MNO infrastructures are built on a core network upon which layers of services can be added. The core services inherent in the MNO’s infrastructure are services easily provided to their customers. These core services include: voice calls, simple-messaging service (SMS or text messaging) and circuit switched data calls.
This core has evolved with an overlay architecture to provide packet-switched data services to allow mobile phones access to services such as wireless application protocol, multimedia messaging services, and internet access. Further evolution of the mobile technology (3G) has migrated to a “network which provides services independent of the technology platform and whose network design standards are same globally1.”
The next step is 4G (competing standards of LTE and WiMax) which will rely upon native IP networks and changes the underlying telecommunications modulation mechanism to handle the never-ending demand for mobile broadband network resources (bandwidth to support the increasing data types and sizes available on the internet and desired by mobile computing users)2.
MNO Business Models
MNOss have three basic business models they employ: traditional direct-to-consumer (think mobile phone service plan), basic information technology enterprise support and global business information technology capabilities. In terms of services specific to healthcare, these models apply to consumer mobile health, hospital IT and health industry solutions.
The business models as listed scale in risk from low to high for the MNO. As in any endeavor, the more integrated the relationship, the higher the risk of failure but the higher the possible reward. If the business model is aligned with a traditional service offering of the MNO, then the ability of the MNO to meet the healthcare requirements for that service is of a high probability. As the service required from the healthcare industry becomes more complex and integrated, then of course, the probability of the MNO meeting the requirements goes down, subject to the MNO’s efforts to adapt their existing capabilities to the health industry.
When referring to the range of healthcare services that an MNO could support, each of these could have simple or complex processes which would then either match very easily to a MNO’s business model or would require an integration of several of the business models and products along with possible development on the part of a healthcare enterprise. For example, for consumer mHealth, sending health tips or providing a health hotline either via a phone call or text messages, would be something fairly easily supported by an MNO. At the other end of the spectrum in health industry solutions, providing remote monitoring and assessment for a chronic disease management protocol could entail development of a back-end database along with software triggers to infrastructure, devices and phones for data gathering and analysis along with alarm notification would be a project that might entail a tighter coupling of the various infrastructures provided by the mobile network operator, medical device manufacturer and healthcare enterprise partner.
Tables 1, 2 and 3 show how the different MNO business models can provide specific healthcare services as stratified into low, medium and high risk to the MNO. Highlighted in each of the tables is a sample of the types of services that can be provided from the MNO to the different healthcare processes/services/requirements.
In table 1, the low risk MNO services are shown with the mHealth model (column) of providing health tips highlighted. In this case, the MNO can provide all of the described services to support a health tips product, ranging from access (to both voice and data) to retail distribution of that product. Out of those services, the ability of the MNO to manage value-added services (the ability to market, package, manage and sell services which are over and above traditional voice and data packages) is core to the ability to offer the health tips product. Another way to look at the table is that the MNO can provide at a low risk access bandwidth (horizontal row) to all of the healthcare services from mHealth to healthcare industry services. Note, also, that the MNO can only provide wireless access (horizontal row) at a low risk to the healthcare services of health tips, a health hotline and remote monitoring.
Table 2 shows the medium risk services that MNOs could provide the healthcare enterprise. Highlighted is the example of basic hospital IT provision. Provision in the MNO parlance is the means by which the services are allocated and subsequently billed. An analogy to healthcare is one’s insurance coverage has provisions for specific healthcare services which are either covered by the insurance provider, are under shared coverage (may require a co-pay) and/or are excluded. In the vertically highlighted case, to support healthcare IT provision, the MNO could provide all of the listed medium risk services from enterprise mobility to enterprise sales and partnership, in addition to the low-risk services of access to voice and data from Table 1. Out of these services, the ability to offer managed services (the ability to package and manage the various enterprise services as a bundle to an organization) is core to being able to offer a healthcare IT solution. Again, horizontally, one can see that messaging services (text messaging) could be provided to the healthcare services of basic IT provisioning, a wellness portal, personal health records, remote monitoring and a turnkey HIS system, but not to cloud-based health data (examples shown as PACS or EMR), a health information exchange (HIE) or claims. This makes sense as the data standards used for data exchange with a PACS, EMR, HIE or claims would not be an SMS or text based format but most probably be DICOM, HL7, CDA (clinical document architecture based on the HL7 messaging standard) and electronic data interchange standard, respectively.
In Table 3, the higher risk business models for the MNOs to provide healthcare services are shown, with the vertical healthcare service section of remote monitoring highlighted. Here, a combination of high-, medium- and low-risk services are needed to deliver a remote monitoring product. Payment (business to business, B2B), content distribution, custom application development and machine to machine (M2M) are services that could be provided by the MNO but at a higher risk. As a comparison, in Table 2, the remote monitoring service column highlighted shows MNO services of enterprise networking, security, messaging and enterprise sales and partnership at a medium risk. In Table 1, for another comparison, the MNO can provide at a low risk the services of access (wireless and bandwidth), core services, tariff and customer care (in this case the customer is the healthcare provider). Out of all these services, the ability to offer M2M services (being able to manage, monitor and track data from embedded SIM transmitters within remote medical devices) is core to providing a remote monitoring solution.
Therefore, as a healthcare enterprise and provider are making a decision as to where they can have an MNO as a technology partner, the tables provided can give them a way in which to ascertain where a simple business relationship can be used versus a shared partnership to provide a healthcare service. If the healthcare enterprise just needs access (voice and data), then this type of service is one in which the MNO is experienced and can be provided turnkey and with standard business contracts as generally defined by the industry. If the healthcare enterprise is looking to have a remote monitoring service which has custom application development (hopefully based on a clinical protocol), along with an M2M and B2B functionality, a customized business relationship will need to be crafted between the MNO and healthcare enterprise.
Summary
As the capabilities of the mobile network are enhanced to provide greater bandwidth and access with all types of mobile computing platforms, they also can provide more customized solutions to meet different healthcare requirements. The basic mobile telecommunication services which have evolved from simple voice call to the use of native IP networks to transmit all types and sizes of data, enable the MNO to expand their competitiveness with traditional telecommunication services for the healthcare enterprise. Nevertheless, it will be incumbent upon the healthcare enterprise to exercise due diligence regarding the technology solution they need and understand the risks associated with choosing a specific technology partner.
This article provides a tool to assist the healthcare enterprise in determining what risks the healthcare services have for your MNO partner. In the following article in this series, specific MNOs healthcare solutions will be highlighted to show how the MNO has met the requirement and/or partnered to meet the healthcare service requirements.
- Kumar, Amit, Yunfei, Liu, Jyotsna Gyupta, Divya, “Evolution of Mobile communication Networks: 1G to 4G," International Journal of Electronics and Communication Technology, Vol 1, Issue 1, Dec 2010
- Pearson, “Evolution of Mobile Broadband,” Telecom Fundamentals of LTE, Chapter 1