September 1, 2006

New Frontiers for Cable Telephony?

By Justin J. Junkus, Telephony Editor

A recent conference on Healthcare Unbound therefore attracted my attention as a source of information on what appears to be a growing need for communications to monitor and manage activities affecting quality of life issues. In particular, the conference announcement's emphasis on the digital home and home networking technologies made me think about all the aging baby boomers with technical toys (ouch, this is getting close to home!) who are soon going to be more concerned about blood pressure monitoring than computer gaming. I decided to sniff out the possibilities for cable telephony, the cable quad play, and broadband in general by attending the event.

The event

Healthcare Unbound is a term that was coined by Michael Barrett in 2002, in a Forrester Research report. Barrett has written extensively on the use of IT in the healthcare and life sciences fields, covering topics such as national health information infrastructure initiatives, ePrescribing, patient self-management tools, healthcare Web sites and physician-patient messaging. The original report introduced the possibility of shifting costly institutional healthcare to self-care enabled by technology, particularly for the baby boomer and senior population segments. Since the report's publication, the Center for Business Innovation (www.tcbi.org) has held the Healthcare Unbound conference annually to update healthcare professionals on the status of technology and issues related to self-care. The conference speaker list reads like a who's who of bio-engineering and medicine, with academics from MIT, Harvard Medical School, Columbia University, and the University of Pittsburgh joined by executives from Qualcomm, Intel, Philips Electronics, Honeywell, and several smaller technology startups. Presentations are supplemented by vendor displays of technology solutions to healthcare and lifestyle issues.

Projections for revenue from digital home health services are enticing. Parks Associates predicts a $2.1 billion market in the United States by 2010. Like any emerging market, however, the revenue curve follows the "hockey stick" shape, and today, the market is on the thin part of the demand curve. Just where it jumps from early adopter to mainstream is a bit hazy, but this is no different than a lot of emerging services we've seen in cable.

Services and categories

Intel Director of Healthcare Device Standards Dave Whitlinger provided a good overview of the type of services that may contribute to this revenue stream and the type of sensors that would need to communicate via a network. Services include disease management, diet/fitness, personal health records, implant monitoring and healthcare provider interfaces. Information to support these services is obtained from home motion sensing devices, bed pressure gauges, implants, audio and visual monitors, weight scales, blood pressure cuffs, glucose meters, pulse oximeters, spirometers (for breath volume measurement), medication training devices, pedometers, self-administered EKGs, and fitness equipment.

Three main categories of healthcare will drive this market: elderly monitoring, disease management, and health and wellness. Elderly monitoring typically involves an adult child helping parents age gracefully in their own home. Parameters being watched include basic life activities such as sleeping and eating (observed via sensors that monitor closely related events, such as pressure on a bed or refrigerator door openings), vital signs, and medication compliance. Disease management includes both chronic disease management for conditions such as diabetes or high blood pressure, and acute disease management for diseases such as terminal cancer. Conditions being monitored here are typically vital signs and medication compliance.

Health and wellness is the category that pertains to the largest number of people. Weight loss and fitness are key concerns that this category addresses, and monitored parameters include weight, blood pressure, glucose, cholesterol and activity levels. Sensors can be embedded in clothing or jewelry, making them easy to use and hidden from view.

Telephony's role

As I had surmised, there is a role for the telephone in providing digital health services, but it is usually as a simple dial-up link between a sensor or data gathering device and a monitoring database. Often, the phone is integrated with the sensor into a single package. Most of the data being downloaded is relatively simple, requiring little bandwidth. Time-stamped readings from blood pressure cuffs, scales and glucose meters are typical examples of events generated by relatively conventional medical devices. There is also specialized equipment, such as pill minders, developed for specific tasks.

In my mind, the conference generates at least four points as food for thought:

1. The connection between sensors and a database is often either a cellular phone link or a standard landline POTS call. Cellular is the most common interface because of the ease of mobility and wearability of the phone interface. We need to remember that cellular connections for medical monitoring could have implications for fixed mobile convergence (FMC) strategies. Even without FMC, however, our Internet protocol (IP) voice installers and customer support personnel need to be aware that some of the devices that could be attached to our IP voice service via RJ-11 jacks may not have been tested for compatibility with an embedded multimedia terminal adapter (EMTA).

2. Although these applications generally require low bandwidth, some of them could be critical and may require precedence over other applications using a communications medium. Because quality of service (QoS) is an inherent part of PacketCable, we may be able to offer guarantees not available through other service providers.

3. Today's many devices and sensors usually have proprietary interfaces to a communications medium, and often each device has its own phone number. There is a movement in healthcare unbound interest groups led by Intel for an aggregation unit that would provide a common interface between devices and the communications medium, which would give more flexibility to where devices would be located within a home. This sounds a lot like a home gateway, and cable service providers may be in a position to offer this gateway as part of a total healthcare service package based upon CableHome specifications.

4. Online access to patient records and patient-medical professional joint review of those records are important parts of healthcare unbound. This could become another multimedia application, which could be accessed via either enhanced telephony customer premises equipment (CPE) or the TV set. In fact, the Motiva business unit of Philips Electronics already offers a dual-purpose set-top box with a specialized graphical interface and remote for simple medical data entry and survey completion. Users can also access short video segments related to their particular condition when prompted by the graphical interface and can switch to standard TV viewing when not interacting with a medical application.

Food for thought

The extent that our industry chooses to participate in healthcare applications will most likely not be determined until this market becomes more mature. It will be influenced by many factors, including revenue potential, the value of these applications in a service bundle, and the legal risks associated with providing these services. But now is the time to begin thinking about the business case.

Justin J. Junkus is president of KnowledgeLink and telephony editor for Communications Technology. Reach him at jjunkus@knowledgelinkinc.com.