Continua for welfare technology

Is Continua the solution to the interoperability problems that the Norwegian municipalities have for their investments in welfare technology? This was the topic of today’s meeting organised by the Norwegian health authorities in Oslo.

Continua Health Alliance was established in 2006 by a group of industry leaders to create design guidelines and standards for connecting health-related devices. The alliance has grown to include more than 240 companies (SINTEF being one of them), and the Continua specifications now cover end-to-end communication from devices to back-end EPJs. In 2012 Denmark decided to adopt the Continua specification for their national welfare technology architecture and standardisation initiatives. Following the Danish decision, the specifications have become an attractive alternative also for the Norwegian initiatives in welfare technologies. The design guidelines from Continua are also published as an ITU-T standard (ITU-T H.810), and it seems like Continua and ITU will cooperate further in the future.

The meeting today was about Continua, but also about national standardization of welfare technology in general. The Norwegian health authorities are asked by the Norwegian health and welfare ministry to evaluate Continua and provide a recommendation. An expert group is appointed to provide advice. I participate in this expert group, not because I am an expert in the topic but merely because of the circumstances (Ståle Walderhaug and Frode Strisland, our real Continua experts, are helping behind the scenes).

The meeting included presentations on the background of the national initiative, introduction to Continua, and a discussion of merits and problems with the specification. Official minutes from the meeting will be provided by the meeting organisers. Here I summarise some highlights from the discussion that I personally found interesting and educational.

  • Continua standard is originating from personal health domain. Some of the welfare challenges Norwegian municipalities face are not directly related to personal health. Continua can provide part of the solution but it needs to co-exist with other standardization initiatives.
  • Additional “features” might be needed to cover areas that are not currently covered by the Continua specifications, such as end-to-end security and two-way communication.
  • Collaboration with Denmark is important and can create traction needed to influence the future direction of Continua. Continua for instance has included some topics related to independent living recently, such as safety alarms, which are more relevant for Scandinavian primary care providers.
  • There is little information about how the certification processes work in Continua. One needs to consider how such certification processes might influence the level of innovation in the welfare technology market if Continua becomes a national recommendation.
  • Continua architecture seems to prioritize monitoring rather than two-way communication. Many services need two-way communication that can support for instance service personalization.
  • Continua seems to be quite specific at the “lower” layers close to devices. At higher service-related layers it becomes more ambiguous.
  • Any solution, Continua or not, needs to take into consideration integration with national databases and portals such as helsenorge.no.

Despite any discussion of Continua’s merits and shortcomings, the fact is that there is no competing framework out there. Continua Alliance is established and a number of devices already exist (although a quite limited number). The question might be how Norway can best influence the future development of the specification, and not whether we should adopt it or not.

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