• The post-pandemic medical scene is undergoing a slow-motion reset involving decentralisation and a wake-up call on the value of network-enabled care products and services
• So what makes this emerging market for connected health infrastructure, products and services worthy of telco attention?
• Simple – it’s networks all the way down

Telcos often decry the ailing state of their balance sheets, complaining that it’s nigh on impossible to get a decent return on capital employed (ROCE). They can address this by spending less and getting others to subsidise their expenditure (think state-backed rural network investment funds and the ‘fair share’ debate) but also by identifying new revenue-generating opportunities, and it seems the health sector is among the vertical sectors that provide the greatest opportunity for the latter. 

Earlier this year, TelecomTV went on the hunt for “connectivity-crucial” applications – those  likely to provide near-term cloud and connectivity revenue growth for telcos. We identified four – mostly because of the prominent role connectivity plays in the associated business models where the network provider could become a business model enabler and partner, and not just a plumber for hire – see Telcos prepare to pipe up.

Now we’re shining a surgical light on what might be the largest single long-term connectivity market or ‘setting’, as they say in the medical business – connected health.

This buzz-phrase could be to medicine what ‘cloud transformation’ has become to telecom: It’s about introducing new, networked technologies to not only enable distant consultation and treatment between clinician and patient, but more broadly to help re-imagine how ‘holistic’ and ‘preventative’ care can be organised and delivered for patients while building what the health industry calls a ‘longitudinal’ health record for each individual. More on those buzz-phrases later. 

Health has always been a popular obsession, but that’s naturally intensified following a global pandemic and concern over the prevalence of chronic conditions – such as type 2 diabetes, heart disease and cancer, to name just three – putting increasing strain on both public and privately funded health services. 

As a result, there is rising interest, from patients as well as service providers, in using a variety of ‘connected health’ technologies to supplement traditional care, enable monitoring and screening to catch conditions early, offer online care programmes economically, and to increase the degree of connectedness and collaboration between the multiple arms of the health ecosystem and within the teams that comprise them.

This is a welcome development for telcos and digital service providers (DSPs) that have identified, and are increasingly acting upon, opportunities to help provide both connections and connected services to the health industry, from plain old fixed and mobile voice and data connections to the home, right up to full-blown multiprotocol networking systems, associated applications and much between.

And that help is needed. Up to now, medical landscapes have tended to be somewhat siloed. For example, a patient with a major complaint might approach their general (non specialist) practitioner to make an initial diagnosis. Their case is then referred to a specialist to organise an appropriate remedial procedure or treatment, following which, other specialists pop out of their silos to take the patient through recovery and follow-up care. It’s all rather disjointed and health professionals are keen to develop better processes and a more connected way of working to provide accurate and timely diagnosis, reduce discomfort and inconvenience for the patient and speed the time taken to recover, all the while containing costs and improving the patient experience.

Depending on the market (regulations, existing service levels and so on), the opportunities for telcos vary, but it’s clear that service providers around the world have identified a real growth opportunity in recent years and some have invested heavily in their healthcare sector strategies. For example, Australia’s Telstra has been an active player in its domestic health service for more than a decade already – see related articles, below: 

• Canada’s Telus bets on digital health sector growth with $1.8bn acquisition
• Veon’s Kyivstar to offer digital health service to all Ukrainians
• Enovacom, Orange Business’ healthcare subsidiary, acquires NEHS Digital and Xperis
• Telia Company and Region Stockholm test the ability of 5G to improve health care
• Telstra Health launches Smart Connected Care
• Verizon Business and Visionable open center dedicated to accelerating connected healthcare.

So what exactly needs to be improved and what are the priorities? That’s the big question for the sector.  

UK observers concerned with efficiency and value for money in public spending had long wondered whether a nationwide computer records system for the UK National Health Service (NHS) might be a good idea. So in 2002, the  government launched a £6.2bn NHS Care Records Service, enabled by a vast ‘top down’ IT project, which was expected to overcome at least some of the efficiency problems the NHS was perennially experiencing. It didn’t go well.

Delays and eye-watering cost overruns resulted in the core of the project being canned in 2011, although the infrastructure and some of the sub-projects have lived on.

This experience made it clear that throwing technology at an existing and complex health service structure from above didn’t work, so in the wake of the project failure it was decided that new technology coupled with new types services and processes required a decentralised organisational structure, with local control over decision-making and supplier selection.

Decentralising logically increases the need for efficient communications and record sharing between the entities, so connectivity and collaboration was prioritised to ensure the smooth flow of information between the various health service entities.  

Enter connected care and connected health

Connected care is not just about getting patients online – it’s also about giving practitioners more choice about who or what they use to meet their patients’ needs via a range of specialists, such as consultants, private clinics, treatment centres, allied public bodies and online services. In short, the policy enables the GP to tap an ecosystem featuring disaggregated parts of a holistic offering. In telecom terms, it might be described as Open RAN with a stethoscope.

Naturally, networks are key to this effort by enabling critical info exchange and the fostering of contact between specialities and functions, just as they have done in the post-Covid corporate ‘setting’ where collaboration and teamwork have been juiced up by the use of Zoom, Slack and collaboration software, as a corrective to the upsurge in home working. So it’s not  surprising that both big tech, biggish telecom and others have been quick to spot an opportunity to flex their expertise and get involved.

For instance, Amazon and Microsoft, and many others, have announced connected care initiatives. Apple offers Apple Health, which naturally gathers health data from its smartwatch and other gadgets; Samsung has announced an application for its Galaxy smartphones that can track health data and let users connect with a range of connected providers; and a multitude of different prospective players and providers are lining up to get a slice of the action by offering things like local service integration and patient data unification.

What’s the telco opportunity?

Telco involvement in providing the connected health plumbing provides an obvious platform from which to climb up the value chain to provide broad digital health services, rather than just network-enable the services for others or the healthcare provider itself.

For example, last year BT launched what it called a virtual ward programme in partnership with UK healthcare providers that involved the use of an integrated care app for clinicians (involving AI, of course), remote monitoring and an online patient consultation platform. 

In the Netherlands, VodafoneZiggo teamed up with Dutch online health specialist Teladoc Health to launch Health-E in September 2023 to its private Vodafone customers initially, with the goal of offering availability across the whole of the Netherlands.

The mission for Health-E is for it to become the service provider’s online “lifestyle support” system. It is intended to complement, not replace, the public health service by providing 24-hour online support and advice via an app to tackle needs that don’t require a visit to the user’s own general practitioner (GP). The GP, however, remains the first point of contact for urgent or chronic conditions. The company says Health-E will focus on lifestyle, prevention and answering healthcare questions: If urgent care or chronic conditions are involved, regular healthcare remains the first point of contact.

As time goes on, these sorts of online services will proliferate and be increasingly prescribable as part of national public health regimes, with the National Health Service picking up all or part of the tab for the elderly or incapacitated with the aim of “keeping patients out of hospital for as long as possible.”

Single issue health services of all kinds are already widely available on the internet, covering everything from dietary advice to dementia care, and offering relief or cure for every medical complaint and chronic condition under the sun.

The opportunity is that telcos become trusted intermediaries by providing packages of quality-assured online services.

For more serious or permanent conditions, or to maintain isolation to prevent infection, there’s ‘ambient health monitoring’. This involves collecting and monitoring patient data remotely (another trend that began to emerge during the pandemic) using sensors and installing cameras and devices into senior care facilities to consistently monitor the health of residents, without the need for regular in-person visits. Again telcos’ expertise with technologies such as interactive video and low bandwidth internet of things  (IoT) technology makes them obvious enablers or partners for this sort of service deployment at scale.

Swings and roundabouts

Telco involvement in providing the connected health plumbing creates an obvious platform from which to climb the value chain to provide broad digital health services rather than just network enable the services for others. As with any area, the consolidation of today’s plethora of competing wellness solutions and treatments is likely, so trustworthy organisations, such as telcos, have a good chance of being amongst the consolidators.

However, there are some potential problems associated with this rosy growth story. The ‘wellness’ scene is already rife with dubious (and outright fraudulent) health claims and chicanery. Turbo-charging it by taking much of its marketing online might make a bonanza for the sprinkling of bad actors that lurk in every market and already find supplementary and alternative medicines a happy grifting ground. Reputational damage from health scandals, such as the opioid crisis in the US, illustrates one potential downside.

On the general upside, connected health and its reliance on longitudinal record-keeping for individual patients is building a vast medical data record that will boost research for new and improved drugs and treatments and validate (or undermine) the long-term effects of current drugs and treatments, especially with the use of GenAI to crunch and inference the data.

Plus a fully functioning connected health ecosystem has other potential advantages: It may enable health providers to tap scarce or expensive medical talent available in a distant market to diagnose difficult cases or to assist or lead operations and training.

One extra upside: The widely discredited network-enabled virtual surgery use case for 5G – remember that? – is almost certainly due for a comeback if connected health really hits the ground running.

- Ian Scales, Managing Editor, TelecomTV