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The October 17, 2005 Issue Provided by System Dynamics Inc.
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In This Issue


Heard on the Net

News about People and Companies Influencing The Broadband Home

People News

Michael Collette has joined Narad Networks as CEO. Michael was previously CEO of Ucentric, which was purchased by Motorola earlier this year. ( www.naradnetworks.com )

Brian Craddock has been appointed VP of Sales for the broadband telecommunications and large enterprise markets at Incognito Software Inc. He was most recently with London-based Systems Union. ( www.incognito.com )

Rick DeGabrielle was appointed President and CEO of Arroyo Video Solutions. He was previously at Catena Networks. ( www.arroyo.tv )

Kenny Frerichs was named President and CEO of Network Physics. He was previously at ForeScout Technologies. ( www.networkphysics.com )

Jim Grams and Bob Pacheco have joined Azaire Networks as the company's CTO and VP Sales, Americas and Asia, respectively. Grams was previously at AT&T Wireless and Pacheco was with Persona Software. ( www.azairenet.com )

Ellen Kirk has joined Tropos Networks as VP of Marketing. She was previously with Qualcomm. ( www.tropos.com )

Michael Librizzi has joined Cygnus Communications, Inc. as VP, Marketing. He was formerly with Entropic Communications. ( www.cygnuscom.com )

(Please email people@bb-home.com to report a change in your position.)


Company News

Acquisitions

Broadcom is acquiring Athena Semiconductors for $21.6 million in cash. The acquisition will provide Broadcom with technologies for mobile digital TV tuners and low-power Wi-Fi. ( www.broadcom.com ) ( www.athenasemi.com )

Covad Communications is acquiring fixed wireless Internet provider NextWeb for $24.7 million. ( www.covad.com ) (www.nextweb.net )

Liberty Global is buying Swiss company Cablecom Holdings AG for $2.19 billion. ( www.lgi.com ) ( www.cablecom.ch/en )

NTL is acquiring Telewest in a transaction valued at approximately $6 billion. It will be the U.K.’s second largest communications company, with a combined customer base of nearly 5 million residential subscribers. ( www.ntl.com ) ( www.telewest.co.uk ).

Viacom's MTV Networks has purchased IFILM for $49 million. IFILM has the largest collection of short videos on the Web and reaches more than 10 million users a month. ( www.viacom.com ) ( www.ifilm.com )

Funding

3e Technologies International (3eTI), a wireless infrastructure supplier, has received strategic funding from Intel Capital. ( www.3eti.com ) ( www.intel.com/capital )

Aperto Networks, a WiMAX systems supplier, raised $17 million in its Series E financing round. ( www.apertonet.com )

Digital 5, a provider of software for streaming multimedia content, has closed an undisclosed amount of financing from an existing investor. ( www.digital5.com )

Modulus Video, a supplier of high-definition video compression technology, closed its Series B round of venture funding with $10 million. ( www.modulusvideo.com )

Redline Communications, a provider of standards-based broadband wireless equipment, announced it has secured $15 million (U.S.) in venture financing. ( www.redlinecommunications.com )

Roundbox, which aims to provide software products for deploying wireless broadcast and multicast services, has raised $8 million in Series A financing to launch the company. ( www.roundbox.com )

Ruckus Wireless, a wireless home networking start-up previously called Video54, raised $9 million in series B financing. [See "Wireless Video Networking" below.] ( www.ruckus.com )

Tropos Networks has received an undisclosed amount of funding from Siemens Venture Capital. ( www.tropos.com ) ( www.siemens.com )

VIVOX, a Pulver.com company that provides online communities with application specific embedded communications services, raised $6 million in venture capital funding. ( www.vivox.com )

Other News

ArrayComm and TeleCIS Wireless announced a joint development agreement to create products for the upcoming WiMAX “e” (mobile) standard. TeleCIS Wireless will support ArrayComm’s smart antenna solutions in its multi-protocol WiMAX mobile chip and ArrayComm will design its smart antenna solutions to facilitate enhanced performance of the TeleCIS chip. ( www.arraycomm.com ) ( www.telecis.com )

Clearwire announced a distribution agreement with retailer Best Buy to sell Clearwire's broadband wireless modem and service in selected locations. The Clearwire service is available in parts of Florida, Oregon, Minnesota, Washington, Texas and Wisconsin. ( www.clearwire.com ) ( www.bestbuy.com )

Intel announced the Asian Broadband Campaign to provide broadband wireless consulting and technical services to governments, telecommunications regulators, education, health and agriculture public sector agencies and carriers in preparation for WiMAX trials. Intel said it would begin WiMAX trials in Malaysia, Thailand and the Philippines by the end of 2005, with trials in Indonesia and Vietnam slated for 2006. ( www.intel.com )

Mediabolic and Broadcom unveiled the new Broadcom NAS media server reference design -- a joint hardware and software storage platform with embedded media server capabilities providing the ability to stream music, photo, and video files to a variety of connected entertainment devices throughout the home. ( www.mediabolic.com ) ( www.broadcom.com )

picoChip has signed a development partnership agreement with the Electronics and Telecommunications Research Institute (ETRI) of Korea in the area of Software Defined Radio for WCDMA/HSDPA and WiMAX. Separately, picoChip announced a family of complete reference designs extending its offering to cover both fixed WiMAX (802.16-2004) and mobile WiMAX (802.16e and WiBRO) for mobile station (MS) and base station (BS) designs. ( www.picochip.com ) ( www.etri.re.kr/www_05/e_etri )

Rogers Communications and Bell Canada announced an agreement to jointly build and manage a Canada-wide wireless broadband network expected to initially reach more than two-thirds of Canadians in less than three years. The companies will pool their wireless broadband spectrum holdings into a joint venture, Inukshuk Internet Inc., which will build and operate the network. ( www.rogers.ca ) ( www.bell.ca ) ( www.inukshuk.ca )


Standards and Forums

The Digital Living Network Alliance (DLNA) announced its Certification and Logo Program of the DLNA Home Networked Device Interoperability Guidelines 1.0. The program is aimed at verifying that products designed to the guidelines meet DLNA’s certification testing requirements. The first DLNA CERTIFIED products are expected to hit the market by the end of 2005. ( www.dlna.org )

The Alliance for Telecommunications Industry Solutions (ATIS) held an inaugural IPTV Interoperability Forum (IIF). The event resulted in creation of four task forces to investigate the areas of Architecture, Digital Rights Management, Interoperability and Testing, and QoS Metrics. This effort is intended to be more than just video over DSL and includes IPTV delivered over any type of infrastructure, specifically also including wireless and fiber. ( www.atis.org )

The Enhanced Wireless Consortium (EWC) "was formed to help accelerate the IEEE 802.11n development process and promote a technology specification for interoperability of next-generation wireless local area networking (WLAN) products." See "Wireless Video Networking" below for further details. ( www.enhancedwirelessconsortium.org )


Briefly Noted: Updates, Observations and Trends

Each month, we collect miscellaneous happenings, studies, trends or observations you might have missed. This month we feature the stampede to offer VoIP and share some statistics on worldwide broadband growth.

VoIP Profusion: Everyone's Doing It

Last month, ebay bought skype. This month a few more companies linked their names with VoIP. These include:

  • Microsoft recently bought Teleo;
  • AOL introduced their TotalTalk service earlier this month;
  • Motorola is demonstrating the operation of Sonus VoIP over Motorola's Canopy wireless broadband system; and
  • Google introduced the Beta of Google Talk.

With all these offerings, how is a consumer to choose what to use? ( www.ebay.com ) ( www.skype.com ) ( www.microsoft.com ) ( www.aol.com ) ( www.motorola.com ) ( www.sonus.com ) ( www.google.com )

Broadband Growth Shifting

Point Topic has issued their World Broadband Statistics for mid-2005 and has made some observations based on the new numbers. The worldwide growth rate of broadband is leveling off (although 16% growth between December 2004 and the end of Q2 2005 is still a pretty big number).

As broadband growth slows in the countries where it first took off--South Korea, Canada, Japan--broadband growth has been shifting to Europe, including the UK, France, Finland, Norway and Switzerland. See additional insights at the Point Topic website.


Wireless Video Networking - Ruckus, Metalink and EWC

We've written many articles about whole-home wireless networking -- using a single wireless network for audio, video, voice and data throughout the home. Of these, video is the most difficult. High-definition video, especially multi-channel HD, needs more bandwidth than existing wireless standards provide.

The IEEE 802.11n standard, in development for several years, promises to provide the key standard that fills in the missing pieces. It provides much higher speeds than the earlier 802.11a and 802.11g standards -- enough to handle several simultaneous channels of high-definition television along with audio, voice and data. It operates in both the crowded 2.4 GHz and uncrowded 5 GHz frequency bands. And it includes MIMO technology to achieve both greater range and higher speeds.

IPTV is a key driving force in the development of these next-generation wireless technologies. As telephone companies move to deploy IPTV over broadband networks to compete with cable companies, they need a way to move the video streams from a home gateway to the TV set. While many technologies are competing to fill this need, next-generation wireless has attracted the bulk of the enthusiasm and investment.

We reported earlier this year on our tests of MIMO-based products based on 802.11g. We found they indeed provided both much greater range and higher speeds, and were encouraged by MIMO's potential as a key factor for whole-home video.

We are now seeing further advancements intended to move the next generation of "whole-home wireless" technology into the marketplace. New MIMO chips from startup Ruckus Wireless are being deployed in Hong Kong to move IPTV around the home. New chips from MetaLink and Marvell promise much higher speeds than possible with 802.11g. And a bombshell announcement by most of the big wireless chip companies suggests these technologies will arrive in the market much sooner than expected -- but very possibly ahead of a formal standard.


Ruckus Wireless

Startup Ruckus Wireless recently announced a "Wi-Fi Multimedia System" intended for whole-home networking. Ruckus also announced that PCCW, Hong Kong's primary telecommunications provider, would use products and technology from Ruckus to offer "a complete wireless multimedia solution" for its Netvigator broadband service. This is a significant endorsement, since PCCW has launched IPTV service over Netvigator and will use Ruckus to carry IPTV around the home.

To learn more about Ruckus and its technologies, we interviewed Dave Logan, VP of Product Development. Dave told us the PCCW system achieves reliable wireless transmission of several simultaneous video channels by using a combination of hardware and software technologies. and a wireless traffic management system called SmartCast.

Formed little more than a year ago, and previously known as Video54, Ruckus had earlier licensed its BeamFlex "smart antenna" technology to Netgear for its RangeMax series of MIMO-based routers and network interface cards. BeamFlex is an innovative MIMO design based on multiple antennas and specialized software.

Ruckus antenna array --> Click for larger pictureBeamFlex uses multiple antennas in a custom array. Dave told us six antennas are used in the PCCW product (seven in the Netgear RangeMax products). The Ruckus software constantly looks for the best path for communications between a wireless access point and its client devices: "the software selects the best antenna combination for each client device and each packet." It is designed to find a good path even in the presence of interference--especially important in Hong Kong, a densely-populated city with very high penetration of broadband and home networking.

SmartCast is a new Ruckus software technology for traffic management. Applied for the first time in the PCCW system, SmartCast is based on IEEE 802.11e QoS and is specifically designed for a mixed network with video. Ruckus uses a special technique for packet classification and queuing, with each video stream in its own queue. It identifies and manages multicast IP streams used for IP video "to provide a robust wireless transport for IPTV streams from the broadband gateway to the set-top-box".

Ruckus MF2900 wireless gateway --> Click for larger pictureRuckus has embedded its technology in a pair of Ruckus-branded products for PCCW: the MF2900 router/access point, and the MF2501 client adapter. Both support 802.11b/g with a software-configurable six-element antenna array and software that integrates Ruckus BeamFlex and SmartCast.

While Ruckus plans to license its technologies to any company that wants to use them in advanced consumer products, Dave said they needed "to build systems today to get to market." He said Ruckus aspires to become "the premier tech provider of digital home enablement technologies--the Dolby of Wi-Fi."


Metalink Broadband

In May and June of this year, Metalink Broadband--an Israeli fabless semiconductor company--announced a pair of chips to implement "a complete solution for wireless multimedia networking." We had followed Metalink as one of the pioneers of ultra-fast VDSL solutions and were not surprised to see them extending their expertise into the home.

In July, we interviewed Ron Cates, Vice President for North American Sales and Marketing, over the telephone to learn more about Metalink's strategy. Ron told us "VDSL providers wanted a solution for home distribution. TVs are not necessarily located where people have phone jacks. They looked at various alternatives (coax, etc) and decided on wireless."

Unlike other chip companies who have primarily focused on extensions to the existing 802.11g standard, Metalink chose to develop an early version of 802.11n--the new standard that will eventually replace 802.11g. In particular, Metalink chose to focus on the 5 GHz spectrum. Ron said others had "targeted applications that one can buy at Fry's and have legacy compatibility with b and g devices. That forces you to operate in the 2.4 GHz band--it's great for backwards compatibility, but inadequate for streaming video in a high-fidelity way." By contrast, he said "5 GHz is cleaner, with lots more places to run and hide."

Metalink has announced two chips to provide a complete solution. The first is a MIMO RF chip providing the front end for a 2x2 MIMO solution in the 5 GHz band, with support for both the existing 802.11a and emerging 802.11n standards. The second is a baseband chip said to be "draft-compliant with the 802.11n evolving standard". Metalink says these two chips together can be used to implement wireless networking for a "broad variety of consumer electronics products including Residential Gateways, DTV, HDTV, Set-Top Boxes, Media Adaptors, Digital Video Recorders (DVR), Portable Display Appliances and Game Consoles."

We asked Ron what Metalink had invented, and he said "Metalink didn't invent any new technology. We implemented those elements that have been openly discussed and were likely to emerge in the final standard--especially those most optimal for our chosen market: video distribution from a PVR-enabled set-top box." The Metalink solution is designed to "optimize data rate and reach. It supports both flavors of Windows MultiMedia (WMM)-HCCA is preferred by the consumer electronics community. It includes a hardware-accelerated encryption engine to support DRM and a MAC aggregation scheme to increase MAC efficiency."

In summary, Ron said "we're one of the first companies trying to do something that's standards friendly and optimized for video delivery." Sample of both chips should be available now, and he predicted we'd see demo products at CES in January.

With the interest in multi-room video heightened by telcos rolling out IPTV, we wondered what other developments were in the works.


Enhanced Wireless Consortium

On October 10, the other shoe dropped. After months of rumors, a new group called the Enhanced Wireless Consortium (EWC) took off the wraps and announced that 27 companies had signed up "to help accelerate the IEEE 802.11n development process and promote a technology specification for interoperability of next-generation wireless local area networking (WLAN) products." It quickly became clear that these companies--including Atheros, Broadcom, Conexant, Intel and Marvell--had been working on this for some time, since they quickly released a joint "interoperability specification".

That evening, we interviewed four EWC representatives in a conference call: Mahesh Venkatraman, Senior Tech Marketing Manager at Marvell; Bill McFarland, CTO at Atheros; Bill Bunch, Director of Product Marketing at Broadcom; and Dave Hedberg, Senior Scientist, Wireless Data Communications at Conexant. They said EWC's objective was to accelerate 802.11n. They had taken the two major competing 802.11n proposals (TGn Sync and WWiSE) and created a "basic interoperability spec" which has now been published on the EWC website.

Their next step will be to take their spec to the Joint Proposal Group established by 802.11n to reconcile the competing specs. If adopted by the Joint Proposal Group, it will be submitted for approval at the November 802.11n meeting; if it receives at least 75% of the vote, the EWC spec will become the "core spec" for 802.11n.

Some observers have pointed out that it seems odd that Airgo, until now the early leader in deploying MIMO technology, was not a part of the EWC group. We asked the EWC group why Airgo was not included and were told that EWC is an open group: "we would like to have more people participating in the process."

Since EWC announced an "interoperability" specification, we asked if EWC was setting itself up to verify interoperability. We were assured that EWC "was not founded to do interoperability testing -- our legal agreement says that once the EWC spec is submitted to the IEEE process, EWC will cease to exist."

On the face of it, this appeared to be an earnest way to speed up the IEEE process, stalled for nearly a year by competing proposals. We asked when chips and products based on the EWC would be available, and were told we'd need to ask individual members.

"Actions Speak Louder Than Words"

The very next day, Marvell--one of the EWC members--announced the 88W8360 family "the first silicon based on the Enhanced Wireless Consortium’s (EWC) recently announced technology specification. ... The Marvell 88W8360 chipset is currently available and Marvell is working closely with key OEMs on related product development." This cast a very different light on the EWC announcement. Clearly the EWC spec is not just a proposal to the Joint Proposal Group, but a spec against which some EWC members have been designing chips for a long time. We won't be surprised to see similar announcements from other EWC members and prototype EWC-based products at CES.

Will the EWC spec be accepted by the Joint Proposal Group and submitted to 802.11n? If so, the EWC spec will indeed form the "core" of 802.11n, and hopefully the standards process will move smoothly and quickly from here.

If not, EWC members appear ready to bring chips to market and OEMs will bring out products based on these chips--thus making EWC the de facto specification for next-generation wireless regardless of the 802.11n deliberations. This scenario smells like an implied threat to 802.11n: "Follow our lead or become irrelevant."

A benign interpretation of these developments is that business customers have been putting pressure on system vendors to provide interoperable high-speed products. 54 Mbps products have been on the market for several years and business customers are looking for higher speeds and improved range. Most consumer products now boast higher speeds than enterprise products, but are based on mutually-incompatible speed-boosting techniques, including several competing flavors of MIMO. One vendor told us he has "seen the level of frustration and disappointment about the pace" of the standards process. So the system vendors have put pressure on the chip makers to accelerate the 802.11n process and EWC is the result.

A more sinister interpretation is that the biggest players in current wireless chips have used this as an opportunity to gang up on Airgo, a disruptive new entrant. For all their words of working to speed up the IEEE process, the immediate availability of chips against a privately-developed "interoperability" specification suggests EWC members may care more about protecting their position than speeding up the standards process. Greg Raleigh, Airgo's CEO, told us "This consortium is delaying the 802.11n process. The only spec that matters is the 802.11n spec. The consumer benefits from an open public process."

In a staff blog on the PC World website Yardena Arar wrote "Since Airgo's technology was widely expected to figure in the 802.11n standard, I get the impression that the Enhanced Wireless Consortium's initiative is more about positioning other Wi-Fi chip vendors, who haven't been able to successfully compete with Airgo's technology, to shut Airgo out of the 802.11n development process, than it is about delivering true benefits to consumers."

The growth of IPTV is creating a near-term need for multi-channel video networking. 802.11n was designed to meet that need. While the open standards process provides a "level playing field" for hammering out specifications, it is often messy and slow, and sometimes fails to complete specifications in time to meet market needs. Sometimes the consumer's interest is best served by moving faster, sometimes by waiting for a more forward-looking spec.

If EWC succeeds in accelerating 802.11n while providing the key technologies for video networking, its efforts will be appreciated by the entire community. If it sacrifices key elements in the interest of higher speeds for enterprise networking and market positioning of its members, it will delay the needed consumer wireless solution--and may open the door wide for the next generation of powerline and coax solutions waiting in the wings.


For more information

( www.ruckuswireless.com ) ( www.netvigator.com/netvigator2003/index_eng.htm ) ( www.metalinkbb.com ) ( www.enhancedwirelessconsortium.org ) ( www.marvell.com ) ( www.atheros.com ) ( www.broadcom.com ) ( www.conexant.com ) ( www.airgo.com )


Hurricanes and Healthcare

Puzzled by the title of this article? We heard a lot about Hurricane Katrina in late September at a Boston symposium about healthcare and telehealth. "The Accelerating Use of Communication Technology in Healthcare" conference took place one month after Katrina’s devastation.

The conference was sponsored by Partners Healthcare, an integrated health care system affiliated with Harvard Medical School and founded by Brigham and Women's Hospital and Massachusetts General Hospital, two of the top teaching hospitals in the United States. The conference drew on healthcare thought leaders from the medical community, government and industry. Over two days, they were addressing each other, not outsiders like us, and we felt their talks were frank and honest.

The speakers overwhelmingly agreed that Katrina has changed people’s thinking, and many spoke of the likely impact on healthcare as a prime example. Although many factors are needed to create the future of health care, communications to and from the home is one of the important ingredients.


Key Messages

The overall conclusion of the conference was summarized by John Glasser, VP & CIO of Partners HealthCare: "It is inconceivable to think of a future ten years from now that does not include more than just face-to-face (health)care."

The main messages we heard can be summarized in three areas:

Pressures for changing the healthcare system:

  • The healthcare system, worldwide and especially in the US, faces a looming crisis from sharply rising costs, the aging of the population and a shortage of providers.
  • Access to the Internet has greatly increased consumer medical awareness and has already become a force for changing the doctor-patient relationship.
  • Thought leaders are seeking ways to speed changes and overcome resistance from medical institutions and individual doctors.

Application of communications technology to improving care:

  • Most initial applications of healthcare IT, including broadband communications, have been internal to the healthcare establishment.
  • Allowing "healthcare to follow the patient" is viewed as the next frontier.
  • The creation of electronic medical records is one of the crucial underpinnings for improving healthcare.

Where we go from here:

  • Activities sponsored by the US Federal and state governments, including public/private partnerships, are underway and are moving in a positive direction.
  • Katrina has provided a banner for accelerating the application of IT to healthcare, but whether this is sustainable remains to be seen.
  • The area of “wellness care” may be more easily addressed than some others, because it could be based on “self-pay”.

Pressures for Change

Lessons We Can Learn

With Hurricane Katrina fresh in everyone’s mind, Dr. Jeremy Nobel, from Harvard School of Public Health, drew some interesting parallels on the lessons we can learn from our preparation for it and the similarity to conditions facing healthcare today. His talk provided both some warnings and a call to action.

The first lesson learned was "Complex systems are always at risk of catastrophic failure." In New Orleans it was the levee systems that failed; for healthcare, the complexity stems from the tangle of relationships and incentives between and among physicians, insurers, governments and patients.

Lesson two: "In retrospect everything was pretty obvious." Studies had predicted the disaster that happened in New Orleans. Similarly, we’ve all heard the cries about the aging of the population, the expenditure of the majority of healthcare dollars on chronic disease and the warnings that the pressures on healthcare systems worldwide by those diseases will become an unsustainable burden.

Lesson three: “We were simply not prepared and could have done a lot better." For Katrina it is obvious. In healthcare, a 2003 Rand study of the care received by patients with chronic illnesses showed that 45% do not get the care called for in best practices. We should do better.

Resistance to Change

A host of impediments make it difficult to introduce technological solutions into the healthcare equation. These include a fear of obsolescence from the high rate of technological change, and the belief that anything "high tech" will take away from the "hands on" “high touch” environment that physicians are used to. Hospital boards understand what it means to buy a respirator, but spending dollars for electronic medical records, wireless networks or new user interfaces is outside their comfort zone.

Several speakers frankly acknowledged doctors' resistance to change. Speaking to an audience largely composed of his peers, Dr. Michael Jellinek, President of Newton Wellesley Hospital, observed that many of the changes physicians are being asked to make require using technologies that are foreign to them, and there have not been sufficient incentives to convince them to change their familiar behaviors.

The conference attendees were a self-selecting group that chose to spend two days discussing these issues. These professionals at the leading edge cannot imagine the future of healthcare without incorporating technology much more deeply into its fabric. But some are pessimistic that change will occur fast enough to cope with ever-rising costs.

Patients Changing, Too

It isn’t only physicians who are undergoing change, it’s also patients. How many of you have gone online to understand symptoms or treatments for some condition you have? Increasingly, patients go to the doctor’s office armed with printouts from the Internet and a list of very specific questions. Some doctors are happy to have patients show such interest, while others view it as an affront to their expertise.

This trend toward the consumer being more actively involved in their own medical care stems from the wealth of medical information available freely on the Internet, and will only grow over time. One speaker described the doctor’s role as transitioning from “the priest" to "the guide.”


The Application of Communication Technology

“Care Follows the Patient”

Many of the conference discussions and presentations honed in on the delivery of "the right information, to the right person, at the right time." Communications is key, and high speed, always-on communications often provides the most value.

Several talks described applications focused on diagnosis and recommendations for treatment:

  • The “tele-ICU” application at Lehigh Valley Hospital connects board-certified critical care specialists to the three sites of this facility; the attending physician consults with the remote intensive care specialist, who can see both the patient and their medical records.
  • In the “telestroke” program at Mass General, an expert at a remote location views a patient suspected of having a stroke and their brain scan and converses with the attending resident to determine whether to use a clot dissolving medication.

Dr. Joe Kvedar --> Click for larger pictureDr. Joe Kvedar, Director of Partners Telemedicine and an early believer in the application of information technology (IT) to medicine, talked about Partners’ new "Connected Health Initiative". Partners has been active in implementing programs that leverage communications technologies to interconnect people within the medical establishment. Connecting medical professionals with residential consumers is the core of the new initiative, based on extending the care community outside of healthcare institutions by bringing healthcare to the places consumers and their families live and work.

In his talk on “Optimizing Care Through Communication Technologies”, Dr. Kvedar observed that the spectrum of care includes Prevention, Diagnosis, Monitoring, Communications and Treatment. While diagnosis and treatment tend to be within the medical community, monitoring and communications can be handled via communications between health care professionals and the consumer at home. Home monitoring has been shown to be very effective for Congestive Heart Failure (CHF) and wound care. Communications technologies are starting to be used for online visits and multimedia messaging.

Electronic Medical Records--Still Moving Slowly

The relationship of Hurricane Katrina to healthcare goes beyond the crisis analogies we’ve mentioned. Cheryl Austein-Casnoff, Director, Office of Health Information Technology at the US Department of Health and Human Services, made it very real when she painted a picture of Katrina evacuees showing up in 19 states without healthcare records, medication prescriptions or immunization records. She believes this is a wake-up call to have accessible Electronic Medical Records (EMRs) for all Americans.

The primary purpose of an EMR is to provide easy access to all important patient health/medical data by authorized personnel, independent of where the patient is located.

In an Executive Order more than a year ago, President Bush endorsed the goal of having widespread adoption of interoperable electronic health records within the next ten years. Following Katrina, the administration announced new regulations that support adoption of e-prescribing and electronic health records. Since every hospital and every doctor's office keeps its own records (often handwritten), a great deal of work still lies ahead.

Johanna Pittman --> Click for larger pictureJohanna Pitman, Vice Consul of the British Consulate, described the very different environment in the UK, where e-records and e-prescribing are well along in implementation. This is made simpler by having a single payer, the National Health Service (NHS). Another UK speaker said the government is spending billions of pounds for the implementation of the NHS Electronic Vision: "a health service designed around the patient." The electronic transfer of prescriptions is well underway in the UK and will be fully implemented by the end of 2007.

In the US, there appears to be a gap between the agreed need for electronic medical records and the pace of implementation. While everyone agrees EMR is a necessary underpinning for future medical services, it seems to be going slowly. People have been talking about portable interoperable medical records for more than two decades, but people still have to fill out the same form every time they visit a doctor, entering information about existing conditions and the drugs they are taking--probably differently each time. In private conversations, several attendees said it was difficult enough to break down walls in their own institutions, much less between institutions.


Home Care: Segments and Solutions

As we listened to speakers describing various applications of technology to home healthcare, it seemed useful to think of the addressable market in terms of the health status of the consumer. The following segmentation has helped us think about applications in terms of user type, appropriate technologies and how the solution will be paid for.

  • People with an acute condition (one that is severe and comes sharply to a crisis).
  • People with a chronic condition (one that requires medical treatment and supervision for a continuous period).
  • People concerned about their health, but are basically well and want to stay that way (sometimes called the “worried well”).

Acute Care

One example of acute care is patients released early from the hospital, receiving close monitoring and supervision at their homes by healthcare professionals. The equipment at the person’s home typically includes specialized "medical grade" devices similar to those in a hospital, provided by the healthcare establishment. This type of care is often paid for by insurance, just as a hospital stay would have been, at a lower cost and with a patient happier to be at home. This was the scenario for Hospital Clínico San Carlos in Madrid discussed in our September 2003 article Home-based Health Services: Telefónica’s Pilot.

Chronic Care

Liverpool trial in the UK --> Click for larger pictureWith the worldwide aging of the population, a large piece of the focus of trial projects has been on the care of chronic conditions. This was the subject of Intel’s research described in Eric Dishman’s article Repurposing Broadband: Home Health Technologies for the Worldwide Age Wave, and the focus of work on both diabetes and congestive heart failure described in the case studies at last year’s Healthcare Unbound conference.

At this conference, Kerstin Nettekoven of BT described a project in Liverpool in which elderly people with chronic conditions are passively monitored, using non-invasive sensors to assist in supportive home care for their independence and safety. Similar projects are underway in the US, often funded through the Centers for Medicare and Medicaid Services (CMS).

The "Worried Well"

Many articles have described the US "baby boomers" who are approaching retirement age and often have a proactive view of healthcare. Many have seen their parents in nursing home situations and want an alternative solution. Searching for ways to stay healthy longer, they spend money on gym memberships, foods and supplements bought at health food stores. These "worried well" have a strong interest in monitoring their health and finding ways to maintain it.

Amir Nashat of Polaris Ventures thinks this segment represents a good opportunity for implementing "self-pay" models for wellness care. This approach would circumvent the thorny questions of "who pays" raised when seeking venture money for telemedicine projects.

Dr. Nat Sims, Harvard Medical School, is particularly interested in the development of monitoring devices appropriate to this segment. These could be high volume/low cost sensors and actuators which might connect with mobile phones to provide "untethered physiologic monitoring across the continuum of care." In this segment, it could be acceptable to use lower-cost "consumer grade" devices to record longitudinal data and deviations--an example would be the consumer measuring blood pressure with an automatic cuff at different times of the day to provide data for the doctor to see if hypertension medication needs to be adjusted.


Looking Forward

Mobile phones appeared in several presentations --> Click for larger pictureSince we came to this conference with a bias toward using broadband communications between healthcare professionals and the home, we were surprised that no speaker mentioned broadband. Several focused on mobile phones as the "break-through enabler" for home communications. It was not clear whether the speakers were referring to the wireless communications channel, the portable personal device, or both. Mobile carriers were far more visible at the conference than fixed-line carriers, and appeared to have paid far more attention to the home healthcare opportunity.

Many speakers made clear that although there are some technology challenges, technology is not the major impediment in moving forward with telehealth. The challenges come from laws and regulations, the need to align rewards and incentives with desired behaviors, and the organizational complexities in the current US system.

Dr. Nobel’s speech presented a view of the evolution of telehealth in which the first generation will focus on solving "the distance and time problem;" the telestroke application described above is an example of this category. The second generation will be more transformative; roles and accountabilities will have to be re-designed and chronic diseases are one of the major challenges to address.

After attending several conferences on the application of technology to healthcare over the past several years, our assessment is that forces are starting to align to disrupt the inertia of the current system. Hopefully the spotlight Hurricane Katrina has focused on major deficiencies in the US healthcare system will provide a positive benefit from the terrible catastrophe.

[Postscript: After completing this article we viewed a TV interview by Charlie Rose of Andy Grove of Intel. Grove has written an article Efficiency in the Health Care Industries -- A View From the Outside which appeared in the July 27, 2005 issue of the Journal of the American Medical Association. We have not yet read the full text of the article, but Grove made very interesting points in the interview, especially the urgent need to take small steps quickly. For EMR, he advocated solving a smaller part of the problem as quickly as possible, then addressing the larger problem over an extended time.]

Presentations from the conference are available at the Partners website

( www.partners.org )


Mobile TV and Video-on-the-Go

After the 2005 CES, we observed that mobile video--we called it "video-on-the-go" or "vidi-go"--was the next big thing. Nine months later the contest is underway to find out which implementations of the concept will stick and which are a flash in the pan.

Although the press and analysts have had a good time airing their skepticism about whether consumers will spend time (and money) watching video on their mobile phones, that hasn't prevented the deals from proliferating. One of the most recent is that MTV Networks will be licensing Warner Music Group's music video catalog to create short form videos for mobile device users.

This month's big news in the mobile video segment came from Apple's much anticipated announcement of its video iPod in 30 gig and 60 gig versions ($299 and $399 respectively). Apple has added music videos to iTunes, which will sell for $1.99. They also made a deal with Disney and ABC to sell episodes from 5 selected TV shows, and a few short films from Pixar, which will cost $1.99 for each show. This will be an interesting chance to see what consumers might watch on a 2.5 inch, 320x240 pixels screen.

Some time ago, TiVo announced a "TiVo To Go" program, which allows consumers to transfer their TiVo recordings to portable devices and laptop computers. The newest addition to this category was EchoStar's launch of a line of PocketDish portable multimedia devices. The product is built on Archos equipment, which comes in screen sizes of 2.2", 4" and 7" widescreen. They retail for $329, $499 and $599 respectively.

In Korea, LG Electronics has added a TiVo-like capability to their TV mobile phones. The new handsets, unveiled at the recent Korea Electronics Show, receive satellite TV and can pause broadcasts while you take a phone call. The phones have 80MB of internal memory and can record up to an hour of programming.

( www.mtv.com ) ( www.wmg.com ) ( www.apple.com ) ( www.disney.com ) ( www.abc.com ) ( www.pixar.com ) ( www.tivo.com ) ( www.dishnetwork.com ) ( www.archos.com ) ( www.lge.com )


Progress With Our Broadband Condo

View of the Gulf from our deck --> Click for larger pictureIn the last issue, we wrote Preparing Our Condo for the Digital Future about rewiring and equipping our Florida condo for digital media. Work is under way; we've made a lot of decisions and thought we'd provide an interim progress report.

Low-voltage outlets behind the PC --> Click for larger pictureWhile the electrician was completing the line-voltage wiring, we finished planning the low-voltage. As we reported last month, we've chosen to use A-BUS for multi-room audio. We described A-BUS for our electrician and worked out the details in a plan for him.

The most difficult set of decisions had to do with flat-screen TVs and home theater. We had decided to use a 42" plasma display in the living room for watching broadcast TV, for playing DVDs and for displaying video and pictures from our Media Center PC. Since we're going to use a cable settop box to receive HDTV, we at first planned to install a plasma monitor without a built-in tuner.

As we thought more about it, we realized that would require turning on the plasma display to see video, the home theater receiver to hear audio, and the cable box to tune a channel. While it would be clear to us, some guests might call us in a panic when they didn't hear the sound after turning on the TV. So we've decided to spend the extra money to get a full plasma TV--guests can watch and listen as soon as they turn on the TV, and can turn on the sound system if they want the full theater experience.

We also want to install a wall-mounted flat-screen TV in the master bedroom. We had been thinking about a 26" LCD, but now think we'll use a 32" LCD. We're looking for one that is "cable ready" so we can avoid installing a cable box on the wall. The only devices on the market now have the first-generation "one way" CableCard. Since CableLabs has started testing second-generation devices, and one recently passed certification tests, we may wait until they reach the market.

Wall behind the PC desk --> Click for larger pictureThe project is moving along fairly quickly now. The picture shows the wall behind the computer desk, with the surround for the whirlpool tub behind the wall. All the low-voltage cabling for the PC will run just above the white pipes, and the wiring center for the condo is in the Utility Closet just out of the picture to the left.

We'll report next month on how it all came together!


The Personal Side of Telecom: Dispatches From Shishapangma

Expressions like "global village" and "making distance irrelevant" have a new meaning for us after receiving almost realtime dispatches from the 14th highest mountain on the planet. Starting in late August, our youngest son, Mike Teger, was on the other side of the planet. He's climbed big mountains before, including the tallest in North America (McKinley), South America (Aconcagua) and Africa (Kilimanjaro--he says it's an "easy" climb compared to the others).

All the other times we resigned ourselves to his being out of touch for a while--sometimes for a month. But a laptop computer, a satellite phone and a Web site made Mike's climb up Shishapangma--one of the highest mountains in Tibet--different. We're not sure it was better from a parent's point of view--who really wants to know that your child is starting the final ascent up to an altitude of over 26,000 feet. But once you know the information is being posted, sometimes almost daily, you have no choice but to follow along, step by step.

Mike Teger at 26,300 feet on Shishapangma --> Click for larger pictureIf you'd like to look at what we saw over the past 6 weeks, visit 2005 Shishapangma expedition dispatches. Use the links on the left to see the pictures. Two of Sandy's favorites are a shot of the mountains from Kathmandu-Lhasa flight and the last picture showing their base camp with moonlight lighting up the clouds. You can enjoy them knowing that Mike is down and safe after making the summit.


Upcoming Conferences

If IPTV and entertainment are on your radar screen, the next couple of months will be a good time to immerse yourself in IPTV in the US and in Asia, plus the content, services and home products that will be finding their way into more and more living rooms. Here are some shows that sound interesting to us.

TelcoTV 2005

TelcoTV 2005, November 8-10, in San Diego should be particularly relevant with the heightened interest in IPTV. The event is focused on video via broadband from a telecom service provider’s point of view. All signs point to this being the biggest year yet for IPTV, so we'll be there. ( www.scievents.com/telcotv05 )

IPTV Asia Forum

If you're interested in IPTV and can be in Hong Kong toward the end of November, put IPTV Asia Forum on your calendar for November 28-29. You'll hear about the current state of the Asian IPTV market as well as business opportunities, technologies and products. ( www.iptv-asia.net )

Digital Living Room

Digital Living Room appropriately calls itself the place where Silicon Valley and Hollywood intersect. If you are following the technologies and services that are transforming the living room into a digital hub, set aside December 5-6, 2005 for this event. ( www.digitallivingroom.com )


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