wireless health: state of the industry 2009 year end report

8/14/2019 Wireless Health: State of the Industry 2009 Year End Report

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WIRELESS HEALTH:

STATE OF THE INDUSTRY

2009 Year End Report

December 16, 2009


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TABLE OF CONTENTS

Publishers Note and Editors 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


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Dear reader,

As 2009, the first year of publishing for MobiHealthNews draws to a close, our team has been

busy revising the top stories, deals, interviews and event coverage from the past 12 months.

Aer wring more than 700 posts on the MobiHealthNews site, publishing 45 newsleers,

aending 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

Instute and AllOne Health for supporng our efforts. We would also like to thank our publica-

on's many outside contributors whose perspecve 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, misconcepons or wayward commentary rest squarely on the shoulders of our editor,Brian Dolan.

Thank you for being an acve member of the MobiHealthNews community. We look forward to

serving you in the New Year.

Sincerely,

Joe Maillie

Publisher, Co-Founder

MobiHealthNews

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 gi to you. Feel free to re-gi 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

investorN.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 meline that chronicles much of the

higher-level acvity that took place throughout 2009.

We hope that the recaps and summaries contained herein provide a snapshot of much of the

acvies that accelerated the wireless health industry these past 12 months. By the looks of it,

2010 should see even more acon for wireless health. We look forward to serving you in the NewYear.

Many thanks,

Brian Dolan

Editor & Co-Founder

MobiHealthNews

Publishers Note

State of the Industry Page 1

Letter from the Editor


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Numbers can be helpful. While industry metrics alone cannot propel an emerging market

forward, they can serve as inspiraon to make a change. Many of the numbers pegged in this

secon point to opportunity. Here is the summaon and aggregaon 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-

ciaon. Cing Parks Associates research, CTIA stated that the market is expected to grow to $4.4

billion in 2013, with esmated annual growth rates of 96 percent in 2010, 126 percent in 2011,

95 percent in 2012, and 68 percent in 2013.

ABI Research esmates 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 esmate the market for wearable

wireless sensors, it believes wireless sensors in general will reach a global market value of $6

billion by 2012. That esmate would include wireless sensors installed at home or in managed

care facilies: Certainly a key technology group for home health.

ABI Research also esmates that revenue from worldwide sales of WiFi-enabled healthcare

products, a specific sub category of wireless health that probably includes medical devices inside

care facilies, will reach nearly $5 billion in 2014.

Forgeng 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 populaon would benefit

from exisng home monitoring soluons currently available, while some 50 percent would

benefit from integrang or connecng exisng medical devices with their mobile phones.

No maer 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 soluons, according to a survey

conducted by CTIA and Harris Interacve. About 15 percent of the US is extremely or very inter-

ested in learning more about mobile health soluons, according to the survey. Interesngly, 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

Industry Metrics: Wireless Health By the Numbers



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replace doctor visits altogether. More than half of respondents said mobile health would benefit

rural populaons the most; just under half of respondents believed people with chronic condi-

ons would benefit the most; 41 percent said that rered and or Medicare paents would

benefit the most from mobile health. Finally, 38 percent said caregivers would gain the mostfrom 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 condion or vital

signs. The figure closely mirrors the near three-quarters of the US populaon interested in

mobile health.

Saying and doing are two separate things: According to a survey conducted by the Naonal Coun-

cil on Aging: One in four people with chronic condions are delaying care. The percentage is

much higher for Baby Boomer women (39 percent) and Lanos (43 percent.) Perhaps easier-to -

use and more producve tools like some mobile health soluons could help encourage those

with chronic condions to take control of their own health sooner.

Expected consumer demand is driving wireless health uptake in managed care facilies: A survey

conducted by the Mathers LifeWays Instute on Aging found that senior living community

administrators expect that smart home and wireless health offerings will aract residents to

their communies. As a result smart home technologies are expected to increase their penetra-

on from 8 percent of senior communies today to 39 percent come 2013.

Overburdened healthcare system

While the aggregate influx of connected health devices and monitoring services could potenally

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 migate these alarming trends.

At the beginning of 2009 during the height of the economic downturn, 71 percent of hospitals

said that budget allocaons 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 cauous about IT spending, while 19 percent said they had

already delayed spending on certain IT purchases. A full 16 percent delayed all non-essenal 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




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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 me they can spend with their paents.

About 42 percent say it increases their responsibilies and about 37 percent say it increases their

paent load.

To compound the problem, Americans as a group are geng older. Today, about 12 percent of

the US is 65 years old or older, but by 2030 about 20 percent of the US populaon 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 populaon 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 Instute 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 condions and others.

There are many factors that lead to disease, but up to 40 percent of all chronic condions are

aributable to our behavior. Wireless health soluons can monitor, analyze, encourage and

ulmately change behavior.

The tools are at hand

For many access to wireless health soluons is a given: Close to 90 percent of the US populaon,

about 276 million Americans, already has a mobile phone. During the first half of the year more

than 740 billion text messages were transmied 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 esmates that there is about 20 or 30 percent of the popula-

on where text message reminders will be very powerful.




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Beyond text messaging, close to 19 percent of Americans now have smartphones. By one

esmate there are about 5,000 health and medical applicaons currently available in the market

for smartphone users.

Smartphone users may include a number of Medicaid paents: According to one unofficial

study referenced at a wireless health industry event this year, five out of seven Medicaid paents

in New York and New Jersey use smartphones.

Of course, healthcare providers are also adopng mobile phones: Manhaan 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 paents 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 usewireless 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.

Esmates for cost savings

Verizon Wireless recently esmated that mobile broadband soluons improved U.S. health care

producvity 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 predicng big numbers: According to one survey conducted

by Cambridge Consultants, 75 percent of healthcare providers, paents, payers and technology

enablers believe that connected health preventave 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

condions, wireless health service providers need to be there with soluons that have demon -

strated efficacy.

Insurers are beginning to increase capitaon 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 Massachuses breathing down its neck to make sure they are man-

aging costs. Capitaon is where the insurance provider pays care providers a flat rate for a year

to care for paents and the care provider then has to do its best to control costs within that




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context. Partners expects that in the next three years close to 50 percent of its revenue will be

capitated. That's movaon to keep paents healthy and prevent readmissions by equipping

paents with the tools that help them to beer 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 soluon can help take a bite out of these figures, there is a business case for

it.




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We took a run at this five years ago and it fizzled out prey quickly, explained Rob Mesirow,

Vice President of CTIA, the internaonal associaon for the wireless industry. Quite frankly, it

just wasnt the me, the stars werent aligned, wireless data networks werent robust enough

and medical data wasnt there. Now, the next generaon of doctors, who are more comfortablewith 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 thats pung it

lightly.... When I specifically asked the carriers which vercals 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 connecvity for devices other than tradi-

onal mobile phones. Earlier this year Verizon Wireless announced a machine-to-machine

(M2M) joint venture with Qualcomm, called nPhase, which among other deviceswill support

wireless remote monitoring company, CardioNet's connecvity. Similarly, AT&T opened a device

cerficaon lab that aims to accelerate the entry of netbooks, eReaders, portable navigaon

devices, ulity products, and healthcare-related tracking devices into the market. Shortly aer

the nPhase and AT&T lab announcements, Sprint inked a mul-year agreement with M2M com-

pany DataSmart to help embedded device makers bring their products to market sooner. Sprint

cited the demand for sophiscated M2M applicaons, 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 its a lile overused

at this point, but the Kindle represents a different model. Its not carrier-based. Its not

subscripon-based. Its one example of the kind of creave 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 penetraon rate in the U.S. for the number of Americans using

mobile phones, the opportunity to reach 500 percent penetraon 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 penetraon.

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

Carriers Take the Lead on Wireless Health



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services over their networks.

Back in 2005 Qualcomm began to publicly discuss plans to launch LifeComm, a mobile phone

service with wireless health applicaons and devices at its core, but back then specialized mobilephones 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

iniave for years unl deciding in 2009 that the exisng wireless carriers, especially Verizon

Wireless, AT&T, Jierbug and Sprint were willing to offer wireless health services themselves.

Early in 2009, just before MobiHealthNews broke the news that LifeComm was shung down,

Qualcomm presented some of the devices and services that LifeComm was planning to support:

A mobile phone with an embedded glucometer for diabecs and a mobile personal emergency

response system (MPERS) medallion for seniors. For the MPERS device think "Lifeline on

steroids," a Qualcomm representave said, a medallion small enough for users to wear around

their neck, but it sll contains the "guts" of a mobile phone and an accelerometer to detect acv -

ity.

Qualcomm is reviewing its opons with LifeComm in light of current capital market condions

that have prevented LifeComm from raising the third-party capital necessary to fully develop its

inial 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 shuering 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 healtha 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, respecvely), 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 Viorio Colao told aendees at the Mobile Healthcare Indus -

try Summit in London this December. Colao explained that key use cases for mobile in healthcare

include: the simplificaon of clinical work flows, stascal analysis of record keeping, supporng

the chronically ill at home as well as reaching under-resourced and geographically dispersed




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communies.

In the short term, Colao said that many mobile health services can be created without having to

develop new technology. More oen than not we think about mobile health as very complexsystems, 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 lile success in scaling these projects. Vodafone

Group recently established a new mobile healthcare unit that aims to work with medical organi-

zaons, governments and pharmaceucal companies to fully understand what the needs are.

We want to start listening to governments and listening to pharmaceucals to understand what

the needs are. It is clear that there is a pressing need for a reevaluaon 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 beer 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-

raon service that allows specialists to conduct video consultaons via mobile devices:

Also coming are even more mobile capabilies, including taking video collaboraon 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 collaboraon service

with mobile endpoints, allowing specialists to do consultaons from almost anywhere.

Verizon offers video consultaons for applicaons like tele-stroke which allows physicians to

review paents 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 effecve

once remote paent monitoring of vitals and video collaboraon applicaons come into the mix,

too.

Jierbug ramps up wireless health services

By any measure GreatCall's Jierbug mobile phone service for seniors has led the pack of carriers

offering or developing wireless health services for their users. In the past year Jierbug has

become profitable; added Internet capabilies 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




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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 withTexas 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 prototypeit called smart slippers, which target the senior care market. One analyst esmated the smartslippers and their service package could run about $100 per month.

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

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 smartphonesrunning on AT&T's data network to access paent records and view images of wounds. WTN

previously inked a deal with Verizon Wireless to support laptop data cards for its physicians. Labworkers at AT&Ts quality tesng lab in San Antonio, Texas also recently let it slip that the carrieris tesng a number of wireless devices and services, including mobile medical tracking systems.

Sprints varied wireless health approach

Along with Johnson & Johnson company Lifescan, Sprint funded a mobile phone-based diabetesmanagement system pilot conducted by WellDoc. WellDoc found that the pilot led to a 2 percentA1c 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 Healthcares sixhospitals with a converged wireless network plaorm. The care provider said that since thesystem could more easily centrally manage the group's communicaons, the number of ITemployees 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 asystem that aims to get crical medical informaon to a physician while they are on their way toa paents bedside.

Conclusion: Carriers are out in front

More so than any other potenal wireless health service provider, wireless carriers are currentlyleading the way for managed wireless health services. Carriers have an engaged user base andthe tools are already at their disposal to offer wireless health services to consumers. It looks likein the year ahead that carriers will connue to dominate as the service providers of choice. In afew years carriers will begin to work more closely with care providers not just to offer services tothe care facilies themselves but also to offer them to the care providers' paents.




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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 beginningof 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 populaon, which prompted the care provider to work toward a

naonal 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] integraon where we

send noficaons directly to member [mobile phones] for a variety of reasons, Matos said. Our

plan is to smulate more immediacy for our members and also make these communicaons

more feature rich by integrang Kaiser Permanentes carepoint soluons. We want to be able to

provide outreach methods that tradionally took the form of mailings and convert those com -

municaons to kp.org or SMS.

Matos also noted that text messaging could help with the care providers populaon care man -

agement. For example, a diabec who has not had an A1c exam in a certain amount of me may

be nofied based on several different elements pulled from his EMR that its me to come in for

an appointment. (Similarly, Mount Sinai recently announced a pilot it was conducng 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 rejecon episodes for

the teens.)

Kaiser Permanente is also white boarding a number of other innovaon projects. One of the

next services Matos said to expect coming out of Kaisers innovaon 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 paents with for at-home use. These

really improve clinical outcomes, Matos said, and they let providers capture very granular infor-

maon 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 congesve heart failure paents

weight over me.

Kaiser's Medical Director of Health Informacs & Web Services Ted Eytan told MobiHealthNews

in an interview this year that the value of mobile "comes back to geng that informaon 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

Care Providers Push Pilots, Look for Results



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always to improve the interacon between paent and doctor in order to improve medical care."

At Kaiser the focus is clearly not on the technology or wireless in parcular, 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 communicaon 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 traumac 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 soluons. mVisum is equipping physicians with a mobile phone appli-

caon that allows them to access paent health informaon while they are on their way to the

paent'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 paent 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 beer 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 infatuaon 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 facilies 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 soluon for a hospital at Stanford University. Rumor has it that the iPhone-EMR soluon 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 applicaon 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




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services for various chronic condions: Partners Healthcare in Boston even spun out a start-up,

named Connected Health, that is inially 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 respiraon. Wireless sensor-enabled

home-based monitoring startup WellAware inked deals with two senior care facilies: Evangeli-

cal Lutheran Good Samaritan Society and Hasn. WellAware will equip the outpaent centers

with wireless sensors for senior care. WellAware inked the deals this fall only a few weeks aer

the startup launched. Mayo Clinic and STMicroelectronics are collaborang on a wireless cardiac

monitoring service that will monitor heart rate, breathing rate, and physical acvity. St. Francis

Hospital is tesng 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 tesng out iShoe'ssmart innersole technology for fall prevenon. iShoe is expected to launch in 2010 with a $100

pricepoint, according to one esmate.

Health insurers offer wireless health services

Health insurers have also begun to take an acve role in offering wireless health soluons 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 informaon 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 ed 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) paents. CKD affects about 26 million

people according to the companies and it has no cure. By adhering to the right medicaon

regimen, however, the disease can be managed. Harvard Pilgrim is pilong the system to deter-

mine its efficacy.

Blue Cross Blue Shield's venture arm has been parcularly acve in invesng 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

paents and determine their insurance coverage immediately. Myca powers a physician collabo-

raon plaorm that integrates everything from billing to EMRs to other administrave tasks and

allows physicians to interact with paents via email or even text message.




16/37

While wireless carriers and care providers are perhaps two of the most important players in wire-

less health aer the paent, of course, this past year saw a growing role for industry organiza-

ons, academic instuons and non-profit instutes. The groups evangelized the industry

through events and educaonal seminars and pushed regulators and lawmakers to ripen themarket for innovaon. 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 Instute

In March the West Wireless Health Instute founded thanks to a $45 million gi from the Gary

and Mary West Foundaon and support from Qualcomm and Scripps Health. The San Diego-

based Instute has since worked to take wireless medicine out of the lab and into the market -

place. Don Jones, Qualcomms Vice President of Health and Life Sciences serves as the Instutes

Founding Board Member while Scripps Healths Chief Academic Officer Eric Topol is theInstutes Chief Medical Officer. Gary West is the Instute's chairman and Mehran Mehregany

recently joined the team as the Instute's execuve vice president of engineering and chief of

engineering research. The organizaon is currently recruing for other leadership posions.

At the me of the Instute's founding, Topol noted that part of the Instute's mandate is to help

validate the hundreds of wireless health devices that may already have FDA approval but are

looking for clinical validaon 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 Corvens, which specializes in detecng heart

fluid status for paents with heart disease. The company uses a peel-and-sck, bandaid-like

wireless sensor that can interface with a wireless device to track and monitor paents vital signs.

The WWHI is currently facilitang clinical trials for the company.

The WWHI has also been parcularly effecve at educang the industry and others about the

wireless health opportunity by evangelizing key condions that wireless health soluons could

beer manage and assembling data about the opportunies to lower costs in the overburdened

US healthcare system through the use of wireless remote monitoring technologies.

UCLA Wireless Health Instute

The Wireless Health Instute (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 meliness and reach of health care through the development and applica-

on of wireless, network-enabled technologies integrated with current and next-generaon

medical enterprise compung. In 2009 UCLA appointed Dr. Patrick Soon-Shiong as execuve

director of the university's Wireless Health Instute.

Alliances and Institutes Accelerate Time to Market



17/37

Soon-Shiong told MobiHealthNews in an interview that the Instutes 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 paents and providers to have access to data that istruly outcomes aconable, 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 transformaon.

Soon-Shiong noted that medicaon 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

potenal of the technology: wireless biometric devices; sensors that can help detect developing

foot ulcers before diabecs realize they are geng them; smart canes that use accelerometers

to nofy caregivers a paent may soon fall; and a wireless lens-less microscope that can use a

phones camera for diagnoscs.

Connua Health Alliance

The Connua Health Alliance, a consorum 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. Aer announcing its first two Connua-cerfied products, the Alliance also announced

two new wireless technologies for its Version 2 guidelines: ZigBee and Bluetooth Low Energy.

Since then Connua has announced addional devices have been cerfied as Connua-approved

and interoperable.

The Connua Health Alliance has also been recognized as one of the key evangelists for remote

paent monitoring on Capitol Hill. Connua'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, Connua's

representaves have been at most of the wireless health focused industry events in the past

year. Chuck Parker, Connua's execuve director gave a srring speech at an event in Seale this

past spring. Parker said that remote paent monitoring doesnt need to do any more trials or

pilots. He said that the Department of Veterans Affairs (VA) has done remote paent monitoring

pilots with about 30,000 paents over the past four years. Thats enough pilots, Parker said, we

dont need to do any more pilots for remote paent monitoring; we need to move to deploy-

ments, and look to the VA for their pilots findings.

CTIA, The Wireless Associaon

CTIA is an industry associaon 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




18/37

wireless health start-ups to show off their wares, the associaon also successfully courted the

AARP to parcipate in the wireless health discussion.

During the summer CTIA organized a wireless health event at the U.S. Senate, which brought thechairman 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-

on for wireless data networks, because, the CTIA argued, regulang the carriers' ability to

manage wireless data traffic could stymie innovaon parcularly in the emerging wireless health

industry. Requiring carriers to treat all data traffic the same would make it difficult for carriers to

ensure crical medical informaon reaches its desnaon on me or in tact, the associaon

argued. CTIA also suggested that the FCC make available more wireless spectrum for carriers

cing the growing interest in wireless health services.

American Telemedicine Associaon

The American Telemedicine Associaon (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 associaon and part professional associaon, because its members

include clinicians, physicians, nurses as well as hospitals, instuons, government organizaons,

corporaons, providers. The ATA offers educaonal 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 pracce

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 me period: More

than 70 percent of telemedicine will be wireless healthcare, according to the firm.

m-Health Innovaon Centre

This winter the GSM Associaon announced a partnership with the University of Manchester in

the UK to establish an m-Health Innovaon 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-

venon through the use of wireless technology, which it believes can improve health outcomes.

The Manchester m-Health Innovaon Centre plans to conduct muldisciplinary research, bring-ing together researchers, healthcare organisaons and industrial partners to conceive, develop

and evaluate mobile health innovaons. A major focus will be on cizen-led health and wellbe-

ing, using mobile technology to enable people to play a more acve 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




19/37

health, facilitaon of pilot trials as well as mHealth educaon and training.

mHealth Alliance

Early in 2009, the Vodafone Foundaon, UN Foundaon and the Rockefeller Foundaon officially

launched a new joint venture called the mHealth Alliance. By mid-year it appointed wireless

industry vet David Aylward to helm the internaonal organizaon as its execuve director.

The mHealth Alliance has a decidedly global health focus with a parcular 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 servicesnot 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-

on 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.

Integrang those services is just one mission of the Alliance. Integrang those kinds of services

into underlying healthcare systems, e-health to use the short language, is a second. Geng

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 acvies,

support acvies like communicaons and connecng people together to technology iniaves.

The mHealth Alliance recently announced a partnership with the Vodafone Americas Foundaon

to create an mHealth Alliance Award for the developer of an innovave wireless technology with

the most potenal to address crical 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 applicaon.




20/37

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 were movinginto, more than ever, if you cant jusfy the cost benefits, then you will fail, Sweeney said. In my

view, geng the FDAs approval is not nearly as hard as geng the CPTs and insurance reim -

bursement approvals.

CardioNet, the wireless remote paent monitoring company that Sweeney founded is perhaps

the poster child for the first generaon of wireless health companies. The company has the

disncon of being the only pure-play wireless health company to have offered an inial 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.

Aer 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, effecve September 1, 2009. Highmark CMS gave no explanaon 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 operaonal costs to sustain its business.

Analyst firm Frost & Sullivan sees a bright future for remote paent monitoring, but the key for

the industry is reimbursement: The market for remote paent 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 paent 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 firms release. As a result, market parcipants are forced to seek alternave

payment strategies, and while some of these have proved successful, the huge billion dollar

market potenal 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 movated to keep their

employees healthy and working.

Reimbursement Rises and Falls



21/37

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 RelayHealths webVisit consultaons with their paents.

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 beer understand the reimbursement eligibility

process:

Itd 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 aendees of the Wireless in

Healthcare IT event held at a Senate office building this past March. What are the metrics for

demonstrang the technology works? How can we get them reimbursed? [Answers to these

quesons could help mHealth move forward] and help to migate 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

geng an audience with the payer. The New York Times published a feature entled Insurers

Shun Multasking Speech Devices, this past September, that focused on a paent 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 soware that turns typed words into speech. In

this paent's case, however, a much cheaper ($190) iPhone app called Proloquo2Go served her

needs beer 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, ulmately 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 conversaon that is not taking place, and if Frost & Sullivan is right, it may

not for a few more years. Unl 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 meanme.

Reimbursement Rises and Falls



22/37

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 thecurrent 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 creang 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 secons in 40 of its stores across the US; App developers created thousands of

health, fitness and medical iPhone applicaons 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 Microso Connected Health Conference in June, Best Buy teamed up with

Microsos HealthVault team to invite device makers to pitch the electronics stores execuves in

a private meeng at the event: If you believe that your product or soluon 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 Microso-Best Buy invitaon. The invitaon also

explained that outstanding soluons providers would have the opportunity to discuss collabo-

raon opportunies 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 soluons 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 acvies, Best Buy stated in its press release. Yet finding the ways and the me to

stay fit and movated can seem more complicated than ever before. Starng today, Best Buy

customers in select markets from Washington, DC to Denver can turn to the naons largest

consumer electronics retailer for help in sasfying their health and fitness equipment and man-

agement needs.

Consumer Health: The Answer to "Who Pays?"



23/37

iPhone demonstrates consumer demand for mobile health

Now heres a class [of services] that we think will be really interesng: medical devices, Apple

SVP of iPhone Soware Sco Forstall announced at the sneak peek event for iPhone 3.0. duringthe summer. Forstall then explained that the new iPhone OS will allow applicaon developers to

sync medical devices like blood pressure monitors or blood glucose monitors via both Bluetooth

and USB. So imagine the possibilies, Forstall connued. We think this is profound. Forstall

then invited a representave 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 integrang its system with smartphones, including

the iPhone perhaps as soon as next year. Most wireless sensor startups, including Corvens,

Sotera Wireless and Proteus Biomedical have all indicated that their sensors would interface with

an applicaon on the iPhone. Those startups are not pursuing a consumer health market strategy

inially, 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 applicaons

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 applicaons; from medicaon adherence apps to sooth -

ing relaxaon applicaons. Chances are if you have thought of a potenal health-related applica-

on, there's a version of it already in the iPhone App Store.

BlackBerry has also begun ramping up its health-related applicaons in its App World store and

they include a wide variety of applicaons 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 SoWave

sensor technology to accurately and safely measure the user's unique sleep paerns 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 transmied to the Zeo




24/37

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 medicaon it uses an accelerometer to

determine when the pillbox is opened and makes a me stamp. The GlowCap can also alert care -

givers when a person forgets to take their medicaon 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 distribuon channel. Vitality hopes to get pharmaceucal

companies or others to subsidize GlowCap for paents' use. AT&T recently announced that it

would provide cellular connecvity 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' moon in three dimensions and converts this data into

usable informaon about daily into useful informaon about your daily acvies. Fitbit uses a

wireless base staon that is posioned in the home whenever a user walks near the basesta -

on 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

unl January 31, 2010.

Philips DirectLife Philips acvity monitor DirectLife measures body acceleraon in three differ-

ent direcons and combines that informaon 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 movates users to increase their goals to exercise

more in successive weeks. The device itself is ny, 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

meeng their exercise goal for the day. The service is currently available from the DirectLife web -

site.




25/37

Wireless Health Venture Capital in 2009

There were 15 venture capital investments announced during 2009 and 11 of them were for

wireless remote paent monitoring start-ups. The remainder included a start-up working on a

converged plaorm for physician-paent communicaons, a smartphone app developer focused

on fitness games, a call-in physician consultaon service, and a tablet-based paent 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-

on 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 ulmately 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 soluons, 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 Corvens in the past, told MobiHealthNews that it was acvely pursuing start-ups like

Corvens that collect clinically-aconable data for point-of-care. MDV was chiefly interested in

companies at the 510K level of FDA regulaon. Products that require long, mul-year clinical

trials before geng 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.


Venture

Capital

2009


26/37

Company Amount Location

Date

Announced Investors Company Description

CardioMEMS $22.1 million Atlanta, GA 08/26/09

Arcapita Ventures, Boston

Millennium, Foundation

Medical

Developer of implantable wireless sensors that

track cardiac output, blood pressure and heart

rate (more)

Autonomic

Technologies $20 million Menlo Park, CA 05/08/09

Lead Investor: InterWest

Partners; Also: Kleiner Perkins

Cau eld & Byers, The

Cleveland Clinic

Developer of implantable devices that aim to

soothe severe headaches (more)

Phreesia $11.6 million New York, NY 02/20/09

Lead Investor: BlueCross

BlueShield Venture Partners;

Also: Polaris Venture Partners,

HLM Venture Partners and

Long River Ventures

Developer of an automatic patient check-in

device and service that aims to improve patient-

provider relationship (more)

BiancaMed $9.8 million Belfast, Ireland 07/20/09

Lead Investor: Seventure

Partners; Also: ePlanet,

Enterprise Ireland, and

ResMed

Developer of wireless monitoring devices,

including a motion sensor that detects heart rate

and respiration (more)

TelaDoc

Medical Services $9 million Dallas, TX 12/04/09

Lead Investor: HLM Venture

Partners; Also: Cardinal

Partners, Trident Capital

National network of primary care physicians that

diagnose illness, recommend treatment, and

prescribe medication over the phone (more)

WellAware $7.5 million Charlottesville, VA 12/08/09

Valhalla Partners, .406

Ventures.

Developer of wireless remote monitoring systems

that track the daily activities of cared for

individuals in the home (more)

Myca Health $5 million San Francisco, CA 10/06/09

BlueCross BlueShield Venture

Partners, Sandbox Industries.

MycaHub combines an EMR, a comprehensive

admin system, and the ability for doctors to

communicate with their patients via a variety of

channels. (more)

Echo T herapeutics $3.6 million Franklin, MA 12/04/09

Investors include Cotswold

Foundation

Echo is developing a wireless blood glucose

monitor for diabetics.

BL Healthcare $3 million Foxborough, MA 08/06/09 undisclosed

BL's platform, TVx, gathers info from Bluetooth-

based wireless medical devices at home and

displays it on the T V.

Monica Healthcare $1.6 m illion Nottingham, U K 04 /27/ 09

Lead Investor: PUK Ventures;

Also: Catapult Venture

Managers, University of

Nottingham

Developer of wireless technology for monitoring

the health of expectant mothers and babies

(more)

Wireless Medcare $535K Roanoke, VA 12/11/09

Carilion Biomedical Institute,

Optimum Sensor Holdings

Developer of medical applications for wireless

and web-enabled devices (more)

GymFu $160K Hampshire, UK 12/01/09 Lead Investor: Channel 4's 4iP

Developer of motion-detecting iPhone tness

apps that include peer challenges to keep users

motivated

eCardioDiagnostics undisclosed The Woodlands, TX 07/01/09 Sequoia Capital

Service provider of remote cardiac monitoring forarrhythmia diagnosis (more)

MiLife undisclosed Bedford, UK 01/16/09

New Venture Partners,

Unilever Ventures

Developer of a personalized online tness

coaching system and wireless monitoring device

(more)

Zephyr Technolo gy undisclosed Annapolis, MD 06/1 8/09 Moto rola Ventures

Developer of real-time physiological and

biomechanical monitoring technology for

defense, rst responder, training and research

markets (more)

Venture

Capital

2009

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Wireless Health Industry Deals in 2009

During the course of 2009, MobiHealthNews chronicled 73 business deals between two or more

companies or organizaons acve in the emerging industry. We defined a deal as an acquision,

pilot, program, joint venture, or product or service launch in conjuncon with another company.

For many global firms, the fastest path to market leadership will be through acquision, Invest -

ment firm TripleTree's research director Chris Hoffmann told MobiHealthNews. This consolida-

on may not come in the same flurry as weve seen in enterprise soware, but some thoughul

strategic deals will begin to occur. Because many of the quesons surrounding mHealth and

Wireless Health soluons center on who pays for them, early M&A acvity may be focused on

those soluons demonstrang recurring revenue growth or meaningful end user (or paent)

retenon.

The 73 deals summarized here could serve as a meline for wireless health acvity 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

traumac 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.

Wirelss

Health

Deals

2009

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28/37

WirelssHealth

Deals

Q1Company A Company B, etc. What was the deal? DateAnnounced Other details?U.S. Army AllOne Health, Diversinet

Army to pilot AllOne Mobile to stay in

touch with wounded warriors

through their mobiles. (more) 01/14/09

Army licensed the technology for 10,000

soldiers, speci cally those with traumatic

brain injuries.

Google Anvita Mobile

Anvita developed a mobile viewer of

Google Health for Android. (more) 02/05/09

The Mobile Viewer allows users to view but

not edit pro le information as well as

current prescriptions, existing health

conditions, known allergies and more.

Kaiser Permanente MobilestormCompleted a pilot for text messageappointment reminders. (more) 02/05/09

KP worked with Mobilestorm for the pilot,

which showed 0.73 fewer no shows.National rollout to follow.

IBM

Continua Health Alliance,

Google

IBM and Continua to create

guidelines for wireless medical

devices to connect to Google Health.

(more) 02/12/09

As part of the announcement, IBM said it

had integrated its Information

Management, Business Intelligence and

WebSphere Premises Server sensor event

platform into Google Health already.

Alcatel-Lucent

Motorola, HP, Samsung,

others

Companies formed, ng Connect, a

group for vendors looking to create

next-gen wireless devices with Alca-

Lu. (more) 02/16/09

The group will focus on ve key areas, one

being: enterprise collaboration and e-

health.

Vodafone Foundation UN Foundation

The Foundations teamed up with the

Rockefeller Foundation to create the

mHealth Alliance. (more) 02/17/09

The mHealth Alliance aims to bring

together the major mHealth stakeholders

for the developing world.

MobilizeMRS FrontlineSMS

MobilizeMRS taps FrontlineSMS

platform for its work in global health.(more) 02/24/09

MobilizeMRS rebranded toFrontlineSMS:Medic following the deal.

Ohio Health iShoe

Ohio Health pilots the smart

innersole for fall prevention. (more) 02/26/09

Ohio Health expects iShoe to hit the

market in 2010 with a pricepoint of $100.

Allscripts Edge Health

Edge Health to embed Allscript's EMR

into its iPhone app, EdgeRPM. (more) 03/04/09

Allscripts launched its own iPhone app a

few weeks later.

AllOne Health Clickatell

Clickatell enables text messaging for

AllOne Mobile. (more) 03/11/09

AllOne Health's users in the Army look to

be the rst to bene t.

AllOne Health

Signi ca Insurance Group

and Erin Group

Administrators

The health plans' members can view,

manage and exchange their health

info with their providers. (more) 03/16/09

The deals made AllOne Mobile available to

more than 400,000 people total.

Rady Children's Hospital Given Imaging

Rady Children's pilots GI's Pillcam, a

tiny wireless camera inside a pill.

(more)03/17/09

Joshua Devine, a high school sophomore,

swallowed the Pillcam at Grady's one of

the rst patients to do so.

Telstra Foundation

Murdoch Children's

Research Institute

Telstra Foundation funded a two year

mobile project for mental health

services. (more) 03/25/09

The grant was for $285,000 Australian

dollars.

Microsoft ANT Wireless

Microsoft to allow personal health

devices to connect to HealthVault via

ANT+. (more) 03/25/09

ANT+ is an alternative short range wireless

technology to ZigBee or Bluetooth.

Gary and Mary West

Foundation

Qualcomm, Scripps

Health

GMWF donated $45M to create the

West Wireless Health Institute. (more) 03/30/09

Qualcomm's Don Jones and Scripps' Dr.

Eric Topol join as part of the Institute's

founding board.

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29/37

WirelssHealthDeals Q2

Company A Company B, etc. What was the deal?

Date

Announced Other details?

Verizon Wireless Alcatel-Lucent, Ericsson

Verizon Wireless launches 4G

innovation center with Alcatel-Lucent

and Ericsson. (more) 04/01/09

The center will focus on three key verticals:

healthcare, utility and security.

Intel General Electric (GE)

Intel and GE announce partnership

for home health monitoring and

contribute $250 million to R&D.

(more) 04/02/09

GE will market Intel's Health Guide as part

of the deal, which also focuses on wireless

sensors for the senior care market.

CardioNet Biotel

CardioNet agrees to buy Biotel and

enter clinical research. (more) 04/02/09 The deal eventually falls through.

GreatCall / Jitterbug Meridian Health, WellDoc

Jitterbug pilots a medication

adherence service from Meridian and

a diabetes management service from

WellDoc. (more) 04/03/09

The services could become part of

Jitterbug's Service Store its version of an

App Store.

MedApps Microsoft

RPM company MedApps connects

devices' data streams to Microsoft's

HealthVault. (more) 04/12/09

MedApps currently uses a dedicated

wireless device to route data from

connected medical devices.

Proteus Biomedical

Two undisclosed pharma

companies

Proteus announces two drug

companies will trial its intelligent

medicine technology and sensor.

(more) 04/14/09

Later in the year, Novartis announces a trial

with Proteus unclear if it's a separate

deal.

A.D.A.M.

HelloHealth, Norton,

LiveStrong, others

A.D.A.M. announces Medzio, a

collaborative mobile app suite from

the newly formed Mobile Health

Network. (more) 04/21/09

Medzio continues to add a few new

partners throughout the year, but the

app's sum does not appear to be more

popular than its parts.

Doylestown H ospital Apple

Doylestown Hospital becomes rst

hospital pro led on Apple's site for

equipping its care workers with

iPhones throughout its facility.

(more) 04/30/09

The hospital connected the iPhones to

their Meditech EMR system and also

noticed doctors favor Epocrates.

AT&T

Texas Instruments,

24Eight

The three companies teamed up to

work on smart innersoles for fall

prevention. (more) 05/26/09

The collaboration results in AT&T's smart

slippers for fall prevention, unveiled in

December.

Jitterbug Samsung, Qualcomm

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

users. The phone and data

connectivity enable the company's

Services Store. (more) 06/02/09

Jitterbug added 1xCDMA data to its

phones but it didn't want the users to

know they had Internet-enabled phones

perhaps too daunting.

Verizon Wireless LifeWatch

Remote cardiac monitoring company

LifeWatch signed an exclusive

agreement with Verizon to use its

network to carry its wireless health

services. (more) 06/04/09 LifeWatch is a big competitor to CardioNet.

White House

Voxiva, CDC, J&J, CTIA,

more

The White House is working with a

number of industry partners to

launch a free text messaging service,called Text4Baby, for low-income

expectant mothers. (more) 06/05/09

Text4Baby originally aimed to launch inSeptember but has since been delayed

until next year.

Continua Health Alliance Nonin

Interoperability consortium Continua

certi ed Nonin's Bluetooth-enabled

pulse oximeter. (more) 06/09/09

This marks the rst wireless health device

with Continua certi cation.

Partners Healthcare Connected Health

Partners Healthcare in Boston spun

out a start-up, named Connected

Health for now, with an initial service

around a wireless blood pressure cu .

(more) 06/16/09

Connected Health just completed a pilot

with EMC, which used the cu for

corporate wellness programs.

West Wireless Health

Institute Corventis

The Institute announced plans to

conduct clinical trials for Corventis

and shepherd the sensor to market.

(more) 06/23/09

Dr. Eric Topol and other Institute directors

demo Corventis' monitoring sensor at

events all year long.

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wireless health: state of the industry 2009 year end report

Documents