 This is JSA TV, the newsroom for tech and telecom professionals and JSA radio, your voice for tech and telecom on iHeart radio. I am Dean Perine, vice president of new media and account strategy at JSA and I will be your moderator today. On behalf of our team here at JSA, welcome to our virtual round table series. Today's round table is brought to you by our video collaboration managed service provider Pinnacle. With their video platform, our panelists are able to stream in live video feeds from across the world. So thank you very much for that Pinnacle. And thank you to our viewers joining us live and joining us on demand after the program is done. Thank you very much. So let's go ahead and get started. Today's topic is telemedicine 2.0. Telemedicine is no longer a novelty with nearly three in five U.S. employers now providing cost savings digital to health care benefits to their employees. Big data and the Internet of Things are increasingly driving the surge. Big data has been a primary focus of change in the U.S. health care system and will drive even more change for individual patients and disrupt both the Internet of Things and the way physicians day to day operations go. This virtual round table will examine the state of telemedicine 2.0 and how big data analytics and IOT are shaping its evolution. So let's go ahead and meet our expert panelists. With us today we have Mr. Brian Eagle. Brian is a principal consultant at Vertix Consulting and we have Mr. John Gardner. John is a partner of Nokia, a partner at Nokia Growth Partners. Gentlemen, welcome to JSA-TV. Great to be here. So let's go ahead and get started. Brian, I'm going to kick this one off with you. Why don't you give our viewers a quick primer on telemedicine, how does it work, why would physicians or health care professionals adopt a telemedicine strategy? Right. So I'm not a health care professional obviously so I'm going to talk about this from a telecom perspective which is my background. And what I've seen over the years with the development of this space is really that you're able to extend the health care and the services that doctors offer in a more centralized hospital or clinic environment out to a much broader audience and you're able to collect more information to make the data that they're getting back in around patients more useful. So telemedicine at its core is just remotely reading or viewing or chatting with a patient and being able to through telecommunications extend the care offering from the doctor's office out to wherever the patient lives. But on a broader basis it's opening up a lot of new areas particularly in home health care which are reducing the cost associated with delivering this service and improving outcomes. And really those are the two things that any new health care system should do improve outcomes and reduce cost. Excellent Brian, thank you very much. John, what's your take? Well I think that you've got to be careful to think of things from a definitional framework. Telemedicine can mean a lot of things to a lot of people. The way we have as investors try to break it down is there's one way of looking at it which is more or less a glorified base time replacement sort of basic triage and or customer or patient care management platform which may be more what you're referring to as telemedicine 1.0. But then there's also telemedicine is fully integrated into the practice management and patient management workflows. I think there's another concept and this is where maybe more of the IoT big data component comes in is what I would call virtual or remote care where you're really talking about depending on the environment as if the patient and the doctor were in the same place or there's some care regimen for severely disabled you know aged things of that nature where you actually have a virtual room or a virtual home connected to some other institution on an ongoing basis. Excellent John and you're actually providing some great segues for me so we're going to stick with you for this next question you know IoT integration and big data capture and analysis are seemingly leading the charge to telemedicine adoption. How are IoT and big data changing or fueling the advancements of telemedicine? Well I think that one of the things in this example if you don't mind me just taking a short diversion the concept of stepping from glorified face time to something that is fully integrated into practice management is not insignificant and the example that I typically use is you know give my mobile number to my family my wife my kids you know work hard just like most of the folks on the phone do you know ask them to call me during the day on a you know as needed or sort of an emergency basis and when you think of a practice or an individual doctor managing hundreds or maybe even thousands of people just sort of turning on the capability creates a whole host of downstream issues that need to be managed and so there is you know one aspect is more of an enterprise software workflow management driver where you know we're seeing companies come up with some pretty innovative things to you know do things from a scheduling management perspective and again deeply integrate with to be able to not only connect a person with a care provider but then also immediately access healthcare records and things of that nature that those types of technologies are really making to Dotto a more practical exercise beyond primary care or or just initial triage so John thank you very much Brian your turn IoT and big data changing the changing the way we do telemedicine talk to us a little bit about that yeah absolutely so you know what's what's been happening in the telecommunications industry for years as the devices are getting smaller and the transport costs are getting lower so you know in the in the very early days being able to send data particularly image data or any kind of high bandwidth requirement data was expensive to do well that that's starting to change significantly now you know lots of things can be monitored I think one of the you know the things that is propelled that back in the early aughts was the proliferation of 2g and how how that really drove down the cost of that sort of telemetry data so you know now you know blood pressure machines can be monitored neonatal devices can be monitored this data can be collected the data on your sleep apnea machine can be collected and sent back to the doctor so now you know what you're starting to do and I'll tell you an example very personal to me is my daughter who's who's type one has a a meter that's monitored it's connected to her cell phone and the cell phone periodically sends data back to her doctor so you know now you're able to see a lot of these devices starting to be connected back into either platforms that do the analytics or the hospital or primary care physician offices where they're doing the diagnostics and then you know on top of that what you're starting to take a look at is you know with cheaper storage and fast processing at the host or server level you're now able to start to grind a lot more of this data looking for patterns so you know back to the example of diabetes you know there's you know it's not an exact science it varies by metabolic rate it varies by you know lots of different things so now you're able to start to get more personalized recommendations on how much insulin you bolus how often you do that etc depending upon what you eat so you can now track what you eat what your response to that is and then how much insulin you should give what your response to that is and over time you start to build a pattern that recognizes you know what you need to do when you eat certain foods when you exercise when you have certain levels of activity all of this big data you know was really not possible 10 years ago but today is very much a an everyday occurrence for people you know with with diabetes or other chronic conditions to be able to have that data go back somewhere where the analysis can take place and more personalized care can be delivered. Excellent Brian thank you and that was actually going to be a question for you and that is so when when can we expect to see some of these kinds these kinds of telemedicine 2.0 data capture and analysis and used in in the real world and I guess the answer to that is right now so very good thank you for that but that also begs the question of security. Security is a very very buzzy thing in our industry right now as you guys know and for good reason but with telemedicine we're going to be handling countless volumes of personal and sensitive information medical records etc all the things that you were just talking about Brian but John why don't you talk to us a little bit about the security issues around IoT and big data and and how those issues are being dealt with. Well you know in a lot of conversations on a framework people can look at that technology adoption from aggressive adopters down to sort of tech laggers tech leaders and tech laggers and on most fronts you know unfortunately healthcare has been a tech lagger but I do think that having been said on this specific aspect of security and privacy the intense focus on that is as a mission critical requirement for all the data systems as they are being built from the ground up actually gives healthcare an advantage on that factor so I think that historically it has been a significant you know compliance with HIPAA making sure that a person's holistic healthcare history is accessible to you know in real time to the point of care in all instances has been a dream but been been something that has been very hard to execute on the fact that it was the right objective and that a fundamental requirement of that objective was an intense security platform I think it's healthcare an advantage in this front. The second one is I'll just since you're you know throwing out a buzzword I'll respond with the buzzword and it may seem crazy but I do think that Bitcoin is something that actually may have very intriguing opportunities within healthcare again giving control to the patient over the healthcare record and a trail and understanding of who has been able to see it and not been able to see it and access and control over that to me is quite intriguing and so that's not something that you'll see you know in the next two three maybe even five years but longer term the convergence of those two buzzy phenomena could be quite interesting very cool very cool Brian what's your what's your thoughts well again from a telecom perspective you know any wireless signal that sent can be hacked and you know this is if you leave it open to people somebody's going to try and hack it and you know I I'm really not sure how exciting someone's sleep apnea data may or may not be to a hacker but where you really start to get into from a wireless standpoint on on security implications is when these devices control your life so there was a lot of buzz you know when Dick Cheney got a pacemaker about you know what level of security was the communication between the control device and the pacemaker and there was even in the HBO series homeland you know a bit of a spin-off on that where the bad guy the terrorist was able to to kill someone through manipulating his his pacemaker so you know you do have to worry about those kinds of things but you know most of the other sort of malicious hacking you know I think the guys that are typically behind that are going to be less interested in you know again your sleep apnea data your your heart pressure data then they are going to be in some of the other healthcare records and and how they can really manipulate some of the billing data if they're able to get into hospital systems because you know remember you know the target hack came not in a direct hack into the system but through you know one of their building management systems one of their HVAC system so you know if you've got a lot of these new remote home healthcare systems feeding data in the hospitals or or clinics and that becomes and you can figure out the path into those clinics you know that's that's where I think the security starts to become more of an issue because you know a lot of what's motivating those guys is money so you know there's not a lot of money to be found in your sleep apnea data but probably more so in billing able to redirect billing now I just have to take up on one point that John said I absolutely agree I mean whether it's bitcoin or ethereum or some of these other you know cryptocurrency or or secure contract systems they're absolutely going to be a part of how you overlay on top of standards I actually just wrote a blog post about that as it relates to can bus and mod bus communication in heavy equipment because you know anytime you start to establish you know any standard like that what you've done is you've given people a roadmap on how to hack it so you know being able to use these kinds of secure contracting technologies I think absolutely agree with John I think that's the wave of the future in terms of being able to make more secure that type of personal data excellent thank you guys very much for that let's talk infrastructure maintaining the telemedicine infrastructure has posed it's going to be a long-term challenge as the proliferation of devices etc but how how is that prolific easy for me to say right proliferation of devices and kind of the taxing of that infrastructure ultimately advancing that infrastructure or is it advancing what are some of the things that we might expect to see out of our existing infrastructure that help us to plan for for the for future devices and for future big data transport and Brian let's stick with you okay yeah so as John alluded to earlier you know healthcare environments haven't been fast to adopt some of these technologies as a matter of fact I know a company that's doing a great business selling fax servers which is a fairly old and outdated technology but you know as HIPAA requires it this is still the main method of moving a lot of data around into hospitals and you know other healthcare agencies and systems so you know we do have to upgrade some of our legal requirements in order to be able to move some of the you know the the the storage and easier movement of data into you know the 20th and 21st century here I think that's sort of step one again speaking from a telecommunications perspective you know 2g and the proliferation of 2g and the you know very low cost of 2g data offerings help to propel a lot of these systems and you know as as we know 2g has been shut down by AT&T and is being shut down by by others both domestically and and globally although on a slower track overseas than than domestically and so now it really gets down to you know will some of the replaced technologies because a you know a straight 4g connection to these devices is going to be more expensive than some of these home healthcare systems are going to look to to embrace so you know the question now is you know will some of these next gen technologies whether it's cat m or or narrowband IoT be sufficient both in terms of bandwidth and low enough in terms of cost to be able to continue to propel that proliferation I think they will be because it's a it's a sizable market and and you know as these are just now being introduced I think you're going to see people start to to adapt pricing and service offerings to meet the requirements of the marketplace and we just haven't had enough time to be able to see that so from a telecom infrastructure standpoint you know some of these next generation IoT technologies that are coming out I hope are going to be able to embrace the the requirements there for some of these low end systems and you know I hope going forward that that the laws and regulations will catch up to the the technologies today and we can move past the fax machine and on to more you know broader technologies that can be more easily integrated into the types of big data systems we've been talking about thank you Brian John infrastructure telemedicine infrastructure what what changes can we expect to see let's just say over the next five to ten years well the benefit of focusing on a tech laggard industry is that you can look at the you know what's going on with with some of the folks on the other side of the continuum and and and try to postulate what what aspects of that are patterns that you should see to be replicated and maybe what aspect wouldn't do to the unique natures of health care at a very high level you know you have public cloud infrastructures working on top of amazon adbs versus private cloud you know I think there's a lot of unique issues with respect to to health care that that make the public cloud approach you know somewhat challenging or or a little bit part of our health care systems to to enthusiastically embrace the private cloud approach has its benefits but then of course it's also the more proprietary approach that an organization would take the more expensive it is and again health care is not an industry where that there are super large it budgets it's not like financial services for instances which has really been driving a lot of the stuff in the private cloud side have very large it budgets to work with for for more customized solutions there so you know I think that's one one interesting part to see play out the other part that's super important is is is you look at other more traditional enterprise data infrastructures the api platforms is sort of a key component of that and again in most enterprise settings you have more flexibility for open api or totally open api the main primary objectives are more about efficiency and not that control and privacy and security are not issues with any organization but you know efficiency usually is is the primary goal that is inverted somewhat when you're talking about health care and and so what we're seeing in the marketplace is that health care organizations themselves are going to have to create some sort of curated sandbox type onboarding approach to connect sensors you know so this mass proliferation of sensors that are available to collect data but also so more frequently the services that are running on top and that are looking to sell these as services the connectivity with the sensors and sell that or the connectivity with people and patients and then sell that in the health care regiments that it will end up having to be a much more highly curated approach to that than maybe what you would see you know invite all comers more sales force platform kind of approach that you'd see in traditional enterprise john thank you very much okay last question guys and john will stick with you what is it about iot and big data analytics that really excites you right now we talked a little bit about what's happening right now you know on the street but what is it that's going to happen that really gets you excited well i i think that what i'm really excited about then in starting to see you know windows on the future uh the the the mass proliferation of sensors you know and the connectivity of those sensors to the cloud is the sort of the core tenant and driver of the opportunity around the iot is exciting in and of itself and we are seeing that today the challenge that has remained is how do you make all that data actionable you know how do you how do you pull insights out of that data and and and actually get it in front of the people that need it in the time frame where it's actually useful and we're seeing dramatic strides forward on that the second thing that's very exciting is the concept that you know of you know internet of things a lot of these and again brian referred to individuals with glucose meters heart heart rate meters the people that are tracking you diet there's a whole host of are you taking your pills all of these things are wonderful from the perspective of capabilities but at the end of the day still a lot of times fall down from the fact that they require a significant amount of manual effort to actually maintain compliance and push the data to the cloud and that that that friction that's involved in the the ongoing continuous manual effort to to make sure that the right data is getting to the right place is actually a barrier to sort of what I would call mass adoption and what I'm really excited about where I'm going with this observation is that we're increasingly seeing new technologies come to the scene which create the what I call ambient sensing environment where data can be collected and machine learning and AI can be applied in ways that push the data structure the data in a way that does not require this manual interface in order to make it use so useful and I think that that is the catalyst that's going to take the 2.0 of telemedicine today iot connectivity and and really create the 3.0 opportunity awesome thank you very much john and brian you have the last word what excites you as we talked about earlier and as john mentioned the automation of some of these therapies is going to be key you know i can only speak to the ones that that i'm very familiar with but you know i have a daughter that's been a type 1 diabetic now for almost 20 years and i've watched those technologies come from is something that was very much a you know you took a shot every day and you sort of guessed what what what was required to systems that are now doing more continuous monitoring and now you're able to see where you are in that pattern and now the next evolution of that which is the stuff that we're just starting to see this year some of the big data implications coming in which is you know how does your body react when you do this this and this you know you can probably do a pretty good job of saying okay well i know if i eat a sandwich and it has bread and this and that that i should bowl as this but you know if i was running around this morning and i ate this sandwich and i had you know this drink and i had coffee and i wasn't feeling well or whatever then you know that's the sort of stuff if you can start to collect that data and start to automate the responses to that you know that's when it becomes i think you know very very exciting because now now you can again back to the two drivers that that all of these things should be focused on which is you know improving outcomes and reducing costs because otherwise you know what why are we doing it if if you can keep people in compliance through these automation tools then you know you are going to improve outcomes and you know i i think on a personal level that's uh that's very meaningful you know if i look out into the into the future and say what is you know what are the things that you know coming down the pike you know again the big data that's the big data analysis that's going around on individualized therapies for cancer is just absolutely mind boggling if we can you know now having gone through you know sequencing dna and collecting a lot of that genetic profiling information we can start to make much more individualized therapies around cancer that were not possible before you know and and and i think you know 20 25 years from now we're going to be looking back at some of what we were doing early on with chemotherapy the same way that you know we look at leaching as a as a healthcare technology from you know the the 1700s and before i think that's the sort of path that we're on and the sort of path that that this sort of big data analytics are allowing us so that's that's my glimpse into the future personalized therapies healthcare therapies driven off of a much broader understanding of what actually makes us different from other people so that those technologies and treatments can be can be more effective outstanding brian thank you very much john thank you as well you guys i feel like we could we could have gone on another hour unfortunately we are out of time but again i want to thank you brian eagle principal at vertix consulting and mr john gardener partner at nokia growth partners for questions or to feature your c level here next time email email us at pr at jsa net thanks for tuning in to jsa tv the newsroom for tech and telecom and jsa radio your voice for tech and telecom on i heart radio i am dean perine thank you again for being with us today and we'll see you soon