Indian foreign ownership rules limit direct investment at 74 per cent

International carrier Vodafone has sold 5.5 per cent of Indian operation Vodafone Essar to Indian medical services provider Piramal Healthcare for $640m. Vodafone is required to divest the stake to bring it back below the 74 percent ownership threshold, which is the Indian limit for foreign investment within a company. In July Vodafone acquired Essar’s holding in the operation, taking it beyond that threshold.

The partnership between a mobile operator and healthcare provider might turn out to be more than just a convenient financial relationship. Wireless health solutions are an area of increasing interest to mobile operators, especially in emerging markets, where traditional health infrastructures are less developed.

In 2009 Vodafone created the Vodafone Health Solutions business unit, which is located within its Global Enterprise division. The unit is tasked with developing a global portfolio of health-related services.

According to the World Health Organization, between the years 2000 and 2050, the number of people worldwide aged over 60 will grow from 600 million to two billion. As the population ages, more and more people are living with chronic disease, shifting the focus of the healthcare sector from acute care—battling illness that is serious but brief or episodic—to the ongoing management of long term conditions like heart disease, diabetes or high blood pressure. The ageing of the population will be most keenly felt in populous, emerging markets like China and India.

For more on m-health look here.

Mobile operators are well positioned to help the health sector to modernise, cut costs and improve efficiencies

The telecoms and healthcare sectors are not without their similarities. We hear much of the challenges faced by operators with disparate silos of information within their business. They have to manage billing, rating, network performance, quality of service, applications, customer care and so on. The health sector, meanwhile, has evolved to create a far larger, and far more delicate collection of data and expertise silos of its own. But instead of frontline infrastructure and back office systems, these silos concern vital organs—the heart, liver and lungs—and other areas of medical speciality, like orthopaedics and vascular medicine. Prod your body, and you’ll hit something that has its own silo. In their structural complexities the two sectors are related.

One of the central historical problems within the healthcare industry would be instantly recognisable to any mobile operator management team. Doctors with different specialities have not been good at communicating with one another about their shared patients. Huge volumes of data have been gathered but not put to work; not exploited in an integrated way to improve the efficiency and quality of performance of the healthcare provision network.

Advances in IT have not necessarily helped this situation. The evolution of a trio of key technologies— storage, broadband and processing—have greatly increased the volume of data that healthcare providers are struggling to manage. Information volumes in the healthcare sector are currently doubling every six months, says Chris Wasden, head of Global Healthcare Innovation at PricewaterhouseCoopers. “You think Moore’s Law is rapid at 18 months,” Wasden says. “Data in healthcare is growing three times faster.”

The explosion in healthcare data can not be attributed solely to the advent of new technologies, though; there is a more fundamental driver at play. The global population has been growing, ageing and getting sick, meaning that there is simply more data to collect.

And this problem is not going away. According to the World Health Organization, between the years 2000 and 2050, the number of people worldwide aged over 60 will grow from 600 million to two billion. As the population ages, more and more people are living with chronic disease, shifting the focus of the healthcare sector from acute care—battling illness that is serious but brief or episodic—to the ongoing management of long term conditions like heart disease, diabetes or high blood pressure.

While advances in technology have contributed to the data management issues facing the healthcare sector, Chris Wasden says that—as an industry— healthcare is a laggard when it comes to IT. He estimates that healthcare is some ten to 15 years behind sectors like manufacturing and finance in the adoption of IT and that it has significantly underinvested in what to most industries is a priority area. In terms of its information processing, Wasden says, the healthcare industry, “hasn’t changed much in 100 years.”

There are logistical issues, too. The ageing of the population will be most keenly felt in populous, emerging markets like China and India. In many developing markets there is a shortage of doctors, often combined with a geographically widespread population. It can be extremely difficult, in some cases impossible, to get a patient to a face-to-face consultation with a doctor.

In mature markets like the UK, or Japan, where access to healthcare is comparatively straightforward, with no shortage of hospitals, the problems are with the cost of provision, rather than with the ability to provide. Cuts to public services are rife in European markets as healthcare providers struggle to make their numbers add up.

“The cost of health is exploding around the world,” says Thierry Zylberberg, executive vice president of Orange Healthcare, a central division set up by the French group in 2007. “All health systems are desperately trying to find ways of bringing the cost down, or at least trying to control the explosion.” With these factors in mind, it’s no surprise that health is seen as one of the most important verticals to be addressed by communications providers. As Jose Perdomo, director of the Global eHealth Business Unit at Telefónica points out in the interview on page 10, healthcare providers are desperate to “improve efficiency, sustainability, quality, access and reach.”

On the face of it, telcos—and in particular mobile operators—have the answer to a lot of these problems. But it is perhaps a little strange that the health sector shouldn’t be looking to solve these problems for itself. Rainer Herzog, head of healthcare and strategy at Ericsson offers a blunt assessment of the situation. “I think the healthcare industry lacks people that are ICT-minded,” he says. “We’re looking at a complex ecosystem here where, in order to make the whole thing work, you need competencies from different sides. The traditional healthcare players just don’t have the competence and the knowledge to drive this.”

As operators become increasingly central to the provision of healthcare, it is conceivable that government subsidy could be an alternative means of reimbursement

While Herzog’s view is shared by many, there is an important distinction between the healthcare institutions and the doctors working within them, says PwC’s Chris Wasden. A recent survey of the US health sector carried out by Wasden’s Healthcare Research Institute  showed that physicians have been inspired to bring the mobile technology they use as consumers into their professional lives.

“Doctors are buying these iPhones, iPads and Androids on their own nickel because they want the latest gadgets,” Wasden says. “Then they walk into the IT department and say ‘I need you to put all of the information we have in the IT organisation on my phone’.

Traditionally, IT in the health sector would provide a new solution and push it onto doctors, who would resist. Now you find doctors starting to use these devices faster than they can be supported by their IT departments.” Which opens the door for the mobile operators. They, after all, are already selling basic connectivity services to hospitals and health organisations—and have been doing so for many years—as part of their basic enterprise play. And they are selling doctors the consumer products that they want to take professional. But they cannot serve this sector alone. Operators may have the relationships and the technology—but they can’t cover all the bases in this complex ecosystem.

Thierry Zylberberg says that Orange is working with GE Healthcare on a project to archive medical images in France (see box). “GE has the software competence and the knowledge to digitise the images and I don’t see why we would try and replicate that knowledge,” he says. “They’re far better at it than we are. On the other hand, we know how to transport and archive all this information safely and securely, and this is our forte.”

It’s an illustration of the importance of partnership in m-health. Application development, industrialisation, billing, CRM, even systems integration can all be done by specialist third parties. Orange’s Zylberberg and his opposite number at Telefónica, Jose Perdomo—and these are two of the most established telcos in the space—are adamant that the operators should stick to areas where they have proven expertise. It’s a lesson carriers have learned at their cost in the consumer content and application space.

This need not mean they have to be anonymous cogs in the machine, however, says Ericsson’s Rainer Herzog. “Operators must take on the role of driver in this sector,” he says. “In some discussions we have some of them still seem to have the attitude that they should just be pipes, or enablers. But if they want to be a serious player in this space then they must accept that they have to be the drivers.”

This is certainly the role that Jose Perdomo is embracing, with Telefónica even refusing to provide single elements of the service. “Some clients say they just want us to manage the devices and we say ‘no’. Some say they just want connectivity—but the point is the integration of the service; it’s critical for us to manage the service end to end,” he says.

So how are carriers structuring their approach this market? Telefónica splits its e-health operations into three areas. Health ICT covers the enterprise services provided to hospitals and other health organisations, TeleCare covers family trackers and panic buttons and TeleHealth gets to the nub of the e-health proposition, linking patients and patient data with remote physicians in a series of projects.

At Orange the structure is slightly different and does not include the basic enterprise services that the firm provides to hospitals and other healthcare institutions. The top tier, Health Professional Services, deals with applications that connect physicians with one another, enabling them to share useful information, sometimes even during surgical procedures. Below that, Health Management covers the exchange of data between patients and doctors, enabling remote monitoring of metrics like glucose levels in diabetics or blood pressure levels. The third element of the Orange play deals with prevention and wellness, and tends to be purely local and patient-centric, says Zylberberg.

Whether there is any room for carrier brands in the array of mobile health products and services is a subject for debate. Orange’s Zylberberg argues that operators should stop short of having a consumer play, suggesting that products could be sold as “powered by” a particular carrier, if they have any patientfacing presence at all.

On the other hand, PwC’s Chris Wasden urges operators to take a lead in the sellthrough of mobile health services to the end user. As part of its recent US market survey, PwC’s HRI spoke to 1,000 consumers in the US about what they would be prepared to spend on mobile health services. The result was somewhere between $5 and $10/month—it might not sound like much, but Wasden argues that carriers should pursue it.

“If the consumer is willing to pay that much for a healthcare bundle of services, that’s a ten to 20 per cent improvement on an operator’s monthly ARPU,” he says. What other services is a telco going to provide to a customer that yields that percentage improvement in their monthly ARPU?”

It’s not that simple, however. Billing is difficult enough for mobile operators but it takes on a whole new level of complexity in the mobile health space; not least because it’s not always clear who should be billed. For services provided to healthcare institutions as enterprises, the approach is straightforward. These services are designed to improve the efficiency of the institution, so the institution pays. For services that involve the deployment of equipment to the patient’s home there is no such obvious solution. “There is no stabilised business model, and everyone seems to be converging on the fact that the insurer has to be the one that pays for the system, because if it improves the health of the patient, then it lowers the risk on the patient,” says Thierry Zylberberg.

This only applies in markets where healthcare is funded by insurance, however. In much of Europe and in many developing markets, health is state-provisioned, so these services would require funding from government or the healthcare sector itself. Chris Wasden says he is “starting to see some movement” in government funding of these solutions.

As operators become increasingly central to the provision of healthcare, it is conceivable that government subsidy could be an alternative means of reimbursement. “Should a telecom operator competing for a license gain priority if it commits to free or discounted healthcare services across its infrastructure?” asks Informa analyst Camille Mendler. “Should such an operator also face a lower financial burden for market entry in view of its community-wide contributions? On these issues governments and regulators remain largely silent, but we believe that this discussion must occur.”

In China, where the largest remote patient monitoring pilot is currently running, involving 100,00 patients, access to care is far more of a driver

There is one key factor acting against mobile operators billing consumers directly, which is that healthcare providers want to be able to reach their entire market, and not just that part of the market served by one operator. Given that they are not likely to strike partnerships with every carrier in a market, mobile operators looking to work with healthcare providers are better served taking their revenue further up the chain. The confusion over billing illustrates one of the wider difficulties of the m-health sector, the provision of services across national borders.

There are enormous differences between different countries’ healthcare provision systems, in terms of technological advancement, funding and resource. For mobile carriers used to addressing multiple markets with essentially the same set of services—dependent on scale for the performance of their business— this represents a challenge.

“One lesson you learn very fast is that there is no global health system, only a series of national health systems, so you have to have a country by country strategy,” says Orange’s Zylberberg. “This is an advantage for telcos that have a lot of knowledge at local operating companies.”

Some argue that the differences between various markets should be looked at in terms of the drivers rather than the difficulties, though.

In the US many doctors aren’t paid a salary, instead charging fees for each patient seen. These doctors aren’t going to be interested in technologies that reduce the number of patients that they have to see. But they will be interested in reducing the cost of seeing each patient.

In China, where the largest remote patient monitoring pilot is currently running, involving 100,00 patients, access to care is far more of a driver. As Chris Wasden says: “Remote patient monitoring, teleconsultation, video communication, these types of solution you see in China, India, the US, Canada and Europe. The difference has to do with the pain points in the countries.

The mHealth Alliance’s Jody Ranck suggests that mobile health solutions ought to be scalable because they can be adapted for deployment in other sectors, multiplying the returns on the work involved in their development. “An application used for data collection in healthcare could also be used in anything from agriculture to citizen reporting,” he says. “We think of telecom as a platform-as-a-service.”

The opportunities for operators in this space are unquestionable, even if the exact models have yet to be defined. There is an increasing conviction within the health sector that communications will be fundamental to the future of healthcare and, with the wider move to cloud services and the restrictions on funding for healthcare, the sector itself is not going to develop services internally when it can outsource to a partner.

Thierry Zylberberg says that Orange is currently deriving slightly less than €1bn in annual revenues from the healthcare sector worldwide, although this includes revenues for standard enterprise services. Jose Perdomo talks of hundreds of millions of Euros in revenue for Telefónica as it looks to commercialise the projects it has been working on.

What seems crucial is that operators manage the ecosystem, much as, say, Apple has with its App Store. They need to ensure the availability of a wide range of services, they need to make sure they can be billed for with transparency and they need to ensure that everything works in harmony with everything else. It’s no mean feat, but the opportunity to control this value chain is open to them in a way that the application store model that they were trying to generate for so long is not.

Mobile technology could form a key element of the response to increasing demands on healthcare services

In the fourth instalment from his book Being Mobile, which is being serialised exclusively on Telecoms.com, Ofcom’s William Webb looks at the opportunities for wireless technology in the healthcare sector and the improvements it could help bring about.

Healthcare is an area of rapidly growing importance. Many studies have shown clearly how the population is aging and demand for healthcare is growing—and yet the number of people in work (and hence paying for the healthcare system) is falling. Under current extrapolations, healthcare will become increasingly unaffordable and impossible to implement, with an unfeasibly large percentage of the population engaged in caring for others. Either the quality of healthcare provided will fall, or new means must be found to care for those who currently rely on the support of others.

Wireless communications provide one possible part of the solution. Through a system of monitors, alerts and the provision of information it might be possible for electronic systems to allow people to monitor their health more effectively or to generate better information that remote medical professionals can monitor and analyse.

The benefit of both scenarios is that the user of wireless medical infrastructures would be able to stay in their homes and look after themselves for longer. A downside is that increased medical monitoring will uncover mild forms of sickness and ailments that have hitherto remained undetected, or have been dealt with by the natural defence mechanisms of the body without medical intervention. This could make individuals excessively health conscious or hypochondriacal.

Developing wireless solutions to healthcare needs might be important both to society as a whole and also to the wireless sector, where important new markets and new uses of technologies might be enabled.  In this article we look at healthcare in the home and hospital, in “Being Mobile” we also cover the ambulance and the individual as well as looking in more depth at the way ahead.

Healthcare at home

Broadly, the function of devices in the home is to monitor the individual to make sure that there is no cause for concern. Monitoring can take many forms, from fall alarms that detect a sudden change in patient orientation, to sensors in pill dispenser boxes that detect whether the daily dose of pills has been taken. Other sensors could be included in scales that chart daily changes in body weight and composition, or movement detectors to assess whether the patient is moving freely around the house.

Such monitoring essentially forms a sensor network. The sensors may be wired or wireless—for the most part wireless sensors would provide more flexibility and avoid the need for complex wiring systems to be inserted around the house.

One of the key problems for sensor networks is power, but in the home this might be eased. Some sensors might be able to use mains powering and in others (scales, for example) sufficiently large batteries could be employed to provide many years of power. Some sensors could have their power supply replaced regularly—pill sensor boxes might have a new battery inserted each time a new supply of pills was delivered, say. Because most of the sensors will be readily accessible, replacing batteries should they fail unexpectedly might not be problematic (as long as a failed battery was identified as the fault).

Because most homes are relatively small environments, a communications system based around a star-architecture might be appropriate. This would consist of a home hub providing wireless communications throughout the home. The most likely candidate for this would be WiFi, which already provides such functionality, although using WiFi in the sensors might be a heavy drain on batteries. Nevertheless, as noted above, this may not be problematic in many situations. WiFi also has the advantage of inexpensive chipsets that can readily be built into many devices.

Alternatives could be cellular-based (using femtocells), BlueTooth, Zigbee or proprietary protocols. Mesh-architectures could also be considered. Any of these could be made to work, but WiFi has the big advantage of the home hub already being available in many cases. Another approach might be a number of powered distribution nodes around the house that communicated with the home hub via WiFi or home powerline communications and communicated with sensors using a lower power and lower range standard such as BlueTooth.

A key question is how such a home healthcare system could come about. It could happen in an evolutionary fashion, as home owners gradually added various items one at a time as they found them valuable. Alternatively it could be offered as a complete “home refit”, with an entire system being installed at one time.

The complete refit offers the possibility of a single system, optimised for the task in hand, without the complexity of having to adapt to the different elements already in the home. It could be installed by professionals and might be simpler to use than multiple systems, because it could have a single combined user interface for all sensors. However, this would require central planning and likely central funding and, while not out of the question, there are many barriers to such deployments. These include issues such as the department benefiting the most (often the hospital) not being the source of funding (which is often the local authority). While it should not be ruled out, it seems unlikely.

Evolutionary deployment is much easier to envisage. A simple example of a home healthcare element that could readily be implemented now is a set of scales that measure weight and body mass composition (these are widely available for around $50 – $100) with in-built WiFi which records the daily measurements and then supplies them to the home computer via the home hub. If the home already had a WiFi system and home PC then, with the download of a simple software program, the scales could provide information both on the weight of the patient and also on the fact that they had weighed themselves at the usual time of day (and hence were active).

There might be a gradual increase in the number of such sensors over time, with end users buying them directly, making use of subsidies where available or building on functionality already provided in devices such as the Wii.

Healthcare in the hospital

Key applications fall into:

• Monitoring the location and movement of people, equipment and drugs.
• Removing wires.
• Facilitating access to information.

The monitoring function is valuable because items can go missing in hospitals. Valuable equipment can be moved by one person resulting in their colleagues being unable to locate it later. Drugs can be misplaced, or given to the wrong person. Even patients can go missing if they choose to move around without informing the staff. Tracking these items can save time, costs and, in some cases, result in better care.

Tracking is generally performed by placing a passive sensor or tag onto devices or in the wrist bands worn by patients. Whenever these devices pass through a controlled point such as a doorway where an active reader is located, the reader notes their presence and records it. Such tagging is already widely used in department stores at the store exit to detect stolen goods and in business premises to open doors with an employee pass. The technology is often known as RFIDs and is well established. Installing it in a hospital would involve some cost but little else.

The removal of wires allows patients with body sensors to move about freely and for equipment to be wheeled from bed to bed without needing to be plugged in. This is all relatively straightforward, making use of either short range standards such as BlueTooth (for example to connect body sensors to nearby monitors) or longer range standards such as WiFi (to connect monitoring equipment to central databases).

Facilitating access to information allows healthcare workers in the hospital to access patient records, central databases and communicate with each other while moving around the hospital.

One concern over implementing these applications using wireless is that most envisage using unlicensed spectrum, often at 2.4GHz. There are no guarantees of freedom from interference in this spectrum, although it might be possible in a hospital environment to control the devices within the hospital to some extent. If the hospital were to become reliant upon unlicensed spectrum to the extent that it could not function properly without such wireless connectivity then the consequences of interference might be severe. Indeed, the possibility of congestion or interference is one that affects much more than hospitals, with the potential to impact WiFi hotspots, home hubs and much more. It is still very much an open question as to whether interference will occur and, if it does, whether there will be acceptable solutions.

Difficulties in introducing new solutions

On the face of it healthcare would seem an excellent place to introduce new wireless services and technologies. There is a strong need for new solutions and many worthwhile concepts can be envisaged that would improve the lives of patients and save money for healthcare authorities. Some of these services might then be further developed into other areas of our lives.

However, there are barriers caused by the manner in which healthcare is provided in many countries of the world. Institutional arrangements are often such that there is little budget for new ideas and the benefits often fall to different budget holders than those who would fund the deployment. Healthcare is also often a conservative world that is difficult to change both because of the entrenched self-interests and also the risk of harming patients, or of legal challenge, if a deployment is not successful.

In addition to this, the benefits that continuous monitoring provides might not be as great as benefits derived from greater investment in more traditional forms of medical infrastructures. Health organisations may need to choose between more operating theatres and wireless systems, just as they might have to choose between wireless devices and more general practitioners.

There are many areas where harmonisation would be very valuable, for example in the standards that sensors use to communicate so that individuals could have one monitoring device and healthcare professionals could link into the sensors when needed. But there is little evidence of harmonisation of this sort taking place, despite the fact that it would not be unduly difficult since many appropriate standards exist already.

These concerns make it most likely that wireless healthcare solutions will be introduced piecemeal, often by individuals. It is much simpler for an individual suffering from a particular condition to purchase a sensor or device that will assist them and link it to their home system than it is for a central agency to supply appropriate technology. Self-purchase works better in a market economy and seems likely to happen in the health sector over the coming years.

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Still, head honcho Bert Nordberg said the company was displaying “continued momentum” even if the initial impetus has tailed off somewhat. Sales were up both consecutively and year on year however to €1.7bn although unit shipments were down slightly year on year at 11 million.

The good cheer continued over in Mountain View, California, where Google reported its customary increase in earnings, from $1.4bn in 2Q09 to $1.8bn in 2Q10, while revenues jumped 24 per cent year on year to $6.82bn. The search giant doesn’t break out mobile in its earnings, but expect it to be a growing part of the business, especially now that the AdMob deal is good to go ahead.

Chip giant Intel also reported its best ever quarter, with revenues rising 34 per cent year on year to reach $10.8bn in the second quarter of 2010. Net income for the same period was up 175 per cent year on year to $2.9bn. The good fortune was largely down to strong demand for desktop processors in the corporate space but Intel said Atom microprocessor and chipset revenue, which targets portable devices and smartphones, hit $413m during the quarter, up 16 per cent sequentially.

However the semiconductor giant lacks cellular chipset assets including basebands and RF chips and is presently understood to have its eye on Infineon’s wireless business, which would complement its Atom business. According to Malik Kamal Saadi, principal analyst at Informa Telecoms & Media, the acquisition of Infineon’s wireless business could help Intel to serve all segments of the mobile market, while Infineon’s HSPA/LTE baseband assets that currently power a number of successful smartphones including Apple’s iPhone, could enable the company to offer more integrated chipsets similar to Snapdragon offered by Qualcomm

There was more M&A speculation this week with Nokia Siemens Networks believed to be mulling a bid for Motorola’s networks business. The number being bandied around in the press is between $1.1bn and $1.3bn, but the Informer does not think it would be a marriage made in heaven. What with every operator and its dog jumping to LTE, Motorola’s CDMA business has a finite lifespan, and NSN’s not really interested in its WiMAX bits either. The Finnish-German vendor did lose out on Nortel’s CDMA and LTE assets last year but the fact that it didn’t bid big bucks against Ericsson suggests that it wasn’t desperate for them. So really the only thing Motorola’s got that NSN might want is a foothold in North America. A classic case of the potential partner being well past their sell by date but still having a nice place in the Hamptons. But whether that’s worth a dowry of more than $1bn remains to be seen.

Going back to LTE for a moment and the 4G love-in continued with Israeli infrastructure vendor Alvarion, a company that bills itself as a “founder of the WiMAX industry,” evidently deciding that if you can’t beat ‘em join ‘em, by announcing plans to start making LTE kit.

The firm, which was badly burned by Nortel’s demise, has decided not to put all its eggs in one basket and has expanded its product line to support the TD-LTE standard. Alvarion expects to engage in TD-LTE field trials in the first quarter of 2011 and will incorporate TD-LTE support into its 4Motion infrastructure portfolio.

Eran Gorev, president and CEO of Alvarion, was quick to point out that the company will continue to actively drive WiMAX activities but said: “The trend in wireless spectrum availability around the globe supports the fact that unpaired TDD spectrum will have an even greater role to play for broadband wireless deployments in the future.”

To be fair, this does fit with what the Informer has heard about the potential for TDD spectrum, and it does seem that there is growing momentum behind the TD-LTE flavour of the technology, even outside of China where China Mobile is flying the flag having already had enough of TD-SCDMA.

Over in Oz, Telstra announced that it has successfully tested LTE in its 1800MHz spectrum, tapping Chinese vendor Huawei to deliver the equipment. The carrier will continue to evaluate the technology in Victoria, using MIMO antenna configurations as well as several advanced features including Inter Cell Interference Coordination to reduce radio network interference and improve throughput, and Self Organising Networks. Telstra expects its 1800MHz spectrum deployments to complement the 2600MHz spectrum and the 700MHz band anticipated to be made available through the digital dividend.

US WiMAX pin up Sprint is also knowing to be considering its options with LTE, after chief executive Dan Hesse said that the company is mulling a deployment of LTE alongside its existing WiMAX network. This week the carrier switched on WiMAX services in a handful of other US cities and revealed that its first WiMAX-enabled handset, the HTC Evo 4G, is selling so well HTC can’t deliver units fast enough.

Still at least HTC’s Android devices won’t self destruct. Crafty handset hackers have discovered that Motorola’s recently announced Droid X, which will be available on Verizon Wireless this summer, has an anti-tamper mechanism called eFuse that will permanently kill the handset if someone tries to modify or install another operating system, which one might think goes against the open source ethos of the Android operating system no?

In other Android news, free mapping and navigation firm Skobbler has launched a version of its app for Android, citing great success for the iPhone version, which was released just four weeks ago and has already chalked up 82,000 downloads in the UK. Vodafone was also getting free in the mapping sense, making its location based services software open source after its little jaunt with Wayfinder reached a dead end.

The Flying V bought Swedish location firm Wayfinder for €26m in December 2008 but revealed in March this year that the unit would cease operations in the face of free offerings from the likes of Nokia and Google. Now Vodafone is releasing its code in the hope of stimulating development from independent players that will see new applications brought forth for its customers.

Meanwhile, Apple chief Steve Jobs himself swam down to the Gulf seabed on Thursday and did what no one else could do, even Kevin Costner: he plugged the leaking BP oil well with his iPhone (is there an app for that?). Ok, he didn’t actually do that but his feat tonight will be on a similar par if you believe the foam-mouthed and frenzied consumer press. Apple is holding a special press conference, presumably to deal with the leaky antenna issues plaguing the iPhone 4, but the big question is, will they hold it the right way? (Boom boom).

Now is it the stormy weather, old age, or not enough milk as a child that makes the Informer’s bones ache so? It’s comforting to know that the industry which has fed and nurtured him so well over the decades also intends to look after him through his golden years. There’s been a right flurry of activity in the mobile healthcare sector led by Telefónica, which launched a global e-health unit tasked with the decentralisation of clinical processes and ubiquitous and remote access to these services.

According to the slightly depressing presentations given in Madrid on Tuesday, by Trinidad Jiménez, Spain’s minister of health, and Telefónica chairman, César Alierta, in 2010, 13.5 per cent of the world’s population – 980 million people – will be over 65, and 60 per cent of these will suffer from chronic and degenerative illnesses. This situation, combined with the current shortfall of specialists in key medical assistance sectors, and the fact that these specialists must spend between 30 per cent and 50 per cent of their time on administrative tasks instead of healthcare activities, are putting additional pressure on public healthcare budgets. But not to fear, mobile technology can save the day.

Orange UK is also in on the action with Smartnumbers, a healthcare specific service that gives callers instant access to the best placed person or team available, providing patients and workers with the ability to reach the right person the first time they call.

Pay attention: you’ll be needing this kind of thing before you know it. Like the man sang, it’s later than you think.

And on that cheery note, the Informer bids you a good weekend.

Take care

The Informer

Telefónica launches global e-health initiative

Demonstrating the growing importance of the healthcare sector in the operator community, Spain-based Telefónica on Tuesday launched a global e-health unit tasked with the decentralisation of clinical processes and ubiquitous and remote access to these services.

According to presentations given in Madrid on Tuesday, by Trinidad Jiménez, Spain’s minister of health, and Telefónica chairman, César Alierta, in 2010, 13.5 per cent of the world’s population – 980 million people – will be over 65, and 60 per cent of these will suffer from chronic and degenerative illnesses. This situation, combined with the current shortfall of specialists in key medical assistance sectors, and the fact that these specialists must spend between 30 per cent and 50 per cent of their time on administrative tasks instead of healthcare activities, are putting additional pressure on public healthcare budgets.

In this context, containing IT costs in the healthcare sector can be achieved through digital standards leading to interoperability, and the use of business intelligence in risk management and patient-centred projects.

According to Telefónica, which is currently participating in over 80 projects in the e-health segment in over nine countries, telemedicine and remote telecare, and greater network integration through ICTs represent the opportunity to optimise resources and budgets, improve productivity and establish an efficient cooperation system between health centres and professionals.

Commenting on the launch of the global e-health unit, which will develop product lines for all countries Telefónica operates in, Alierta said: “This global unit has a cross-company character, and already has local units in Spain, Europe and Latin America, composed of professionals who define the strategy and planning of services and their industrialisation, operation and support. It aims to become a standard bearer in the areas of products, pilot projects and know-how.”

The new unit will build on Telefónica’s existing efforts 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.

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Healthy opportunities in the m-health sector

Opportunities in the global mobile healthcare market are estimated to be worth between $50bn and $60bn in 2010, prompting operators to step up their initiatives in this emerging sector.

The figures come from a global market survey from management consultancy McKinsey & Company, and suggest that mobile health (m-health) opportunities in 2010 could be worth $20bn in the US alone.

To test consumer demand for m-health services, McKinsey conducted a global market research survey of 3,000 consumers in six countries (500 each in Brazil, USA, Germany, South Africa, India and China). The findings indicate 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.

According to the research, almost 70 per cent of respondents were extremely or very interested in at least one m-mealth product, with Indian and South African consumers having the highest levels of interest (40-60 per cent across all products). However, US consumers expressed high levels of interest in PhoneDoctor (60 per cent) and HealthWatch (35 per cent) services.

Willingness to pay for such services was also surprisingly high for several products across geographies, with Indian customers willing to pay ten times airtime rates, and US consumers 20 times airtime rates to be able to speak to a doctor via PhoneDoctor. Brazilian and Chinese consumers meanwhile were willing to pay equivalent to a new mobile phone subscription for HealthWatch.

These two sectors – PhoneDoctor and HealthWatch – were found to hold the greatest opportunities, with almost 50 per cent of the market opportunity likely to be captured by connected biosensor devices, representing almost $30bn of incremental opportunity globally. HealthWatch services might include a SIM embedded biosensor watch that monitors vitals, and is connected to the emergency services. PhoneDoctor, which was estimated as a $10bn global market opportunity, allows customers call to speak with a qualified physician for remote diagnosis and advice.

“Mobile healthcare is clearly an opportunity to improve healthcare, manage costs and at the same time drive growth. We believe it is something that mobile operators, hospitals, pharmaceutical and medical device manufacturers, technology players, health insurance companies and governments too should all be looking at closely,” said Alessio Ascari, director at McKinsey’s Milan office.

Vodafone, a founding member of the mHealth Alliance, already has an m-health initiative up and running and Orange recently announced that it too had joined the Alliance – a partnership which uses mobile technology to improve public health and patient care in the developing world.

Orange said it will work on projects focused in West Africa, where it has a mobile presence, including Botswana, Kenya, Senegal, Burkina-Faso and Mali.

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While last week, O2 UK appointed Keith Nurcombe, a former executive at GlaxoSmithKline, to head up its new mobile healthcare division. The new department will launch in May and will examine and develop m-health and M2M initiatives that could be applied to Telefonica’s operations in Europe and Latin America.

Mike Short, vice president of public affairs at Telefonica O2 Europe, recently spoke to telecoms.com about the future of the mobile operator, and said that m-health would be a main focus going forward. ”

If you look at healthcare, national health services cannot deliver all the care we need. It will cost a fortune and, with the ageing population in Europe, there are not enough carers. So we need new ways of looking at healthcare and an understanding of how communications can help these evolve, We think there will be more focus on prevention rather than cure, on health rather than illness. That means wearable devices, or self measurement. It’s about taking some ideas from the sports field and making them mass market,” Short said.

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Working towards mAfrica

M-health is set to take a considerable slice of the US medical device and pharma markets. Europe is eyeing the market, too. But to determine the adaptability of the concept in local context, Africa could well provide a good example.

M-health works in Africa for two reasons. The people, and the widely spread African diaspora across the world, are already adept at using mobile phones for social and financial transactions. Also, the technological concept gets to start from the best place you can possibly imagine: from the bottom up.

At the end of 2008, there were four billion mobile phone subscriptions and the fastest growing market for new mobile subscriptions is Africa. It recorded a 47 per cent rise in compound annual growth rate in 2008 over 2003, which shouldn’t be surprising given that Africa is the most urbanised region in the world.

Telecoms.com recently met with Dr Adesina Iluyemi, who co-founded Sinseprod, a UK-registered social enterprise company, to stimulate technological innovations and investments into Africa. The start-up advises and works with businesses, governments and NGOs on ICT innovations for development, centering on m-health and e-health or telemedicine. Not overlooking “wastes”, a growing issue especially in the electronics industry, Sinseprod also works on sustainable and renewable energy.

The company’s principle, Iluyemi said, is based on three Ps: “Price innovation, product reengineering and process innovation and realignment, Sinseprod’s aim is to consult and to create a model where global technology can be made or incubated in a developing country, as well as supporting and stimulating local innovations in and sustainable technology transfer to developing countries.”

The m-Africa concept Iluyemi proposes has already been developed, but it requires partnerships for implementation.

It was developed in partnerships with the Global Living Lab, which is based in Barcelona. The Global Living Labs platform helps to solve technological problems through user-led innovations and localisation. The Sinseprod-Global Living Lab initiative focuses on how to develop health service around m-health technology.

Mobile wireless technology is the most logical solution for this concept because, “It is the most available platform,” Iluyemi said. For some time, Africans have been using mobile phones to transfer money, and to get rural healthcare schemes going. Sinseprod uses this existing platform to address problems faced at local level relating to conventional medical device applications. The latter are, on occasions, not sustainable and expensive.

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

For global health, the NEPAD Council, with which Iluyemi is involved, is targeting the development of programmes related to not only HIV and malaria, but other types of tropical diseases as well. For example, diabetes Type 2, commonly associated with diet. The local African diet was formally starch-based. Type 2 is caused partly by diets and lifestyle, symptomatic of the trend in urbanisation.

“M-diagnostics is aligned with global health. It can be useful for the detection of HIV and diabetes from saliva tests, not just relying on blood tests. The m-health application envisaged will be non-invasive and quick to utilise. Blood tests can provide greater accuracy but the nature with blood is that its integrity has to be preserved,” he said.

But what might scupper m-health’s chances of taking off in a big way in Africa? “Funding is a big issue,” Iluyemi said. NGO funding is common, but is “not sustainable on a medium and long-term basis”.

“Many projects, however, are limited by this type of funding, but most m-health initiatives depend on it. NGO funding can be problematic because it usually has a three-year life span.” Iluyemi said the trick – or challenge, whichever way you see it – is to foster the R&D projects at university level and gradually let them evolve into a business model. “Social enterprise” could be nice way to start. Indeed, m-health has taken off in South Africa on the social enterprise ticket. “This is non-business, non investment type of funding,” Ilyumi said, “but to survive, m-health must have a business model. M-health can go down the route of ‘purely business’ or social enterprise.”

While the technology is the same, the users and the environment are going to vary. “Technology convergence and rapid consumerism are driving down prices of mobile devices, but what matters are how you go about this translation,” Iluyemi said.

“The African market for example can be divided into three tiers. The first tier represents on average the richest 5-10 per cent of the African population depending on the country, who pay for products as consumed in the advanced markets without any significant change in model of delivery.

“The second represents the emerging middle class. The third represents about 40-50 per cent of African population and it is for this majority that m-health has to be designed to evolve from the bottom up.

In a first world context, if a medical device company plans to offer m-health services for self medication or compliance, especially relating to chronic diseases or age-related diseases, or diabetes, then it has to go for the most common technological denominator in terms of digital literacy and digital infrastructure. And this, as Iluyemi points out, means getting to know who the real clients are – the patients.

Salina Christmas is editor of multimedia at Clinica

Although there are plenty of apparently robust mobile-health “solutions” out there, and there’s a compelling business case for their use as an extension of digitization efforts by health authorities, most are still in the pilot phase of deployment, awaiting widespread take-up. One big barrier is budgetary constraints. But, more significantly, there is a lot of resistance to change within the institutions and among the professionals working in healthcare. The healthcare industry is one of the last big industries to be touched by automation, and it can be very conservative and set in its ways.

Some of the resistance is based on risk aversion – the fear of what harm these new technologies might do to, for example, patient-data privacy or patient health itself. But there is also resistance based on vested interests – on the fear that the technology might make redundant certain tasks or jobs performed by humans – even though health services are overstretched already and demand for them is rising so steeply that any efficiencies these technologies bring are unlikely to lead to job losses.

People are naturally resistant to change, no matter where they live. But, in the case of healthcare, that resistance is harder to fight in countries where there is a well established health industry. In emerging markets, where many areas lack even the most basic healthcare infrastructure, a large void is waiting to be filled – with no legacy institutions or professions obstinately clinging to old ways. In these countries, operators can actually spearhead the provision of frontline health services – in the same way that they are doing with banking and digital-money services, of which there is also a severe dearth in many parts of the developing world.

A telling statistic revealed by Vittorio Colao, CEO of Vodafone Group and keynote speaker at the event, is that although there are 2.3 billion mobile subscriptions in the developing world, there are only 11 million hospital beds and 300 million computers.

Different needs

Although in the developed world the priorities that m-health services should address are the chronic-illness and lifestyle-choice issues facing an increasingly aging population, in the developing world the priorities are the provision of basic healthcare – to stop children from dying from hunger and infectious diseases and to deal with injuries and other emergencies.

M-health projects are under way in numerous developing countries to, for example, deliver health information to frontline staff in outlying areas; to collect information out in the field on infectious diseases and other illnesses and send it back remotely to health centers; and to train healthcare workers. Many of these projects are happening in Africa, involving operators such as Vodafone and welfare organizations such as the UN.

It is still early. Most of these projects have not achieved significant scale. But given enough funding, things are likely to move faster in emerging markets than in developed ones. Many of the vendors that have been hitting brick walls in some of the richest parts of the world might ironically find a more fertile ground for their products in some of the poorest. And the products that take root there might eventually make their way back to the rich world, where governments, health authorities and health professionals might finally be shamed into action.