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[...] via CTIA: All wireless carriers want mHealth | mobihealthnews. [...]

Diabetech has been offering an mHealth service since 2002 including an end to end wireless data service provider platform within our operations. We’ve run on Mobitex, ReFlex and GSM/GPRS networks. The time is better than it was but as much as carriers would like to run in and sell a million devices with recurring data revenue and nice margins, this is still healthcare and the answer to the question of who pays is still being figured out. Technology and availability are not the limiting factors.

I think those are fair points. What role do you think carriers should play in deciding the “who pays?” barrier-to-market? Any role?

The fact that the CTIA is interested in these sorts of applications is definitely true. At Voxiva, we’ve had a lot of great support from them on a number of projects and they really do seem to get behind the idea of better health.

[...] the first to admit that not everyone agrees with my opinion on this, indeed only last week Rob Mesirow Vice President of the CTIA gave a talk where he claimed that the Kindle was an example of a new type of device that should be used to [...]

Besides the reimbursement issue that Kevin mentioned, incompatible business models are also holding carriers back from healthcare revenues. Many wireless medical applications require a service level that is higher than consumer voice communications. The way carriers provision consumer devices is often a poor fit with medical device vendor’s products. The rate plans are also a poor fit for many health care applications and markets. All this is further complicated by the fact that patients that can manage a cell phone already have one — the idea of replacing it, or having to carry another, is not very appealing.

Working out exactly what a recurring revenue/nice margin health care application would do and look like is an interesting exercise that has yet to really excite carriers (let alone come to market). When I did wireless data bus dev targeting health care for AT&T Wireless, the challenge was engaging medical device vendors early enough in the development cycle to package the mobile features in a way that worked for the device vendor, patients and the wireless carrier. The focus back then (circa 2000) was the acute care market (hospitals), and home health — existing markets with revenue and/or reimbursement.

A carrier that wants to position itself for future health care business could co-fund trials (in trade or with cash) to demonstrate the cost effectiveness and clinical efficacy of mobile health applications. A carrier that wants to penetrate health care and make money near term, should look to the hospital market — and be prepared to meet the actual market requirements rather than treat them just like a horizontal market wireless customer.

Great advice, Tim.

I think your analysis points to why Qualcomm does a lot of the service-level, heavy-lifting for CardioNet and has talked about launching LifeComm, an MVNO that could handle medical data flow for other startups and connected devices in the emerging wireless health industry.

Clearly managing the Kindle’s data flow is not without its challenges, and it is a device worth looking to, as Mesirow points out. Managing a Kindle-like device’s data flow for the healthcare industry, however, would bring a whole set of new considerations.

Even publishers would agree: Pirated books < Stolen health information. All. Day. Long.

I was glad to see a healthy discussion on this article. This is the meat that’s been missing from the sandwich when it comes to the question of adoption of WWAN mobile operator devices in health care. As an answer to Brian’s questions early in the comments:

Brian’s question – What role can the carriers play in helping to answer (not deciding) the question of who pays? My answer – The carrier’s need to expand their relationship with people who use their networks and part of that is transmission of health data. Today they recognize voice and data without necessarily knowing the context of the content traveling across their network. The only difference with calling out health data is the heightened service level as Tim points out. The funny thing about my customers who have diabetes is that almost all of them also use cell phones for voice. I have some strong opinions around Bluetooth enabled medical devices vs. our embedded broadband wireless approach but regardless, carriers are not yet selling to patient-centered ecosystems. For example, they could easily throw in a health monitoring service in return for securing a multiple of voice subscribers tied to the patient (think friends and family of those with a chronic disease). Communication is a key requirement for people with chronic illness! They simply need to build or partner in order to provide that health knowledgeable patient experience on the health feature.

As to how the Operators can stimulate and accelerate – funding for randomized, controlled clinical trials would be huge since the real magic here is not simply wireless data but the specific design of a patient monitoring protocol or self-directed program – The Secret Recipe – that differentiates the Colonel from plain old fried chicken. Trials of this sort will be long and varied providing a long window in getting it right.

Regarding the airtime aspect, that’s been solved for a while when you’re dealing with low data volumes as in our case with diabetes – we just eat the cost as if it were postage or some other necessary administrative overhead since it is trivial when compared to our standing reimbursement rates with the payers. When you get into images and ECG waveforms, etc… there is still a barrier since those data volumes and costs are highly variable and not insignificant.

It might help also if you read through a timeline of our efforts since 2001 and how we’ve dealt with these changes. The most exciting part is that payer coverage is finally arrived. That final barrier will be getting providers to refer and recommend and we have some progress in that area too for getting non-reimbursed time covered as well. That timeline is on my blog at http://challengediabetes.diabetech.net/2007/08/21/toward-the-holy-grail-of-diabetes-management/

[...] in the year Mesirow explained that CTIA’s wireless carrier association members had put healthcare initiatives at the top of their list for new areas to explore for next generation services, which is why at the [...]