Creative Connectivity

Mobile Health needs some Medical Pornography

If you’ve been working in Mobile Health or telecare, you’re probably frustrated by the slow progress being made in bringing products to market. Whilst analysts like research2guidance see a rosy future, more down to earth reviews, such as the recent 2020health report “Healthcare without walls: Delivering telehealth at scale”, and Frost & Sullivan’s “E- Healthcare Initiatives in the United Kingdom” continue to point out that very few projects have scaled up past a few tens of users.

Many reasons are put forward for that, ranging from the natural inertia of the medical industry, the barriers imposed by regulators, through to the difficulty in persuading doctors to hand over disease management to their patients.

Technology has been blamed in the past, but that’s no longer a valid reason. Over recent years there have been major advances in sensors, wireless connectivity and processing power. We certainly don’t have solutions to every problem, but there is a wide range of conditions where mHealth could provide significant benefits. So what’s holding it back?

Next week the Mobile Health Industry Review at the King’s Fund in London will be bringing experts and VCs together to talk about business models. I’ll be suggesting that mHealth isn’t the first industry to have suffered from this phenomenon. Even for disruptive technologies, it often needs an unexpected and sometimes even unconnected industry to invent and develop a new application in order to drive things to a point where the disruption can be taken up and embraced by others. One of the classic cases is the Internet. Much of the development of streaming, payment mechanisms and user interface was driven by the porn industry. Once that work was done, it was adopted by others, giving us the e-commerce, video streaming and compelling content that we now expect from every site.

So, if Mobile Health is going to get anywhere it probably needs to follow the same course and forget about conventional medical thinking, (which generally involves a doctor), and embrace some more disruptive models. To put it more bluntly, we need to find out what the equivalent of pornography is for healthcare.

The Evolution of Interoperability. Making the Dream a Reality.

I’ve been attending a lot of Smart Energy meetings recently and listening to industry experts talking about the need for interoperability in the connections between smart meters and appliances around the home. I’ve also been hearing a number of standards organisations trying to promote the message that the concepts of interoperability and a standard are synonymous. That’s a very dangerous message, because the two are only very loosely related. Just because you have a standard, it does not mean that products which use it are, or will become interoperable.

To understand why equating a standard with interoperability is a fallacy, let’s start with an analogy. In many ways, a standard is like a language. So we could define English, or French or Russian as standards. The standards bodies would then claim that everyone who speaks the same language is interoperable. I’d disagree. The language defines the grammar and the vocabulary, but you only have to listen to a Democrat and Republican senator debating health reforms to understand that speaking the same language does nothing to promote interoperability. If anything, a standard provides the tools to ensure that conflict is more, rather than less likely to occur.

Interoperability is about working together seamlessly. To achieve that requires more than just a standard. It needs a set of interoperability tests and the testing tools to confirm compliance with those tests. These don’t generally come with a standard – they need to be put in place to support it. That entails time and money, which means most standards can’t support them until they’re already fairly well established. Industries like Smart Energy demand interoperability, as they want the meters they install today to work with devices that customers may install in ten or twenty years’ time. But if they want to achieve it, they, need to understand how this process works.

Patent Trolls anticipate Smart Metering Bonanza

Over the last year, different groups have been beavering away to decide on a wireless standard for smart meters. It’s been interesting to observe the ways that different countries have approached this. There’s been the pragmatic approach of going with what’s available today, but with the understanding that it might need to be changed, so that everything currently being installed is at risk of needing replacement. That’s the UK approach of DECC. Then there’s the academic approach which is favoured by SGIP in the US, which entails producing a giant matrix of the vital (and not so vital) statistics of every possible wireless standard. At which point there will presumably be a flash of smoke, a glamorous assistant and a magician will be brought on stage to perform the conjuring trick of comparing apples, lobsters and elephants and deciding which is most appropriate of them for the smart energy feast. Or we have the slightly nepotistic ETSI approach over in Europe, which seems to be one of giving EU funding to all of their consultant or professor friends, who in return for this largesse promise to write their own, brand new wireless specification in time for the party.

Whilst some of these approaches consider cost in terms of the price of silicon, or even the opportunity cost in terms of time to market, one significant cost has been missing from their calculations – the cost of choosing a standard that opens up Intellectual Property disputes. That’s a real risk. The only place I’ve seen it publicly stated is in a briefing document from the Bluetooth SIG, which points out that from the IP viewpoint, wireless standards are far from equal. It’s a very valid concern. We’re already seeing the patent trolls coming out and attacking ZigBee and Wi-Fi. As volumes start to increase, so will their determination to make a fast buck. As soon as that happens, deployment could grind to a halt.

Goodbye Clinical Evidence, Hello Celebrity GPs

Governments like change, so when the UK acquired its recent coalition government, it didn’t take a genius to predict that change was on the way for the National Health Service. The NHS holds a rather special place in the hearts of the UK electorate. Although the UK media loves to hate it, and most people gripe about it, the bulk of the population have a great affection for what it does. Few realise that outside the UK most people involved in the medical industry view it with admiration. Because of its popularity, the incoming government mollified public concern by announcing that they would “ring-fence” spending on the NHS, but then promptly started to change it.

That change was heralded by a consultation on “Liberating the NHS”, which was slipped out before the summer holidays, probably in the hope that few would notice or respond to it before the deadline at the end of September. It signalled a major change in direction, where control would be moved from the current Primary Care Trusts (PCTs) to consortia of General Practitioners (GPs).

That raises some concerns. The first is that we don’t train GPs to be managers. We still train them in much the same way we did a hundred years ago. So the most likely effect is that all of the managers who get made redundant from PCTs will simply go and work for GP consortia. And as there are far more of these, it just results in an even bigger set of people micromanaging.

The more worrying concern is what effect this will have on prescribing practice. The consultation document keeps on trotting out the phrase “clinical evidence”, implying that the NHS and local GP practices base everything they do on good clinical evidence. It’s a nice theory, and it would be nice to think that those developing this policy change believed in and supported it. It should be possible – we have a body called NICE (The National Institute for Clinical Excellence) whose job is to promote it. But as soon as everyone got back from their summer holidays, Andrew Lansley – the new Minister for Health, got out his rusty shears and castrated NICE. It’s difficult to understand why, but the implications for the NHS and GPs are disastrous. It’s goodbye to clinical evidence, and hello to whoever can get the most publicity for their favoured drug of the month.

Medica goes Wireless

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.

Bluetooth Low Energy rides the Wave at Electronica

Electronica only comes every other year but it’s still the biggest electronics trade show in the world. The last time it ran, Bluetooth low energy was still better known as Wibree. In the intervening two years half a dozen companies have announced chips and the standard has been completed and published. So visitors to Munich last week had the first major opportunity for to see just how much progress has been made.

It’s obvious that the industry has moved from PowerPoint presentations to reality. Chips were on display, along with development boards and the first few modules. In the Forum within Electronica there were sessions on the applications it will enable, and in the adjoining Wireless Congress a full day’s track was devoted to developer training and further applications.

The silicon and tools are definitely here. Now it’s time for developers to add their imagination.