Standard Bearer update from June 2011

Operators believe they have a pivotal role to play in the transformation of the healthcare system. Telefónica’s Jose Perdomo is planting the flag for the spanish carrier.

When Spain’s Telefónica announced its plan to establish an e-health division in the summer of 2010, Cesar Alierta, the firm’s chairman, said he wanted the new unit to be a “standard-bearer” in the emerging e-health sector. It was a statement that reflected a widely held belief that telcos have a central role to play in this space.

As director of the Global e-Health Business Unit, Jose Perdomo is the man charged with planting the Telefónica flag—and he has little doubt that it is the telecoms industry that needs to facilitate the evolution of the healthcare sector. “For us it’s very clear,” he says. “The next wave of transformation in the healthcare sector will be based on communications— and we’re the ones who know how to connect people.”

It is notable that Perdomo doesn’t talk about the technological evolution of healthcare in terms of IT system overhauls—the kind of massive deployments that so often seem to go horribly wrong. Instead, as he says, the focus is communication. The single biggest challenge facing the global healthcare sector is chronic disease management, Perdomo explains. An ageing population is living with disease for longer periods of time and the resulting healthcare requirements are too much for the existing infrastructure to cope with.

“Patients will need to be managed at their homes remotely, not in the health care systems,” Perdomo says. “There’s full agreement on that across the healthcare sector. So this is about residential service; it’s not a product it’s a service and it’s delivered to the premises of the patient. There are not too many companies who can manage technology services for thousands of millions of consumers around the world. Only the telcos can do it.”

Not that the e-health ecosystem can be driven purely by telcos looking to expand their revenue opportunities, though. “We might want to push but if [the healthcare sector] doesn’t want to buy it, then it’s no good. But what we’re seeing is that the healthcare industry really does want to buy these solutions. They’re eager to improve efficiency, sustainability, quality access and reach—they have to change the way they do things, but to change they need technology,” he says.

Perdomo’s business unit comprises a central office at Telefónica’s Spanish headquarters, as well as regional outposts in the firm’s principal overseas markets, including Brazil and the UK. The regional arms have specialist sales forces, while the vertical core supports them in taking products and services to market, he explains.

Since he took the helm in September last year, Perdomo has been focused on building his team, looking to recruit internal staff with health sector experience as well as secure partnerships with a wide range of external players. He has also specified his unit’s key areas of operation, and secured budget and targets from the Spanish incumbent’s senior management.

Telefónica’s e-health operations are split into three areas, Perdomo explains. At the simplest end is a batch of services grouped together under the TeleCare category. These include panic buttons and family trackers, and will be built on the carrier’s Mi Familia platform, which was announced last year.

At the opposite extreme, the firm’s Health ICT offering includes a CRM tool for health care providers, mobile productivity solutions and appointment management solutions. These services are “moving quite fast” in the UK, Perdomo says. Cloud based services such as medical image storage and software as a service for healthcare providers also fall under the Health ICT umbrella.

Between TeleCare and Health ICT sits TeleHealth, which pulls together the real innovations in patient/doctor interactions and solutions designed to greatly improve physician efficiency.

The chronic disease management solution, still under development, is the flagship of the TeleHealth offering. This, says Perdomo, kits the patient out with a connected tablet device, as well as bio-medical measurement devices that feed health data back to doctors. Patients are given multi channel communication with medical staff, including voice and web chat. It is, Perdomo says, “an end to end solution.”

There are other interesting developments within the TeleHealth segment. Telediagnostic solutions enable doctors to communicate with one another virtually to aid remote diagnosis.

“We’re in the process of learning and developing the consulting skills to sell this product,” Perdomo says. “It’s almost industrialised in a few countries, but it’s about building the organisational capabilities.”

In Latin America, Telefónica is trialling a direct to consumer service that enables its customers to pay a small fee to be connected to a doctor for a voice call during which they can seek medical advice. In the carrier’s European markets demand for such a service would be weak, given the provisions made by the state and private healthcare sectors. But in Latin America, health infrastructure is less developed, Perdomo says.

“The public sector in much of Latin America is underdeveloped, and there are so many people who have medical questions. With this service they can get some advice and find out whether they need to see a doctor urgently or not.” Telefónica would like to evolve the solution, but is hampered by health regulation, he says. “It is very difficult to change regulation in many countries, so we are unable to do actual diagnosis over the phone. That’s the goal at some point, and it is happening in a few markets. But in the markets we’re starting with, it’s just basic orientation advice, delivered for a small fee,” he says. “That’s a pilot for now and we’ll probably launch the B2C service late this year, or early in 2012.”

The diversity to be found in healthcare country to country is one of the key challenges that faces telcos looking to take e-health services to an international audience. Regulatory practices, the balance between public and private sector provision, and the sophistication of services on offer vary enormously from market to market. While an operator can develop a voice or data telephony service centrally and deploy it across its footprint, with relatively minor adjustments, the same is not true for e-health services.

Perdomo concedes that this is difficult, but argues that it has nothing to do with national boundaries. “It’s different client by client,” he says. “Yes you have to be adaptable, but you have to do that sometimes with offerings in the North and South of Spain. The industry is complex.”

He says that Telefónica aims to have interest from clients in a number of markets when it is developing a new e-health service. Some elements of a service can be industrialised globally, he says, while some elements will have to be developed in the local market. Telefónica’s local teams supplement central development budget with their own funds in this scenario. “It’s not simple, but it’s the best way to do it,” Perdomo says.

Not that all development is carried out by Telefónica, though. The e-health sector, like any other, requires an ecosystem of players to service it effectively and Perdomo sees Telefónica’s role as marshalling that ecosystem to bring services to market. “We are in charge of controlling the service, but we’re not developing the software. And we’re not doing the industrialisation. It’s an ecosystem of suppliers and we own and integrate the solution,” he says.

And in some instances, a carrier’s network of partners will have to include its direct competitors, Perdomo says, depending on the business model of the service in question. “The [UK health provider] NHS wants to provide a service to all of its patients, regardless of who their mobile provider is, so we need to make sure that if we’re developing an application for them, that it runs on everyone’s mobile phone.”

Ubiquity is not the only motivation for ensuring applications can run across competitor networks, however. “If it doesn’t run over, say, an Orange phone, then I have to give the patient a new phone. And I am not allowed to gain market share as result of a B2B deal with a healthcare provider,” he says. “The NHS won’t let us force the patient to join O2 so they can get the service, it would not be allowed.” Furthermore, the provision of new devices is a costly business. The fewer devices Telefónica has to push into the market to enable ehealth services, the better.

Nonetheless, device management, inventory and replacement should be managed by the carrier, Perdomo says. “We have gone into clients who have bought many devices from the vendor and the devices are just sitting in the warehouse because the client didn’t know what to do with them.

And they’re healthcare providers so it’s normal for them not to know what to do with them. It’s critical that the telco manages the service from end to end.” Beyond the management of the service the telco should not go, he adds, saying: “We don’t want to position ourselves as the ones in the white coats.”

Most large carriers have identified the e- or m-health sectors as areas they need to be playing in; areas that have the scope to be extremely lucrative. Perdomo says the revenue potential for his unit could be €100m or more within three years, adding: “We expect to build a big business.”

What’s more, he says, growth will only be checked by the pace at which the healthcare sector can embrace and adopt the advances that the telecoms industry has to offer. “The speed at which we capture revenues will not depend on us but will depend on the speet at which the healthcare system is able to digest the transformation it needs to go through.”