In this guest article, industry analyst and futurist Dean Bubley discusses the ongoing shift from monolithic to decoupled best-of-breed solutions which can be seen across many industries. How will this transition affect current and future telecare and telehealth solutions and what will Solution Providers have to do to stay competitive? The answer: cloud-based telecare enablers.

De-layering is commonplace…

It is not news that the Internet – and cloud platforms more generally – have disrupted many industries. Retail, travel, music and many other domains have seen vertically-integrated sectors broken down into separate providers of products, marketplace, packaging and delivery.

Often, the technology stacks themselves have fragmented as well, enabling huge creativity and innovation. Cloud-native platforms have improved user interfaces, analytics, data sources and enabled different – and highly scalable – business models. Often, this has also allowed specialist or niche providers to emerge, adding extra functions via open APIs and shared data. Communications platforms have allowed the easy integration of voice, video or messaging elements.

Yet some industries and technology products have remained unchanged by these revolutions. In some parts of the world, doctors and lawyers still use fax machines. Cars still have proprietary software and engine-management software.

In particular, many IoT products and services remain in vertical “silos” with proprietary interfaces and integral data-management. Some still seem very “analogue”. This includes many in the health, telecare and remote patient monitoring sector, as will be discussed in this article.

It’s harder to break apart sectors that “touch the real world”

The legacy approach is sometimes reasonable. Safety-critical systems are often monolithic, or based on custom integration projects. There isn’t an open API or cloud-based appstore for nuclear power-station control software, for instance. Critical systems make a conscious trade-off between safety and performance versus flexibility.

It is easiest to “disaggregate” systems that are purely information-based, with no interaction with the physical world. In the Internet, cloud and IoT era, there is a sequence of sectors that have changed structure, where each level is harder to evolve:

  1. Information and content providers
  2. Retailers
  3. Agency and broking models for sales of goods and services
  4. Consumer technology such as smart-home systems and appliances
  5. Business-critical systems such as industrial automation
  6. Safety-critical systems such as medical devices or food storage/distribution
  7. Critical infrastructure

Media and retail were the first to break apart. In general, the de-coupling of services into front- and back-end applications means less risk of “lock-in” to a specific supplier. There is greater agility to replace/update components, enhance input/output sources, or shift aspects to the cloud where appropriate.

But the more “cyber-physical” a system, the less easy it is to split into independent parts. It is more likely to have reliability, compliance and performance requirements in the real world as well as virtual – and real-world consequences if it goes wrong.

Overall, many people feel safe at stages 3 and 4, but we’re just starting to see online services in categories 5 and 6 emerge in the mainstream.

Disaggregating the remote care & health sector

Telecare and telehealth is just becoming more flexible

One of the industries that has not changed much in recent years, despite the advent of broadband, IoT and cloud, is telecare. This is a mix of levels 4 and 6 – some functions such as day-to-day monitoring of patients, or routine welfare / telehealth calls, are closely aligned with a “smart home” model, especially for assisted-living scenarios. There’s already quite a lot of use of web- and app-based tools, especially during the pandemic. These can integrate communications as well – for instance a smart pill-box can trigger a reminder text or call from a nurse, if a patient fails to take their medication on time.

But emergency telecare situations and alarm-response are obviously more safety-critical. If someone falls, or pushes an alert button because of an urgent medical condition, it is seen as less-risky to have an integrated system. While replacing proprietary elements with open alternatives could give theoretical benefits, there is understandable conservatism and risk-aversion, when it comes to safety issues.

But even that is starting to change, for instance with more-capable wearables like watches, that can monitor and communicate vital signs reliably, often to a third-party telecare app or healthcare service provider. Decoupling of legacy IoT stacks can also occur if there is a particular external catalyst or disruption.

A good example of this type of change is the switch-off of older analogue PSTN networks, and the retirement of old infrastructure. This has impacts on niche systems that have relied on the phone network, from elder-care alarms, to controllers of railway points or elevator emergency call-buttons. Various features such as support for DTMF tones, or the ability to power passive devices over copper wires, have disappeared or changed in the move to IP and fibre-based systems.

Disaggregating the remote care & health sector

Disaggregating the remote care & health sector

Many millions of people – especially the elderly – depend on emergency buttons and wearables to trigger alarms, initiate medical call-centre calls or get an emergency response. These products have been addressing long-term needs, often hard-coded for particular national markets’ healthcare systems and regulations.

But recently, factors including the pandemic, trends towards ageing in one’s own home, and higher awareness of extra physical and psychological issues are extending the reach of telecare and related systems. This is putting a premium on flexibility.

A number of major transitions and new opportunities for telecare are coming into focus:

Input sources are expanding

Input sources are expanding with the rise in IoT, wearable, voice and smart-home technologies and connectivity methods. Motion detectors, cameras, personal health and biometric monitors, sensors for door-opening or room-occupancy, smart utility- and water-usage systems and so on – all of these provide insight into the health and welfare of older or vulnerable people.

Home-based remote care

Home-based remote care was rising even before the pandemic, and the need to reduce unnecessary personal contact to avoid coronavirus transmission has accelerated it. Older and vulnerable people increasingly prefer to stay in their own homes, rather than institutional care settings. Assisted living is dependent on good monitoring and communications technology – which will evolve continually, being adapted to different specific contexts and situations.

Remote communications

Remote communications is becoming more important for caregivers, family members and others. Reliable and secure video and voice communications – suitable for older people or those unfamiliar with modern apps and devices – must be carefully optimised. This goes beyond rigid use-cases such as emergency alarms – but they must work reliably too. Friendly voice-assistants, video links for regular care and emergencies, non-intrusive surveillance and automated diagnostics are all options here. One of the effects of home assisted living is potential loneliness, which needs to be countered as well.

Intelligence and data analytics

Intelligence and data analytics are increasingly important parts of future care and welfare systems. The ability to capture, safely store and manage, and analyse data from multiple sources will enable improved standards of care, pre-emptive actions and automated communications when issues are detected. Patterns across a large population can be correlated, to give early-warning of problems such as disease outbreaks. This is far harder to achieve in a closed and monolithic system; alarm-focused companies are unlikely to have internal skillsets around AI and data-science.

Continued evolution

Continued evolution will occur in future. We can expect new styles of sensor, in-home systems such as care-robots, shifts in practices as learnings from the pandemic filter through, and so on. Additional innovations and new processes will be added to the installed base of systems, rather than complete refreshes or replacements. Openness and disaggregation will help here.

Yet while there have been various attempts to integrate established systems with wider smart-home platforms or solution-stacks from Apple, Google and Amazon, there still remains a stubbornly large base of legacy telecare products. Not only are they restricted in capabilities – albeit remaining very reliable – they face an additional challenge in some parts of the world from PSTN switch-off.

Characteristics of a Communications Platform for business-critical solutions: Protocols

The answer: cloud-based telecare enablers

In Disruptive Analysis view, the telecare industry should see the PSTN switch-off as a major phase transition. Rather than just re-invent existing silos for IP-based networks, the vendors and solution providers should examine the opportunity to move to a completely new model, based around cloud, APIs and extensibility.

Existing providers of vertically-integrated personal health and welfare alarms should recognise the threat from “Internet-native” rivals. Today, many combine and tightly-couple input sources (sensors, cameras, wearables) with the communications platform and alarm management systems, as well as dedicated staff and call centres.

They should now look to disaggregate their propositions and leverage their brands, channels and installed base, as part of a move to open and more flexible platforms. They can use and integrate 3rd-party IoT, new models of cloud-based communications, and ultimately intelligent and AI-based predictive models of user behaviour and context to move up the value chain, and help avoid the risk of displacement by general smart-home or wearable systems providers.

However, this move will not be straightforward. To retain security and reliability, they will need to adopt new skillsets and migrate their existing base smoothly. They will need to rely on a new set of vendor and platform partners to achieve this – yet the endpoint should potentially be greater opportunity and growth.

The monoliths are going to be broken apart – yet the components could prove more valuable than the whole.

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Dean Bubley is a global outspoken industry analyst and futurist, with huge experience in areas such as CPaaS, WebRTC, 5G and telecom strategy. He is known for his visionary but challenging opinions, his online presence as @disruptivedean, and is regularly seen at live and virtual conferences around the world and quoted in publications such as The Economist, FT and Wall Street Journal.

Mr. Bubley’s clients include many of the world’s leading and most innovative telecom operators. Make sure to follow him on Linkedin and  Twitter.

Dean Bubley

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