|Issue:||Europe I 2007|
|Topic:||Converging on health|
|Organisation:||Mobile Data Association|
Nick Hunn is an Executive Director of the Mobile Data Association, covering the brief of mobile healthcare, and CEO of EZURiO Ltd. Mr Hunn has over 30 years of design experience, developing a diverse range of products, including a medical device that was awarded the Queen’s Award for Technology. Over the past 15 years, he has been closely involved with PC and GSM communications, designing convergence products for mobile data. Mr Hunn sits on working groups within the Bluetooth SIG, where he is helping drive medical and M2M standards. Mr Hunn holds an MA degree in Natural Sciences from Cambridge, and is a Member of the Institution of Engineering and Technology (MIET), and a Fellow of the Royal Society of ARTS (FRSA).
There are many varieties of convergence. Few, however, have the potential of wireless networks to alleviate human suffering and concern by monitoring remotely the health of, and providing healthcare for, not only our rapidly ageing population but for us all. The EU and a number of governments are funding research into low-power ‘Wibree’ technology that can be inexpensively added to Bluetooth-enabled mobile phones, economically enabling mobile operators to provide cost-effective remote health monitoring services.
Convergence can be a slippery fish. Those of us who have been in this industry long enough will remember the enthusiasm of the convergence advocates in the early days of PCs and PSTN, public switched telephone network. With the Internet on the horizon, both camps saw the opportunity to steal each other’s business case and raised the clarion cry of convergence to signal the disruption that was to come. The Internet grew, made fortunes for some and destroyed others without the pain of disruptive changes that were promised. Most of the players remained, but modified their customer offerings. New companies grew and some matured into the infrastructure giants behind today’s telecommunications business. It is probably true that some of the disruptive effect of conversion was missed as an even bigger change was taking place – the growth of mobile telephony. At the time few envisaged the speed at which it would move from a business offering to a lifestyle one. The human desire to talk overran all of those early predictions and gave the market the behemoths that exist today. Now we hear that call of convergence once again, this time as a disruptive battle for the voice market. Others in this issue will be arguing the case for winners and losers. I suspect that in a few years time we will look back and wonder what all of the noise was about? Instead of a blood-letting, we will see a repeat of the last battle of convergence, where the players morph their models to suit the new reality. They have reached the size they are today because of their ability to adapt and it’s naïve to suggest that most will not manage that trick again. Voice convergence will happen; I predict that it will happen with little change to the landscape. Instead, I would argue that the more interesting case of convergence is in data services where the mobile operators will discover an opportunity to move away from their dependence on voice to a range of new services. Those who plan and build for these will see an opportunity to establish long-term sources of revenue. Of the data opportunities available, one of the major ones will be as a provider of Telecare. The medical opportunity Governments around the world are looking with concern at the impact of an increasingly ageing population. In most Western countries, over one in five people have some form of long-term chronic condition needing therapy or medication. That will increase. As health resources become stretched, there will be an ever greater need to find ways to manage the health of the population without recourse to physical consulting. Instead governments, insurers and individuals will depend on Telecare and assisted living initiatives to keep the population healthy and able to work. By 2020 it is possible that up to 40 per cent of the population will be participating in some form of Telecare to remove their current dependence on face-to-face health services. The aim of Telecare is to make patients independent and mobile. That involves some key changes to how we approach a healthy society and moving away from current assumptions about the need for personal medical intervention. Telecare calls for convergence between the mobile networks and the health providers around the world. Telecare introduces the prospect that we will rely on our network operators, not just for our ability to talk but also to maintain our health. Despite the level of coverage of Telecare initiatives, up until this point their development and delivery has been provided in a piecemeal fashion by independent providers. Safety and security within the home has largely been the province of monitoring companies offering basic personal alarm systems. More direct monitoring of health signs has been limited mainly to clinical studies. What is about to change this is the availability of new short-range wireless technology that will make low cost medical devices possible, and which will transform the handset into a mobile monitoring gateway. The innovation that is set to drive this change is a new wireless standard called Wibree. Bluetooth and WiFi are already embedded within handsets, but have power requirements that are too high for low cost medical sensors that need to run off a button cell for a year. Although a number of different ultra-low-power radios have emerged, they have not been adopted within phones or other access points, and so cannot provide a way to transfer patient data back to medical service providers. Wibree is a novel approach that has been developed by Nokia, but is set to be converted to an industry standard. It is a specification for a very-low-power radio that can meet the requirements of patient-worn sensors. It can also be built as a dual mode radio within a Bluetooth chip, using key Bluetooth components, such as the radio and the antenna. The clever part of this approach is that it adds almost no cost to the Bluetooth chip within the handset, making it an obvious choice for handset manufacturers to include in their next generation of phones. That means that Wibree will quickly become embedded into a wide range of mobile phones. Wibree allows the phone to act as a gateway for medical information, transmitting it back over the network to an Internet-based monitoring service. In general, the data throughputs involved will be small, so the transmission costs will be low and the traffic will not swamp the networks’ capacity, but it allows the networks to charge for a high-value service. We won’t see Wibree in handsets much before the end of 2008, but because it will be part of the Bluetooth solution in most handsets it will rapidly grow to a deployed base of over 100 million devices. In parallel, the industry is working hard to produce standards for medical devices. Bluetooth has an active medical device working group that is being supported by the medical device manufacturers. Alongside it there is an ISO/IEEE group specifying the data protocols such devices will use to talk to each other in a standardised manner. What this level of standardisation means to product designers is that they can start designing their products for Bluetooth today, knowing that low-power Wibree devices will be incorporated in these products and available to a massive number of consumers within a few years. This provides the confidence to develop devices for the early deployments, which will start the collection of data for use by the ‘expert systems’ that will sit behind tomorrow’s wireless health applications. Governments are also starting to direct significant amounts of money into these systems. National funding is appearing in many countries to facilitate trials. The EU’s new FP7 research framework is devoting significant research funding to healthcare systems and the ICT support to deploy them. Most are realistic about the magnitude of the task ahead, understanding that this is not an area that will produce a quick change, but over the next decade mobile healthcare will move from a novelty to a necessity. To deliver this, mobile networks need to work with healthcare services to define the rules of this new convergence. They can participate in developing a future as the providers of health monitoring. That monitoring is not just for the ill, but will extend to keeping the bulk of the population healthy for longer. In fact, promoting health may well provide the first opportunity for Wibree-based systems deployment; the mobile monitoring of exercise that many gyms are using can become part of our lifestyles via our mobile phones. These services also offer other benefits. If a network can establish itself as a trusted supplier of health services it may mark the first substantive move from being a churnable pipe to the position of a long-term partner. Few people churn their doctor; when the network provider takes on the health role it may find customer loyalty changes to match. Although there may be little visible evidence of Telecare at the moment, the pieces are being put into place. Medical devices are shrinking, Wibree will provide the low power connection they need and planned large-scale trials will begin to populate the databases that will make intelligent sense of the mass of monitored data. Importantly, the changing demographics of an increasingly ageing population mean that governments have no alternative but to resource and promote remote health monitoring and healthy living incentives. Converging the existing reactive healthcare provision of the state with the preventative monitoring that these new technologies will provide is a solution that economics will force to happen. If it succeeds, then in ten years’ time we face the interesting question of whether we buy our healthcare from our network provider or our phone from our general practitioner. That will be a convergence more substantive than any we have seen before.