Helping the medicine go down

At Informa’s second Mobile Healthcare Industry Summit, held in London in September, sat down for half an hour with Thierry Zylberberg, executive vice president of the Health Line of Business at Orange and Michael Reilly, director of Orange Healthcare UK, to discuss the recent flurry of activity in the mobile health sector.

Zylberberg, who was one of the keynote speakers at the event, is quick to point out that this flurry of activity does not mark Orange’s debut in the mhealth space. Orange Healthcare was created as a division three and a half years ago, with Zylberberg adding that the company has been learning, experimenting and developing products and services in this sector for a significant period of time.

UK-based Reilly has been heading up the healthcare line of business in the UK for two years now. Originally, his function was part of the group organisation but with the establishment of Everything Everywhere he’s developing strategies with regards to the new entity now.

Mhealth, or ehealth to use a broader term, feels like an alien topic to explore as a member of the telecoms press. The attendees at the summit, many of which was not familiar with, highlighted the difference between the two sectors, while Zylberberg acknowledged the difficulty of breaking into the space as an operator.

“There’s the brand lesson,” says Zylberberg. “In France we launched a test product called Orange Santé and the response was a unanimous: ‘We don’t want to see Orange there, you don’t belong there.’ So we called it something else, the branding is green, not orange, and we said ‘powered by Orange’ instead. And that added a lot of value for consumers. No to see it our brand on the frontline but to see us adding technological support.”

Trust is a major consideration in healthcare and Zylberberg believes that there is enough confidence in the Orange brand to allow the operator to unlock potential in the sector. “We bring trust in hosting medical data and telcos are in a unique position to enter that space. They have the data centres and the very high security, ideal for hosting medical data,” he says.

According to Reilly, 30 per cent of all data stored worldwide on computers is medical data. And the big question for Orange is: “How do you liberate that information? How do you make it more easily moveable and manageable in a secure environment? Governments are now imposing severe regulations on who can host medical data. You need to be able to prove that your processes are good enough in order to get a government approval,” Reilly adds.

Zylberberg is quick to point out that telcos should be aware of their place within this new ecosystem. While some carriers expect to have a direct relationship with the end user in the delivery of mhealth services, Orange acknowledges the importance of relevant partners and sees its place as somewhere further along the value chain. “It’s not a common belief among the operators but I don’t think the operator will have a direct relationship with the end user. There are many dangers in that model and one is that I don’t want to be responsible for a patient in a life threatening situation with a life critical service,” Zylberberg says. “Telecom networks are not 100 per cent, they’re 99 point something per cent. You get dropped calls. I don’t want someone to depend on a network that drops calls. They’re not designed for it.”

Instead, Zylberberg sees the device manufacturers as having a more direct relationship with the consumer. “The patient is really always attached to a device, because that’s where the information is, so the device manufacturer controls the patient, not the telco. The telco takes the info and transports it somewhere else,” he says. “The telco’s role in my view will be hosting, transport, billing, security, cloud computing, but not much more. The partners will be the software industry, the over the top players, and the device manufacturers,” Zylberberg adds.

The importance of partnerships is a common mantra heard among telcos shifting into the healthcare space, and not least because the healthcare ecosystem is very complex. “You have the insurers which pay for health. You have doctors, You have private and public hospitals. All the various parts of the ecosystem are misaligned, which makes it very difficult for the whole system to change. Today it’s in some form of equilibrium but if you want to change any process then it means someone will gain and someone will lose. This is why technology takes so long to penetrate into this domain when compared to other sectors like finance and travel,” Zylberberg explains.

“Ehealth is really about two different ecosystems: the classical one we know from the telecom world – the telco and the vendor; and the other is the classical medical ecosystem and the two are merging, they’re colliding, it’s not just operators, it’s the whole telco ecosystem that’s going in that direction,” Zylberberg says. “Mobile health is not just about patients. Its not really a very solid concept, it includes many things, including access to medical information for doctors, medical devices for caregivers but also sending SMSes to people, iPhone apps, also measuring devices, pedometers, monitoring blood pressure or glucose level of the patient. Today it’s very fuzzy.”

There’s also a vast distinction in the drivers for mhealthcare between mature and developing markets. In emerging markets the main issues is access to healthcare, it’s as simple as that. In the face of economic challenges, mobile is bringing health services to the population, by allowing the sending of medical information, or organising people to meet a doctor in one village. While in mature markets it’s a quest for efficiency.

“Health costs are rising around the world at around five per cent per year. In Europe, healthcare represents ten per cent or 11 per cent of the GDP, and in the US it’s 16 per cent. By 2020 it’s going to be 20 per cent of GDP in the US,” says Zylberberg, adding that, “Over 50 per cent of the world’s population have a chronic condition.” And the drivers here are an ageing population and the rise of chronic diseases. Everyone is looking for a solution to curb rise in expenses. We need to contain the explosion. But it’s not as easy as in other economic systems.”

Orange, like many of its peers, sees a bright future in healthcare but acknowledges the fact that as a telco it has a very specific role to play. With patients increasingly demanding health service access at their convenience – and these are not necessarily high risk patients, but more the ‘worried well’ and low-risk consumers – there is an opportunity to put health information or remote access to health services in their hands, easing the communication between providers and their patients as well as internal communications for healthcare providers themselves.

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