Remote monitoring and telepresence for doctor-patient meetings are among applications that Telefónica is offering to practitioners, insurers, health services and even concerned relatives via a newly set up division of the company 
 
 

 
Spain’s Minister of Health, Trinidad Jiménez, and Telefónica
CEO César Alierta see a health presence system at the launch
of the company's new unit, which “aims to become a standard
bearer in the areas of products, pilot projects and knowhow”,
says Alierta 
 

 
 
 
 
 
 
The doctor will see you now. Except the doctor is not in her office, but hundreds of kilometres away in a big city hospital, talking over a telepresence system.
This is one of the likely offerings from Spanish incumbent Telefónica, which has launched a new business unit focused on meeting the demand for electronic health monitoring and healthcare.
The new division, based at the company’s head office in Madrid with a research centre in Grenada, will cover 11 of the countries where Telefónica operates — five in Europe including Spain and six in Latin America.
It’s clearly an important move for the group, which is one of the largest telecoms operators in the world. The launch in Madrid — by company chairman and CEO César Alierta — was attended by Trinidad Jiménez, Spain’s Minister of Health. Alierta said at the launch that the unit “aims to become a standard bearer in the areas of products, pilot projects and knowhow”.
According to Álvaro Fernández de Araoz, director of the new unit, the business will sell services to local health organisations and to carers. Products include a sign language translation service, to link deaf people to call centres and other services, and systems to help people rehabilitate after surgery. Much of the development took place at Telefónica’s specialist health R&D unit in Granada.
Telefónica is working with Intel and Cisco on projects and is a member of the Continua Health Alliance, a cross-industry organisation which sets up protocols for interconnecting electronic health equipment. The GSM Association is also a member.
The telepresence project is a result of the Cisco partnership. Cisco already offers video conferencing to multinational companies, using high-definition TV screens, high-quality audio and very low latency. Global Telecoms Business has used telepresence to conduct interviews with executives, and the results are excellent.
 
 
Health presence

“We’re in the process of partnering with Cisco on a version of telepresence, called health presence,” says Fernández de Araoz. But with health presence, the cameras can focus not just on the doctor and the patient, but on parts of the body that need close examination. “The doctor can look at your throat,” he says. “These aren’t devices for the first meeting between a doctor and the patient”, but they can be useful for follow-up visits.
Telefónica is planning to try the technology in the Balearic islands — the islands off the eastern coast of mainland Spain with a total population of just over a million. The biggest is Mallorca, where the health services are concentrated. Someone in Formentara, with barely 7,500, needs to travel into the main island for most services.
“We’re also working with Intel on patient health guides, to set reminders to take pills or to attend appointments with the doctor,” says Fernández de Araoz.
But why the interest from Telefónica? “Governments are being squeezed. We need to reduce health care costs,” he says.
He is ehealth director within the new growth opportunities division at Telefónica, a unit that was set up in 2003. “We have 50 engineers working on health care in Granada,” he notes. So far one of the company’s products has been launched commercially, while the others are still in pilot phase.
One of the products is in mobile telecare, aimed at people in the 60-70 age range who are still mobile. “It includes location-based services, with perimeter crossing alarms,” says Fernández de Araoz, who once worked in the pharmaceutical industry in the US and eastern Europe but joined Telefónica’s Terra Networks broadband service in 1999.
Most of the resources of the new unit are in Spain, where Telefónica’s revenues are as much as its earnings in the rest of Europe together — the Czech Republic, Germany, Ireland and the UK, where this project will be offered. Slovakia, where O2 is also active, is not on the list. The unit has a total of 90 staff, of who 62 are in Spain and 12 in the UK.
 
 
On call service

The telecare system allows a person to see which family member is “on call” in case of emergency — and the system is being promoted via local health organisations. “It’s the next generation that is going to be buying those services,” he says. But Telefónica is piloting the project to patients’ insurance companies in Spain as a business-to-business model and hopes to launch it in early 2011 in the UK, where the company owns the O2 mobile and fixed telecoms company.
“There are B-to-B and B-to-C models, and that gives you B-to-B-to-C,” says Fernández de Araoz. The service links the frail and elderly to a call centre, where an assistant can decide on the necessary action. “Most of the calls from fixed line connections are from people who are feeling lonely,” he says. “About 10% are related to some health issue, but only 6% are a real emergency.”
Effectively, though, it’s a managed phone service that a member of the younger generation can offer to an elderly relative. “They can even remotely load up family pictures and maybe a range of applications,” says Fernández de Araoz.
Hospitals rather than relatives are likely to be the customers for another of Telefónica’s Granada projects: telerehabilitation, which is designed — at least at first — to help people who have had knee operations. “They normally get three days of rehabilitation in hospital,” he says. “After that they get a tablet PC” that is fitted with sensors and other equipment. “An avatar on the tablet will tell you how to move your knee and check that you are doing it.” It sends the results back to the rehab centre — which can reset the training level.
“This will result in a 9-11% cost reduction in rehabilitation,” says Fernández de Araoz. “In telecare we talk about a return on investment of five to one.”
The aim is to use telecare to cut spending on healthcare “and do more preventative care”, he says. “You can check things before they become very bad.”
But the term “preventative care” even applied to the effects of accidents, he notes. If an elderly person suffers a bad fall then it’s important to get medical aid to them within 30 minutes. “If they’re not seen for four to five hours people tend to die.” The faster that a team reaches someone, with appropriate instrumentation, the better are their chances of survival.
 
 
Hospital information

Telefónica will be marketing its telecare services differently in its various operations in Europe and Latin America. In some countries its businesses — which operate under the Movistar brand in both Spain and Latin America — are mainly mobile and “the hosting of hospital information systems is not in the DNA of a mobile company”, he says.
But Telefónica in Spain and in some other countries are “fixed line intensive”, so the company can take a different route.
One of the applications it is exploring he likens to Cisco’s Webex system, which allows people to collaborate online with colleagues inside and outside the organisation. “You can provide any digital asset to a PC,” says Fernández de Araoz. “Click on it and it is integrated into your PC.”
For example, a family doctor on a remote island could use it to send data to a specialist in a city hospital on the mainland for feedback and interpretation.
“We’re selling this already in Spain and Chile,” he says. “It’s good for linking primary care to specialists, and it doesn’t use too much bandwidth.” With compressed video it can transmit data such as blood analysis and heart monitors. “It can link to various doctors at the same time.”
Video means Telefónica can also offer a remote service translating sign language for deaf people, he adds. It allows deaf people to talk to government agencies as well as doctors and specialists.
And, for Telefónica, that’s when it can bring business benefits — because access to the service will mean deaf people are more likely to subscribe to ADSL broadband or to wireless broadband. “It improves the penetration of mobile broadband, and you can charge government entities for the video.”
So far Telefónica has had little success in Latin America with this application, he admits candidly. But in Spain it’s different: a law there has made sign language an official language, so government agencies are obliged to provide it 24 hours a day.
“It’s showing us that here is a way to get video into residential telephony,” says Fernández de Araoz.
The group is working with companies such as Philips and Intel, which are working towards an international standards alliance to establish protocols for medical equipment.
Telefónica is looking towards the day when it can be involved in the remote management of serious diseases such as diabetes, cardiovascular and pulmonary problems. Standards are needed so that different sensors can be connected to a hub, uploaded and monitored.
 
 
Check the insulin

“Diabetes, for example, is a complex disease to manage,” he notes. Systems have to watch kidneys and eyesight, monitor what the patient eats, and check the insulin dose. “These are unstable diseases and people often have to go into hospital for two or three days if things go wrong.”
Telemedicine can help keep people at home and at work, and out of hospital, he hopes. “These are solutions,” he says. “It means the doctor can monitor the patient and the system gives an alarm if levels go above or below the line — the patient contacts the doctor only when required, so the doctor gives a better service to the customer.”
The need for telecare exists already, says Fernández de Araoz, with 15% of the population over 65: “It will be 35% by 2050. As people live longer, they are more expensive in terms of healthcare. Above 65, 70% of people have a chronic disease. But when you’re 65 you’re going to live another 20 years.”
So what will Telefónica’s role in this be? As he has already hinted, it will vary from country to country. In the less developed countries where it is active, it will be a systems integrator working with local health services, fulfilling a role that he compares with that of IBM. “In more developed countries we won’t compete with IBM,” he adds.
Telefónica will not offer the service in countries where it does not have a network, he emphasises. “That wouldn’t make sense. I’m a business unit.” GTB