Virtual Whistler

Intel has taken a somewhat shocking step away from its roots in the chip industry with its new Health Guide, a small tabletop gadget that Intel will build, sell, and manage through a suite of backend services.

Intel will develop pilot programs with several healthcare organizations, including Aetna, to assess how the Health Guide works in the home. The chip giant is also working with the American Heart Association to develop care plans for patients who have suffered heart attacks.

The Health Guide is being deployed now, after being approved by the FDA as a Class II device this past summer. It will be supplied by healthcare organizations. "This product is ready to go, end to end," said Louis Burns, general manager of the Digital Health division at Intel.

A small device about the size of a small-form-factor PC, the Health Guide PHS6000 is a small white box with a flip-up 10.4-inch LCD touchscreen, a webcam with privacy shield, and a touchscreen. Inside it is an undisclosed Intel processor and motherboard, together with Bluetooth and four USB ports.

The Health Guide requires a broadband connection, which it uses to connect to doctors and healthcare professionals, and to download content onto its small hard drive. Intel designed the interface, which is both spare and functional, allowing users to access contact numbers for their doctors, schedule appointments, and upload new medical data via a small line of connected health devices, such as glucose meters and blood-oxygen sensors, that are already on the market from third-party suppliers. The webcam also allows the patient to videoconference with a nurse or healthcare provider, possibly its most important function.

The overarching goal, Burns and other Intel executives explained, is to provide a means for both patient and doctor to monitor a chronic condition, such as diabetes, without the need to constantly stop by a doctor's office for updates and new tests. Data uploaded by the device is automatically plugged into a mathematical model customized for the patient, where signs of an impending heart attack or other life-threatening condition can be analyzed and assigned treatment before a patient is forced to enter an emergency room.

While the Health Guide represents a sea change for Intel, it's also true that the company has done almost everything but ship its own PCs and other devices. The company manufactures chipsets, and publishes reference designs for both motherboards and guidelines for the PCs they form the heart of. Intel also has pushed OEMs to manufacture Mobile Internet Devices, developed a Viiv PC initiative mixing software and entertainment services, sold an electronic microscope, and designed or co-designed smartphone and in-vehicle entertainment reference platforms. Intel's design efforts have had some success, but generally influenced the design of existing platforms.

This is actually Intel's second step into integrating IT into healthcare; in 2006 and 2007, Intel helped develop a tablet-based device called a mobile clinical assistant, which Motion Computing backed. Just last week, Panasonic launched a ruggedized Toughbook that conformed to the mobile clinical assistant standard.

The culmination of about three and a half years of work, the Intel Health Guide didn't start out as a healthcare product at all.

According to Eric Dishman, an Intel fellow in its health group and its director of product research and innovation, the Health Guide evolved from a 1999 study of 100 homes in the U.S., evaluating the "future of fun" with a pre-TiVo DVR-like device and a portable MP3 player. What the study's participants kept asking for, however, was a device to help manage aging parents and their diseases.

Dishman and Intel see the problem as something akin to the transition to mobile computing. "Healthcare today is largely a mainframe model," Dishman said, dating back to 30 years ago where hospitals were basically single massive resources timeshared across large urban centers.

But as more and more people enter the healthcare system, baby boomers begin retiring and an estimated 240 million uninsured stress the system further, an estimated $4 trillion to $5 trillion in treatment costs will need to be spent over the next five years, Dishman said.

"We can't afford mainframe healthcare today," Dishman said. "We're about to double or triple the number of people coming into the system… We want to create, foment the transition from mainframe healthcare to personal healthcare."

"Personal healthcare," however, still requires back-end monitoring by nurses and doctors, Intel executives said, as well as self-education. Intel will license video content and other educational material from the Mayo Clinic, Burns said.

The HealthGuide includes a clinician-facing suite of services that allows access to a patient's healthcare data and vital information, allows a nurse to schedule appointments and followup visits, and set alerts in case a patient's blood pressure, glucose levels, or other key indicators indicate a dangerous trend.

Several FDA-approved peripherals are already on the market, which can connect to the Health Guide. They include blood-pressure cuffs; weight scales; blood-glucose monitors; SPO2 monitors, which measure the oxygen saturation in blood; and pulse oximeters, which perform roughly the same function. All can connect to PCs and the Health Guide through a special serial cable.

A healthcare professional can set up a series of questions to guide a patient through a self-diagnosis, with questions about his sleep habits or general state of health. Finally, the integrated webcam can also permit a personal consultation without the need for an on-site visit.

"All this information can help me know what's going on with the patient before a videoconference," said Julie Cherry, a registered nurse and director of product marketing for Intel. According to Cherry, the U.S. healthcare market is plagued by "intermittent acute care," where patients are treated, and then "fall into a black hole, a disconnected space, until they have a reason to go into the healthcare system again."

Pilot studies within the U.S. are planned with Aetna, Erickson Retirement Communities, Providence Medical Group in Oregon, and the SCAN Health Plan. SCAN, a nonprofit that has helped manage patients with chronic conditions for 30 years, will try out the Health Guide with 25 patients suffering from heart disease, according to Hank Osowski, SCAN's senior vice president of corporate development.

"If this works effectively, we hope to roll it out to several hundred patients with chronic diseases," Osowski said. In a year's time, SCAN could extend the Health Guide to its 105,000 members in Arizona and California, he said.

Osowski said he was "excited" about the device, which would allow healthcare professionals to intervene "early and appropriately". Both Osowski and Dishman said that patients would appreciate the feedback the Health Guide provides, which would allow them to work toward a goal.

Some patients used the Health Guide's flip screen to hide the small box from guests to protect their privacy; others were proud that they could show how off how they managed their condition, they said. But for the most part, the reaction has been positive, Dishman said in a followup email.

"Most of the folks undergoing chronic disease management programs today are writing stuff down on paper and calling in to a phone-based menu to report their results, with no feedback, coaching, content, or personalization," Dishman said. "So when we focus group the Intel Health Guide, they are usually saying things to us like 'Thank god we can stop the sticky note and phone tag nightmare with my health coach!' or 'This lets me do my care routine at my own time and my own pace – I hate it when a nurse calls me during a lunch party or while I am watching Oprah."

"They have had mostly positive responses to the physical appearance of the device with phrases like 'friendly' and 'innovative' and 'trustworthy' – they trust it more because it looks more like a medical device than a personal computer," Dishman added. "Their biggest complaint has been that it is too large to pack up and take with them on trips – people clearly want another more portable version to take with them to their vacation home or weekend trip."

To solve that particular problem, Intel showed off the Health Guide in a portable format, running as an application on the T-Mobile G1, powered by Google's "Android" operating system, as well as a Sharp MID. In both cases, users would be limited by the hardware constraints of the mobile device, but could manually upload data and access some of the other features of the device, such as video content.

Portable healthcare also makes more sense in Europe, where even the elderly have mobile phones. Even simple things like an accelerometer in a mobile phone can provide clues about a person's stride, which can be slowed by an adverse reaction to medication, Dishman said. One of the best ways to judge the onset of a neurological condition is to examine how people type, he said; Intel already has three year's worth of data to that effect by monitoring how people interact with PCs in Europe, he said.

That has also prompted concerns about privacy. Some elderly patients in Intel's trials said that they don't want to be reminded of their conditions on their phone, which they regard as an entertainment device, Dishman said.

Will the Health Guide make money for Intel? In the short term, probably not. Intel lumps its NAND Products Group, Flash Memory Group, Digital Home Group, Software and Services Group, and the Digital Health Group into an "All Other" group within its balance sheet. Revenue for that category is primarily related to the sale of NOR and NAND memory products, Intel has said. The "All Other" segment recorded a loss of $519 million on revenue of $218 million for the third calendar quarter.

Burns declined to comment on when the product might have a material effect on Intel's revenue. But he said that the product has had the backing of Intel senior executives, including chief executive Paul Otellini, who apparently shares Burns' view that the Health Guide can put a chunk of that $5 trillion in U.S. healthcare costs into Intel's pocket.

But even at Intel, which reported a record third quarter, times are tough. Intel has divested so-called non-core assets, such as its optical networking business, when it failed to deliver. In the nine months from Dec. 2007 through Sept. 2008, Intel burned through about half of its on-hand cash, which decreased from $7.3 billion to $3.7 billion.

But when asked if in two years the Health Guide was destined to be spun off or discontinued, Burns' response was, well, sanguine. "It'll be here," he said. "Come talk to me in two years."

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