Lewis Insight

The telecommunications market has been inward-looking for most of its history, focusing on the technology transitions and what it allows people and businesses to do. Now it’s beginning to shift that emphasis to the industries that telecoms serve and how it needs to adapt. Tackling one market at a time is the only realistic approach, and healthcare (including social care) is an industry that impacts every body in different ways at different points in our lives. 

To understand how telecoms and healthcare can interact, it is essential to start with the industry structure and how the technology available for each element can be implemented to facilitate change.

Healthcare infrastructure: From centralized to localized

For many people, healthcare consists of occasional and temporary interactions. For others, it involves on-going appointments, tests, care, and treatments. The sector, like the telecoms industry, demands high quality, secure devices to deliver its services. These devices continue to break new limits of analysis, which in turn generate vast volumes of data. The tendency had been to centralize activities into ever-expanding medical facilities, requiring people to travel to receive consultations and treatment. 

Before the COVID-19 pandemic, I was beginning to witness a shift away from these larger medical facilities and a trend towards more localized delivery of care. The availability of broadband, fixed and mobile was undoubtedly one of the most significant contributors to this trend. In addition, the increasing power of consumer electronics acting as proxies for medical-grade devices was growing. The sensors available on smart devices (e.g., wearables, smartphones, smart speakers), along with the powerful impact of health trackers, have made the medical industry embrace these formerly dismissed technologies.

The cultural barriers overcome during the pandemic regarding doctors and patients accepting video-based consultation should not be underestimated.

The pandemic has also forced medical practitioners to embrace remote technology and video, especially since face-to-face appointments have become challenging. This varies by healthcare area, but for example, a renal consultant told me his video consultations have gone from 5 to 90 percent (and some doctors report 100 percent). We will undoubtedly swing back to more face-to-face interactions in the future, but the critical breakthrough has been made to give patients and doctors alike the confidence to use the technology. Some medical authorities still insist on proprietary security video platforms to protect patients’ privacy and keep data within hospital systems, with applications such as Zoom and Teams being used only for internal meetings.

If we had suffered this pandemic ten years ago, this shift to telemedicine would not have been possible. Fortunately, the reliability of broadband combined with the ubiquity of high-resolution cameras and high-quality audio facilitates these interactions and provides a far more efficient service for all parties.

What the future of healthcare can build upon is the ability to bring a high level of expertise and analysis into everyone’s homes. This may smack of Big Brother, but it is a matter of balance as with any technological advance. For example, the benefits of monitoring an older adult in their own home both by relations and the medical profession have potentially massive positive financial implications. 

Can private networks help deliver services to the most vulnerable communities?

Early 5G hype was around remote surgery and leveraging the low latency and high bandwidth of new mobile generations. While these benefits will gradually materialize, it is the more mundane set of services that will have an early impact. For example, the Liverpool 5G Hub initiative uses a one-way video device to allow carers to monitor people taking their daily medication – resulting in both patients getting the right treatment and reducing wasted medicines. 

The Liverpool example is also important for another reason: it is delivered over a private 5G network. Hopefully, this will be a blueprint for other healthcare authorities to bring effective services into communities. As an industry, we tend to think of the latest smartphones and the shift to an even bigger or unlimited data package. In reality, many of the most vulnerable people in society have little or no access to those services. Increasing the digital poverty gap seems inevitable unless an intervention of this kind takes place. Liverpool is now looking at bringing their private network together with cellular offerings to build out the service. Once again, it is not a question of one or the other but a blend of public and private, which will deliver a community solution.

The assumption is often that increased smartphone penetration is the answer to this problem. The Internet of Things brings a myriad of other devices into play. A simple movement monitor can inform a carer that an individual is active and moving around their home. Sensors in beds, doors, floors, and even embedded into prosthetic limbs can all feed information back to families, specialists, and authorities as appropriate. Most of these require small amounts of bandwidth. The key thing is that the technology in terms of devices and connectivity is affordable. As always, who pays is an issue, but the Liverpool example shows that local government can deploy private networks to deliver this at a sensible price.

Financial barriers aren’t the only concern for telcos

These solutions may not provide the boom in revenue that the telecoms industry has been expecting. It is, however, a relatively straightforward path to delivering a future-proof healthcare system. Technology does not have to have an extra zero on the price tag just because it is medical. Governments will have to intervene to different degrees depending on their respective healthcare systems, but the technology is available and affordable. See also

The cultural barriers overcome during the pandemic regarding doctors and patients accepting video-based consultation should not be underestimated.  And whether the shift from city to more rural living is a temporary reaction to the pandemic, it is supported by the ubiquitous broadband initiatives of most governments around the world. 

My initial analysis of telecoms’ potential in healthcare had assumed it would be built on an individual‘s mobile and/or fixed broadband subscriptions. I now believe that community networks, private authority networks like that in Liverpool, or even an MVNO for the sector will help deliver and maintain healthcare services. Multiple new business models will be evaluated under 5G. Healthcare is no different, with a range of essential services that can benefit from fresh thinking about how the technologies can be brought to the people rather than how people have to go to the technology.

The telecoms industry’s lesson is clear: allowing the healthcare industry’s processes and systems to exploit the power of communications in their own way is vital. We should not fall into the old trap where technology restricted activities. When asking medical professionals about how technology and especially 5G might change their particular role, they assume that the connectivity will be there. COVID-19 has certainly accelerated the shift to digital healthcare. Still, the telecoms industry now needs to ensure that all stakeholders deliver against the promise of ubiquitous high-quality connectivity to facilitate society’s future vision.

This article first appeared in Futurithmic in October 2020.

When I first went to a blind school in the early 1970s, the only technology available for visually impaired people was a braille machine and magnifying glasses. Fifty years later, we are on the brink of fully bridging the disability divide through the use of communications devices and general-purpose technology. 

Back then, technology was expensive and specific for each disability. At university, I used a Kurzweil reading machine that was the size of a photocopier, cost $100,000 and only managed to produce low-quality Optical Character Recognition (OCR)  to help me consume content relating to my course. I also sent documents off to the Student Tape Library to be recorded (getting them back weeks later).

What has changed in the interim? In a nutshell, the content has gone digital, and devices can render content in an audible format in real-time provided from mainstream suppliers rather than the past specialists. Furthermore, the growth of the apps economy and its global scale means that I can now access industry and news content through my smartphone and laptop as well as specialist apps that help me with things like navigation, object recognition and technical support. In addition, the wealth of collaboration apps has put me on equal footing with everyone else during the lockdown shift to home and webinar-centric working. One other important component is the shift to the cloud. As long as we have broadband, information is accessible from anywhere, and pretty much on any device.

This transformation has allowed me to develop my career as a telecoms industry analyst working alongside non-disabled people. This shift from expensive disability-specific technology to mainstream devices means that former barriers are being torn down for the world’s billion disabled people getting access to the digital economy. 

The main categories of disability are hearing, visual, learning and physical impairments – each of which has many degrees and complexities. The evolution of the tech industry, international standards and apps mean that scale can now be applied across all disabilities. For example, sign language was physically limited to the speaker’s location but can now be supported through a smartphone with the interpretation delivered remotely. It is too simplistic to say that a microphone, camera, speaker or screen can replace any sense that is impaired but they can certainly be great proxies. 

One of the most striking changes has been the arrival of the smart speaker. Using speech as the means of interaction helps the visually impaired and physically impaired easily access a wealth of content. Furthermore, linking these smart speakers to household items such as lights, heating, security and television all contribute to a more intelligent home for all people – irrespective of whether they have a disability or not. Are they, in fact, the ultimate companion device? 

Furthermore, be in no doubt, Brain-Computer Interfaces (BCI) are coming. The ability to interpret brain waves and take action accordingly comes with some obvious concerns. However, for those suffering from locked-in syndrome, this may be the best solution to communicating with the outside world. 

How accessible tech helps increase diversity and inclusion

Coming at it from a slightly different perspective, the range of communications options also plays well into inclusion. The goal of unified communications was to bring all forms of interaction together. What is evident from the disabled community is that the blend of text, speech, collaboration tools and social media all have their relative roles. The hearing impaired have relied heavily on text messages in the past and are now benefiting from lip-reading via high-quality video.

Many visually impaired use screen readers to turn text into the spoken word and, if my blind cricket team is anything to go by, record messages in social media rather than typing them. There is, however, a responsibility on developers to label and design their offerings more cleanly. For instance, in a conferencing app, finding the unmute button, identifying and using the Chat or Q&A function shouldn’t be a major ordeal, but believe me, it is. App designers must include accessibility from scratch. And, of course, a well-designed app is better for everyone. If you think about it, modern in-car interactive technology is based on the same text-to-voice and voice-to-text technology that I use every day. 

This diversity of communications options also applies to the area of customer service and experience. When I was researching different disabilities, I had extensive email and social media exchanges with someone with cerebral palsy. I suggested we tried a voice call, but we failed to communicate. We reverted to messaging and continue the dialogue to this day. Companies interacting with the ‘Billion’ need to identify the most appropriate channel for individual customer’s needs – and human voice can still be the best option. 

As we build out a more digital society, the availability of smart devices, connected via the latest generation of communications services, can help bring that ‘Billion’ into the digital economy. According to my calculations, people with disabilities have a spending power of roughly $4 trillion. This not counting the value of the improvement in lifestyle it also brings to often isolated people. 

I usually present the world of communications services as a series of concentric circles with the individual at the centre surrounded by layers representing the household, business and society. Leveraging all mass-market communications services not only brings the ‘Billion’ into the digital marketplace but also allows public services such as healthcare and government to communicate with the individual – and vice versa.  

For example, the COVID-19 lockdown has demonstrated how relatively straightforward and effective remote healthcare can be for many situations. Opening the communication channels to the ‘Billion’ will undoubtedly improve healthcare and social care in the long term. 

Is everything in place? 

Mostly but not quite. Devices have become more accessible with assistive technology ready-built into smartphones, computers and televisions, helping different disability groups gain immediate access to digital services to improve their lifestyles. Website and apps are increasingly better labelled to allow easier navigation but there’s still work to be done.  

The move to 5G and increased fiber roll-out offers an opportunity to bring all individuals and households into the connected world. However, this requires a stronger political will to keep penetration levels at the highest for rural as well as urban communities. 

Perhaps most importantly, the education of individuals is still needed to increase awareness and raise confidence levels in using the technology and accessing services. Lastly, employers require a cultural shift in making internal systems accessible for all and opening up employment opportunities for the disabled.   

In some ways, this shift is the ultimate personalization service. We talk about putting the customer at the centre of our industry. This is the ultimate test of how we bring all of the technology and services down to that individual level. As we enter the 5G era of high speed, low latency communications affordable for all, let’s not lose sight of the goal of bringing the ‘Billion’ into the digital community.

This article was originally published in Futurithmic in August 2020.

Thinking ahead to the shape of the telecoms industry as it emerges into digital reality, what sort of product portfolio business processes and supporting systems will be required? This is a chance to rethink the industry, recalibrate in the light of a shifting role for the world’s communications service providers and position for the long-term rather than for the quarterly shareholder demands.

• Product portfolio:The history of telecoms is strewn with the corpses of failed offerings. ATM (Another Telecoms Mistake), MERLIN (Means Early Retirement Looks Even Nearer), let alone what X.25 or Frame Relay ever meant! Hiding behind technology is no longer acceptable. What is needed is a simplified portfolio of fixed and mobile broadband with easily understandable pricing (not tariffing) and an open approach to APIs. This will allow the entrepreneurialism of applications developers and associated services to be smoothly integrated.
• Business processes: These evolved along individual service lines and in different lines of business (LOBs) with their own idiosyncratic support services. The industry is crying out for business processes that short-cut the traditional complexity of getting a service ordered, installed and delivered to the customer and supported through suitable customer service channels.
• Systems:Much is made of building the ‘programmable platform’ needed by the future telecoms players. This blend of formerly separate IT and network-derived components is brought much closer by the blurring of lines between network and IT assets, cloud delivered functions and the web scale players disrupting the hitherto hardware-centric marketplace.
• AI/Analytics:on top of all of this now comes the power of AI/analytics and the ability to predict network and IT activity and even throw light on the customer’s behaviour.

In my early days at Logica, we always had the acid test of ‘fitness for purpose’  – i.e. did the software do what it was supposed to do. The goal for the future telco is to have a programmable platform which can serve as the engine to drive all consumer, business and wholesale services whether they find themselves playing directly or indirectly in the wealth of emerging business models. This means building economies of scale across all the operating functions within the telco. From outside of the telecoms industry it appears there is a lot of slack built into the system!

Yes, simplification means driving a lot of cost out of the business. A simpler portfolio will be more easily presented to the marketing functions of the LOBs and will remove unnecessary complexity from the billing side. In fact, how about removing billing altogether, flat rate bundles and even ask a credit card company to deal with the billing (as suggested to me by Tier 1 telco CIO)?

Cloud partners provide the ideal hybrid approach to building the platform of the future. We simply cannot predict the traffic patterns that will result from individuals, households, businesses and the wealth of ‘Things’ connected to each.

My suggestion: let’s start thinking from the outside-in. What are our partners, customers and customers’ customers trying to achieve? And how can we, as the telecoms industry, make ourselves as easy as possible to work with? Thinking in current telco terms doesn’t help the rest of the world build trust in telco’s role in the digital world.

What do you get when you mix an academic, an optimistic technologist, a sceptical regulator, and the Great Telco Debate? A pragmatic view of where 5G is and where it is going.

I thought it timely to revisit the 5G debate. The expert witness comments at the Great Telco Debate 2017 from Professor Rahim Tafazolli from the University of Surrey 5G Lab, Hossein Moiin from Nokia and Clive Carter from Ofcom gave us plenty to consider on the day. Mobile World Congress gave me an additional chance to test these thoughts against the glitz and glamour of Barcelona and subsequent posturing from suppliers and mobile operators alike are bringing the 5G investment question into stark highlight.

Key threads to emerge from the debate:

•  5G is an engine, a framework for future proofing the whole network
• It will start with mobile broadband because the industry is comfortable with the business model of connectivity. The newer business models requiring interworking with the automotive, health, energy sectors will need some time for both sides to agree how to work together. It must be a win/win situation where savings of 60-80% sited around healthcare for example, would be shared between parties, benefiting all.
• 4G is a very good system. We can add more speed  e.g. massive MIM) to 4G to improve its performance.
• 5G will support higher speed broadband connecting people and ‘Things’ of different capabilities, but most importantly it will support automation.
• 5G does not treat IoT in isolation, automotive in isolation or mobile in isolation, but all together in a new all-inclusive system. These can’t all have separate networks so the single network has to be programmable. The reason for virtualisation is not about customer service but about reducing the cost of supporting this ever-expanding demand on the network.
• Mission criticality and resilience are what is needed to support verticals like health and automotive but also to support the swift roll out of services contrary to traditional telecoms timescales. More important than low latency is guaranteed latency. Knowing what you have to work with when building and managing applications is vital. Take out the variability. We need more and more capacity because more and more applications include video content. The structure of the wave form and the frame size in 4G just can’t cope with this explosion of connections from low to high bandwidth and from low to high latency requirements.
• Analytics gives the underlying fabric of 5G the intelligence to build future systems to support all activities. This turns the dumb pipes into intelligent pipes that the customers need.
• We need 1 million connections per square kilometre! Where is the money to support this? ARPU is flattening or shrinking in some countries. The new money for the telcos is in automation, powered by data analytics and ultra-reliable, low latency communications. It is also important to note that data analytics and AI is not so much about what has happened in the past, but what will happen in the future and how to adapt the network around this demand. Excel spreadsheet can do the retrospective but AI/Analytics can do the future. Leveraging MEC and Analytics to have the content cached at the nearest cell site would save everyone a lot of trouble and improve performance as well as satisfaction.
• We will see islands of 5G emerging: some from the telcos, some from other parties like cities, governments, major manufacturers. It will result in a very localised, scalable network infrastructure linking closely into the activities of people and things across the network.
• The 5G Innovation Centre (5GIC): The role of Service Providers, Network Equipment Providers (NEPs), cloud providers, academia and regulators is to create an ecosystem capable of supporting the new industry.
• The more and more personalised service that services and analytics brings to the table just isn’t the model the industry has been built on in the past. We built large scale networks that did lots of things for lots of people. This stuff really matters to society, to the economy, and of course, to the individual.
• Universal service for everyone is somewhat at odds with the notion of more personalised service and making more money out of certain individuals. Targeting individuals can make the telecoms players more profitable. Great, but can you make the networks available at a uniform price to all customers?
• In economic terms, we are redistributing the pie, not creating new ones or bigger ones. From a regulator (referee’s perspective), the redistribution of the pie results in people complaining to the regulator about losing a slice or two. The industry is giving productivity back to the customer through lower prices and the Skype dividend rather than giving it to the telcos and providers of equipment and devices. There is inevitably going to be a bun fight between suppliers for a share of a fixed pie.
• 5G rollout will vary dramatically based on regional differences, control economies, political motivation and regulation
• Mobile operators can only afford 5G with additional sources of financing, income or perhaps a removal of the spectrum auction.

As the debate motion posited: The market can’t afford 5G.  Well, it has to. It requires a rethink in terms of a broader investment for society as a whole. Benefits will accrue to citizens and not necessarily to the telcos.  So how do governments and regulators encourage the investment? Tying it all back to economics, perhaps it’s time for a reconsideration of the value being created. The business case is built on saving money and driving operational efficiency into an industry that has gorged itself on fat margins and is now waking up to digital reality.

The Great Telco Debate 2018 on 29th November in London is open for registrations. Please contact me for speaking opportunities.