Bits and Pieces of Conclusions

…SO FAR

Trends in Health Care - Recap

I have said it over and over again: the healthcare market is one cow ready to be milked. Market Forces like an aging population, health care economics/politics (more and more laws regard the prevention of disease – preventative management), acute need for highly trained specialists and care takers, consumerism drive, increasing demand for portability, ease of use, targeted use, miniaturization and a confusing regulatory pathway shape it into a profitable yet difficult market.

As far device technology goes, the importance of interoperability cannot be stressed enough while the limitations of batteries drive innovation into specific target areas. Wireless is becoming ubiquitous under these considerations (e.g., Bluetooth Health Device Profile) and low energy consumption is also becoming an ardent issue with research into LPR (Low Power Radio) e.g. Zigbee Healthcare and Bluetooth LE. Flexible platforms systems and auto managed power technologies together with and increased RF traffic challenge the tasks of designers.

Promising Forecasts & False Suppositions

The forecasts in the ehealth medium keep pouring down and they put forward very promising scenarios. Deloitte Center for Health Solutions' survey found that 50% of consumers want a "personal monitoring device" to alert and guide them to improve their state of health or treat an already existing condition. A research done by PricewaterhouseCoopers places the market of mobile health applications at $7.7 billion with 40% of U.S. adults "willing to pay". In 2009, McKinsey's survey on mobile health estimated the market at $50 billion to $60 billion worldwide and $20 billion in the U.S. Parks Associates projects the wireless home health monitoring market will reach $4.4 billion in 2013.  Juniper Research places the market of remote patient monitoring via mobile network at $2 billion by 2014.

It cannot be denied that some of these reports are commissioned by various players looking to boost one aspect of the market or another. But what is there behind these numbers?

Clash of the Titans?

Continua Alliance’s main goal is to achieve certified interoperability. For an industry organization, it faces a lot obstruction from official standardization bodies. On top of that, as Gianluca mentioned here, the FDA poses some problems and delays the entire market of healthcare. Continua is playing on an international market and is therefore affected by measures taken in the US. What is happening on the European continent? A serious contender boosted by the European bodies has appeared promoting the same goals as the international industry based organization, Continua Alliance.

A Standard does not Secure Interoperability

Publishing and adopting a standard is by no means enough. Without test documentation, certification services, and a logo license agreement, interoperability is an illusion.

Industry vs. Formal Standardization Bodies

It appears that industry standards are not well regarded by formal standardization bodies. Then it makes all the sense in the world to have industry bodies like Continua Alliance to promulgate industry standards.

“ETSI is non-profit organization whose mission is to produce telecommunications standards for today and for the future. It is an open forum that unites over 800 Members from 53 countries and brings together manufacturers, network operators and service providers, administrations, research bodies and users. ETSI prides itself on being a market-driven organization; its Members, which represent all aspects of the industry, decide its work programme and allocate resources accordingly.”(ETSI 2000c)

However, in the quest for interoperability, European Standards committee tends to neglect the industry based standards. They consider them of lower quality. A standard developed by a formal standardization body has the advantage that it undergoes a certain process (apparently just the right one to give perfect quality) but the cherry on top is that governments may interfere and refer to it within a law. Thus, even though there is no quality guarantee besides word of mouth, the adaptation process is secured to some extent. Selection/adoption of any standard will entail, besides the actual technical details, a bit of drama over who can and will make more profit, irrespective if the environment is official or industry based.

The Law Suit around the Corner with IP

I have talked about the market and profit possibilities in my last post and this aspect of the whole standardization process is undoubtedly very important. The cost of a product is given by the size of silicon used or by the market gap it can fill out. Or at least that is how we usually look at the value for money of a product. It would be all hunky dory if it were so simple. Unfortunately, the danger with new technologies is that Intellectual Property rights can make the price of a product encompassing that particular technology to go way up. This is not even the major problem, because, if these rights are handled up front at the beginning, the cost can increase but will remain fixed. So no surprises! But what if chips start selling by the billions and greedy money makers claim rights in your product, in the technology you use? That’s known in this environment as the patent trolls and boy can they strip you down of a lot of pennies.

Healthcare – a procrastinated market ready to explode

Bluetooth wireless technology already is a de facto standard and one of the measures that brought it here is the regulation for car drivers to have a hands free connection to the mobile phone while driving. I mention this because Bluetooth Low Energy has a similar faith. As I mentioned before, its chances of making it into the real world seemed slim at the beginning, but as soon as it was adopted by the Bluetooth SIG and the focus market shifted to healthcare products, there was only one tiny step left for it to be introduced in a regulation of some sort. And it was; Continua Alliance included it as a standard for certified healthcare products.

The winner takes it all

Wireless is highly employed nowadays in various setups. The boom is partly due to the available technologies developed: Wireless LAN, Classic Bluetooth, IEEE 802.15.4/ZigBee, and Wireless HART serve different purposes. I mentioned in my last post the possible interfaces in the healthcare products ecosystem. The PAN devices (sensors and actuators) require a cheap, low energy, fast, reliable wireless connection method. Bluetooth low energy wireless technology, the hallmark feature of the v4.0 Bluetooth Core Specification, solves all problems.

Bluetooth Low Energy – The technology

The main advantage of Bluetooth Low Energy as its name has it is low power consumption. This is due to features like sleep mode, less than 15mA peak and 1uA average power consumption, which in turn were achievable through very fast connection time and very short message lengths. Therefore, BT LE can be up to 10 times more energy efficient than Bluetooth. I keep looking at the big brother when analyzing the performance tests of BT LE not because this newer standard is supposed to replace the older one but because it gives assessment criteria.

The Global Architecture of Interrelated Devices

In this attempt to learn more about the standards and the standardization process, let’s take a closer look at the architecture of what is referred to as “ecosystem” of devices so as to better understand the capabilities and requirements a standard should satisfy.

Design Guidelines – The process

In 2009 the Version One Design Guidelines was published. These guidelines focus exclusively on the interoperability features of devices and not on particular functionalities. The method of coming up with these results was based on analyzing the interoperability requirements from different use cases submitted by the members of the alliance. The guidelines on their own, however, revolve around already existing industry standards. The process kicks off by receiving use cases from member companies on interoperability issues regarding one of the three target areas: Living Independently, Disease Management, Health & Wellness. Based on all use cases, a generalized list of problems is formulated, which in turn is used to prioritize capabilities, interfaces and requirements. The next step is to search the industry and the standard bodies for standards which answer questions related to the capabilities and requirements. Aspects like how well the standards address the capabilities in under discussion, is the standard international and can if not can it be made so, what is the relation between the standard under scrutiny and other standards in the same area, what is the associated intellectual property claims, what are the specification access and control mechanisms, what is the level of adoption and maturity, are analyzed. All these issues narrow down the possible standards available to meet the initial requirements. The final decision is taken according to a performance comparison between candidates with respect to the requirements.

The buzz about E-Health

The aging population of the West has opened a new booming profitable market: E-health. Nevertheless, it’s not only about the elderly, there are chronic diseases (diabetes, heart diseases, etc.), where 24/7 monitoring is of utmost importance, and also staying fit equipment for those striving to improve their figure. However, e-health has proven to be an ongoing crusade for the healthcare policymakers. While attempts are being made to achieve an integrated European e-health market, since the technology is available so as to secure state-of-the-art user friendly products, the actual results are far from ideal – a few independent solutions introduced by remote companies.

And there was the need for interoperability

Technology is a hot buzz nowadays with so many smart phones emerging the market and hybrid cars developing characteristics comparable to a Ferrari. While all this technology development is going on at supersonic speeds, there aren’t so many people interested in reading about what goes behind the curtains, how a certain motor is devised or how a standard is introduced.

This blog will try to look a bit deeper into the plot that takes places behind closed doors before certain standards are adopted. I am only a Telecom Master student, but the academic environment has brought me into contact with standards, thus nudging me to search further and discover the reasons why certain technologies are adopted into standards. I wanted to make this quest for the truth public so that other people get the chance to accompany me in this adventure I am embarking on. I do believe that there are others like me, wretched with the need to know and the desire to discover hidden details in the technology world, but at the same time also be willing to share their vision on this particular topic: INTEROPERABILITY STANDARDS IN THE MEDICAL WORLD. Thus, if you are one of those people, and find my blog the least bit interesting, please don’t hesitate to leave a comment and I will reply, for sure.