Guru Insights on mHealth !!

Presentation1
The GSMA believes that mobile operators, through their evolving capabilities in creating meaningful connections between people, organisations and ultimately systems, can have a dramatic impact on the healthcare industry in improving access, reach and quality. Today the GSMA (Invitation only ) Ministerial sessions on m health certainly highlighted that developed countries are under intense pressure to reduce the cost of healthcare, whereas developing countries have a greater need to deliver life-saving services more broadly.The session deliberated on several key questions : What role can mobile play in delivering future healthcare worldwide? How can governments embrace the significant opportunity to improve quality of life for individuals, and increase access and efficiency in health services for its citizens? What are the emerging best practices from mHealth implementations. Believe it or not TB is a largely curable disease but requires six months of diligent adherence to the medication regime. mHealth could help control TB mortalities by ensuring treatment compliance through simple SMS reminders. Delivering mobile-assisted awareness to pregnant mothers and traditional birth attendants could reduce perinatal and maternal mortality by 30%.

In some developing countries, where there is less or totally non existing technical infrastructure and eHealth systems installed in hospitals, so the focus will be on basic health data collection, basic ICT infrastructure such as connectivity, and health access. Clinical adoption issues (relative to the developed world) will be lower, although the degree of IT literacy will cause issues depending on the specific market. However, budgets will also be correspondingly tighter, particularly in relation to eHealth systems which have been developed to cater more to the Western market, and particularly as health budgets will be devoted more to basic health provision, medical supplies and manpower.As mobile operators develop capability in the ICT space and begin to replicate the capabilities of an ICT infrastructure provider (such as IBM, EDS and Oracle). This may be acceptable in markets where the mobile operator has a natural incumbent advantage – but in other markets where this is not the case the key challenge then becomes one of differentiation.There are two parameters that provide mobile operators with a unique value proposition in the eHealth industry according to GSMA :

1. Leverage Global Integration capabilities for Supply Chain efficiencies

Traditionally, the mobile operator value chain consists of those core capabilities that enable it to acquire customers through its sales and distribution network, set them up on the network, identify and connect consumers on a network, create value added services in both voice and data, provide customer service and run sophisticated billing and tariff programs to optimise revenue per customer. In recent years, some mobile operators (particularly those with strong group operations) have developed specialised global business integration capabilities, ranging from cloud computing, portal technologies, payment mechanisms, Machine-to-Machine (M2M) platforms and solutions, and systems integration. These are the capabilities that allow the mobile operator to create solutions connecting the healthcare providers with the patient, as well as with other healthcare players in the industry, providing the industry level integration.

2. Shifting Demand with Integrated Participative Healthcare

In developing countries, the chronic shortage of healthcare professionals as well the prohibitive cost of building healthcare facilities in rural areas, are also indicators of a need for healthcare to develop beyond its traditional hospital-bound model. This can be done either by keeping patients from entering the system through effective prevention and wellness, or by managing patients consistently after they exit the system through medication adherence, effective monitoring and post-discharge management, particularly in the case of chronic diseases.

One key opportunity discussed is the ability to take mobile operators’ core capabilities and apply them inventively to solve healthcare problems both large and small. Telefonica talks of a “lift and shift” economies of scale methodology whereby there is a rule about being able to re-use a significant percentage of the investment made into any particular technology in another region.”. AT&T speaks of “utilising all of AT&T’s core assets to apply to healthcare”, and also of the importance of “scaling up” applications in both simple and complex settings, working from small to large scale.

Contingent upon the mobile operator’s global business integration capabilities is its ability to offer health specific solutions e.g. Cloud-based PACS or records hosting, remote monitoring solutions to manage chronic diseases, or sophisticated tele-medicine capabilities incorporating collaboration technologies with remote diagnostic equipment. These will enable the mobile operator to differentiate its offering while leveraging on its core ICT capabilities. Depending on the mobile operator’s business strategy, such capabilities can be developed either through internal development, partnering or acquisition. This strategy however requires greater internal investment in order to develop specialised health expertise, as well as to select suitable business partners with which there is mutual benefit.

Collaboration is an example of a capability that can apply both within the enterprise, between different healthcare institutions, as well as between the institution and the patient. At the simplest level, this can be web-enabled audio and video-conferencing solutions between physicians, to sophisticated solutions which incorporate both videoconference as well as peripherals which allow specialists to conduct diagnostic assessments to patients in remote areas. Cisco, for example, partners with both Telefonica and AT&T to provide such solutions. In Telefonica’s case, the Health Presence product was introduced in order to alleviate the travel needs for patients in the Balearic Islands who previously had to travel to Mallorca for diagnosis.

Orange set up their Orange Healthcare business unit in 2007, talks of “joining up healthcare”, echoing the role of mobile operators in connecting both the healthcare enterprise and the patient, as well as helping to remove the boundaries between the increasing number of players in the healthcare industry. They have organised themselves into services supporting the patient (in terms of wellness and prevention), to services supporting the healthcare professional and hospital operations, to services connecting the two in order to better manage the number one problem driving healthcare costs globally, that of chronic disease management.Telefónica, which set up their global eHealth unit in 2009, speak of their unit as being a “standard bearer for health products and services”, with three focus areas in Remote Patient Management (RPM), Telecare and Health IT. Grounded in the belief that healthcare both has a local context, as well as a need to cross-pollinate ideas and scale across geographies, their organisational strategy was to have separate individuals which have both a functional responsibility, as well as a regional/country focus

While the mobile operator industry relies a lot on partnerships to get into the health industry and expertise, the more established players do recognise the need to create their own in-house health expertise. When AT&T started their health business unit, for example, it hired 60% of their staff directly from the healthcare industry. Telefónica decided to build their team combining staff coming from the healthcare industry with experienced employees with deep knowledge of ICT as well as of the functioning and capabilities of a telco operator. Orange has 100 R&D professionals in healthcare in 4 Skill Centres globally in order to develop expertise tailored to healthcare systems in their global footprint. Telefonica centralises their technical resources in a Living Lab in Granada which houses all their healthcare application development expertise.

Cloud-based eHealth systems are gaining traction, as the number of locations of healthcare practice increase, along with the high cost of deployment and maintenance for traditional client-server models. These are particularly attractive to smaller clients with less complex needs, or clients with budget constraints. However, there are still residual concerns with the security and reliability of using a fully cloud-based solution for mission-critical health applications. Security and reliability can often be obtained through more “private” clouds which offer dedicated resources and guaranteed access, which unfortunately reduces the core cost advantage which cloud systems are procured for.Use case for the cloud is in the hosting of health records or acting as a connector between different enterprise level EMR systems. AT&T’s Healthcare Community Online product is a health information exchange based on cloud technologies, supporting collaborative care through secure messaging, access to multiple applications through one portal, integrating with the American Medical Association’s own portal.

Be sure of one thing “ the mobile operator’s evolving participation in eHealth will ultimately depend on the extent to which there is mutual value creation between the two sectors. For the mobile operator, there is the promise of a new corporate segment, a means to better utilise and monetise their enterprise ICT capabilities, an opportunity to extend their brand in the healthcare industry, and provide more subscriber value in their own mHealth services as they better integrate into the enterprise healthcare sector. SMART, a mobile operator based in the Philippines, recently rolled out a lightweight eHealth system in two major cities, with these constraints in mind. A mobile operator based in South Korea, has also recently developed a hospital information system that it plans to roll out across various sites in its home country, and currently considering expansion to China.For the healthcare sector, the mobile operator’s involvement represents an opportunity to reap the large economies of scale of using mobile operators’ significant IT investment, and partnering with an ICT player who is best placed in helping it extend its reach to the patient.

Sadiq Malik ( Telco Strategist )

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