Creative Connectivity

mHealth Apps need an injection of reality

If you’ve been reading the mHealth blogs and analyst reports over Christmas and the New Year, you’ll have realised that medical apps are being promoted as being the next big thing. You’d be forgiven by thinking that by 2015 we’ll have given up on conventional medicine and the only reason we’ll be going to see our GP is because GPs will replace the Apps Store as the primary source of these apps. So, if you’ve any money left after Christmas the message seems to be to go and invest it in health apps development, as that’s where the cash will be.

Although it feels a little early in the year to be contrarian, I think that the industry is running before it can walk. Do we really think doctors are ready to be start practising the mantra of “first I’ll dispense an iPhone app; if that doesn’t work I’ll give them an Android one; and if they’re still not better I’ll put them on the Symbian app – if that doesn’t cure them, nothing will. They won’t come back after that!”.

I’m not knocking innovation in health apps. As I’ve said before the industry probably needs to think more out of the box than it currently is, but there are already lots around and there will be more to come. Whether they will transform our health is another matter, as is whether anyone will make money out of them. A lot of the current thinking seems to be making unsupportable jumps and simply inflating the mHealth bubble. Let’s look at whether it makes sense…

Festive Christmas Ravioli

This year the mother-in-law’s coming over for dinner on Christmas day. The main course is fine – we’ve got the goose patiently waiting to be roasted. The desert’s already organised as Chris is the Christmas Pudding wizard of the known world. But what do we do for a starter? It’s Christmas Eve, the shops have shut and all that’s left is what’s in the freezer along with a desperate need for inspiration.

We do have lots of sprouts. And because I keep on thinking we’ve run out of pasta flour and buy more and more until we have a cupboard full of it, fresh pasta’s a distinct possibility. And what could be more festive than Brussels Sprout Ravioli? So, armed only with a pasta maker, a ready supply of alcohol and a daughter bravely taking the triple roles of photographer, glamorous assistant and general dogsbody, it seemed time to break new culinary boundaries.

And just before we started I remembered I’d also got a piece of Zebra fillet lurking somewhere in the freezer waiting for a suitable recipe. A quick search of the web revealed a shameful lack of recipes for either zebra or sprout ravioli. Time for inventive genius to put right the deficiencies of the Internet for the benefit of the gastronomically adventurous…

GE – The Appliance of Ignorance

Back in the 1980’s when they were trying to establish themselves in the British market, Zanussi ran a campaign for their products using the advertising strapline “the Appliance of Science“. I was reminded of it this week when I was reading a white paper from another appliance manufacturer – GE. Not because it had anything to do with science; in fact just the opposite – it was about the most unscientific paper I’ve ever come across.

It was written to promote GE’s view on which wireless standard should be chosen for the Home Area Network (HAN). These are designed to connect devices around the home to a smart meter or a home gateway that has access to information about your current energy tariffs. GE thinks the best choice should be ZigBee because “ZigBee is better than Wi-Fi”. One of the paper’s authors is an active editor for the ZigBee Alliance Smart Energy Profile, so that’s not surprising – he’s entitled to be enthusiastic about the technology he’s part of. And it may be that ZigBee is a good choice. But GE’s analysis doesn’t provide any evidence as to why it might be. Instead it provides an evidence-free quasi-analysis that does ZigBee more harm than good.

We’ve had a year of hype as different wireless standards vie for the crown of being chosen as the de facto one for smart metering. Much of that obscured the facts which need to be considered to make that choice. In the last few months I thought the industry had settled down and was beginning to a bit more logical. This rant from GE suggests that some of those involved in the debate still have a lot to learn. If you want to see how not to make a reasoned argument, download and read the GE white paper. I’ll highlight what is so wrong about it.

Mobile Health needs some Medical Pornography

If you’ve been working in Mobile Health or telecare, you’re probably frustrated by the slow progress being made in bringing products to market. Whilst analysts like research2guidance see a rosy future, more down to earth reviews, such as the recent 2020health report “Healthcare without walls: Delivering telehealth at scale”, and Frost & Sullivan’s “E- Healthcare Initiatives in the United Kingdom” continue to point out that very few projects have scaled up past a few tens of users.

Many reasons are put forward for that, ranging from the natural inertia of the medical industry, the barriers imposed by regulators, through to the difficulty in persuading doctors to hand over disease management to their patients.

Technology has been blamed in the past, but that’s no longer a valid reason. Over recent years there have been major advances in sensors, wireless connectivity and processing power. We certainly don’t have solutions to every problem, but there is a wide range of conditions where mHealth could provide significant benefits. So what’s holding it back?

Next week the Mobile Health Industry Review at the King’s Fund in London will be bringing experts and VCs together to talk about business models. I’ll be suggesting that mHealth isn’t the first industry to have suffered from this phenomenon. Even for disruptive technologies, it often needs an unexpected and sometimes even unconnected industry to invent and develop a new application in order to drive things to a point where the disruption can be taken up and embraced by others. One of the classic cases is the Internet. Much of the development of streaming, payment mechanisms and user interface was driven by the porn industry. Once that work was done, it was adopted by others, giving us the e-commerce, video streaming and compelling content that we now expect from every site.

So, if Mobile Health is going to get anywhere it probably needs to follow the same course and forget about conventional medical thinking, (which generally involves a doctor), and embrace some more disruptive models. To put it more bluntly, we need to find out what the equivalent of pornography is for healthcare.

The Evolution of Interoperability. Making the Dream a Reality.

I’ve been attending a lot of Smart Energy meetings recently and listening to industry experts talking about the need for interoperability in the connections between smart meters and appliances around the home. I’ve also been hearing a number of standards organisations trying to promote the message that the concepts of interoperability and a standard are synonymous. That’s a very dangerous message, because the two are only very loosely related. Just because you have a standard, it does not mean that products which use it are, or will become interoperable.

To understand why equating a standard with interoperability is a fallacy, let’s start with an analogy. In many ways, a standard is like a language. So we could define English, or French or Russian as standards. The standards bodies would then claim that everyone who speaks the same language is interoperable. I’d disagree. The language defines the grammar and the vocabulary, but you only have to listen to a Democrat and Republican senator debating health reforms to understand that speaking the same language does nothing to promote interoperability. If anything, a standard provides the tools to ensure that conflict is more, rather than less likely to occur.

Interoperability is about working together seamlessly. To achieve that requires more than just a standard. It needs a set of interoperability tests and the testing tools to confirm compliance with those tests. These don’t generally come with a standard – they need to be put in place to support it. That entails time and money, which means most standards can’t support them until they’re already fairly well established. Industries like Smart Energy demand interoperability, as they want the meters they install today to work with devices that customers may install in ten or twenty years’ time. But if they want to achieve it, they, need to understand how this process works.

Patent Trolls anticipate Smart Metering Bonanza

Over the last year, different groups have been beavering away to decide on a wireless standard for smart meters. It’s been interesting to observe the ways that different countries have approached this. There’s been the pragmatic approach of going with what’s available today, but with the understanding that it might need to be changed, so that everything currently being installed is at risk of needing replacement. That’s the UK approach of DECC. Then there’s the academic approach which is favoured by SGIP in the US, which entails producing a giant matrix of the vital (and not so vital) statistics of every possible wireless standard. At which point there will presumably be a flash of smoke, a glamorous assistant and a magician will be brought on stage to perform the conjuring trick of comparing apples, lobsters and elephants and deciding which is most appropriate of them for the smart energy feast. Or we have the slightly nepotistic ETSI approach over in Europe, which seems to be one of giving EU funding to all of their consultant or professor friends, who in return for this largesse promise to write their own, brand new wireless specification in time for the party.

Whilst some of these approaches consider cost in terms of the price of silicon, or even the opportunity cost in terms of time to market, one significant cost has been missing from their calculations – the cost of choosing a standard that opens up Intellectual Property disputes. That’s a real risk. The only place I’ve seen it publicly stated is in a briefing document from the Bluetooth SIG, which points out that from the IP viewpoint, wireless standards are far from equal. It’s a very valid concern. We’re already seeing the patent trolls coming out and attacking ZigBee and Wi-Fi. As volumes start to increase, so will their determination to make a fast buck. As soon as that happens, deployment could grind to a halt.