The role of Standards in Telehealth

Standards DilemmaNew market research on the convergence of telemedicine and mHealth suggests that “telemedicine now delivered on proprietary devices is becoming obsolete,” and I agree. I first wrote about the role of standards in telehealth two years ago in an article on Video Conferencing for Home Healthcare and have written several articles on the topic of standards since then, including The Smart Refrigerator & Smart Medical Device.

Platform Standards

Earlier this week I weighed in on a LinkedIn discussion of Tablets used in Video Telemedicine. It morphed into a discussion of HIPPA, so the comment I added applies just as much to HIPPA regulations as to the use of standards in telehealth.

Proprietary video conferencing solutions from Cisco, Polycom, Lifesize and others touted as HIPPA compliant will likely remain in niche markets and have little impact on telehealth. That’s because mass-market adoption of communications products, like the phone system before itself, depends on standards and Metcalfe’s Law.

Robert Metcalfe, inventor of Ethernet, stated that “the value of a telecommunications network is proportional to the square of the number of connected users of the system.” That means free video conferencing services that rely on open standards — like Skype, FaceTime, and Google Hangouts — can provide value that increases exponentially as they scale to connect far more users. Yes, their video quality is limited by network speed, but they are already supporting HDTV resolutions as bandwidth increases. They also adjust resolution automatically to match network speed, so the same software can be used for low- or high-res video calls, depending on who you’re calling and where. They’re also gaining the ability to connect many parties into the same call, including the patient, doctor, paid caregiver, family advocate, and insurer. That way, everyone is able to agree on the care plan.

Before standards are established and mass markets develop, designers build products around proprietary hardware and software platforms that require them to do most of the work themselves. Such was the case with the medical tablets from Intel-GE Care Innovations, GrandCare Systems, and Waldo Health. While they had first-mover advantage, their proprietary designs increased product costs, minimized third-party app development, and limited market penetration. If they were to start over from scratch, I expect they’d instead build apps for the Apple iPad or Android-based tablets and sell services to people using devices that they already have and use daily, rather than selling them a proprietary new device just to access the service.

Apple established the smartphone and tablet markets with its iPhone and iPad, which quickly became defacto standards for product developers. That was largely due to the company’s market dominance, standardized program interfaces within its iOS operating system, and standard distribution channel through the Apple Store. Apple’s primary challenger is Goodle’s Android operating system, because that was designed from the ground up as an open standard that, with minor modifications, can run on a variety of hardware platforms from different manufacturers.

Both of these platforms have attracted an army of developers, resulting in fast pace tech innovation in health & wellness apps and sensors — far more more impressive than anything possible with proprietary systems. This is why Modern Health Talk continues to promote standard platforms, whether for medical devices or video conferencing. And it’s why we encourage designers to develop for the standard products that have become so ubiquitous in the market. I often tell people, “don’t buy specialized medical devices if you can get an app or attachment for the smartphone or tablet you already have.” They’ll almost certainly spend less and have more function and future expansion.

Networking Standards

The Internet of Things — in which medical devices and ordinary objects get smart and connected — promises to give us better health care, smarter homes & cities, fewer traffic jams, and a cleaner environment; but while many companies hype the technology as if it were already here, it’s not really. That’s because the Things don’t speak the same language.

Manufacturers of Things live in different market silos and see the world differently, some needing high bandwidth, others needing long battery life, and still others wanting real-time communication or not needing to communicate beyond their silo at all. That leads to different decision criteria among constantly changing technologies and protocols. No wonder one developer picks Wi-Fi for wireless connectivity while others pick ANT+, Bluetooth, Zigbee, Z-Wave or whatever.

What’s needed is a gateway — some sort of device or service to interface between remote monitoring services and in-home (or mobile) medical & environmental sensors using different networking standards. Will that be a PC, tablet, smartphone, TV set-top box, or a specialized device? There’s likely no one answer and the choice may depend on (1) the Rent vs. Buy business model and (2) the need to interoperate with other subsystems, including home security, HVAC, lighting, surveillance, electronic door locks, etc. Smartphones and tablets already serve as health gateways, because they can connect to cellular networks, Wi-Fi and Bluetooth. If you’ve followed me on Modern Health Talk, you know that I’m an advocate of using a smartphone or tablet as a health gateway, and specifically the Apple devices or ones based on Android.