Creative Connectivity

Goodbye Clinical Evidence, Hello Celebrity GPs

Governments like change, so when the UK acquired its recent coalition government, it didn’t take a genius to predict that change was on the way for the National Health Service. The NHS holds a rather special place in the hearts of the UK electorate. Although the UK media loves to hate it, and most people gripe about it, the bulk of the population have a great affection for what it does. Few realise that outside the UK most people involved in the medical industry view it with admiration. Because of its popularity, the incoming government mollified public concern by announcing that they would “ring-fence” spending on the NHS, but then promptly started to change it.

That change was heralded by a consultation on “Liberating the NHS”, which was slipped out before the summer holidays, probably in the hope that few would notice or respond to it before the deadline at the end of September. It signalled a major change in direction, where control would be moved from the current Primary Care Trusts (PCTs) to consortia of General Practitioners (GPs).

That raises some concerns. The first is that we don’t train GPs to be managers. We still train them in much the same way we did a hundred years ago. So the most likely effect is that all of the managers who get made redundant from PCTs will simply go and work for GP consortia. And as there are far more of these, it just results in an even bigger set of people micromanaging.

The more worrying concern is what effect this will have on prescribing practice. The consultation document keeps on trotting out the phrase “clinical evidence”, implying that the NHS and local GP practices base everything they do on good clinical evidence. It’s a nice theory, and it would be nice to think that those developing this policy change believed in and supported it. It should be possible – we have a body called NICE (The National Institute for Clinical Excellence) whose job is to promote it. But as soon as everyone got back from their summer holidays, Andrew Lansley – the new Minister for Health, got out his rusty shears and castrated NICE. It’s difficult to understand why, but the implications for the NHS and GPs are disastrous. It’s goodbye to clinical evidence, and hello to whoever can get the most publicity for their favoured drug of the month.

Medica goes Wireless

Medica claims to be the world’s largest medical show. It’s a very monochrome event – all of the equipment is white and shiny, and most of the exhibitors and visitors are soberly dressed in dark suits, as befits the serious profession of medicine and spending money in Dusseldorf. Looking at the equipment on display and the crowds thronging the show, you certainly wouldn’t get any impression that there’s a recession around, other than slightly more suits than normal and rather fewer bow-ties around the necks of the visiting consultants.

As far as the medical industry is concerned, it’s business as usual, and hopefully more so, as more of us get older and less healthy. But there are some interesting trends. One of which is the increased prevalence of wireless connectivity. In previous years equipment manufacturers were happy for nurses to jot down the readings from their instruments. A few devices had wireless links, but they were the exception. This year, particularly at the consumer end of the market, wireless was becoming the norm, at least at the top end of product ranges.

Almost all of that was Bluetooth. I stopped counting after the first hundred devices, and that was in just two of the twenty halls. ANT was in evidence, helped with a demonstration of a prototype X10 Nano phone from Sony Ericsson, which was using the ANT protocol to connect to a weighing scale, heart rate belt and pedometer. Wi-Fi was there in a few products, but mostly confined to tags for asset management, and I failed to find a single ZigBee medical device. There also seemed to be very little profile for the Continua Alliance in terms of products or signage. Even The Intel stand was conspicuously Continua-free.

Bluetooth Low Energy rides the Wave at Electronica

Electronica only comes every other year but it’s still the biggest electronics trade show in the world. The last time it ran, Bluetooth low energy was still better known as Wibree. In the intervening two years half a dozen companies have announced chips and the standard has been completed and published. So visitors to Munich last week had the first major opportunity for to see just how much progress has been made.

It’s obvious that the industry has moved from PowerPoint presentations to reality. Chips were on display, along with development boards and the first few modules. In the Forum within Electronica there were sessions on the applications it will enable, and in the adjoining Wireless Congress a full day’s track was devoted to developer training and further applications.

The silicon and tools are definitely here. Now it’s time for developers to add their imagination.

All I want for Christmas is Smart Energy

Have the girls and boys who have been working hard to make Smart Energy happen been good this year? Will Santa bring them what they want? It’s looking less than likely. Despite promises that specifications would be complete, progress has inevitably slipped. What’s worse, the elves in some of the utilities didn’t pay attention to the lists the boys and girls stuck up their chimneys last year, and instead of sending them energy savings, it turns out that they actually sent them higher utility bills.

Of course, things were never going to happen as quickly as projected, even with the amount of stimulus money being thrown at the companies involved. If anything that’s resulted in things slowing down as everyone has concentrated on scrabbling around for a part of the pie, insisting that their toys are better than anyone else’s, and that they deserves the biggest box under the tree.

However, the story of the year is probably the level of consumer resentment that has built up towards smart metering deployments. Much of that seems to have been unnecessarily self-inflicted. In the Netherlands we’ve seen programs delayed because of privacy issues, and in the US there has been major customer resentment at higher bills. And that’s before we get into the ridiculous paranoia about the meters irradiating the population.

It’s interesting to contrast what’s happening within the UK. Not only are they taking a lead in deployment of real smart metering, with British Gas’ decision to roll out 2 million gas and electricity meters. There’s also the UK Government’s highly detailed consultation and a growing level of consumer education. It will be interesting to see whether that results in more customer satisfaction, and a bigger change in energy usage? That level of up-front education may be the most significant initiative of all the Smart Energy deployments that are happening around the world.

Ten Wireless Standards, Sitting on the Wall…

The Smart Metering industry is deperate to decide on a standard for short range communication. The UK Goverment has rushed through its consultation with a deadline for a technical standard by the end of next year, and in the US, SGIP’s PAP02 group wants to do it even faster. Whilst we need to start deploying devices, it concerns me that there’s a rush to make decisions with very little consideration of the relative merits of the different contenders.

There’s no shortage of contenders. At the last count I came across ten short range wireless standards that all think they should be the winner. Those include Bluetooth, Wi-Fi, ZigBee, Wavenis, Dash7, wireless MBUS, wireless KNX, DECT, Z-Wave and Bluetooth low energy. And they’re just the industry developed standards.

What worried me even more than the obvious rush was a off-hand comment made in a European standards meeting that I attended earlier this year. One of the people responsible for deciding on a common standard for Europe made the comment that “we’re not going to give any time to industry standards”. The subject of her venom was ZigBee, but it’s a charge that I’m increasingly hearing levelled at all of the “industry” standards. It appears there’s a perception amongst members of the older established Standards Development Organisations (SDOs) that because industry standards have not been produced by their traditional specification process, they’re not as good. That’s a very dangerous approach to take.

mHealth in the NHS – Everywhere and Nowhere

If you follow the mHealth blogs and groups on LinkedIn you’ll see a constant debate about where mHealth is in out existing health services. I’ve been looking at some of the applications which are already in use within the NHS. As yet, there’s no central policy for mHealth, and it’s debatable whether much of the good practice using mHealth is even acknowledged, but that doesn’t mean it’s not providing benefit.

Much of mHealth is invisible. It’s not the high tech monitoring that we find in glossy medical device brochures, but far simpler, everyday applications. Many of these use SMS, but mHealth extends through voice and video, and we’re already seeing local use of applications on iPhones and Android. However, there is little coordination of deployment, and almost all that is happening is as a result of local initiatives.

Let’s look at some of the examples.