Institute's mandate is to help validate the hundreds of wireless health devices that may already have FDA approval but are looking for clinical validation to make it to the market. By mid-year the WWHI announced that the first start-up it would help bring to market was wire- less sensor-enabled remote monitoring start-up Corventis, which specializes in detecting heart fluid status for patients with heart disease. The company uses a peel-and-stick, bandaid-like wireless sensor that can interface with a wireless device to track and monitor patients’ vital signs. The WWHI is currently facilitating clinical trials for the company. The WWHI has also been particularly effective at educating the industry and others about the wireless health opportunity by evangelizing key conditions that wireless health solutions could better manage and assembling data about the opportunities to lower costs in the overburdened US healthcare system through the use of wireless remote monitoring technologies. UCLA Wireless Health Institute The Wireless Health Institute (WHI) was established last year as a community of UCLA experts from engineering, medicine, nursing, pharmacology, public health and other disciplines that aims to improve “the timeliness and reach of health care through the development and applica- tion of wireless, network-enabled technologies integrated with current and next-generation medical enterprise computing.” In 2009 UCLA appointed Dr. Patrick Soon-Shiong as executive director of the university's Wireless Health Institute. State of the Industry Page 14
  • 17. Alliances and Institutes Accelerate Time to Market Soon-Shiong told MobiHealthNews in an interview that the Institute’s mandate is to not only enable the development of these technologies but also to foster wireless health start-ups and test the wireless health technologies to prove their efficacy: “I believe the only way we can truly transform healthcare is if we enable both patients and providers to have access to data that is truly ‘outcomes actionable,’” Soon-Shiong said. “Evidence-based, outcomes-driven data at the point-of-care is the goal. Those few words have a deep meaning to them — evidence-based outcomes based point-of-care. That is the holy grail for healthcare transformation.” Soon-Shiong noted that medication adherence is a key problem that wireless health can work to solve. He also pointed to a few other wireless health technologies he thinks encapsulates the potential of the technology: wireless biometric devices; sensors that can help detect developing foot ulcers before diabetics realize they are getting them; “smart” canes that use accelerometers to notify caregivers a patient may soon fall; and a wireless lens-less microscope that can use a phone’s camera for diagnostics. Continua Health Alliance The Continua Health Alliance, a consortium of more than 220 wireless and medical companies, which aim to create an interoperable ecosystem of medical devices and systems, has been busy this year. After announcing its first two Continua-certified products, the Alliance also announced two new wireless technologies for its Version 2 guidelines: ZigBee and Bluetooth Low Energy. Since then Continua has announced additional devices have been certified as Continua-approved and interoperable. The Continua Health Alliance has also been recognized as one of the key evangelists for remote patient monitoring on Capitol Hill. Continua's lobbying efforts helped convinced lawmakers to include remote monitoring in the US healthcare bill. Apart from ensuring interoperability among devices and lobbying the legislature, Continua's representatives have been at most of the wireless health focused industry events in the past year. Chuck Parker, Continua's executive director gave a stirring speech at an event in Seattle this past spring. Parker said that remote patient monitoring doesn’t need to do any more trials or pilots. He said that the Department of Veterans Affairs (VA) has done remote patient monitoring pilots with about 30,000 patients over the past four years. That’s enough pilots, Parker said, we don’t need to do any more pilots for remote patient monitoring; we need to move to deploy- ments, and look to the VA for their pilots’ findings. CTIA, The Wireless Association CTIA is an industry association for the wireless industry that hosts a number of events through- out the year and also serves as the wireless industry's liaison with Congress and various regula- tory bodies. CTIA quickly became a champion of wireless health in 2009 as it made the emerging industry a focus at its November event in San Diego. Apart from bringing in more than two-dozen State of the Industry Page 15
  • 18. Alliances and Institutes Accelerate Time to Market wireless health start-ups to show off their wares, the association also successfully courted the AARP to participate in the wireless health discussion. During the summer CTIA organized a wireless health event at the U.S. Senate, which brought the chairman of Intel and other wireless industry luminaries to discuss the opportunity that wireless presents to the healthcare industry. CTIA also lobbied the FCC not to enact net neutrality legisla- tion for wireless data networks, because, the CTIA argued, regulating the carriers' ability to manage wireless data traffic could stymie innovation particularly in the emerging wireless health industry. Requiring carriers to treat all data traffic the same would make it difficult for carriers to ensure critical medical information reaches its destination on time or in tact, the association argued. CTIA also suggested that the FCC make available more wireless spectrum for carriers citing the growing interest in wireless health services. American Telemedicine Association The American Telemedicine Association (ATA) was created in 1993 by a group of doctors who were using video conferencing links between larger health centers and rural clinics. The ATA now describes itself as part trade association and part professional association, because its members include clinicians, physicians, nurses as well as hospitals, institutions, government organizations, corporations, providers. The ATA offers educational work, including its annual conference, advo- cacy in Washington and elsewhere. The ATA also has special interest groups, about 15 different member groups in various areas that provide networking, and it is beginning to create practice guidelines related to healthcare. Why is the ATA interested in wireless healthcare? Pike & Fischer recently predicted that the market for telemedicine devices and services will climb to $3.6 billion in annual revenue over the next five years largely thanks to a push from wireless technologies, data compression and smart- phones. Telemedicine will be dominated by wireless technologies during that time period: More than 70 percent of telemedicine will be wireless healthcare, according to the firm. m-Health Innovation Centre This winter the GSM Association announced a partnership with the University of Manchester in the UK to establish an m-Health Innovation Centre in the city of Manchester. The groups said that the center will have a UK focus to start and aims to promote healthier lifestyles and early inter- vention through the use of wireless technology, which it believes can improve health outcomes. The Manchester m-Health Innovation Centre plans to conduct multidisciplinary research, bring- ing together researchers, healthcare organisations and industrial partners to conceive, develop and evaluate mobile health innovations. A major focus will be on citizen-led health and wellbe- ing, using mobile technology to enable people to play a more active role in determining their own health, providing a more personalized and responsive interface to public services. The new center hopes to provide a forum for sharing ideas, in-depth analysis of the market for wireless State of the Industry Page 16
  • 19. Alliances and Institutes Accelerate Time to Market health, facilitation of pilot trials as well as mHealth education and training. mHealth Alliance Early in 2009, the Vodafone Foundation, UN Foundation and the Rockefeller Foundation officially launched a new joint venture called the mHealth Alliance. By mid-year it appointed wireless industry vet David Aylward to helm the international organization as its executive director. The mHealth Alliance has a decidedly global health focus with a particular interest in bringing the wireless health stakeholders to developing markets. Aylward told MobiHealthNews in an inter- view that no group has managed to scale mHealth services—not in developed or developing markets. There haven't even been large trials yet. Most of what is out there are small, non- sustainable proofs of concept. The mHealth Alliance aims to support and facilitate the integra- tion of services so that rather than having a series of point services these services will become integrated and part of the healthcare system already in existence in that market. Integrating those services is just one mission of the Alliance. Integrating those kinds of services into underlying healthcare systems, e-health to use the short language, is a second. Getting sustainable economics under both of those is a third. Researching and showing the health and economic effect of doing that is a fourth. Underneath those there are more procedural activities, support activities like communications and connecting people together to technology initiatives. The mHealth Alliance recently announced a partnership with the Vodafone Americas Foundation to create an mHealth Alliance Award for the developer of an innovative wireless technology with the most potential to address critical health challenges, especially in developing regions. The prize for the award includes cash and benefits totaling $50,000 and guidance from the Alliance about developing the application. State of the Industry Page 17
  • 20. Reimbursement Rises and Falls “You are not going to get paid for cool ideas,” IntelliDOT CEO and founder of CardioNet James Sweeney told a group of wireless health entrepreneurs at the Wireless Life Sciences Alliance event this past spring. “You are not going to get paid for saving lives. You are not going to get paid for anything unless you can prove that you can save them money.... In the world we’re moving into, more than ever, if you can’t justify the cost benefits, then you will fail,” Sweeney said. “In my view, getting the FDA’s approval is not nearly as hard as getting the CPTs and insurance reim- bursement approvals.” CardioNet, the wireless remote patient monitoring company that Sweeney founded is perhaps the poster child for the first generation of wireless health companies. The company has the distinction of being the only pure-play wireless health company to have offered an initial public offering and one of the few to acquire reimbursement from the Centers for Medicaid & Medicare Services (CMS). At the very end of 2008, CardioNet secured a CPT that enabled it to collect $1,123.07 for its Mobile Cardiovascular Telemetry Service. After months of rumors that Highmark CMS planned to reduce its reimbursement rate for Cari- doNet and other MCOT services, the payer did. In July CardioNet announced that Highmark Medicare Services planned to slash its reimbursement rate for MCOT services to $754 per service, effective September 1, 2009. Highmark CMS gave no explanation for the cut other than that it believed it was the true value of the service. CardioNet's reimbursement dip sent the company's stock tumbling and forced it to announce plans to cut back on operational costs to sustain its business. Analyst firm Frost & Sullivan sees a bright future for remote patient monitoring, but the key for the industry is reimbursement: The market for remote patient monitoring is set to achieve double digit growth in North America, according to the firm, so long as successful payment strat- egies are implemented. Last year the remote patient monitoring market made more than $98.2 million, but the market could top $428.6 million by 2015. Frost points to direct reimbursement as one type of payment strategy that needs to mature for the market to grow at this rate: “At present, it seems very unlikely that any significant progress will be made toward direct reim- bursement in the next two to five years,” Zachary Bujnoch, industry analyst, Frost & Sullivan stated in the firm’s release. “As a result, market participants are forced to seek alternative payment strategies, and while some of these have proved successful, the huge billion dollar market potential this space possesses is unlikely to be reached without some form of direct reim- bursement.” Two to five years before significant progress is made toward direct reimbursement? If Frost is correct, then more wireless health start-ups will pursue a direct-to-consumer model or an indirect to consumer model through their employers, who are financially motivated to keep their employees healthy and working. State of the Industry Page 18
  • 21. Reimbursement Rises and Falls Some online health services began to see some progress on the reimbursement front this past year: New York-based MPV Health Care plans to reimburse for more than 22,0000 physicians who use McKesson subsidiary RelayHealth’s webVisit consultations with their patients. Mobile health companies, however, remain frustrated by CMS. Chronic disease management service provider BeWell Mobile's Vice President and General Manager Greg Seiler believes that CMS should help wireless health companies better understand the reimbursement eligibility process: “It’d help to have clear support and guidance coming from Washington for how to enter the CMS system and get reimbursed for technologies that work,” Seiler told attendees of the Wireless in Healthcare IT event held at a Senate office building this past March. “What are the metrics for demonstrating the technology works? How can we get them reimbursed? [Answers to these questions could help mHealth move forward] and help to mitigate some of the risks that we would otherwise enjoy taking on.” Even devices that are much cheaper than the ones CMS reimburses for currently have trouble getting an audience with the payer. The New York Times published a feature entitled Insurers Shun Multitasking Speech Devices, this past September, that focused on a patient with A.L.S. Since the muscles around her mouth and throat no longer allowed her to speak, she used an $8,000 computer that Medicare approved with software that turns typed words into speech. In this patient's case, however, a much cheaper ($190) iPhone app called Proloquo2Go served her needs better as a person living a mobile life. Payers do not seem to be interested in taking advan- tage of consumer devices' cheaper price points, which could, ultimately help curb healthcare expenditures. CMS, however, has yet to answer Seiler, Proloquo2Go and the rest of the industry's calls for a seat at the table. It's a conversation that is not taking place, and if Frost & Sullivan is right, it may not for a few more years. Until then, wireless health companies need to keep pounding on CMS' door, while proving their products efficacy and perhaps eyeing a different go to market strategy in the meantime. State of the Industry Page 19
  • 22. Consumer Health: The Answer to "Who Pays?" There are currently 1.2 million people who use mobile fitness products to track their vital signs while working out. It starts with fitness, but use cases for health and medical wireless health services are set to become increasingly popular. A recent ABI report found that 90 percent of the current wearable wireless sensor market is dominated by the fitness industry. By 2014, the market will swell to 400 million units, thanks in large part to growing use of sensors for health- care and medical uses. With resistance from payers and uncertainty about the stability of a business model dependent on their steady support, a number of wireless health service providers and device makers have turned to direct to consumer as the best go-to-market strategy. Others never planned to become a part of the healthcare system and focused on creating personal health devices with an eye on the consumer market from the outset. During the course of the year a number of breakthroughs occurred for the wireless health consumer play: Best Buy invited wireless health startups to pitch it for shelf space and then launched fitness sections in 40 of its stores across the US; App developers created thousands of health, fitness and medical iPhone applications available for download directly from the App- Store; A myriad of personal health devices began selling their services direct to consumer via online stores like Amazon. Best Buy begins selling personal health devices One of the largest big box electronics stores took an interest in personal wireless health devices this past year: At the Microsoft Connected Health Conference in June, Best Buy teamed up with Microsoft’s HealthVault team to invite device makers to pitch the electronics store’s executives in a private meeting at the event: “If you believe that your product or solution can wow health- conscious shoppers at the largest consumer electronics retailer in the United States, this is your chance to make it happen,” stated the Microsoft-Best Buy invitation. The invitation also explained that “outstanding solutions providers” would have the opportunity to discuss collabo- ration opportunities with Best Buy during a special dinner later this summer. A few months later Best Buy announced that 40 of its stores in the U.S. had begun offering personal health solutions devices like pedometers, Bluetooth-enabled weight scales and blood pressure monitors. “New technologies are emerging daily to help people plan, monitor, and enhance their health and fitness activities,” Best Buy stated in its press release. “Yet finding the ways and the time to stay fit and motivated can seem more complicated than ever before. Starting today, Best Buy customers in select markets from Washington, DC to Denver can turn to the nation’s largest consumer electronics retailer for help in satisfying their health and fitness equipment and man- agement needs.” State of the Industry Page 20
  • 23. Consumer Health: The Answer to "Who Pays?" iPhone demonstrates consumer demand for mobile health ”Now here’s a class [of services] that we think will be really interesting: medical devices,” Apple SVP of iPhone Software Scott Forstall announced at the sneak peek event for iPhone 3.0. during the summer. Forstall then explained that the new iPhone OS will allow application developers to sync medical devices like blood pressure monitors or blood glucose monitors via both Bluetooth and USB. “So imagine the possibilities,” Forstall continued. “We think this is profound.” Forstall then invited a representative from Johnson & Johnson subsidiary Lifescan who demonstrated a concept iPhone app that interfaced with a connected blood glucose meter device. Since the iPhone 3.0 event in June, medical device makers and chronic disease management service providers have all been forging mobile strategies. iTMP is one startup that was early to market with a peripheral device for the iPhone: SM Heart Link, is a “wireless bridge” that can collect data from wireless sensors like heart rate chest straps or cycling sensors on bikes and send them to an iPhone for display and tracking. Wireless remote monitoring company MedApps looks to be integrating its system with smartphones, including the iPhone perhaps as soon as next year. Most wireless sensor startups, including Corventis, Sotera Wireless and Proteus Biomedical have all indicated that their sensors would interface with an application on the iPhone. Those startups are not pursuing a consumer health market strategy initially, but many expect them to create cheaper, consumer versions of their sensors in the future. Of course, the market for peripheral medical devices that interface with the iPhone could be a big market opportunity, however, the real success story for the wireless health services via mobile phones in the past year has been the rise of health, fitness and medical applications themselves. No other smartphone app store comes close to iPhone's thousands of health- related apps. From symptom navigators to chronic disease management tools; from medical reference guides to remote monitoring applications; from medication adherence apps to sooth- ing relaxation applications. Chances are if you have thought of a potential health-related applica- tion, there's a version of it already in the iPhone App Store. BlackBerry has also begun ramping up its health-related applications in its App World store and they include a wide variety of applications – many of them also offered for iPhone. BlackBerry, however, only offers a few hundred health apps compared to the thousands available for iPhones. Examples of other wireless personal health devices in the market Zeo Personal Sleep Coach - The Zeo headband uses the startup's patent-pending SoftWave sensor technology to accurately and safely measure the user's unique sleep patterns through the electrical signals produced by the brain. Zeo records those signals and can track which level of sleep the user is in and for how long based on the data. That data is then transmitted to the Zeo State of the Industry Page 21
  • 24. Consumer Health: The Answer to "Who Pays?" alarm clock, which acts as a gateway to send the data to Zeo's server where users can log-in and review their sleep habits. Zeo is available via Amazon.com or directly from the company's web- site. GlowCap – Vitality's GlowCap is a smart pillbox cap that can fit the average pillbox. GlowCap glows different colors when users forget to take their medication – it uses an accelerometer to determine when the pillbox is opened and makes a time stamp. The GlowCap can also alert care- givers when a person forgets to take their medication and can even call the pharmacy to get a refill. GlowCap is currently available via Amazon.com but the company does not believe direct to consumer will be its most successful distribution channel. Vitality hopes to get pharmaceutical companies or others to subsidize GlowCap for patients' use. AT&T recently announced that it would provide cellular connectivity for the product. Fitbit – This personal fitness device is currently sold out and on backorder, according to the com- pany. Fitbit tracks calories burned, steps taken, distance traveled and sleep quality by using an accelerometer. Fitbit tracks its users' motion in three dimensions and converts this data into usable information about daily into useful information about your daily activities. Fitbit uses a wireless base station that is positioned in the home – whenever a user walks near the basesta- tion the data is uploaded to Fitbit.com where users can analyze their personal health data. Fitbit is sold through the company's website but it is currently out of stock and not filling new orders until January 31, 2010. Philips DirectLife – Philips activity monitor DirectLife measures body acceleration in three differ- ent directions and combines that information with the user's age, gender, height and weight. The measurements are then converted to energy use, or calories burned. DirectLife's online program helps users establish goals and encourages and motivates users to increase their goals to exercise more in successive weeks. The device itself is tiny, smaller than a matchbox, and has no display screen. Instead it has a half dozen green LED lights that indicate to the user how close they are to meeting their exercise goal for the day. The service is currently available from the DirectLife web- site. State of the Industry Page 22
  • 25. Venture Capital 2009 Wireless Health Venture Capital in 2009 There were 15 venture capital investments announced during 2009 and 11 of them were for wireless remote patient monitoring start-ups. The remainder included a start-up working on a converged platform for physician-patient communications, a smartphone app developer focused on fitness games, a call-in physician consultation service, and a tablet-based patient check-in device for physician offices. While there were few, this year's investments cover a variety of wire- less health business models and offerings. In September MedMarket Diligence noted that investments and other financings in the medical device sector topped $400 million in July and August. The $22 million round that wireless health start-up CardioMEMS secured, led the pack. MedMarket predicted another $400 million in investments in medtech for the month of September alone. By October venture capitalists focused on healthcare were hedging their bets based on the direc- tion US healthcare reform was heading: VCs like Psilos and Chrysalis looked to fund companies that help people stay healthier and manage chronic diseases, figuring this is one way the govern- ment will ultimately move to take costs out of healthcare. In November following the CTIA Wireless IT & Entertainment event in San Diego, where more than two dozen wireless health start-ups demonstrated their solutions, wireless industry veteran analyst Chetan Sharma predicted a “lot of investment” would flow into the sector in the coming days. One venture capital firm, Mohr Davidow Ventures (MDV), which invested in wireless sensor start-up Corventis in the past, told MobiHealthNews that it was actively pursuing start-ups like Corventis that collect clinically-actionable data for point-of-care. MDV was chiefly interested in companies at the 510K level of FDA regulation. Products that require long, multi-year clinical trials before getting an FDA regulatory decision were not of interest. For the most part, the list of venture capital deals in the chart on the next page follow that trend. State of the Industry Page 23
  • 26. Venture Capital 2009 Date Company Amount Location Announced Investors Company Description Arcapita Ventures, Boston Developer of implantable wireless sensors that Millennium, Foundation track cardiac output, blood pressure and heart CardioMEMS $22.1 million Atlanta, GA 08/26/09 Medical rate (more) Lead Investor: InterWest Partners; Also: Kleiner Perkins Autonomic Cau eld & Byers, The Developer of implantable devices that aim to Technologies $20 million Menlo Park, CA 05/08/09 Cleveland Clinic soothe severe headaches (more) Lead Investor: BlueCross BlueShield Venture Partners; Also: Polaris Venture Partners, Developer of an automatic patient check-in HLM Venture Partners and device and service that aims to improve patient- Phreesia $11.6 million New York, NY 02/20/09 Long River Ventures provider relationship (more) Lead Investor: Seventure Partners; Also: ePlanet, Developer of wireless monitoring devices, Enterprise Ireland, and including a motion sensor that detects heart rate BiancaMed $9.8 million Belfast, Ireland 07/20/09 ResMed and respiration (more) Lead Investor: HLM Venture National network of primary care physicians that TelaDoc Partners; Also: Cardinal diagnose illness, recommend treatment, and Medical Services $9 million Dallas, TX 12/04/09 Partners, Trident Capital prescribe medication over the phone (more) Developer of wireless remote monitoring systems Valhalla Partners, .406 that track the daily activities of cared for WellAware $7.5 million Charlottesville, VA 12/08/09 Ventures. individuals in the home (more) MycaHub combines an EMR, a comprehensive admin system, and the ability for doctors to BlueCross BlueShield Venture communicate with their patients via a variety of Myca Health $5 million San Francisco, CA 10/06/09 Partners, Sandbox Industries. channels. (more) Investors include Cotswold Echo is developing a wireless blood glucose Echo Therapeutics $3.6 million Franklin, MA 12/04/09 Foundation monitor for diabetics. BL's platform, TVx, gathers info from Bluetooth- based wireless medical devices at home and BL Healthcare $3 million Foxborough, MA 08/06/09 undisclosed displays it on the TV. Lead Investor: PUK Ventures; Also: Catapult Venture Developer of wireless technology for monitoring Managers, University of the health of expectant mothers and babies Monica Healthcare $1.6 million Nottingham, UK 04/27/09 Nottingham (more) Carilion Biomedical Institute, Developer of medical applications for wireless Wireless Medcare $535K Roanoke, VA 12/11/09 Optimum Sensor Holdings and web-enabled devices (more) Developer of motion-detecting iPhone tness apps that include peer challenges to keep users GymFu $160K Hampshire, UK 12/01/09 Lead Investor: Channel 4's 4iP motivated eCardio Service provider of remote cardiac monitoring for Diagnostics undisclosed The Woodlands, TX 07/01/09 Sequoia Capital arrhythmia diagnosis (more) Developer of a personalized online tness New Venture Partners, coaching system and wireless monitoring device MiLife undisclosed Bedford, UK 01/16/09 Unilever Ventures (more) Developer of real-time physiological and biomechanical monitoring technology for defense, rst responder, training and research Zephyr Technology undisclosed Annapolis, MD 06/18/09 Motorola Ventures markets (more) Page 24
  • 27. 2009 Wirelss Health Deals Wireless Health Industry Deals in 2009 During the course of 2009, MobiHealthNews chronicled 73 business deals between two or more companies or organizations active in the emerging industry. We defined a deal as an acquisition, pilot, program, joint venture, or product or service launch in conjunction with another company. “For many global firms, the fastest path to market leadership will be through acquisition,” Invest- ment firm TripleTree's research director Chris Hoffmann told MobiHealthNews. “This consolida- tion may not come in the same flurry as we’ve seen in enterprise software, but some thoughtful strategic deals will begin to occur. Because many of the questions surrounding mHealth and Wireless Health solutions center on ‘who pays for them’, early M&A activity may be focused on those solutions demonstrating recurring revenue growth or meaningful end user (or patient) retention.” The 73 deals summarized here could serve as a timeline for wireless health activity in the past year. The deals are ordered chronologically, beginning with AllOne Health's massive pilot with the U.S. Army, which licensed AllOne Mobile for more than 10,000 wounded warriors managing traumatic brain injuries. The charts on the following pages are testament to the work accom- plished this year by wireless health companies, and it points to many more deals in 2010. Page 25
  • 28. Q1 Wirelss Health Deals Date Company A Company B, etc. What was the deal? Announced Other details? Army to pilot AllOne Mobile to stay in Army licensed the technology for 10,000 touch with “wounded warriors” soldiers, speci cally those with traumatic U.S. Army AllOne Health, Diversinet through their mobiles. (more) 01/14/09 brain injuries. The Mobile Viewer allows users to view but not edit pro le information as well as Anvita developed a mobile viewer of current prescriptions, existing health Google Anvita Mobile Google Health for Android. (more) 02/05/09 conditions, known allergies and more. KP worked with Mobilestorm for the pilot, Completed a pilot for text message which showed 0.73 fewer “no shows.” Kaiser Permanente Mobilestorm appointment reminders. (more) 02/05/09 National rollout to follow. As part of the announcement, IBM said it IBM and Continua to create had integrated its Information guidelines for wireless medical Management, Business Intelligence and Continua Health Alliance, devices to connect to Google Health. WebSphere Premises Server sensor event IBM Google (more) 02/12/09 platform into Google Health already. Companies formed, ng Connect, a group for vendors looking to create The group will focus on ve key areas, one Motorola, HP, Samsung, next-gen wireless devices with Alca- being: enterprise collaboration and e- Alcatel-Lucent others Lu. (more) 02/16/09 health. The Foundations teamed up with the The mHealth Alliance aims to bring Rockefeller Foundation to create the together the major mHealth stakeholders Vodafone Foundation UN Foundation mHealth Alliance. (more) 02/17/09 for the developing world. MobilizeMRS taps FrontlineSMS platform for its work in global health. MobilizeMRS rebranded to MobilizeMRS FrontlineSMS (more) 02/24/09 FrontlineSMS:Medic following the deal. Ohio Health pilots the smart Ohio Health expects iShoe to hit the Ohio Health iShoe innersole for fall prevention. (more) 02/26/09 market in 2010 with a pricepoint of $100. Edge Health to embed Allscript's EMR Allscripts launched its own iPhone app a Allscripts Edge Health into its iPhone app, EdgeRPM. (more) 03/04/09 few weeks later. Clickatell enables text messaging for AllOne Health's users in the Army look to AllOne Health Clickatell AllOne Mobile. (more) 03/11/09 be the rst to bene t. Signi ca Insurance Group The health plans' members can view, and Erin Group manage and exchange their health The deals made AllOne Mobile available to AllOne Health Administrators info with their providers. (more) 03/16/09 more than 400,000 people total. Rady Children's pilots GI's Pillcam, a Joshua Devine, a high school sophomore, tiny wireless camera inside a pill. swallowed the Pillcam at Grady's – one of Rady Children's Hospital Given Imaging (more) 03/17/09 the rst patients to do so. Telstra Foundation funded a two year Murdoch Children's mobile project for mental health The grant was for $285,000 Australian Telstra Foundation Research Institute services. (more) 03/25/09 dollars. Microsoft to allow personal health devices to connect to HealthVault via ANT+ is an alternative short range wireless Microsoft ANT Wireless ANT+. (more) 03/25/09 technology to ZigBee or Bluetooth. Qualcomm's Don Jones and Scripps' Dr. Gary and Mary West Qualcomm, Scripps GMWF donated $45M to create the Eric Topol join as part of the Institute's Foundation Health West Wireless Health Institute. (more) 03/30/09 founding board. Page 26
  • 29. Q2 Wirelss Health Deals Date Company A Company B, etc. What was the deal? Announced Other details? Verizon Wireless launches 4G innovation center with Alcatel-Lucent The center will focus on three key verticals: Verizon Wireless Alcatel-Lucent, Ericsson and Ericsson. (more) 04/01/09 healthcare, utility and security. Intel and GE announce partnership for home health monitoring and GE will market Intel's Health Guide as part contribute $250 million to R&D. of the deal, which also focuses on wireless Intel General Electric (GE) (more) 04/02/09 sensors for the senior care market. CardioNet agrees to buy Biotel and CardioNet Biotel enter clinical research. (more) 04/02/09 The deal eventually falls through. Jitterbug pilots a medication adherence service from Meridian and The services could become part of a diabetes management service from Jitterbug's Service Store – its version of an GreatCall / Jitterbug Meridian Health, WellDoc WellDoc. (more) 04/03/09 App Store. RPM company MedApps connects MedApps currently uses a dedicated devices' data streams to Microsoft's wireless device to route data from MedApps Microsoft HealthVault. (more) 04/12/09 connected medical devices. Proteus announces two drug companies will trial its “intelligent Later in the year, Novartis announces a trial Two undisclosed pharma medicine” technology and sensor. with Proteus – unclear if it's a separate Proteus Biomedical companies (more) 04/14/09 deal. A.D.A.M. announces Medzio, a Medzio continues to add a few new collaborative mobile app suite from partners throughout the year, but the HelloHealth, Norton, the newly formed Mobile Health app's sum does not appear to be more A.D.A.M. LiveStrong, others Network. (more) 04/21/09 popular than its parts. Doylestown Hospital becomes rst hospital pro led on Apple's site for equipping its care workers with The hospital connected the iPhones to iPhones throughout its facility. their Meditech EMR system and also Doylestown Hospital Apple (more) 04/30/09 noticed doctors favor Epocrates. The three companies teamed up to The collaboration results in AT&T's “smart Texas Instruments, work on smart innersoles for fall slippers” for fall prevention, unveiled in AT&T 24Eight prevention. (more) 05/26/09 December. Senior phone service provider Jitterbug worked with phone maker Samsung on its new Jitterbug J phone and Qualcomm to create a more “seamless” data connectivity for Jitterbug added 1xCDMA data to its users. The phone and data phones but it didn't want the users to connectivity enable the company's know they had Internet-enabled phones – Jitterbug Samsung, Qualcomm Services Store. (more) 06/02/09 perhaps too daunting. Remote cardiac monitoring company LifeWatch signed an exclusive agreement with Verizon to use its network to carry its wireless health Verizon Wireless LifeWatch services. (more) 06/04/09 LifeWatch is a big competitor to CardioNet. The White House is working with a number of industry partners to launch a free text messaging service, Text4Baby originally aimed to launch in Voxiva, CDC, J&J, CTIA, called Text4Baby, for low-income September but has since been delayed White House more expectant mothers. (more) 06/05/09 until next year. Interoperability consortium Continua certi ed Nonin's Bluetooth-enabled This marks the rst wireless health device Continua Health Alliance Nonin pulse oximeter. (more) 06/09/09 with Continua certi cation. Partners Healthcare in Boston spun out a start-up, named Connected Health for now, with an initial service Connected Health just completed a pilot around a wireless blood pressure cu . with EMC, which used the cu for Partners Healthcare Connected Health (more) 06/16/09 corporate wellness programs. The Institute announced plans to conduct clinical trials for Corventis Dr. Eric Topol and other Institute directors West Wireless Health and shepherd the sensor to market. demo Corventis' monitoring sensor at Institute Corventis (more) 06/23/09 events all year long. Page 27
  • 30. Q3 Wirelss Health Deals Date Company A Company B, etc. What was the deal? Announced Other details? Roche inked a deal with diabetes app developer MYLEstone Health to include some of Roche's diabetes MYLEstone saw the deal as a baby step for management software into the the industry and was fed up with hype company's Glucose Buddy around meter integration into Roche Diagnostics MYLEstone Health application. (more) 07/01/09 smartphones. Evangelical Lutheran WellAware to out t the outpatient Good Samaritan Society, centers with wireless sensors for WellAware only launched a few weeks WellAware Hastin senior care. (more) 07/01/09 before the announcement. Centura Health signed on as the rst sponsored listing in Healthagen's iTriage smartphone application. Healthagen's iTriage helps users determine Healthagen / iTriage Centura Health (more) 07/08/09 wait times at hospitals. Highmark CMS slashed CardioNet's reimbursement rate by one third. The move followed months of rumors and Highmark CMS CardioNet (more) 07/13/09 sent the company's stock plummeting. Modavox bought Augme Mobile, a Augme Mobile Health is the start-up's mobile marketing company for an wireless health focused marketing arm. Modavox Augme Mobile undisclosed sum. (more) 07/15/09 Quickly becomes a focus at Modavox. Bayer created “Didget” a blood glucose meter that plugs into Nintendo DS portable game system. The peripheral could spark a healthy Bayer Healthcare Nintendo (more) 07/16/09 games movement. CallMD joins A.D.A.M.'s Medzio CallMD will license A.D.A.M. Symptom CallMD A.D.A.M. Mobile Health Network. (more) 07/17/09 navigator content, too. The pilot involves getting physicians The pilot became public after the VA Department of Veterans access to patient data while they are announced it would tighten the belt on A airs mVisum on their way to the bedside. (more) 07/21/09 pilot spending. Digital sales and health marketing company Physicians Interactive (PI) acquired mobile medical content Skyscape has long created mobile publisher Skyscape for an applications for healthcare workers dating Skyscape Physicians Interactive undisclosed sum. (more) 07/27/09 back to PDAs. Verizon Wireless and Qualcomm form a joint venture called nPhase to manage machine-to-machine services, including many wireless nPhase also took over managing Verizon Wireless Qualcomm health o erings. 07/28/09 CardioNet's service as part of the deal. Patient at the hospital is rst to receive wireless-enabled, remote The pacemaker connects to the server at St. Francis Hospital St. Jude Medical monitoring pace maker. (more) 08/10/09 least once a day to make reports. Page 28
  • 31. Q3 Wirelss Health Deals Continued Date Company A Company B, etc. What was the deal? Announced Other details? The store chain teamed up with Microsoft to invite wireless health Best Buy launched tness sections at its device makers to pitch it to carry their stores with some connected health Best Buy Microsoft products. (more) 08/20/09 products a few months later. Verizon Wireless certi ed Panasonic's The H1 was speci cally designed for Toughbook H1 to run on its network. clinicians and based on extensive research Verizon Wireless Panasonic (more) 08/27/09 conducted by Intel and Panasonic. Jitterbug switched over to Verizon Jitterbug also announced it was now Verizon Wireless GreatCall / Jitterbug Wireless' network from Sprint. (more) 08/27/09 pro table. Harvard Pilgrim will pilot Chronic kidney disease a ects about 26 Harvard Pilgrim Health MedMinder's wireless-enabled PillBox million people and has no cure, but it can Care MedMinder for CKD patients. (more) 08/31/09 be managed. The carrier is working with the M2M company to accelerate time to market for healthcare services and According to one estimate: 430 million Sprint DataSmart connected devices. (more) 09/03/09 M2M devices will ship in 2013 Halo's myHalo wireless monitoring myHalo wirelessly transmits secure vital o ering now synchs to Microsoft signs, activities of daily living, and critical Halo Monitoring Microsoft HealthVault. (more) 09/09/09 event info. Novartis has tapped Proteus for a small, 20 patient study to track compliance with a blood pressure Novartis told reporters (inexplicably) that Novartis Proteus Biomedical drug regimen. (more) 09/22/09 the deal could become exclusive. GE and Sprint installed a converged wireless network at the company's six Methodist may hire more nurses thanks to Methodist Healthcare GE, Sprint hospitals. (more) 09/23/09 the savings from the network, reportedly. AirStrip inked a purchasing Premier Healthcare agreement with the alliance, which AirStrip had more than 100 customers at AirStrip Alliance has 2,200 hospital members. (more) 09/29/09 the time. EosHealth, StratREF, DeviceAnywhere tests the wireless DA noted an uptick in wireless health DeviceAnywhere Sensei health service's for QoS. (more) 09/30/09 services looking to test QoS in 2009. Page 29