Medica claims to be the world’s largest medical show. It’s a very monochrome event – all of the equipment is white and shiny, and most of the exhibitors and visitors are soberly dressed in dark suits, as befits the serious profession of medicine and spending money in Dusseldorf. Looking at the equipment on display and the crowds thronging the show, you certainly wouldn’t get any impression that there’s a recession around, other than slightly more suits than normal and rather fewer bow-ties around the necks of the visiting consultants.
As far as the medical industry is concerned, it’s business as usual, and hopefully more so, as more of us get older and less healthy. But there are some interesting trends. One of which is the increased prevalence of wireless connectivity. In previous years equipment manufacturers were happy for nurses to jot down the readings from their instruments. A few devices had wireless links, but they were the exception. This year, particularly at the consumer end of the market, wireless was becoming the norm, at least at the top end of product ranges.
Almost all of that was Bluetooth. I stopped counting after the first hundred devices, and that was in just two of the twenty halls. ANT was in evidence, helped with a demonstration of a prototype X10 Nano phone from Sony Ericsson, which was using the ANT protocol to connect to a weighing scale, heart rate belt and pedometer. Wi-Fi was there in a few products, but mostly confined to tags for asset management, and I failed to find a single ZigBee medical device. There also seemed to be very little profile for the Continua Alliance in terms of products or signage. Even The Intel stand was conspicuously Continua-free.
If you follow the mHealth blogs and groups on LinkedIn you’ll see a constant debate about where mHealth is in out existing health services. I’ve been looking at some of the applications which are already in use within the NHS. As yet, there’s no central policy for mHealth, and it’s debatable whether much of the good practice using mHealth is even acknowledged, but that doesn’t mean it’s not providing benefit.
Much of mHealth is invisible. It’s not the high tech monitoring that we find in glossy medical device brochures, but far simpler, everyday applications. Many of these use SMS, but mHealth extends through voice and video, and we’re already seeing local use of applications on iPhones and Android. However, there is little coordination of deployment, and almost all that is happening is as a result of local initiatives.
Everyone seems to think that mHealth is about to take off. mobihealthnews.com’s recent roundup of analyst predictions estimated sales of around $4 billion per year by 2014, and my own more fanciful review of potential savings ran into tens of billions of dollars. Network Operators are setting up mHealth divisions faster than you can say “long term chronic condition” and the outpouring of mHealth apps for smartphones continues to grow exponentially.
It has all of the characteristics of the next technical bubble, but with the added benefit that, if we can make it work, it might actually save our healthcare systems from terminal meltdown. We need the disruption that mHealth will bring. As Clayton Christensen points out in his seminal book – The Innovator’s Prescription, the only way we are going to effect a major change in healthcare is through the introduction of new, parallel business models to challenge those that our current healthcare structure is built on. That will need new technologies that provide more effective diagnosis of symptoms, as well as devices that encourage personal participation in healthcare by putting monitoring and health records into the hands of patients. Which are exactly the areas being targeted by the mHealth community.
However, there’s an invisible gorilla in the mHealth room that could consign the whole enterprise to history. It’s called the FDA. The FDA has the ability to apply regulations that would choke the development of mHealth. Like all regulators, the FDA moves slowly – far more slowly than the emerging mHealth technology. It is important for the industry to engage with it to reset the levels of regulation for mHealth. What is worrying is that most of the noise around regulation is not about that resetting of expectations, but scare-mongering about the possible reaction of the FDA to an expansion of connected healthcare and new delivery methods. It’s important that manufacturers understand the barriers that regulation might bring, but we’re at risk of crying “Wolf” to the extent that mHealth may never happen, or else only evolve outside the U.S.
A few weeks ago I was talking to someone who mentioned the Talisman SOS bracelet that she and her family wore and suggested that people should be encouraged to add basic medical information into their phone. In the UK there have been a number of campaigns to persuade people to add an ICE (In Case of Emergency) number into their list of contacts. Her suggestion was that this could be expanded to include key medical details. Plenty of such phone apps like this already exist, such as My Life Record, Smart-ICE, Hermes and Allscripts Remote. The problem they bring is how much they can be trusted, particularly in an emergency. It’s something that is causing considerable anguish not only within the medical profession, but also within industry groups who are trying to move medical monitoring into the home. It was a hot topic at this week’s Wireless Communications in Healthcare Conference in London.
At the heart of the problem is the integrity of data that goes into a clinical record. Until recently, data was only ever entered by members of the medical profession. The advent of accessible electronic health records means that patients can begin to enter their own data or modify their records. Whilst I believe that’s the way the world has got to move, it raises important issues.
The organisers probably weren’t expecting snow, but it didn’t stop the audience turning up en masse to Mobile Monday’s mHealth meeting in Amsterdam last week. The presentations were far from chilling; mHealth is moving from a position of relative obscurity a year ago, to something that every network operator feels they need to have. Vodafone, AT&T and Telefonica have already declared that it’s a key part of their strategy. The potentially still-born US health reform and accompanying monetary stimulus plans have convinced many more that there’s money to be made from it, and 400 plus attendees were keen to understand where those opportunities may be.
It’s been a good week for Bluetooth low energy. At times it’s felt like a long, slow path since it was first announced as Wibree in October 2006, but that feeling is changing as the standard is coming to completion. This week saw the first Bluetooth low energy conference take place in Munich where chips vendors were showing off demos, whilst on the other side of the world, at the ARM Techcon in Santa Clara, there were more live demonstrations of the technology.
The mood of the industry has become increasingly upbeat. It was noticeable in Munich that a significant number of companies have moved from cautious interest to being serious about starting to deploy it. The questions that they are asking have changed to the practical ones of qualification and access to test equipment. That change in mood was reinforced by the Bluetooth SIG announcing that the specification is on course to be released this December.
The Bluetooth low energy standard can be confusing at first. Although it carries the name Bluetooth, it is a completely new radio with a completely new protocol stack on top of it. It has been designed from scratch to allow developers to add connectivity to products that only want to send small pieces of data on an irregular basis, but with such low power consumption that it can run on coin cells. The companies attending the Conference in Munich have understood that difference and are keen to exploit the new products and service models that Bluetooth low energy offers.