Telecom in the telemedicine value chain

Telecom service providers are methodically addressing the business side of the telemedicine value chain by focusing new resources on the health care industry, in particular hospitals and medical practitioners. They are finding opportunities in developing managed services specifically aimed at health care needs and in helping improve healthcare IT efficiency.

But the larger question looming is whether US telecom service providers have a bigger role to play in helping knit together the disparate parts of the complex value chain that is health care in this country. And that’s a question that is yet to be answered.

Without a doubt, telecom service providers have a significant part in enabling a wide array of telemedicine services, from the sharing of medical images over broadband pipes connecting hospitals to the use of wireless networks for personal health monitoring devices – sometimes called medical jewelry – that will enable both the monitoring of chronically ill and the potential for portable wellness applications as well. That’s why the Continua Health Alliance, which includes medical and technology companies among its members, welcomed AT&T and Verizon as well.

“Telecom providers participating in the alliance are very significant in the sense that several of our capabilities are based upon a mobile capability and having that ability to roam around and be able to monitor yourself,” said Charles Parker, Continua executive director.  “From the telecom providers’ perspective, there is incremental business here for them. I say what you are going to see is a jump into more broadband type of capabilities or use of cellular capability to be able to start to monitor people in their homes. You are going to create extended care teams that will monitor and use that type of equipment and technology as well.”

That monitoring goes on today, via devices that are distributed by hospitals or other medical practitioners, and plugging into standard phone lines or broadband lines. The role of the telecom service provider is only to provide the conduit, and occasionally to help troubleshoot when a device or service isn’t working, said Mike Lemnitzer, senior director for patient telemonitoring services, for Phillips TeleHealth Business (NYSE: PHG).

“Typically in our model, the device comes from the health care provider – the hospital or a home care agency,” Lemnitzer said. “The consumer goes home and plugs it in, and normally what we have found is that it does work. We have testing procedures for our customers for the quality of service, to make sure it is there, and a high percentage of the times, it does work. There are strange occurrences, and we find that telecom companies are pretty open to working with us.”

Phillips, as one of the leading device makers, doesn’t partner with telecom service providers today, and Lemnitzer admits that while the company would probably be open to such partnerships, he’s not certain where the telecom operator fits in.

“I think on the per-application basis, there could be partnerships there,” Lemnitzer said. “But in terms of our clinical model, where you have to have a physicians’ order, and data flowing into medical record somewhere, it gets more dicey. You have to tie in the health care provider, link in physicians, have a PHR [personal health record]. The service will always be a part of the solution, but it’s not necessarily going to be anything more than the connection.”

Robert Miller, executive director of technology research at AT&T Labs, AT&T Bell Labs (NYSE:T), believes telecom service providers have a critical role to play, not only in helping to link hospitals, doctors, insurance companies and patients, but also in creating an end-to-end solution that meets everyone’s needs. That’s why, when AT&T joined the Continua alliance – the first telecom service provider to do so, Miller said, the company was greeted warmly.

“We are generally welcomed by everyone there,” Miller said. “They pretty much said, ‘Wow, really great that you joined, this gives us an eye toward the rest of the story. It tells how our devices and systems will work in a real network with real databases and APIs and health care records and systems and all of that stuff including network security and database resiliency and disaster recovery and all of that.’ I think, if I might go out on a limb here, I think that, without that, the whole telehealth thing may be doomed to a continuation of a niche mentality.”
The key value telecom can bring is helping to create a solution that works for the doctors themselves, Miller said.

“Doctors don’t have the time to futz around understanding all the details of 70 billion different solutions,” he said. “They are under pressure to handle more patients per hour and do more real healing as opposed to record keeping. They are working for a living, being paid by insurance companies or government or both. The entire medical profession is under a lot of pressure and it is mostly efficiency that is driving that. If you are trying to force a solution that requires more unbilled time by the doctors, that’s not going to play.”

If a group such as Continua can define the ecosystem, service providers such as AT&T can deliver, Miller said.

“I believe it has to be a service that allows devices to interoperate in an environment that doesn’t require the end users – which by the way are the patients, doctors, insurance payers, and the hospital groups – to understand what is going on, only to know that it works and to use it productively,” Miller said. “And I believe that’s a combination of devices, standards, and ecosystem of certified interoperability, a network that makes it play together right and a number of solutions, maybe some of them by AT&T but maybe some of them by others that make the whole thing work right.”

AT&T is the State of Tennessee’s partner in developing the Tennessee Information Infrastructure eHealth Exchange Zone, a new network designed to deliver confidential patient records and files between health care providers over a secure network, Miller points out. AT&T also has its own personal health record solution.

From the Verizon Business (NYSE:VZ) viewpoint, it is absolutely important that telecom move past just providing the connectivity, said Barry Zipp, director of Verizon Connected Health Care Solutions.

“No doubt our bread and butter is communications services and there is a terrific need for communications services in healthcare and other industries, but for us to be successful we have to move well beyond providing the pipe,” Zipp said. “That is where we are focusing a lot of our attention.”

That includes partnering with states which are looking to use broadband stimulus funding to bring broadband into rural and underserved communities to use those broadband pipes to make health care more available as well, Zipp said.

“It’s not an end goal simply to work with state agencies to deploy broadband in rural markets, what excites us a lot is the ability to activate new services at the end of that connectivity,” Zipp said. “We’ve talked to a few different companies who have said they want to set up high definition, immersive video in small towns because they have a huge shortage of specialists. I’ve talked to a radiological imaging company who wants to work in rural markets providing digital imaging and send that back to a centralized center where a radiologist can read the image but with no high-speed connectivity, it’s really hard to do that.”

Verizon is also working with medical device companies that produce the wearable monitors for heart patients that send real-time data over the Verizon Wireless data network to the provider, picking up episodic problems that might not be discovered in the office, Zipp said.   

What Verizon can bring is the connectivity, the security, massive data storage and the ability to manage all of that for a health care provider, Zipp added. Particularly as health care companies look for the most efficient way to move to electronic health records and to determine how to securely share patient information, Verizon’s ability to offer managed security solutions will have value, he said.

“We are building a robust solution roadmap,” Zipp said. “Verizon and healthcare aren’t mentioned in the same breath a lot. We don’t have the same credibility as [device manufacturers] do today. But we do want to be a bigger, more sizeable player- our success will be based at least in part on working with partners. We will compliment our experience in providing robust, secure networking solutions with others’ skills in more specific health care issues.”

Continua’s Parker sees the need for a new kind of service provider – one that provides the glue that knits together the often messy and complex world of health care as it exists in the US today.

“You are going to see existing providers or organizations who are going to be providing some of these capabilities now,” Parker said. “You are also going to see that new ones emerge as well in the sense that I don’t know what to call them yet because we don’t know who they are going to be. You are going to have these coordinating organizations who are going to in essence create a monitoring health stream.”