25 February 2011 – Global Telecom Business
Mobile health is moving beyond vanity projects and hype as operators and medical suppliers start to engage in projects with commercial potential
Mobile health is moving beyond vanity projects and hype as operators and medical suppliers start to engage in projects with commercial potential and real clinical advantages. George Malim reports
Much of the hype surrounding mobile health initiatives has centred on what might be possible, with operators putting forward one-off demonstrations showing apparently altruistic examples in which doctors in the developing world diagnose patients in remote villages using mobile video.
The fact that in the bulk of those locations, the bandwidth isn’t available for such services today doesn’t seem to matter.
However, dismissing the future-gazing aspect of these demonstrations is perhaps unfair given that mobile health is at a very early stage of its development. That development is certainly underway — although the applications are less exciting, with the early deployments focused around more prosaic SMS-based applications.
Michael Reilly, director of healthcare at Everything Everywhere, the merger of Orange UK and T-Mobile UK, resists the temptation to get carried away: “Mobile is one aspect of the total technological possibilities,” he says. “You don’t have to continuously innovate to the newest technology. SMS is a warhorse technology that can be used to excellent effect.”
He gives the example of a deployment in the UK by Orange that addresses the challenge of missed hospital appointments using SMS. “Missed appointments cost the (UK) National Health Service £400 million each year — that’s 10,000 nurses. The technology is capable of being deployed and existing bearer technologies have a high degree of citizen and shareholder familiarity. If you want scale you need to use something people are familiar with.”
He quips: “Where there’s much, there’s brass. It’s a recipe for disaster to engage in some sort of technological fetish. You have to look at what you’ve got and be pragmatic.”
Olivier Pauzet, who is the director of segment and product marketing at Sierra Wireless, a company that embeds wireless technology within the devices used by vertical industry sectors, also takes the practical view.
He says the mobile health sector should be viewed as three different markets: medical; wellbeing; and sport and fitness. The medical market comprises devices used in hospitals and emergency rooms and typically encompasses the use of low power radio technologies for monitoring vital signs, although mobile medics such as ambulance crews make extensive use of cellular technologies.
That market covers essential, life-saving devices and solutions that enable improved efficiency.
Operators are likely to have only limited involvement in this sector with specialist clinical providers and hospitals themselves being the most likely service providers. Operators will have a role in facilitating communications beyond the local area, perhaps to integrate low power radio solutions with the internet to enable data to be stored, for example.
A far larger market, which Pauzet describes as a “nice to have”, is the wellbeing sector, which involves applications to make life easier for sufferers of chronic diseases. That might involve reminders via SMS to patients to take drugs, appointment reminders, the provision of data regarding care options or the reporting of data gathered by other devices such as those that monitor diabetes patients.
The case for wireless enabled pill boxes still seems some way away, since SMS or IM reminders do a similar job at a fraction of the cost. “This sector is all about devices to make life easier, but it’s not about life or death,” says Pauzet.
That’s a view Reilly agrees with. “We can, as a network operator, legitimately join up the sector using technology to enable better healthcare,” he says. “We look at developing solutions with partners and work with them in a far more mature and collaborative way to deliver solutions. That’s important because network operators don’t work well with supplier companies — look at their relationships with device manufacturers. You couldn’t possibly have that relationship with a partner that provides an application for helping a diabetes patient, nor deal with the NHS. You can’t just believe people will buy off a menu sheet.”
The wellbeing sector, however, is in its infancy. Pauzat says the total market worldwide in 2010 saw 300,000 to 500,000 units deployed.
“We see North America being the primary market because there is a willingness to pay for wellbeing applications among consumers because they are used to paying for medical treatment with their own money,” he says.
“In Europe, it is different because a lot of people rely on states and social security so there is less willingness to pay with their own money. People will not buy a device or system, they’ll wait for insurers or the state to pay for it. I expect the US to lead, followed by Europe and then Asia — except Japan, which is similar to the US.”
Clint McClellan, at Qualcomm, disagrees and thinks the lack of health infrastructure will see developing countries take up mobile health first. “The market will take off first outside Europe and US in countries where there is either poor healthcare or no systems,” he says.
“We’re working with mobile operators in India and the African countries using low end smartphones with sensors to go into villages and monitor biometrics for applications such as electrocardiograms, glucose meters and blood pressure. We don’t know how the model pays out yet but in India patients will pay $1 for a check up.”
Pauzet also points out that the market today, in developed markets, is about providing convenience and better efficiency of treatment. “It’s not about cost efficiency yet,” he says. “Today there are lots of start-up companies developing technologies that will use cellular technology but not much has been deployed. The big hardware people like Philips and medical suppliers like Johnson & Johnson are not yet significantly involved. The market is driven by small companies which, when their products work, will get acquired.”
It’s also a challenging market for the operators because they have to establish an understanding in the medical and applications professions of their own needs. “It is not easy to bring all the principals together and there is a worry that the agenda of change is going to disintermediate them,” adds Reilly.
“Our projects have involved a lot of candid engagement in the first place. We’re trying to develop propositions that have scale and are commercial products. We’re not an open wallet for trials and developments.”
Even so, there are examples of successful mobile health applications. Resmed, an Australian company, has worked for several years providing an application to help sleep apnoea sufferers. Users need to monitor how many times each night their sleep is disrupted and in the past has a memory card in a device to record this. They then had to post the card to their doctor or hospital each week.
However, after a few weeks, users forgot to send the cards back — so the service now uses cellular technology to transmit the data automatically, thereby resulting in a simpler service for the user.
Reilly gives an example, which sounds suspiciously like the CSR-tinged mobile health demonstrations of the last several years, until he gets into the detail. “In Mali, we’ve deployed text-based services for the weighing of children which enable it to be established which children need to be referred to a specialist. The technology, which replaces cumbersome and slow paper-based reporting, gets distributed but people have to be trained to use it. There’s nothing there that you wouldn’t need in the developed world. There also has to be a payer and a validator that you’re doing what you said you would.”
This is not a vanity play, Reilly insists: “This hasn’t been launched by a surge in altruism.”
It’s unlikely any altruism at all will be required for Pauzet’s final sector of sport and fitness. Brands, consumers and health insurers will pay for it all. Pauzet sees this area as a large consumer market that will involve insurers as well as sports equipment manufacturers providing devices to monitor the heart rate of users while they take exercise.
Brands such as Nike and Apple are already active in this market. Nike has a device that fits in some of its shoes that integrates with an iPhone to measure footfall. Applications that are more medical are likely to follow.
McClellan also sees that sector taking off. “The bottom line is that people know they’re not in great shape and understand that their health would be better if they monitored it more,” he says. “We are at the early stage of the real era of deployment and the business models will have to work. Will people pay for it themselves or will companies like Nike provide wellness kits to their customers?”
Pauzet sees the mobile health market as an attractive market for operators. In contrast to other machine to machine communication verticals, mobile health touches consumers directly. “For operators, this is a very interesting market because they know their customers from old to young and can make specific propositions based on what they know,” he says. “They also serve enterprises so know how to deliver applications to doctors and hospitals.”
Reilly, given France Telecom Orange’s four-year commitment to mobile health, shares that view. “We’re beyond the early stage for sure,” he says. “There seems to be a confluence of factors in both the public and private sector health services. The change is there, commissioning is altering and more local and regional responsibility is going to be taken to deal with the manner in which care is delivered. That’s a very important development for mobile health.”
McClellan thinks the operator can and should be the enabler. “Operators can be the driver,” he says.
“In the Middle East, for example, healthcare systems are not very good, so mobile operators want to work with hospitals to get technology into them. Operators are going to be a wonderful connective set of tissues across the countries.” GTB