a special report from ComputerWeekly

Kicking off an
e-health revolution
Telefonica is hoping to inject some movement into
e-health after acquiring a stake in Saluspot,
a health community which serves as a social
network for the health industry
ALMOOND/ISTOCK/THINKSTOCK
 Kicking off an e-health revolution

Is e-health a cure for European healthcare?

Contents Steve Evans, Editor, Computer Weekly

Is e-health a cure for It has been hailed as the next big thing for many years but, it is fair to say, e-
European healthcare?
health the use of technology in healthcare to improve services delivered to
Consumerisation set patients has failed to fulfill its potential. Issues around cost, ease of use
to revolutionise and privacy have held back its adoption.
healthcare
Now, however, Telefonica is
Mobile devices hoping to kick-start the e-health
support healthcare in revolution. The company has
the developing world
acquired a stake in Saluspot, a
health community which aims to
connect doctors and patients via a
question and answer service.

Csar Rodrguez, head of e-health

at Telefonica, says the Saluspot
system is like a social network for
the health industry. Users can post
details of their ailment on the site to seek advice for example, Ive had a
sharp pain in my left knee for three days and Saluspot will flag it to a
doctor specialising in that area. The doctor will do their best to determine
what the problem is by asking further questions and then recommend
potential treatment.

If medication or even medical treatment is required, the user will have the
option to schedule a face-to-face meeting with the doctor they were talking
to, or one closer to their location. Telefonica says once a face-to-face
meeting has taken place, the user becomes an e-patient of the doctor,
meaning their personal health record can be shared and more conversations
can take place.

All doctors using the service have to authenticate themselves by matching

the unique code on their medical licence with their National Identity Number.

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 Kicking off an e-health revolution

Latin American potential

Contents Saluspot already has a large presence in Spain and Chile, and the
agreement will enable both parties to push the service further into Latin
Is e-health a cure for America, particularly the Spanish-speaking nations, where Telefonicas brand
European healthcare? is already well known. Rodrguez says the Latin American market is a good
fit for this sort of service.
Consumerisation set
to revolutionise
healthcare In Latin America the public healthcare system is not on the same level as in
the US or Europe, where there are higher standards and lots of hospitals and
Mobile devices doctors, he says. So the only solution is to have private insurance, but most
support healthcare in people dont have the financial capacity for that. This is a new approach to
the developing world patient management.

Rodrguez likens Saluspot to HealthTap, a similar service that is offered in

the US. HealthTap has 55,000 registered doctors and users have so far
asked over 1.3 billion questions. Saluspot has the potential to reach the
same numbers across Latin America and Spain, he says.

The service is currently offered free of charge, but a premium subscription

service is likely to be added in the next few months. Details of the premium
model are still to be determined, but Rodrguez says it is likely to involve
users having access to more services, such as the ability to enter into a
private conversation via email with the doctor, and to choose which doctor
answers their query.

Prices for the premium model have yet to be revealed publicly, however
Rodrguez says Telefonica has to remain aware of its users financial
situations. Prices will have to be much lower than private healthcare to make
it seem more attractive and are likely to be under 5 per month. Existing
Telefonica customers will have the option to add the cost to their bills,
Rodrguez suggested.

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 Kicking off an e-health revolution

Keeping private data private

Privacy has been seen as a barrier to e-health for many years; patients are
rightly worried about what data they need to provide and how secure it will be
Contents online.

Is e-health a cure for Saluspot can be used completely anonymously users can ask a question
European healthcare?
without providing any personal data. Subscribers to the service, however, are
Consumerisation set required to provide their age, gender, location (limited to their city) and an
to revolutionise email address. Those users who pay for the premium model, when it
healthcare eventually launches, will need to provide more details, such as a name and
address, for billing purposes.
Mobile devices
support healthcare in
In terms of looking after that data, Rodrguez says: We adhere to all the data
the developing world
protection rules for each country we operate in and Saluspot has a legal
department that checks were meeting all the policies each country has.
Additionally, Telefonica has a huge cyber security division, and data
protection was one of the big points during the due diligence process before
the deal was completed.

The sensitive nature of information being uploaded to e-health systems

means data protection will remain an issue for the foreseeable future.
Despite this, there is hope that technology such as Saluspot will help the e-
health sector grow over the next few years.

Doctor Josep Morera Prat, a pulmonologist based in Barcelona, says this

sort of technology is useful for interacting with patients across the world,
particularly those who may require a specialist doctor to talk to.

I think use will grow in the future, with some limitations. It depends on the
speciality; some may be better suited to it than others, he says, adding that
while the technology is providing a valuable service it can still be improved.

Changing of the guard

One thing Prat is keen to stress is that technology like this, while useful, is
not a replacement for face-to-face doctor-patient meetings. Its not the same
as face to face. Maybe some specialities, such as dermatology, could work

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 Kicking off an e-health revolution

that way, but overall it would be very difficult; we would need information we
cannot get over the internet, he says.

Contents That is a point Telefonicas Rodrguez agrees with, and he says that getting
older medical professionals to accept and use this type of technology is one
Is e-health a cure for of the challenges the company faces.
European healthcare?
We are employing doctors to help with [adoption], says Rodrguez. The
Consumerisation set
conversations are not about technology, they are about healthcare needs.
to revolutionise
healthcare We will respect all rules and processes doctors work to in that country, such
as only prescribing medicine after a face-to-face meeting. So the model of
Mobile devices the relationship between doctor and patient is still the same.
support healthcare in
the developing world Some doctors just prefer to deal with patients face to face, but the younger
generation of doctors are perhaps more open to helping patients to get
answers in this way.

And that seems to be the biggest draw for e-health at the moment using
technology to open up new ways of delivering medical services to those who,
for economic or geographical reasons, cannot get medical advice as quickly
and easily as they would like.

Page 4 of 14
 Kicking off an e-health revolution

Consumerisation set to revolutionise healthcare

Cliff Saran, Editor, Computer Weekly

Contents Healthcare will be driven by consumerisation through the adoption of mobile

technology and improved data analytics and collaboration in clinical
Is e-health a cure for environments.
European healthcare?
Speaking at the Forrester Forum in London, Philips Healthcare CEO Jeroen
Consumerisation set
to revolutionise Tas, who was previously the global CIO for the electronics giant, said: There
healthcare is a tremendous opportunity to consumerise health.

Mobile devices But healthcare needs to move

support healthcare in from individual, standalone
the developing world products to value a complete
proposition, according to Tas.

Connecting different product

groups together requires IT to
build infrastructure that allows
teams from across the
company to collaborate and
share common IT systems,
such as a single authentication
service.

Mobile medical technology

Philips Healthcare is known for its medical scanners and x-ray machines
used in hospitals, but some of this technology is trickling down into mobile
devices.

Mobile technology is not just a lower-end version of what we do [in Philips

Healthcare]. It gives people access to medical technology, said Tas.

According to Tas, technology that exists in the systems the company has
developed for hospital intensive care units can be scaled down to something
that can be worn on a wrist.

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 Kicking off an e-health revolution

Last week, Apple launched its Healthkit. And look at the investments Google
is making in healthcare. This is an industry that will change very quickly, he
said.
Contents
Connected products
Is e-health a cure for Tas admitted that at Philips, products are not developed in the context of an
European healthcare?
overall customer experience. They are standalone products, so the
Consumerisation set company's smart lamps have their own authentication.
to revolutionise
healthcare This is not the way to set up a proposition," he said. "It cannot happen if
everyone runs their own stack. You need to create an ecosystem to build a
Mobile devices richer experience.
support healthcare in
the developing world
As CIO, he oversaw a common architecture to enable the smart products
Philips develops to communicate together. People from healthcare and
lighting are now starting to work together, using the same platform.

We are moving from product to proposition, Tas said. This means the
company is starting to link together products from different areas of the
business to create something that enhances the customer experience.

We are there [with ultrasound] when you see your baby for the first time.
And we can help you track the health of that baby. We have a baby monitor
that can measure vital signs and can be linked to your lights so the baby can
fall asleep with soothing light.

Cloud collaboration
Tas believes there are many opportunities to link different pieces of
technology to create integrated healthcare.

Healthcare is the biggest industry in many countries. It represents 13% of

UK GDP. But there is a huge gap. We are very good at products, but they
are standalone, he said.

Products today, such as FitBit, are point solutions. Tas said a device cloud is
needed to manage healthcare devices in an integrated fashion. There is also

Page 6 of 14
 Kicking off an e-health revolution

a need to ensure experts from different areas of healthcare are able to

communicate effectively. We need collaboration in the cloud, he said.

Contents Tas also suggested that marketing techniques could be applied to manage
health proactively: Half of people don't stick to the medicine plan. In
Is e-health a cure for marketing, we motivate people to buy products. Can we apply this to
European healthcare? motivate people to be more healthy and take their medicines?

Consumerisation set
to revolutionise
healthcare

Mobile devices
support healthcare in
the developing world

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 Kicking off an e-health revolution

Mobile Devices support healthcare in the developing

world
Cliff Saran, Editor, Computer Weekly
Contents
Mobile technology has the potential to revolutionise health care in developing
Is e-health a cure for countries, particularly in the area of heath awareness schemes and training
European healthcare? health care professionals. Mobile phones are generally affordable and
Consumerisation set available to the population at large, making them more accessible than
to revolutionise computers and far more cost-effective than hospital beds.
healthcare
Widespread mobile resource
Mobile devices
support healthcare in
the developing world Mobile phone usage in developing countries is increasing. 64% of mobile
phones are being used in the developing world. There are more mobile than
fixed lines. According to the International Telecommunications Union, the
continent of Africa has some 280 million total telephone subscribers, of which
some 260 million (over 85%) are mobile cellular subscribers. As such it
represents the continent with the highest ratio of mobile to total telephone
subscribers of any region in the world.

The question is how to tap into

this explosion ofmobile phone
usage to support health care
programmes in developing
countries.

Patricia Mechael, a researcher at

the Millenium Village project at
the Earth Institute in Columbia,
has been looking at mHealth
since 2001, as part of a research
project at the London School of Hygiene. "People are using mobile health
whenever they call their mothers for advice or use Google to find health
related information." She says the biggest benefit of the mobile revolution
has been that it enables emergency response teams to co-ordinate their
efforts using mobile phones. Over the last few years, mobile technology has
allowed health professionals to gather large amounts of information from the

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 Kicking off an e-health revolution

public in real time, replacing paperwork that would have previously been
passed up from local, district, regional up to national health organisations.

Contents mHealth for Development

Is e-health a cure for This is a growing area of research for the health sector and non-government
European healthcare?
organisations like the United Nations Foundation, which is collaborating with
Consumerisation set Vodafone Foundation and Rockefeller Foundation. In July 2008 the UN
to revolutionise Foundation and Vodafone technology partnership held a week-long
healthcare workshop during a Rockefeller Foundation eHealth event, which brought
together 25 experts in the use of mobile technology for health care. The three
Mobile devices organisations have now combined forces to create the mHealth for
support healthcare in Development programme, which was unveiled at GSM MobileWorld
the developing world
Congress.

The group has been set up to help promote best practices in using mobile
technology to support healthcare programmes in developing nations.

Claire Thwaites, head of Vodafone Foundation and United Nations

Foundation Partnership, says: "The partnership has been focusing on
mHeath for three years. Mobile is so ubiquitous in emerging markets.
Infrastructure can more easily be deployed than fixed line infrastructure. We
are looking at how mobile communications can improve health care." She
says some of the areas mobiles are being used include SMS text alerts to
enable patients adhere to their prescriptions, education programmes to
improve health awareness, data collection and training of health care
workers.

According to Claire Thwaites, educational awareness can be improved by

using SMS messages to disseminate information. "SMS is a relatively simple
application. A group called Text to Change operating in Uganda sends SMS
text to the population to improve awareness of HIV Aids treatment and
prevention. We have seen that encouraging the population to participate in a
quiz is raising awareness of the disease and how to prevent it. We are
actually seeing a 40% increase in those going in for HIV tests."

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 Kicking off an e-health revolution

She says the scheme has been a huge success with uptake of over 40%.
People are being encouraged through free air time from the mobile provider
involved in the project.
Contents
SMS to encourage medication
Is e-health a cure for
European healthcare?
SIMpill is another example of SMS, being used to help combat diseases.
Consumerisation set This time it is about making sure people take their medication. It was used
to revolutionise during a 2007 trial in South Africa to ensure people took their medication for
healthcare TB. In the pilot, 90% of patients complied with their TB medication compared
to 22% to 60% take-up without it.
Mobile devices
support healthcare in Developed by David Green, a South African GP,SIMpill uses a prescription
the developing world
bottle with an embedded mobile phone chip. Basically, it is a pill bottle that
uses mobile phone technology to remind people on medication to take their
pills on time. Italso warns the patient if they are about to take too much.

The system works in two parts. The patient's pill-taking schedule is

programmed into a tamper-proof pill bottle which communicate with the
patient's mobile phone. The SIMpill server is also programmed with the
patient's medication schedule and communicates with the patient's SIMpill
dispenser in which their medication is kept. The server monitors the patient
medication schedule against the times when the patient opens the dispenser
and initiates, in real time, the programmed responses as detailed below.

If the patient takes their medication as prescribed, no communication is

made and the "medication event" is stored in the database. If the patient
does not take their medication as prescribed, then, after a set deviation
period, the patient is sent a reminder to take their medication.

It looks like mHealth will revolutionise healthcare in developing counties by

allowing medical staff to survey the population, train staff in the field and use
SMS marketing to change the population's attitude towards health issues.
Furthermore, Mechael from the Millenium Village project believes mobile
health is moving from informal to more formal use thanks to the huge amount
of interest from the mobile telecommunications industry, it seems that
mHealth is now being deployed far wider than was possible previously.

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 Kicking off an e-health revolution

Case study: Text to Change

Text to Change, the Dutch non-profit organisation, is an example of how a
Contents simple application can make a big difference. It runs a series of four-week
education programmes using SMS messaging. Each programme starts with
Is e-health a cure for
an announcement SMS message to target a group of mobile users in a given
European healthcare?
region, which encourages them to opt into a questionnaire. Participants are
Consumerisation set then sent multiple choice quiz questions as SMS messages. They receive
to revolutionise airtime as an incentive. Hajo van Beijma at Text to Change, says, "We
healthcare increase their knowledge, gather data about their current knowledge on
HIV/AIDS and stimulate them to go for HIV testing."
Mobile devices
support healthcare in
Text to Change ran a pilot in Mbarara, Uganda to test this initiative in
the developing world
February 2008. From February 14th 2008 until April 8th 2008 there were
15,000 Celtel (now ZAIN) mobile phone users targeted in the Greater
Mbarara region. The duration of the programme was 8 weeks. During this
time 2,610 (17.4%) people responded to one or more SMS question.

The current Ugandan programmes have to be scaled up to a nationwide

programme. Expansion to other EastAfrican countries is expected to start
from mid-2009. Text to Change is part of the Open Mobile Consortium. The
group pans to redevelop its SMS software to make in open source this year.

Case study EpiSurveyor

EpiSurveyor is an open source field survey tool made by DataDyne,

designed to help healthcare professionals gather information from the
population to curb the spread of epidemics. With backing from the United
Nations Foundation, Vodafone Foundation and the World Health
Organisation, EpiSurveyor has been deployed in 20 countries in sub-
Sarharan Africa and Kenya, Uganda and Zambia. It is regarded as a shining
example of mHealth in action.

Health workers need to run surveys and collect health data to run
immunisation programmes, such as the programme to provide immunisation
against measles. The software, which runs on Palm handheld computers,

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 Kicking off an e-health revolution

allows healthcare workers to gather information from the population. This

information is uploaded onto a central database.

Contents According to a report by the World Bank, The DataDyne EpiSurveyor project
is lowering the barriers to collecting high-quality data by creating
Is e-health a cure for inexpensive, easy-to-use software for data collection on handhelds. "If the
European healthcare? cost and difficulty of collecting data are drastically reduced, data is more
likely to be collected."
Consumerisation set
to revolutionise
healthcare The World Bank also believes the creation of a public domain, common-data
collection platform will have other, far-reaching effects. For instance it
Mobile devices believes the digitally collecting data will allow more and faster analysis.
support healthcare in "Because the data collected with EpiSurveyor will be digital from the moment
the developing world of collection and because digital data is much easier to analyse, we believe
that analysis is much more likely to be done, and done promptly, without
having to wait months for data entry."

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 Kicking off an e-health revolution

Contents Free resources for technology professionals

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Is e-health a cure for
European healthcare? information and resources for researching products, developing strategy and
making cost-effective purchase decisions. Our network of technology-specific
Consumerisation set Web sites gives you access to industry experts, independent content and
to revolutionise analysis and the Webs largest library of vendor-provided white papers,
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Mobile devices drawing on the rich R&D resources of technology providers to address
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