Challenges of Connected Health Interoperability
Tuesday, January 25, 2011
| Rob Havasy
About the Author: Rob Havasy (@rob_havasy) is a Business Analyst and mHealth Strategist at the Center for Connected Health.
Recently I had the privilege of joining 130 like-minded Connected Health advocates from across Europe at the Continua Health Alliance European Summit. I was asked to deliver one half of the keynote address on the second day of the conference, splitting the time with John Turner, the CEO of NHS 24 from Scotland, to give perspectives on Connected Health adoption and success from “both sides of the pond.”
European health systems are somewhat of a mystery to Americans, particularly after the recent rancorous debates about our own health system. Broadly painted as “Socialized Medicine,” in fact health systems across Europe have a variety of payment models which vary not only from country to country, but sometimes from region to region within a single nation. And many areas have a similar pay for procedure structure that we have in the United States.
I left the conference (I’m writing this on the plane from Brussels to Montreal on my way home) both encouraged by the success we have had at the Center and by the new areas we are researching. I also left more certain than ever that we are all trying to figure out Connected Health solutions together, in America, Europe, and elsewhere, and experiencing many of the same problems along the way.
One of the themes which emerged was a growing frustration with the lack of interoperability, not just between the latest devices, but between emerging devices and existing communications networks. Whether people were experiencing difficulties getting devices built for analog phone lines to work in the new digital phone-line world or recent wireless devices only working with one type of sensor that physicians won’t support, this idea of interoperability came up again and again.
A few months ago I was being interviewed for an article and I remarked, regarding the state of communications technology that we are faced with today: “At least we used to be able to count on a landline. Now it seems that every patient has a slightly different combination of phone provider, wiring, and services.”
In the months since I have become even more convinced that this increasing complexity, driven by the proliferation of communication services available to consumers, is the largest technical hurdle to broad Connected Health adoption that we face. Here in Boston we are both blessed and cursed with a very competitive communications environment. Many residents of Boston and surrounding towns can choose to get their television service from up to five companies (cable and satellite); their broadband from three or four companies; and in-home telephone service from another three or four companies. Or they could abandon their landline phone all together and go cellular only, or even choose from one of the broadband phone companies like Vonage.
One of the problems we face daily at the Center is not the lack of some new device or some awesome new wireless communication method. It’s the difficulty of getting a simple and inexpensive combination of devices into someone’s home that doesn’t require outside technical experts to help install and use them. As Dr. George Crooks, Medical Director/COO of the Scottish Ambulance Service/NHS 24 and Director of the Scottish National Telemedicine Center put it at the Continua conference, “If we could only deploy the technology we had five years ago we’d all be better off.”
By far, the biggest problem we are experiencing is mixing devices built for an analog world with new digital phone services and old in-home wiring. Not to be confused with Voice Over IP (VOIP) services like Vonage, digital phone services are typically provided by the phone or cable company in an area. In principle, these services should be fully backwards compatible and should work with any equipment designed for traditional phone lines. And in a near perfect environment, they do. I have tested all of our analog equipment with two different digital phone service providers in my own home and it has always worked. But I have also rewired the entire phone system in my home myself, so I know the connections are good. In practice though, we are increasingly finding that these devices do not work for our patients without significant, and expensive, technical interventions and this is a troubling trend. For decades the traditional landline telephone was the communications workhorse of the home. And, analog or digital, when it works, it remains the least expensive and most robust way to get data to or from a patient’s home, and the simplest way to avoid shifting the cost of the data transfer onto the patient, through the use of toll-free calling numbers. In fact, through the use of a toll-free number, a patient who hasn’t paid their bill can still send data over a traditional analog line. In an article in the January 1 edition, The Economist pointed to a survey by a British telecom firm which determined that the biggest factor determining the total amount of time people spent making phone calls, and indeed the mix of landline and wireless minutes they use to make those calls is cost (Hanging Up, The Economist, January 1, 2011, p.50). I believe therefore, that the landline phone, digital or otherwise, will remain the primary communications channel for a large portion of the most cost-sensitive people, like those with one or more chronic illnesses, for a long while.
I encourage anyone looking to enter the growing field of Connected Health to think about interoperability and ease-of-use first; new technology can come second. Hospitals and health systems will be under increasing pressure over the coming years to reduce costs. While Connected Health solutions often demonstrate cost savings versus traditional care models, in the coming years that won’t be enough as Connected Health operations themselves will be pressed to reduce costs just like every other part of the healthcare system. These cost reductions will only be possible when we can build economies of scale by broadly deploying many interoperable and easy-to-use communications devices to the greatest number of patients.