U.S. Healthcare: Too Much Money/Too Little Results

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Wireless Technologies: The Challenges and Opportunities Facing Telehealth

Henry RosenVice President, M2M Business SolutionsNumerex CorporationUsual story about Boston Conference1

Best Practice Wireless DNA Architecture

Extensive Device Management Tools

Representative Virtual Architecture - Hardware

Data Center Must Allow for Deep Application Monitoring

Telehealth has a language of its own 510k alliance analog ansi ata Asynchronous Transfer Mode (ATM) Audio-teleconferencing Backbone Bandwidth Basic Rate Interface (BRI) Bit bis cardiac care ccd cdc cesl chf chin chronic care continuaa copd CMS Defense Data Network (DDN) dax devices diabetes doj Dedicated Line Demarc Dip (Dual In-line Package) Switch Distribution Amplifier Duplex Audio ehr emr fcc fda forward ftc hcaho hcii hie himss hitsp Home Tele-Health (HTH) Hard Wired Half Duplex hl7 hme hmo hpsa icd9 implantable cardiac devices initiative interoperability ip matmo mcot meaningful use medix mhealth iniative monitoring Monitored Medication Dispensing Systems (MMDS) Monitoring Center/Station MBPS (Megabits per Second) mua nchsr nhsc ohih phr point of care post-acute care pots Patient Tele-Monitoring Systems (PTMS) Pendant Peripherals Programmable ppo ppp pprc protocol reimbursement remote sonet ss7 store & forward t1 t3 tcp telematics telemedicine tia-506Adding Wireless Increases Complexity of Telehealth Even More1800mhz 1900mhz 1xrtt 2g 3g 4g adl agps nalog-to-wireless ansi apis bearers bluetooth bridged bsc bus cdma certifications command converter counter csd ctia debug dialserv dna dns dota edge ether ethernet etsi ev-do evdo event fast fcc fcm flash fota gateway ggps ggsn gpio gprs gps gsm hlr hsdpa hspa http iccid imei imsi incoming indication infrastructure input integrated ip iso-27001 iwf leo lte management memory mesh messages mobile model module modem msc mt100a2w-g-eu mt100a2w-g-gb mt100a2w-g-nam mt100a2w-nam object plugins power-up ppo protocols pstn ptcrb receipt registration rf rj-11 rs-232 secure serial service sgsn shell sim sms standards tcp tftp timer trace translator udp udpapi unsent usb vlr voip wap wifi wimax wireless zigbee

When you add in WIRELESS to the equation, things really start to get dicey.

I am NOT going to address the challenges related to the MEDICAL side of Telehealth; instead, Im going to focus on addressing the complexity that Wireless adds to the equation.7

Successful Wireless Telehealth Initiatives Must Solve Many IssuesWhats the best way to configure & activate devices?Should I use a module or embedded modem?How can we optimize the payload to make it affordable?Whats the right wireless network(s) to use?How do I pick a wireless module?Can I automate orders and requests for equipment?How do I manage support when patients call in?What is the right rate plan?How do I protect my data so I am compliant with all regulations ?How will we ship hardware so it is plug and play?What about international coverage?How will I handle billing to insure reimbursement?What if something isnt working how will we handle returns?Can I integrate into our legacy systems?How do I manage my devices over the air?2G/2.5G Most Existing M2M Applications still use this technology or GPRS

Will eventually be sun-setted by carriers lots of consternation

Lowest cost modules in this category Many different flavors of 3G (HSPA, EVDO, etc) most useful for data intensive apps (web sites, etc.)

Modules must be backward compatible for non-3G coverage and are larger/more costly

Modules becoming more affordable4G & beyondStands for Long-Term Evolution

No agreement yet (Sprint vs. AT&T/Verizon) on convergence

High speeds not required for Telehealth apps

Modules typically much more expensive (for now)Wireless Network Evolution

1xRTT

DNA is the key to Wireless Telehealth but Product Lifecycle Management services are vital as well

Device & Network Agnostic Platform?

Administrative Console w/ Device Management (FOTA, etc.)?

Hosted or Self-Managed Data Center?

Application Monitoring Tools?

Easy Integration to Legacy Systems? DNA is the key to Wireless Telehealth but Product Lifecycle Management services are vital as well

Recurring Monthly Billing?

First and Second Tier Customer Support?

RMAs and Return Management? DNA is the key to Wireless Telehealth but Product Lifecycle Management services are vital as wellWireless Technologies: The Challenges and Opportunities Facing Telehealth

Henry RosenVice President, M2M Business SolutionsNumerex CorporationUsual story about Boston Conference16Minimal transaction countMinimal transaction sizeAsynchronous communicationsStateless applicationsMinimal implementation of transport layer functions Wireless Application Architecture Is DifferentPollingVerbose messages (Ascii text)Sending static/duplicate dataSending unchanged/unimportant dynamic dataOver-reportingConfirming transactions/excessive handshakingSynchronizing state between client and serverSynchronizing time between client and serverUsing session-based, confirmed delivery transportCommon Wireline Application Issues Wireline applications must usually be rearchitectedAssumptions underlying wireline application architecture are invalidFundamental system design usually has to changeTuning or optimization can improve performance a little

Otherwise, high usage-based charges on every device forever

Good news! Its almost always softwareConverting Wireline Applications to Wireless Wireless Technologies: The Challenges and Opportunities Facing Telehealth


Examples of Wireless Converter Devices

Go Wireless Immediately with an ON vs. IN approachPlug the existing unit into a wireless conversion device instead of the phone lineAdding a conversion device lets customers go wireless immediately with little or no change to their existing solution at either the device or application end

Concurrently begin working to develop an all-wireless solution (adding wireless IN the device)23

Conversion Device Solutions using PPP Pass-through Require Little or No Change PPP Pass-through ModeThe customer legacy device initiates a dial-up PPP session, the conversion device completes a PPP connection to the cellular network and transparently passes through PPP data to the customer legacy back end server without ANY modifications on the customers part.24Wireless Technologies: The Challenges and Opportunities Facing Telehealth

Henry RosenVice President, M2M Business SolutionsNumerex CorporationUsual story about Boston Conference25Wireless Technologies: The Challenges and Opportunities Facing Telehealth


Henry RosenVice President, M2M Business SolutionsNumerex CorporationUsual story about Boston Conference29Minimize transaction countException-based reportingBatched reportingCustom transport layer protocol functionsCustom application and presentation layer protocolsMinimize transaction sizeEmploying UDPCustom application and presentation layer protocolsClient application designed for configurabilityClient application designed for modular updatingOther techniquesData model modificationTime-base management and calibration

Best Practices for Wireless Telehealth Applications Wireless Technologies: The Challenges and Opportunities Facing Telehealth


Typical Regulatory / Network Certification Timetable Wireless Technologies: The Challenges and Opportunities Facing Telehealth


World SIMFor Devices & Patients Moving Around the Globe

OR

Where opening new countries w/ low density of connections

Single SIM, Simplified RatesOne SIM works everywhere. Simplified rates for >185 countries

Dual IMSI Technology Domestic & international profiles on a single SIM card allows for Single console management of all Connections

Local SIMFor Devices Permanently Installed in a Fixed Location

AND

Where in-country density of connections exists (>10,000)

Locally Sourced SIMWith enough in-country density local SIMs provide the most competitive rates

Requires Local Contract With enough in-country density local SIMs provide the most competitive rates

Consider Two International Approaches based on density Wireless Technologies: The Challenges and Opportunities Facing Telehealth






Deep Network Visibility at the SIM level Wireless Technologies: The Challenges and Opportunities Facing Telehealth





Extensive Device Management ToolsWireless Technologies: The Challenges and Opportunities Facing Telehealth





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U.S. Healthcare: Too Much Money/Too Little Results