The Smart Services Leadership Summit brought together industry leaders, researchers and vendors to explore how intelligent wireless devices and "smart services" can promote efficiency and innovation. This research will assist the healthcare provider CIO in planning for future mobile health initiatives.

• Mobile phones, sensor technology, portable medical devices and wireless health applications will play a larger role in connecting patients with their healthcare providers within the next few years.
• Advances in the wearable and implantable sensor technology that transmits data over the broadband and cellular networks are available now or are in development. Some examples include electronic band-aids that transmit vital signs; smart pills for monitoring drug consumption; and mobile cardiac monitors.
• The mobile phone will continue to mature as an important platform for chronic-disease management. Diseases such as asthma, depression, obesity and hypertension are being targeted by wireless medical technology and content vendors.

• Actively engage wireless and mobility product and service vendors to share their views of the smart healthcare provider enterprise. Work with the vendors that are interested in partnering with your enterprise and sharing some of the risk associated with wireless and mobility initiatives.
• Develop wireless strategies for clinical and business workflows and constituents that can most benefit from mobility enhancements. Different approaches will be required for the inpatient, outpatient and home venues, but all should focus on safer and more convenient care for the patient.
• Align your wireless and mobility strategy with your clinical and patient portal strategies as they have much in common.
• Plan for new security, integration and compliance issues associated with the introduction of this mobility-generated healthcare information.

Intelligent mobile and wireless services will be vital to address the challenges and opportunities associated with increased care quality, patient safety, customer convenience and satisfaction, and lower costs that will be necessary to achieve going forward. A care delivery organization's (CDO's) desire to evolve into an agile and responsive enterprise will be enabled in no small part by its sophistication in wireless and mobility. Innovation in this space must be balanced against the realities of cost, culture and compliance.

Qualcomm held its Smart Services Leadership Summit in San Diego from 27 July through 29 July, inviting executives from client companies, industry leaders and analysts, and experts from the academic community to discuss wireless and mobility issues and opportunities and to participate in focused sessions, panels and round tables surrounding so-called wireless "smart services" (see Note 1). The conference included general session speakers such as Dr. Eric Topol, consulting cardiologist and chief medical officer of West Wireless Health Institute; Russell Baker, director of the Amazon Kindle project; and Lance Russo, director of strategy at Best Buy. The conference also featured breakout sessions on business strategy and technology enablement. During the event, Qualcomm announced a joint venture with Verizon to provide advanced machine to machine (M2M) and smart services solutions across a variety of markets, including healthcare, manufacturing, utilities, and distribution and consumer products.

The Qualcomm summit was about fostering thought leadership surrounding smart services. But it has gone far beyond the original notion of smart services. At its core, smart services rely on machine-to-machine communications. M2M communications allow devices to wirelessly capture and transmit detailed performance and usage data over the Internet, utilizing onboard monitoring and communication components. The evolution of Internet protocols and increased broadband availability have lowered the cost of networking devices, and M2M has benefited from improved security, quality and transfer rates. Many product-centric companies look to cut costs or grow revenues by offering new or more efficient services that go beyond the basic automation of upgrades and remote maintenance. Companies are building in more and more intelligence into their devices so they are continually connected and aware. Vendors can develop service offerings based on the information they regularly collect, organize and analyze.

Today's smart services are different from service offerings of the past in that they tend to be more proactive rather than reactive. Smart services can create new value for the customer — from anticipating maintenance needs to provisioning to customer profiling. Nearly all electronic devices today have sensors, controllers and microprocessors and possess some diagnostic and monitoring capabilities and some inherent data-processing capability. As such, the devices can provide information about their status and performance and, in some cases, their usage history. This has been true for some time for some consumer products and more-sophisticated medical devices. The purpose of the Qualcomm summit was to highlight and explore the innovative uses of smart services in a number of traditional and emerging industries.

Wireless access to the Internet, along with the phenomena of social networking, has served to increase our sense of community and empowerment. It has revealed new and unexpected opportunities and spawned entirely new industries and business models. "Wireless medicine" is one of those called out at this summit. Wireless medicine is not limited to extending the reach of hospital-based services — although this is an important component — but encompasses a broad range of solutions that enable healthcare providers and caregivers to diagnose, prevent, monitor and manage a host of acute and chronic health conditions. There is potential for wireless devices and services in areas such as high-risk pregnancies, sleep disorders, continuous vital-sign monitoring and chronic-disease management. It is possible that the money currently spent on healthcare in the U.S., particularly for the treatment and management of chronic diseases, could be substantially reduced by more aggressive introduction of intelligent wireless devices and remote monitoring services.

Players in the wireless medicine space range from small startups to global healthcare organizations. During one general session, several examples of innovative wireless medicine technologies and applications were introduced. Examples of some of the more innovative wireless applications and technologies included:

• A smartphone application that obstetricians could use to remotely access real-time, high-resolution fetal heart rate tracings, maternal contraction patterns, and other critical data directly from labor and delivery units
• A wireless platform for continuous vital-sign monitoring that keeps clinicians connected to their patients, whether in transport, in the emergency room or in general inpatient units
• A mobile medication reminder application that is available on many wireless phones
• An intelligent pill for electronically controlled drug delivery
• A wireless cardiovascular solution that offers visibility into a patient's health status, using an unobtrusive, water-resistant, patient-worn device that adheres to the skin and automatically collects and transmits physiological information
• An application that allows an emergency medical service team to wirelessly transfer patient data from mobile patient-monitoring devices to an electronic patient care report to provide a complete prehospital patient record
• An application that provides the ambulatory cardiac-monitoring service with beat-to-beat, real-time analysis, automatic arrhythmia detection and wireless electrocardiogram (ECG) transmission
• A host of iPhone applications that allow both patients and physicians to monitor care, keep track of treatments or even see the amount of sleep that patients are getting

A significant portion of the U.S. national healthcare budget is spent on managing chronic diseases — like diabetes, obesity, hypertension and depression — and wireless should help reduce the utilization of hospital services to control these diseases. Hospitals aren't so much used to control these diseases but rather bear the brunt of the increased morbidity and acute episodes that failure to control them spawns. Greater emphasis on chronic-disease management and a "medical home" for chronic-disease patients are key tenets of proposed healthcare reform in the U.S.

In the hospital, wireless and mobility have already found useful remote monitoring applications within the ICU and step-down unit and in the support of medication management, patient tracking, specimen tracking, location and condition sensing, and others. Wireless medicine could help reduce the utilization of hospital services to manage chronic diseases such as asthma, COPD, depression, diabetes and hypertension, as well as Alzheimer's, breast cancer and heart failure. Calorie-tracking wireless applications and band-aid sensing devices can help treat obesity and collect data necessary to diagnose and treat sleep disorders. There are already a large number of wireless continuous glucose-monitoring devices on the market to assist the diabetic. Remote monitoring will enable seniors to stay in their homes and "age in place."

These wireless initiatives are in keeping with Gartner's view of "convenient care," where consumers have more ways to access care, thanks to the Internet and remote access to care and health information (see "The Convenient Care Scenario for Healthcare in 2019: Characteristics and Implications"). Next-generation technologies — like wireless, 3G networks and advanced sensor technology — will help engage consumers, deliver care and control costs. IT initiatives inside and outside the CDO will focus on making healthcare access more convenient, available, responsive and secure. Healthcare information transmitted wirelessly will enable emergency and physician care readiness.

Advances in mobile communications technologies and medical devices have removed many of the technical barriers to mobile health monitoring and have encouraged innovation. In the near term, healthcare applications and devices will supplement wired devices and more-conventional software systems. To prepare, CDOs must focus on the process and business issues raised by mobile health monitoring. It is essential to develop the ability to manage large numbers of devices and patients and to be able to orchestrate time-critical interventions for individual patients. It will be necessary for CDOs to enhance their support, security, compliance and data management capabilities to handle a significant increase in healthcare data that will be generated from mobile devices and applications.

Two interesting nonhealthcare presentations by Zipcar and Amazon.com were illustrative of the disruptive and transformational impact that innovative wireless and mobility solutions can have on traditional and entrenched industries. Zipcar is the world's largest car-sharing company that offers an alternative to car ownership or rental. Zipcar is to Hertz Rent a Car and Budget Rent A Car as Netflix is to Blockbuster — it is born of a business model that relies heavily on technology and appeals to those who value access and convenience over traditional ownership. Amazon Kindle is a digital reading device that leverages 3G wireless to download books anytime and anywhere, with no monthly fees or service plans. Kindle is potentially a disruptive innovation to book publishers and booksellers.

"Introducing the Healthcare Consumer of the Future"

"The Top 11 Actions for the Care Delivery Organization CIO, 2009"

"The Convenient Care Scenario for Healthcare in 2019: Characteristics and Implications"

"Hype Cycle for Healthcare Provider Technologies and Standards, 2009"

"Hype Cycle for Telemedicine, 2009"

"Cool Vendors in Mobile and Wireless, 2009"