Keeping the doctor away

In a world where health services often don’t exist in emerging markets and are overstretched in developed ones, mobile health represents a balm, rather than a panacea, for lack of medical resource.

The subject of health is never far from the headlines both in the emerging markets, where services and infrastructure can be dangerously scarce, and in developed nations where resources are increasingly overstretched. In many countries it is a sector for which the future does not hold much promise in terms of additional funding and resources—and for many people it is fast becoming evident that national health services cannot deliver all the care that’s needed.

For those of us lucky enough to live in wealthy societies with access to decent healthcare services, there is a serious concern that, in the not too distant future, the cost of care will rise to unaffordable levels. To make matters worse, regions like Europe with ageing populations face the very real risk of not having enough carers to look after the sick. According to figures from O2’s recently launched healthcare unit, global healthcare spend is running at a 5.5 per cent increase year on year. If that trend continues, by 2080 40 per cent of global GDP will be spent on healthcare, which means no one will be able to afford it.

The communications industry touches more lives than most and it is uniquely positioned to help develop new ways of looking at healthcare.

At the inaugural Mobile Healthcare Industry Summit hosted by Informa Telecoms & Media in London in December 2009, it emerged that there are plenty of apparently robust mobilehealth “solutions” out there supported by compelling business cases. Yet most are still in the pilot phase of deployment, awaiting widespread take-up. Why is this the case? Well, one large and unsurprising barrier is budgetary constraints. But more significantly, there is substantial resistance to change within the healthcare sector itself—it is one of the last big verticals to be touched by automation.

Some of the resistance is based on risk aversion—the fear of what harm these new technologies might do to patient-data privacy or patient health itself. But there is also resistance based on vested interests—on the fear that new technology might make certain tasks or jobs performed by humans redundant. This is despite the fact that health services are overstretched already, and demand is still increasing.

Resistance to change is a very human condition and, in the case of healthcare, that resistance is harder to fight in countries where there is a well established health industry.

So it is in emerging markets, where many areas lack even the most basic healthcare infrastructure, that the first opportunities may arise. A large void is waiting to be filled—with no legacy institutions obstinately clinging to old ways. According to the analysts, it is in these countries that operators can actually spearhead the provision of frontline health services in the same way they are doing with banking and digital-money services.

The nascent m-health sector is certainly ripe with potential. A recent global market survey from management consultancy McKinsey & Company pegs the value of the global mobile healthcare market at between $50bn and $60bn in 2010, with opportunities worth $20bn in the US alone.

To gauge consumer demand for m-health services, McKinsey conducted a global market survey of 3,000 consumers in six countries (500 each in Brazil, USA, Germany, South Africa, India and China), with findings indicating that a large proportion of the four billion people using mobile phones today struggle to gain access to good quality and affordable healthcare, both in emerging markets and more developed societies.

Obviously, the problem is exacerbated in the developing world. A telling statistic, revealed by Vittorio Colao, CEO of Vodafone Group and keynote speaker at the Mobile Healthcare Industry Summit, is that although there are more than 2.3 billion mobile subscriptions in the developing world, there are only 11 million hospital beds and 300 million computers.

So it makes sense to use mobile as a foundation. Dr Adesina Iluyemi, co-founder of SinseProd, a UK-registered social enterprise company stimulating technological innovations and investments into Africa, believes that, because low access to power stops crucial medical devices being used in certain regions in Africa, mobile phone connectivity is a more realistic platform for healthcare delivery.

“We are talking about technology obsolescence, devices that were phased out 30 years ago,” he said. “To get a vendor to retro fit parts to an old medical machine would cost ten times more than it would cost to buy a new machine, when even a new machine is not affordable.”

According to Iluyemi, even in South Africa, the most economically advanced country in the African region, an estimated 50 per cent of medical devices are useless. “There are no standards and there is nowhere to plug these devices in, because only 20 per cent of Africa has access to a national power grid. These devices are power hungry, they are not green, they are big, they are not mobile, and to solve 90 per cent of the population’s difficulties we have to use mobile.”

Iluyemi has a point that is supported by McKinsey’s research, which found that almost 70 per cent of respondents were extremely or very interested in at least one m-health product, with Indian and South African consumers showing the highest levels of interest (40-60 per cent across all products). Willingness to pay for such services was also surprisingly high for several products across geographies, with Indian customers willing to pay ten times their standard airtime rates, and US consumers 20 times standard airtime rates, to be able to speak to a doctor via PhoneDoctor. Brazilian and Chinese consumers meanwhile were willing to pay the equivalent of a new mobile phone subscription for the patient monitoring system HealthWatch.

The product names—PhoneDoctor and HealthWatch—and the very concept of electronically delivered health services have a somewhat futuristic connotation but this is reality rather than science fiction. Keith Nurcombe, head of O2 UK’s recently launched health unit, said that the technology itself exists today but most people are unaware of it.

“It’s very much not tomorrow’s world. It’s here now. We’re just joining a handful of existing technologies from other sectors together to create the offering. None of this is particularly expensive technology, it’s just redeployed in a different way,” he said.

With m-health, the focus is on prevention rather than cure, on health rather than illness. It’s an initiative facilitated by wearable devices and self measurement, and often involves taking some ideas from the sports field and making them mass market. O2 Health has a service called Home Physio trialling in the UK and already in commercial use in Spain, which offers home-based physiotherapy using sensors that fit on the body and a touch screen PC, which shows patients how to do exercises and sends info back to the hospital to make sure they are being done correctly.

But this is not to say that mobile applications will replace an MRI scanner. Accurate readings are still needed, especially in serious cases, but SinseProd’s Iluyemi argues that the industry needs to consider extending some medical technology to processes that are not blood-based, like saliva tests, where a fridge or adequate storage is not needed to preserve the sample.

So by moving and shifting existing technologies to a new environment, O2’s Nurcombe claims that health can and will be a key offering from Telefónica—and he’s not alone in this attitude. It may well be coincidence, but during July, there were no fewer than four mobile health offerings launched.

Telefónica’s new unit will build on the carrier’s existing efforts in m-health including the creation of the Living Lab R&D department in Granada in 2005, with products and services based on converging communications, managed web services with point-to-point coverage and a pay-per-use policy, and a model that provides economies of scale to extend applications with a minimum outlay on technology.

Orange also joined the movement with Smartnumbers, a healthcare specific service that gives callers instant access to the best placed medical professional or team available, providing patients and workers with the ability to reach the right person the first time they call. Meanwhile, Vodafone, a founding member of the m-Health Alliance, already has an m-health initiative up and running.

For Orange, health is one of three new areas of business growth, alongside audience and advertising and content. The operator has identified a market opportunity in the healthcare sector based on three key factors: healthcare expenditure is unsustainably allocated to chronic disease treatment; populations are ageing, particularly in France, adding to the burden on resource; and there is a fundamental shift occurring in the approach to care by both patients and doctors that crucially depends on new ways to manage information.

As an integrated operator, with both fixed and mobile operations, Orange sees itself as a natural player to connect the various domains of the healthcare ecosystem—from pharmaceutical companies and hospitals to subscribers and patients—and puts this role of “intermediary” squarely at the centre of its strategic goal to be a European leader in e-health.

The brand may well be of core importance to the success of this strategy because trust is essential, and given that operators and services providers already have a billing relationship and a cache of sensitive data on their customers, the foundations are already there.

“We need to deliver these solutions with credibility, which means we recognise that we are moving into a new market,” said O2’s Nurcombe. “Our approach is very much crawl, walk, run, so we can demonstrate our credibility and gain trust. We’ve got to be able to demonstrate that we have a right to enter this new market. We’ll only get one bite of this cherry so we have to get it right first time,” he said.

Mobile Healthcare Industry Summit, London UK
21 – Sep 22, 2010

Unique to Mobile Healthcare Industry Summit 2010! Over 60 leading innovator speakers from the wireless and healthcare sectors. Over 10 CEO Keynote presentations from global wireless and healthcare companies. Endorsing support from ALL the key associations and guidance from unique 360 degrees advisory board.

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